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Care bundle for ventilator-associated pneumonia in a medical intensive care unit in Northern Taiwan
Wen-Ping Zeng1, Han Su2, Chein-Wen Chen3, Shu-Meng Cheng4, Li-Fang Chang2, Wen-Chii Tzeng1, Bing-Hsiean Tzeng4
1 Department of Nursing, Medical Intensive Care Unit, Taipei, Taiwan; School of Nursing, National Defense Medical Center, Taipei, Taiwan, Republic of China
2 Department of Nursing, Medical Intensive Care Unit, Taipei, Taiwan, Republic of China
3 Department of Medicine, Division of Pulmonary, Taipei, Taiwan, Republic of China
4 Department of Medicine, Division of Cardiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
Correspondence Address:
Dr. Bing-Hsiean Tzeng
Department of Medicine, Division of Cardiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, No. 325, Section 2, Cheng-Kung Road, Neihu 11490, Taipei, Taiwan
Republic of China
Dr. Wen-Chii Tzeng
Department of Nursing, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, No. 325, Section 2, Cheng-Kung Road, Neihu 11490, Taipei, Taiwan
Republic of China
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1011-4564.156013
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Background: Ventilator-associated pneumonia (VAP) occurs in patients requiring mechanical ventilators for more than 48 h. VAP is the most common nosocomial infection and the leading cause of complications and death in intensive care units (ICUs). Materials and Methods: Two historical comparison groups of 375 patients who used mechanical ventilators for more than 48 h in the medical ICU (MICU) from December 1, 2011 to May 31, 2012 and December 1, 2013 to May 31, 2014 were enrolled in this study. There were 194 adult patients in the control group that received traditional care, and there were 181 patients in the experimental VAP care bundle group. Our VAP care bundle entailed several preventive strategies including daily assessments of sedation, daily consideration of weaning and extubation by the doctors and respiratory therapists charged with the care of the patients, maintenance of the intra-cuff pressure values at approximately 20-30 cm H 2 O, hand hygiene, daily oral hygiene, personal protective equipment for suctioning, the placement of patients in semi-recumbent positions with the head of the bed elevated to at least 30°, aspiration of an endotracheal tube and oral cavity prior to position changes, daily cleaning of the ventilator and suction bottle with sterile distilled water, weekly replacement of the ventilator circuit and heater, sterilization of the circuit by pasteurization, and the use of an independent care room. The data were collected by reviewing the patients' medical records and by retrieving information from the Nosocomial Infection Control Unit of one medical center in Northern Taiwan. Results: The incidence of VAP in the VAP care bundle group (0.281 cases per 1000 ventilator days) was significantly lower than that in the control group (0.495 cases per 1000 ventilator days). We estimated that the occurrence of VAP in the MICU increased the medical costs by an average of NT $68317 per patient. Conclusions: VAP care bundle is an effective strategy to reduce the incidence of VAP in the MICU and to reduce healthcare costs. |
