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Quality improvement: reducing ventilator-associated pneumonia


Ventilator-associated pneumonia (VAP) is associated with increased morbidity in intensive care [1]. Education and checklists may improve adherence to preventative interventions [2].


A 'VAP prevention bundle' was introduced in November 2005. Bundle compliance was assessed 1 year later (50 patients) and twice again (59 and 50 patients) after introduction of an educational package. The incidence of VAP was concurrently measured using HELICS definitions [3].


VAP rates and bundle compliance were unaffected by passive bundle introduction. However, compliance increased following the intervention. The quarterly VAP incidence fell from 24 to 6/1,000 patient-ventilated days. There was a significant increase in the number of 'at-risk ventilated patient-days' between each incidence of VAP. See Table 1 and Figure 1.

Table 1 Bundle compliance
Figure 1
figure 1

Ventilator-associated pneumonia (VAP) geometric distribution chart.


Passive introduction of the bundle had limited effect as demonstrated by initial compliance. Compliance improved following education. Improved compliance was associated with a decreased incidence of VAP.


  1. Heyland DK, et al.: Am J Respir Crit Care Med. 1999, 159: 1249-1256.

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  2. Evidence Report/Technology Assessment[]

  3. HELICS[]

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Hawe, C., Ellis, K., Cairns, C. et al. Quality improvement: reducing ventilator-associated pneumonia. Crit Care 12 (Suppl 2), P432 (2008).

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