• Raymond Khan, Hasan M Al-Dorzi, Khalid Al-Attas, Faisal Wali Ahmed, Abdellatif M Marini, Shihab Mundekkadan, Hanan H Balkhy, Joseph Tannous, Adel Almesnad, Dianne Mannion, Hani M Tamim, and Yaseen M Arabi.
• Intensive Care Department, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. Electronic address: raymondkhan@yahoo.com.
• Am J Infect Control. 2016 Mar 1; 44 (3): 320-6.

BackgroundVentilator-associated pneumonia (VAP) is a frequent hospital acquired infections among intensive care unit patients. The Institute for Healthcare Improvement has suggested a "care bundle" approach for the prevention of VAP. This report describes the effects of implementing this strategy on VAP rates.MethodsAll mechanically ventilated patients admitted to the intensive care unit between 2008 and 2013 were prospectively followed for VAP development according to the National Healthcare Safety Network criteria. In 2011, a 7-element care bundle was implemented, including head-of-bed elevation 30°-45°, daily sedation vacation and assessment for extubation, peptic ulcer disease prophylaxis, deep vein thrombosis prophylaxis, oral care with chlorhexidine, endotracheal intubation with in-line suction and subglottic suctioning, and maintenance of endotracheal tube cuff pressure at 20-30 mmHg. The bundle compliance and VAP rates were then followed.ResultsA total of 3665 patients received mechanical ventilation, and there were 9445 monitored observations for bundle compliance. The total bundle compliance before and after initiation of the VAP team was 90.7% and 94.2%, respectively (P < .001). The number of VAP episodes decreased from 144 during 2008-2010 to only 14 during 2011-2013 (P < .0001). The rate of VAP decreased from 8.6 per 1000 ventilator-days to 2.0 per 1000 ventilator-days (P < .0001) after implementation of the care bundle.ConclusionsThis study suggests that systematic implementation of a multidisciplinary team approach can reduce the incidence of VAP. Further sustained improvement requires persistent vigilant inspections.Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

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