Ventilator-associated pneumonia rate and ventilator bundle compliance in a district general hospital

Introduction

An observational study to establish the incidence of ventilator-associated pneumonia (VAP), and ventilator care bundle (VCB) compliance. Neither has previously been quantified at our institution. VAP is a nosocomial pneumonia presenting in patients mechanically ventilated for ≥48 hours [1]. Use of microbiological data in conjunction with the Clinical Pulmonary Infection Score (CPIS) improves VAP diagnostic specificity [1]. VCBs reduce VAP rates, in some cases to zero. The Department of Health VCB is one such collection of evidence-based interventions [2].

Methods

A 3-month (April 2009 to June 2009) prospective observational study, in an eight-bed critical care unit in a district general hospital. All mechanically ventilated patients, age ≥18, intubated >48 hours were included. Pregnant or immunosuppressed patients were excluded. Patients treated with antibiotics for suspected or confirmed VAP were identified. CPIS was calculated on day 0 and day 3 of treatment. VCB compliance was recorded weekly in all patients.

Results

A total of 190 ventilator-days were identified with no cases of VAP. The VAP rate per 1,000 ventilator-days is 0. Sixty-nine percent of cases achieved 100% VCB compliance. Four of the six VCB elements were 100% compliant (Table 1). All incidents of noncompliance had valid clinical reasons.

Table 1 Ventilator care bundle compliance

Conclusions

The VAP rate at Wansbeck General Hospital is zero. Compliance with a recognised VCB is high. The previous VAP rate was unknown. The impact of the VCB and the short study duration are unclear. Continuous data collection has been implemented to establish whether such results are representative and sustainable. Use of the CPIS to limit inappropriate antibiotic in suspected VAP is planned.