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Prevention of ventilator-associated pneumonia in the surgical ICU at Siriraj Hospital


VAP has continued to be a major cause of morbidity and mortality in critically ill patients in Thailand for decades. Previous research found that the implementation of VAP care bundles and the educational program can reduce VAP incidence in the ICU [1]. In this research we aimed to observe the reduction of VAP incidence after the implementation of VAP care bundles to ICU medical personnel.


Inclusion criteria: all adult surgical patients (>18 years old) who are on ventilatory support in the surgical ICU at Siriraj Hospital. There are two groups, divided into pre-educational group (group I) and post-educational group (group II) (n = 220/group). We also observed the adherence rate to VAP care bundles according to the educational program. The pretest and post-test to determine the efficacy of the educational program were done. The VAP care bundles consisted of weaning according to weaning protocol, sedation vacation, head-of-bed elevation, measurement of cuff pressures four times/day, 2% chlorhexidine use for mouth care and emptying of ventilator circuit condensate.


There were 45.38 and 25.25 episodes of VAP per 1,000 ventilator-days in group I and group II, respectively (P = 0.020). The incidence of VAP was 21.82% in group I and 9.09% in group II (P = 0.000). There was significant reduction in the length of ventilatory support per person (group I = 2, group II = 1 (median), P = 0.013, 95% CI = 0.319 to 0.936) and mortality rate (group I = 15.5%, group II = 8.2%, P = 0.017). There was no significant difference in LOI, LOH and ATB cost. The pretest scores were 15.53 and 17.53 on average from 40 medical personnel in group I and group II, respectively (P = 0.000). The head-of-bed elevation adherence rate was improved after the educational program (group I = 50.1%, group II = 70.36%, P = 0.017). But the adherence to other bundles was not improved. See Tables 1 and 2.

Table 1 Impact of the educational program on outcomes
Table 2 Adherence rate to VAP care bundles


The educational program and the implementation of VAP care bundles can reduce the incidence of VAP, length of ventilatory support and mortality rate in the ICU.


  1. 1.

    Apisarnthanarak A, Pinitchai U, Thongphubeth K, Yeukyen C, Warren DK, Zack JE, et al.: Effectiveness of an educational program to reduce ventilator-associated pneumonia in a tertiary care center in Thailand: a 4-year study. Clin Infect Dis 2007, 45: 704-711. 10.1086/520987

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Correspondence to CH Pisitsak.

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Pisitsak, C., Chaiwat, O. Prevention of ventilator-associated pneumonia in the surgical ICU at Siriraj Hospital. Crit Care 17, P498 (2013).

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  • Pneumonia
  • Educational Program
  • Ventilatory Support
  • Chlorhexidine
  • Adherence Rate