Compliance with VAP bundle implementation and its effectiveness on surgical and medical sub-population in adult ICU

IntroductionDespite broad implementation of a bundled strategy aimed at preventing ventilator-associated adverse events in many hospitals, the ability of the bundle to prevent VAP has not been definitively established with high-quality studies.Aim of the workTo implement VAP bundle as a performance improvement project in adult ICU and follow up the compliance rate over the 12 month study period as well as the effectiveness on surgical and medical subgroups.Patients and methodVAP Bundle Program was implemented in adult ICU, data were collected and analyzed for ventilated-associated pneumonia (VAP), and compared before and after intervention. Our bundle components were head of bed elevation greater than 30°, daily sedation break, assessment for extubation, peptic ulcer prophylaxis and deep vein thrombosis prophylaxis.ResultsThe results clearly show the difference between pre and post-intervention period and lower VAP rate after application of VAP bundle. The total VAP bundle compliance rate steadily increased during the period of implementation. We documented a significant reduction of mean ICU LOS (from 15.4 ± 5.2 to 10.8 ± 4.9 days) and duration of mechanical ventilation (from 12.8 ± 4.9 to 8.5 ± 4.3 days) for patients with VAP bundle compliance at the end of the study. There was a significant improvement in the outcome of surgical patients who were studied after VAP bundle initiation reflecting a decreased mortality rate.ConclusionOur study highlights that adherence with the VAP-bundle approach in our ICU decreases the incidence of VAP, more rapid ventilator weaning, fewer ICU days, and shorter hospitalizations and it has also a great impact on patient outcomes. Our study looked into surgical sub-population as getting more benefit by initiation of the VAP bundle in reducing the length of stay. Thus it results in a decrease in the burden of the health care costs and the ICU resources.