Adherence to VAP Bundle Decreases Incidence of Ventilator-Associated Pneumonia in the Surgical Intensive Care Unit
Dorothy Bird, MD, Amanda Zambuto, MD, Charles O’Donnell, MS, Julie Silva, MD, Cathy Kom, MPH, Robert Burke, MD, Peter Burke, MD, Suresh Agarwal, MD
Boston Medical Center, Boston, MA
PURPOSE OF STUDY
Ventilator-associated pneumonia (VAP) remains a dangerous source of morbidity, mortality and cost. The Institute for Healthcare Improvement (IHI) claims adherence to a “VAP bundle” will decrease VAP in the ICU. We examined the impact of the IHI “VAP bundle” on our surgical ICUs.
Prospectively collected data was retrospectively examined from our Infection Control Committee surveillance database of surgical ICU patients. Adherence to “VAP bundle” was acknowledged if all five criteria as delineated by the IHI were met. Incidence of VAP in the surgical ICUs was examined over a 32 month period. Cost of VAP was estimated to add $30,000 to each patient stay.
SUMMARY OF RESULTS
Prior to initiation of the VAP bundle, the VAP was seen at a rate of 10.2 per 1000 vent days. Compliance with the VAP bundle increased over the study period (Figure 1). VAP decreased to a rate of 3.4 per 1000 vent days (Figure 2). A cost savings of $1.08 million dollars was seen.
VAP “bundle” initiation is associated with a significantly reduced incidence of VAP in surgical patients in the intensive care unit. Initiation of a VAP bundle protocol is an easy, effective, and inexpensive method for VAP reduction when optimal compliance is maintained.
TABLES AND CHARTS
Figure 1. Summary of total VAP bundle compliance in two SICUs between January 2007 and April 2009.
Figure 2. Summary of total annual VAPs in two SICUs between March 2006 and April 2009. Bars represent annual VAP/1000 ventilator days.