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90th Annual Meeting Abstracts
Adherence to VAP Bundle Decreases Incidence of Ventilator-Associated Pneumonia in the Surgical Intensive Care Unit
*Dorothy Bird, MD, *Charlie O'Donnell, *Julie Silva, *Cathy Korn, MPH, *Robert Burke, Peter Burke, MD, Suresh Agarwal, MD
Boston University Medical Center, Boston, MA
Objective:
Ventilator-associated pneumonia (VAP) remains a dangerous source of morbidity, mortality and cost. The Institute for Healthcare Improvement (IHI) claims adherence to a “VAP bundle” will decrease VAP in the ICU. We examined the impact of the IHI “VAP bundle” on our surgical ICUs.
Design:
Prospectively collected data was retrospectively examined from our Infection Control Committee surveillance database of surgical ICU patients over a 42-month period. Cost of VAP was estimated to add $30,000 to each patient stay.
Setting:
Two surgical intensive care units: tertiary-care university teaching hospital and level I urban trauma center.
Patients:
All ventilated patients admitted to both surgical ICUs.
Interventions:
The IHI bundle was instituted at the beginning of the study. It included the following measures: head-of-bed elevation, assessment for extubation, sedation break, peptic ulcer prophylaxis, and DVT prophylaxis. A daily checklist was “compliant” if all five items were performed for each patient.
Main Outcome Measures:
Patients were assessed for ventilator-associated pneumonia. Staff was assessed for compliance with VAP bundle.
Results:
Prior to initiation of the VAP bundle, the VAP was seen at a rate of 10.2 per 1000 vent days. Compliance with the vent bundle increased over the study period from 56.2% and 61.6% to 90.6% and 81.1% in each SICU. VAP decreased to a rate of 3.4 per 1000 vent days. A cost savings of $1.08 million dollars was seen.
Conclusions:
VAP “bundle” initiation is associated with a significantly reduced incidence of VAP in patients in the surgical intensive care unit. Initiation of a VAP bundle protocol is an effective method for VAP reduction when compliance is maintained.
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