Use of ventilator bundle to prevent ventilator associated pneumonia.

Objectives: To determine if the knowledge and awareness of "ventilator bundle" helped in the prevention of ventilator associated pneumonia and other outcome variables in the patients admitted to our AICU.

Design: A retrospective obsevational study from a pospectively collected data.

Participants: All the adult medical and surgical patients who were intubated and ventilated in our AICU from January to September in the year 2005 and 2006 were included in the study. During the period of October to December 2005 the critical care nurses and the staff were educated and made aware about the problem of VAP and the use of vrntilator bundle in helping to prevent this nososcomial infection. Patients who expired within 24 hrs of admission, who were transferred to tertiary care unit within 48hrs, and those who were diagnosed with pulmonary embolism or had gastrointestinal bleed prior to admission were excluded from this study.

Intervention: The concept of " ventilator bundle' was introduced after educating the nursing staff, respiratory therapists and the medical personnel through group discussions and presentations in the infection control and staff development symposia. "Ventilator bundle "is a package of evidence -based interventions that include: (1) Elevation of patient's head of bed to 30- 45 degrees; (2) Daily sedation vacation and daily assessment of readiness to extubation; (3) Peptic ulcer prophylaxis; (4) Deep vein thrombosis (DVT) prophylaxis.

Measurement: Demographic data was collected from the computer database. VAP was diagnosed when it met the (clinical non-invasive) diagnostic criteria. Incidence of VAP was calculated in the medical and surgical patients separately.

Results: Introducing the concept of "ventilator bundle" significantly reduced the incidence of VAP by 24.2% in the surgical patients and by 12% in the medical group. It significantly reduced the incidence of upper gastrointestinal bleed. The mean age of patients who developed VAP in 2006 was significantly higher in both the medical and the surgical groups. The length of stay decreased significantly in the surgical group, while it increased in the medical group. The mean duration of ventilation was reduced by 29.1% in the medical group and by 55.12% in the surgical group in those patients who developed VAP. In patients who did not develop VAP, the decrease of 9.9% in the mean duration of ventilation was seen in the surgical group while the mean duration of ventilation increased by 14.2% in the medical group.

Conclusions: Introducing the concept of "ventilator bundle" helped us to reduce the incidence of VAP, reduce the incidence of upper gastrointestinal bleed. It reduced the mean duration of ventilation in both the medical and surgical patients who developed VAP. The effect on decreasing the length of stay was seen in the surgical patients only.