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
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.
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.
Two surgical intensive care units: tertiary-care university teaching hospital and level I urban trauma center.
All ventilated patients admitted to both surgical ICUs.
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.
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.
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.