BACKGROUND: Mercy & Unity Hospitals of Minnesota implemented the ventilator bundle concept as part of an Institute for Healthcare Improvement (IHI) collaborative on improving care in the intensive care unit (ICU). METHODS: The two hospitals, which function as a single hospital, have a total of 450 beds, and each has a 20-bed ICU. The IHI bundle was composed of (1) head-of-bed elevation, (2) a daily "sedation vacation" along with a readiness-to-wean assessment, (3) peptic ulcer disease prophylaxis, and (4) deep vein thrombosis prophylaxis. Additional interventions likely complementary to the ventilator bundle were a hand hygiene campaign and an oral care protocol. RESULTS: Overall compliance with the four bundle elements reached 100% by January 2004. At the end of the collaborative, Mercy's VAP rate decreased from 6.1 to 2.70 per 1000 ventilator days, and Unity's VAP rate decreased from 2.66 to 0 per 1000 ventilator days. DISCUSSION: The all-or-none nature of the bundle may have helped multidisciplinary staff members perceive the project as a systemic change versus a one-time intervention. Staff members needed to implement both structural changes, such as preprinted order sets for ventilator management and sedation, and cultural changes, such as increased collaboration with respiratory therapy. CONCLUSION: The decrease in VAP provides a promising example of the potential of intervention techniques and bundle implementation in a community hospital.
BACKGROUND: Mercy & Unity Hospitals of Minnesota implemented the ventilator bundle concept as part of an Institute for Healthcare Improvement (IHI) collaborative on improving care in the intensive care unit (ICU). METHODS: The two hospitals, which function as a single hospital, have a total of 450 beds, and each has a 20-bed ICU. The IHI bundle was composed of (1) head-of-bed elevation, (2) a daily "sedation vacation" along with a readiness-to-wean assessment, (3) peptic ulcer disease prophylaxis, and (4) deep vein thrombosis prophylaxis. Additional interventions likely complementary to the ventilator bundle were a hand hygiene campaign and an oral care protocol. RESULTS: Overall compliance with the four bundle elements reached 100% by January 2004. At the end of the collaborative, Mercy's VAP rate decreased from 6.1 to 2.70 per 1000 ventilator days, and Unity's VAP rate decreased from 2.66 to 0 per 1000 ventilator days. DISCUSSION: The all-or-none nature of the bundle may have helped multidisciplinary staff members perceive the project as a systemic change versus a one-time intervention. Staff members needed to implement both structural changes, such as preprinted order sets for ventilator management and sedation, and cultural changes, such as increased collaboration with respiratory therapy. CONCLUSION: The decrease in VAP provides a promising example of the potential of intervention techniques and bundle implementation in a community hospital.
Authors: Raquel A Caserta; Alexandre R Marra; Marcelino S Durão; Cláudia Vallone Silva; Oscar Fernando Pavao dos Santos; Henrique Sutton de Sousa Neves; Michael B Edmond; Karina Tavares Timenetsky Journal: BMC Infect Dis Date: 2012-09-29 Impact factor: 3.090
Authors: Reem Alsadat; Hussam Al-Bardan; Mona N Mazloum; Asem A Shamah; Mohamed F E Eltayeb; Ali Marie; Abdulrahman Dakkak; Ola Naes; Faten Esber; Ibrahim Betelmal; Mazen Kherallah Journal: Avicenna J Med Date: 2012-10
Authors: Michael Klompas; Yosef Khan; Kenneth Kleinman; R Scott Evans; James F Lloyd; Kurt Stevenson; Matthew Samore; Richard Platt Journal: PLoS One Date: 2011-03-22 Impact factor: 3.240
Authors: Andrew Hutchings; Mary Alison Durand; Richard Grieve; David Harrison; Kathy Rowan; Judith Green; John Cairns; Nick Black Journal: BMJ Date: 2009-11-11