2007 OPEN FORUM Abstracts
THE PROCESS INSTITUTING A VENTILATOR BUNDLE PROTOCOL TO REDUCE THE INCIDENCE OF VENTILATOR ASSOCIATED PNEUMONIA.
K. Hampton1, G. Divertie2, C. Burger2
Background: VAP is a leading cause of nosocomial infection resulting in prolonged duration of mechanical ventilation, increased cost of care and length of stay in the ICU, and is the leading cause of mortality in hospital acquired infections. We decided to implement a process termed the ventilator bundle in our MICU that combines interventions using a multidisciplinary approach. In the 3 years prior to the institution of the ventilator bundle project in 2004, the incidence of VAP in our facility ranged from 6 to 9 cases per 1000 ventilator days. VAP is identified using National Nosocomial Infections Surveillance System (NNIS) criteria.
Method: Prior to the institution of the ventilator bundle, Respiratory Services added documentation of HOB elevation to the ventilator flow sheet for all patients. In January 2004, daily checks for compliance was implemented to verify HOB was at 30 degrees unless contraindicated. Other parameters were evaluated for the bundle project and a multidisciplinary team was established to review compliance and efficacy of all elements. In March 2005, the ventilator bundle was officially initiated. The four parameters included in the ventilator bundle were: 1) maintain HOB elevation at 30 degrees, 2) prophylaxis for PUD and DVT, 3) daily interruption of sedation, 4) daily assessment of readiness for spontaneous breathing. A ventilator bundle multidisciplinary task force was formed for on-going review of compliance and VAP rates. The task force members consist of a physician, respiratory therapist, ICU nurse manager, infection control nurse, and an outcomes analyst.
Results: At the start of the initiative, the VAP rate decreased to zero and remained at zero for 18 months. Overall, the VAP rate per 1000 ventilator days decreased from 6 to 0.72. The ventilator bundle has been adopted as standard practice in our facility.
Conclusions: The ventilator bundle approach for reducing the incidence of VAP proved to be a successful strategy at our facility and should be considered by other institutions.