RT Journal
A1 Bird D, Zambuto A, O’Donnell C, et al
T1 ADherence to ventilator-associated pneumonia bundle and incidence of ventilator-associated pneumonia in the surgical intensive care unit
JF Archives of Surgery
JO Archives of Surgery
YR 2010
FD May 1
VO 145
IS 5
SP 465
OP 470
DO 10.1001/archsurg.2010.69
UL http://dx.doi.org/10.1001/archsurg.2010.69
AB Objective 
    To examine the impact of adherence to a ventilator-associated pneumonia (VAP) bundle on the incidence of VAP in our surgical intensive care units (SICUs).Design 
    Prospectively collected data were retrospectively examined from our Infection Control Committee surveillance database of SICU patients over a 38-month period. Cost of VAP was estimated at $30 000 per patient stay.Setting 
    Two SICUs at a tertiary care academic level I trauma center.Patients 
    Ventilated patients admitted to a SICU.Intervention 
    The Institute for Healthcare Improvement VAP bundle was instituted at the beginning of the study and included head-of-bed elevation, extubation assessment, sedation break, peptic ulcer prophylaxis, and deep vein thrombosis prophylaxis. A daily checklist was considered compliant if all 5 items were performed for each patient.Main Outcome Measures 
    Patients were assessed for VAP. Staff were assessed for compliance with the VAP bundle.Results 
    Prior to initiation of the bundle, VAP was seen at a rate of 10.2 cases/1000 ventilator days. Compliance with the VAP bundle increased over the study period from 53% and 63% to 91% and 81% in each respective SICU. The rate of VAP decreased to 3.4 cases/1000 ventilator days. A cost savings of $1.08 million was estimated.Conclusions 
    Initiation of the VAP bundle is associated with a significantly reduced incidence of VAP in patients in the SICU and with cost savings. Initiation of a VAP bundle protocol is an effective method for VAP reduction when compliance is maintained.