Major articleThe impact of implementing multifaceted interventions on the prevention of ventilator-associated pneumonia

- A multidisciplinary team using a multifaceted approach can reduce ventilator-associated pneumonia (VAP) rates.
- Oral care and subglottic suctioning are effective ventilator care bundle elements.
- Active feedback on bundle compliance and VAP rates is probably beneficial.
- Sustained improvement in care quality and patient safety requires a culture change.

BackgroundVentilator-associated pneumonia (VAP) is a frequent hospital acquired infections among intensive care unit patients. The Institute for Healthcare Improvement has suggested a “care bundle” approach for the prevention of VAP. This report describes the effects of implementing this strategy on VAP rates.MethodsAll mechanically ventilated patients admitted to the intensive care unit between 2008 and 2013 were prospectively followed for VAP development according to the National Healthcare Safety Network criteria. In 2011, a 7-element care bundle was implemented, including head-of-bed elevation 30°-45°, daily sedation vacation and assessment for extubation, peptic ulcer disease prophylaxis, deep vein thrombosis prophylaxis, oral care with chlorhexidine, endotracheal intubation with in-line suction and subglottic suctioning, and maintenance of endotracheal tube cuff pressure at 20-30 mmHg. The bundle compliance and VAP rates were then followed.ResultsA total of 3665 patients received mechanical ventilation, and there were 9445 monitored observations for bundle compliance. The total bundle compliance before and after initiation of the VAP team was 90.7% and 94.2%, respectively (P < .001). The number of VAP episodes decreased from 144 during 2008-2010 to only 14 during 2011-2013 (P < .0001). The rate of VAP decreased from 8.6 per 1000 ventilator-days to 2.0 per 1000 ventilator-days (P < .0001) after implementation of the care bundle.ConclusionsThis study suggests that systematic implementation of a multidisciplinary team approach can reduce the incidence of VAP. Further sustained improvement requires persistent vigilant inspections.