Major article
Decreasing ventilator-associated pneumonia in adult intensive care units using the Institute for Healthcare Improvement bundle

https://doi.org/10.1016/j.ajic.2010.01.008Get rights and content

Background

Ventilator-associated pneumonia (VAP) increases in-hospital mortality of ventilated patients to 46%, compared with 32% for ventilated patients who do not develop VAP. In addition, VAP prolongs time spent on the ventilator, length of intensive care unit (ICU) stay, and length of hospital stay.

Methods

In this study, we implemented VAP bundle to decrease the rate of VAP infection. This is a pre- and postintervention trial beginning in 2006 to decrease the rate of VAP in adult ICUs after initiation of the Institute for Healthcare Improvement (IHI) VAP bundle compared with the VAP rate for the preceding 12 months. The study was conducted at a private general hospital in Saudi Arabia. The study included all adult patients who were on mechanical ventilation from 2006 to 2008. An interdisciplinary performance improvement team was formed. The team implemented an evidence-based VAP bundle adopted from the IHI.

Results

The implementation of the VAP prevention bundle resulted in the reduction of VAP rates from a mean of 9.3 cases per 1000 ventilator-days in fiscal year 2006 to 2.3 cases per 1000 ventilator-days in 2007 and to 2.2 in 2008 (P < .001). It is estimated that each VAP case increases the hospital length of stay attributable by 10 days and the mean hospital cost by $40,000. Thus, the potential decrease in hospital cost is $780,000 annually.

Conclusion

Implementing the IHI VAP bundle significantly resulted in the reduction of the VAP rate with potential great cost avoidance.

Section snippets

Methods

This study was conducted in the 18-bed adult ICU including the medical, surgical, and coronary care units at Dhahran Health Center, a 350-bed hospital in Eastern Saudi Arabia. Dhahran Health Center has 5 ICUs (cardiac, medical, surgical, pediatric, and neonatal). The study was conducted at the adult ICUs.

Results

Adherence with all the elements of the VAP bundle improved from 20% in the first 3 months to 82% in the final 3 months of the intervention. There were 29 VAP events (9.3 events/1000 ventilator-days) during the 12-month period from January 2006 through December 2006 compared with 10 VAP events (3 events/1000 ventilator-days) in 2007 and 9 VAP events (2.1 events/1000 ventilator-days) in 2008 (Fig 1). Thus, the annual average VAP rate in the postintervention period was 2.5/1000 ventilator-days.

Discussion

In the current study, we adopted the IHI VAP bundle that resulted in a significant decrease in the VAP rate and maintained such a reduction over 24 months. In Saudi Arabia, 2 previous studies were conducted to decrease the VAP rate.5, 13 In a prospective randomized study in a tertiary care ICU, authors compared the incidence of VAP using the heat and moisture exchanger versus the heated humidifying system. They found no significant difference in the incidence of VAP between the 2 systems in

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      Although included cost-benefit studies provided a broad indication of reduced acute care costs following VB implementation, financial impacts were not the primary outcomes of this group of studies, and the strength of findings was limited by a moderate-to-high degree of methodological bias. Of key concern, these studies primarily focused on cost-avoidance, with only 2 such studies explicitly accounting for costs added by the use of VBs.12,32 Overall, clinical studies that used local institutional administrative data to measure the financial impact of VBs11, 12, 30, 31 provided minimal information about how ICU costs were derived, and no details were reported regarding the elements included when calculating the cost of an “ICU bed-day,” limiting generalizability.

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    The authors thank the Saudi Aramco Medical Services Organization (SAMSO) facilities for the research data utilized in this paper. Opinions expressed in this article are those of the authors and not necessarily of SAMSO.

    Conflicts of interest: None to report.

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