Reducing ventilator-associated pneumonia in intensive care: Impact of implementing a care bundle*

Abstract

Implementation of a ventilator-associated pneumonia prevention bundle was associated with a statistically significant reduction in ventilator-associated pneumonia, which had not been achieved with earlier ad hoc ventilator-associated pneumonia prevention guidelines in our unit. This occurred despite an inability to meet bundle compliance targets of 95% for all elements. Our data support the systematic approach to achieving high rates of process compliance and suggest systematic introduction can decrease both infection incidence and antibiotic use, especially for patients requiring longer duration of ventilation.

Recognition and management of acute kidney injury in hospitalised patients can be partially improved with the use of a care bundle

“…In some hospitals, nurse-led AKI outreach teams, based on the model of critical care outreach services, and AKI specialist nurses have also been introduced with potentially life-threatening conditions like sepsis or ventilatorassociated pneumonia. 11 Finlay et al identified several risk factors associated with community-acquired AKI in undifferentiated acute medical patients and proposed that an AKI bundle could be applied to high-risk patients in order to prevent AKI occurring. 12 Tsui et al reported that the introduction of a specially designed care bundle in a large urban London hospital significantly improved assessment and optimisation of fluid status, performance of urinalysis, discontinuation of nephrotoxic drugs, appropriate monitoring of urine output and prescription of renal drug doses.…”

Implementing selective digestive tract decontamination in the intensive care unit: A qualitative analysis of nurse-identified considerations

“…(Muscedere et al, 2008, National Institute for Health andClinical Excellence, 2008, American Thoracic Society and Infectious Diseases Society of America, 2005) In some regions, implementation of 'care bundles' for VAP prevention has been strongly supported by professional societies and government agencies and there is some evidence that implementation of VAP bundles reduces VAP rates despite variable compliance with recommendations within the bundles. (Morris et al, 2011) Selective digestive decontamination (SDD) is a prophylactic strategy which aims to reduce infections and improve mortality in critically ill patients by eradicating potentially pathogenic microorganisms (PPMs) in the oropharynx and digestive tract. ) SDD involves four components: 1) a four day course of parenteral antibiotics to control PPMs present on admission; 2) administration non-absorbable antimicrobials (normally polymyxin E, tobramycin and amphotericin B) to the oral cavity and gastrointestinal tract; 3) continuation of standard hygiene measures to control exogenous infections; and 4) cultures of the throat and rectum on admission and then twice weekly to assess the efficacy of SDD and identify emergence of resistant bacteria.…”

Review article: Perioperative checklist methodologies

“…Results of a Scottish study showed the effects of a ventilator bundle in ICU patients, i.e., the cases of VAP decreased from 32 per 1,000 ventilator days to 12 per 1,000 ventilator days in the post-intervention period. 18 This bundle ensured oral care with chlorhexidine, elevating the head of the bed to at least 30°, holding sedation medication each day as able, and implementing a ventilator weaning protocol. Each process was independently shown to reduce rates of VAP.…”