Efficacy of a bundle approach in preventing the incidence of ventilator associated pneumonia (VAP)

Abstract

Ventilator-associated pneumonia (VAP) is a potentially preventable iatrogenic illness that may develop following mechanical ventilation. A bundle for the prevention of VAP consists of different measures which may vary between institutions, and may include: elevation of the head of the bed, oral care with chlorhexidine, subglottic suctioning, daily assessment for extubation and the need for proton-pump inhibitors, use of closed suction systems, and maintaining endotracheal cuff pressure at 25 cmH2O. Our aim was to determine the efficacy of a VAP prevention bundle, consisting of the above-mentioned measures, by evaluating the incidence of VAP before (no-VAP-B group) and after (VAP-B group) the introduction of the bundle. We retrospectively evaluated the data for patients who were mechanically ventilated with an endotracheal tube, in the period between 1 September and 31 December 2014 (no-VAP-B group, n = 55, 54.5% males, mean age 67.8 ± 14.5 years) and between 1 January to 30 April 2015 (VAP-B group, n = 74, 62.1% males, mean age 64.8 ± 13.7 years). There were no statistically significant differences between no-VAP-B and VAP-B groups in demographic data, intensive care unit (ICU) mortality, hospital mortality, duration of ICU treatment, and duration of mechanical ventilation. No significant differences in the rates of VAP and early VAP (onset ≤7 days after intubation) were found between no-VAP-B and VAP-B groups (41.8% versus 25.7%, p = 0.06 and 10.9% versus 12.2%, p > 0.99, respectively). However, a significant decrease in the late VAP (onset >8 days after intubation) was found in VAP-B group compared to no-VAP-B group (13.5% versus 30.9%, p = 0.027). Overall, our results support the use of VAP prevention bundle in clinical practice.

Nursing in Intensive Care Unit: Exploring Factors Related to Ventilator-Associated Pneumonia

“…Clustering is currently recommended to prevent VAP. Recent studies also con rmed the effectiveness of the VAP prophylaxis package [14,15] . We found that most of these measures were related to nursing [16] .Our survey found that nurse sta ng and nursing practices affect the incidence of ventilator-associated pneumonia ( Table 5).…”

Measures used in intensive care units to prevent infection: an integrative review

“…Desta forma, a aspiração rotineira das secreções subglóticas foi descrita como relevante para diminuição do risco de infecção, evitando o acúmulo de secreções. Referente ao monitoramento da pressão do cuff, a recomendação é que seja mantida entre 25 e 30 cmH2O ou 18 a 22 mmHg, reduzindo o vazamento de secreções orofaríngeas para o trato respiratório inferior (19) .…”

Analysis of Risk Factors for Early-onset Ventilator-associated Pneumonia in a Neurosurgical Intensive Care Unit: A Single-center Retrospective Study

“…Ventilator-associated pneumonia (VAP) remains a common complication among neurosurgery intensive care unit (NICU) patients who require invasive mechanical ventilation. Several measures are available to decrease the incidence of VAP, such as elevation of the head of the bed, maintenance of tracheal cuff pressure, spontaneous awakening trials and starting enteral nutrition as early as possible [1,2]. However, despite the application of these interventions, VAP is reported to affect 5-40% of patients receiving mechanical ventilation for more than 2 days [3,4].…”