Ventilator-associated pneumonia bundle impact in an intermediate respiratory care unit

Introduction

Ventilator-associated pneumonia (VAP) is the most frequent ICU-related infection in patients requiring mechanical ventilation, who have a mortality rate ranging from 20% to 50%, prolonging the duration of mechanical ventilation and the ICU length of stay, and increasing costs. We describe the impact of VAP bundle use in an intermediate respiratory care unit (IRCU) to prevent VAP in patients requiring prolonged mechanical ventilation.

Methods

A prospective observational study enrolled all tracheotomized patients admitted to a seven-bed IRCU of a tertiary care hospital between March 2005 and October 2007. The daily VAP bundle checklist as described by the Institute for Healthcare Improvement [1] was performed since March 2006 to evaluate compliance. VAP diagnosis was supported by the Clinical Pulmonary Index Score and microbiological quantitative criteria. The mean duration of mechanical ventilation and VAP rate per 1,000 ventilator-days pre and post the bundle period was evaluated and compared using the likelihood ratio for VAP from a Poisson distribution. P < 0.05 was considered significant.

Results

Eighty-eight patients were studied, 40 females and 48 males. The mean age and APACHE II score were 76 ± 12 years and 14 ± 5, respectively. We analyzed 3,727 records during the study period. There were a total of 53 VAP episodes. The compliance rate was 97%. The mean duration of mechanical ventilation pre and post bundle was similar (17.8 and 17.78 days, respectively). The VAP rate decreased from 22 cases per 1,000 ventilator-days to 9.76 cases per 1,000 ventilator-days: a 55.78% reduction at the end of 20 months of bundle use (P < 0.05).

Conclusion

The application of the VAP bundle in chronic ventilated patients resulted in a significant reduction in the incidence of VAP.