The impact of the implementation of bundle in the prevention of ventilator-associated pneumonia in intensive care units

Abstract

Introduction/objectives: Ventilator-associated pneumonias (VAP) are the most prevalent infections in intensive care units (ICU). To reduce this rate, it is recommended the application of bundles - groups of individual practices that result in substantial improved care. Aim: To measure the adherence to VAP bundle, correlating with the incidence of VAP per 1000 days of mechanical ventilation (MV). Methods: The study was conductedin three general ICU (adult, cardiology and pediatric) of a medium sized hospital in Sao Paulo (Brazil) from June/ 2009 to April/2010. All patients on MV were assessed using a check list with five key measures: physiotherapy, presence of condensate in the circuit, a high head>30degree, oral hygiene with chlorhexidine and manual resuscitator individual. The visits were carried out fortnightly, without notice, by the same researcher, with subsequent calculation of compliance. Results: At the beginning, the incidence of VAP was 20/1000 days of MV and the adherence to the measures was 15%. In the second month, the membership had increased gradually, inversely proportional to the rate of VAP. From September to December, adherence ranged from 40 to 70%, with rates of VAP from 5 to 15/1000 days of MV. In February, there was a peak (30/1000 days of MV) and good adhesion to the bundle (70%), which may reflect the increase of patient severity. Later, the Infection Control Team developed an educational work, resulting in significant decrease in VAP rate (8/1000 days of MV) and 90% adherence to the bundle. Conclusion: The application bundle is a feasible reality that produces good results in nosocomial infection rates. However, education and periodic training remain a fundamental process of improving health services.