Utilization of a tool to help intensivists in the implementation and monitoring of the ventilator-associated pneumonia bundle protocol running in an adult medical – surgical critical care unit

Background

Ventilator-associated pneumonia (VAP) is an airways infection that must have developed more than 48 hours after the patient was intubated. VAP is the leading cause of death among hospital-acquired infections, exceeding the rate of death due to central line infections, severe sepsis, and respiratory tract infections in the nonintubated patient. The hospital mortality of ventilated patients who develop VAP is 46%, compared with 32% for ventilated patients who do not develop VAP. Reducing mortality due to VAP requires an organized process that guarantees early recognition of pneumonia and consistent application of the best evidence-based practices. The Ventilator Bundle is a series of interventions related to ventilator care that, when implemented together, will achieve significantly better outcomes than when implemented individually.

Objective

To evaluate the implementation effect of a VAP bundle in a general ICU, with the utilization of homemade software designed for this purpose http://www.bundle.com.br.

Methods

In a 15-bed general ICU, implementation of the bundle was done over 3 months beginning in January 2006. The key components of the VAP bundle are: elevation of the head of the bed; daily sedation interruptions; a ventilation tube with a subglotic aspiration system; peptic ulcer disease prophylaxis; deep venous thrombosis prophylaxis; an oral feeding tube instead of a nasal feeding tube; and oral hygiene with chlorexidine twice a day. We compared the incidence density rate from April to December 2005 with the same period in 2006 (Software Stata 8.0).

Results

The VAP incidence rate reduced from 21.15/1,000 to 6.72/1,000 mechanical ventilation days (P < 0.01) – an incidence rate ratio of 3.15 (95% CI 1.2–9.5). After 5 months, the rate of VAP was zero. This period was the lowest incidence of VAP ever registered in the ICU. The incidence of multiresistant Gram-negative bacteria infections was also lower than before bundle implementation.

Conclusion

After 5 months of VAP bundle implementation with the aid of homemade software to help clinicians follow the results in daily basis, results have demonstrated an important reduction in the incidence of VAP in our ICU. The impact of this system implementation for a longer period should be followed with the aid of homemade software.