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Updated: May 30, 2026

Murine Oropharyngeal Aspiration Model of Ventilator-associated and Hospital-acquired Bacterial Pneumonia
Published on: June 28, 2018
Impact of the ventilator bundle on ventilator-associated pneumonia in intensive care unit
Monika Pogorzelska1, Patricia W Stone, E Yoko Furuya
1Columbia University School of Nursing, Mailman School of Public Health, New York, NY 10032, USA. mp2422@columbia.edu
Objective:
The ventilator bundle is being promoted to prevent adverse events in ventilated patients including ventilator-associated pneumonia (VAP). We aimed to: (i) examine adoption of the ventilator bundle elements; (ii) determine effectiveness of individual elements and setting characteristics in reducing VAP; (iii) determine effectiveness of two infection-specific elements on reducing VAP; and, (iv) assess crossover effects of complying with VAP elements on central line-associated bloodstream infections.
Design:
Cross-sectional survey.
Setting:
Four hundred and fifteen ICUs from 250 US hospitals.
Participants:
Managers/directors of infection prevention and control departments.
Interventions:
Adoption and compliance with ventilator bundle elements.
Main Outcome Measures:
VAP rates.
Results:
The mean VAP rate was 2.7/1000 ventilator days. Two-thirds (n = 284) reported presence of the full ventilator bundle policy. However, only 66% (n = 188/284) monitored implementation; of those, 39% (n = 73/188) reported high compliance. Only when an intensive care unit (ICU) had a policy, monitored compliance and achieved high compliance were VAP rates lower. Compliance with individual elements or just one of two infection-related element had no impact on VAP (β = -0.79, P= 0.15). There was an association between complying with two infection elements and lower rates (β = -1.81, P< 0.01). There were no crossover effects. Presence of a full-time hospital epidemiologist (HE) was significantly associated with lower VAP rates (β = -3.62, P< 0.01).
Conclusions:
The ventilator bundle was frequently present but not well implemented. Individual elements did not appear effective; strict compliance with infection elements was needed. Efforts to prevent VAP may be successful in settings of high levels of compliance with all infection-specific elements and in settings with full-time HEs.
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