Using evidence-based practice to prevent ventilator-associated pneumonia

Abstract

Background: Strategies are needed to help prevent ventilator-associated pneumonia. Objective: To develop a ventilator bundle and care practices for nurses in critical care units to reduce the rate of ventilator-associated pneumonia. Method: The ventilator bundle developed by the Institute for Healthcare Improvement was expanded to include protocols for mouth care and hand washing, headof-bed alarms, subglottic suctioning, and use of an electronic compliance feedback tool. Compliance audits were used to provide immediate electronic feedback. Results: Adherence to practices included in the bundle increased. Compliance rates were greater than 98% for prophylaxis for peptic ulcer disease and deep-vein thrombosis, interruption of sedation, and elevation of the head of the bed. The compliance rate for the oral care protocol increased from 76% to 96.8%. Readiness for extubation reached at least 92.4%. Rates of ventilator-associated pneumonia decreased from 9.47 to 1.9 cases per 1000 ventilator days. The decrease in rates produced an estimated savings of approximately $ 1.5 million. Conclusion: Strict adherence to bundled practices for preventing ventilatorassociated pneumonia, enhanced accountability for initiating protocols, use of a feedback system, and interdisciplinary collaboration improved patients' outcomes and produced marked savings in costs. © 2012 American Association of Critical-Care Nurses.