Results of an evidence-based care bundle for reducing ventilator-associated pneumonia (VAP) in neurosurgical patients

Abstract

© 2016, Medical Association of Thailand. All rights reserved. Background: Ventilator-associated pneumonia (VAP) is the most common intensive care unit-acquired infection, resulting in increased morbidity and mortality as well as increased hospital costs. Objective: To determine the VAP rate before and after using the care bundle. Material and Method: A pre- and intervention study was conducted in the Neurosurgical Critical Care Unit (NCCU) at a university hospital between April 2012 and February 2013. This was compared with the twelve-month period before intervention. The six-element VAP prevention bundle called SuandokModel was implemented. It included 30-degree head elevation, bedside hand hygiene, oral chlorhexidine mouth care, inflating of the cuff of the endotracheal tube maintaining 20 to 25 mmHg, checking residual gastric content before feeding, and implementing a weaning protocol. Results: The samples before and after interventions were 66 and 68 cases, respectively. There were no significant differences between sex, age, GCS, diagnosis, and operation. The incidence rates of VAP in the intervention period showed a significant decrease (p = 0.001, 39.55 per 1,000 ventilator days vs. 13.30 per 1,000 ventilator days). Conclusion: The Suandok Model reduced VAP in NCCU patients.