BACKGROUND: Strategies are needed to help prevent ventilator-associated pneumonia. OBJECTIVE: To develop a ventilator bundle and care practices for nurses in critical care units to reduce the rate of ventilator-associated pneumonia. METHOD: The ventilator bundle developed by the Institute for Healthcare Improvement was expanded to include protocols for mouth care and hand washing, head-of-bed alarms, subglottic suctioning, and use of an electronic compliance feedback tool. Compliance audits were used to provide immediate electronic feedback. RESULTS: Adherence to practices included in the bundle increased. Compliance rates were greater than 98% for prophylaxis for peptic ulcer disease and deep-vein thrombosis, interruption of sedation, and elevation of the head of the bed. The compliance rate for the oral care protocol increased from 76% to 96.8%. Readiness for extubation reached at least 92.4%. Rates of ventilator-associated pneumonia decreased from 9.47 to 1.9 cases per 1000 ventilator days. The decrease in rates produced an estimated savings of approximately $1.5 million. CONCLUSION: Strict adherence to bundled practices for preventing ventilator-associated pneumonia, enhanced accountability for initiating protocols, use of a feedback system, and interdisciplinary collaboration improved patients' outcomes and produced marked savings in costs.
BACKGROUND: Strategies are needed to help prevent ventilator-associated pneumonia. OBJECTIVE: To develop a ventilator bundle and care practices for nurses in critical care units to reduce the rate of ventilator-associated pneumonia. METHOD: The ventilator bundle developed by the Institute for Healthcare Improvement was expanded to include protocols for mouth care and hand washing, head-of-bed alarms, subglottic suctioning, and use of an electronic compliance feedback tool. Compliance audits were used to provide immediate electronic feedback. RESULTS: Adherence to practices included in the bundle increased. Compliance rates were greater than 98% for prophylaxis for peptic ulcer disease and deep-vein thrombosis, interruption of sedation, and elevation of the head of the bed. The compliance rate for the oral care protocol increased from 76% to 96.8%. Readiness for extubation reached at least 92.4%. Rates of ventilator-associated pneumonia decreased from 9.47 to 1.9 cases per 1000 ventilator days. The decrease in rates produced an estimated savings of approximately $1.5 million. CONCLUSION: Strict adherence to bundled practices for preventing ventilator-associated pneumonia, enhanced accountability for initiating protocols, use of a feedback system, and interdisciplinary collaboration improved patients' outcomes and produced marked savings in costs.
Authors: C Landelle; V Nocquet Boyer; M Abbas; E Genevois; N Abidi; S Naimo; R Raulais; L Bouchoud; F Boroli; H Terrisse; J-L Bosson; S Harbarth; J Pugin Journal: Intensive Care Med Date: 2018-10-21 Impact factor: 17.440