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Updated: Aug 8, 2025
Murine Oropharyngeal Aspiration Model of Ventilator-associated and Hospital-acquired Bacterial Pneumonia
Published on: June 28, 2018
Evaluation of a bundle approach for the prophylaxis of ventilator-associated pneumonia: A retrospective single-center
Keigo Sekihara1,2, Tatsuya Okamoto1, Takatoshi Shibasaki1,3
1Department of Intensive Care Medicine, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan.
Insights
Implementing a novel ventilator-associated pneumonia (VAP) bundle significantly reduced VAP incidence in intensive care units. Adherence to the VAP bundle, a set of 10 preventive measures, proved effective in patient care.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Hospital Epidemiology
Background:
- Ventilator-associated pneumonia (VAP) is a common hospital-acquired infection in intensive care units (ICUs).
- VAP necessitates prolonged mechanical ventilation and increases patient morbidity and mortality.
- Effective preventive strategies are crucial for reducing VAP rates.
Purpose of the Study:
- To introduce and evaluate a novel 10-item VAP prevention bundle.
- To assess compliance rates with the VAP bundle.
- To determine the clinical effectiveness of the VAP bundle in reducing VAP incidence.
Main Methods:
- Retrospective analysis of 684 patients undergoing mechanical ventilation in the ICU.
- VAP diagnosis based on CDC criteria.
- Evaluation of compliance with a 10-item VAP bundle and its association with VAP incidence.
Main Results:
- Overall compliance with the VAP bundle was 77% and remained stable.
- VAP incidence significantly decreased over the study period.
- Higher compliance (≥75%) was associated with lower VAP rates (15.8% vs. 24.1%, p=0.018).
- Low compliance was noted in head-of-bed elevation, sedation management, extubation assessment, and early mobilization.
Conclusions:
- The novel VAP bundle is effective in preventing ventilator-associated pneumonia.
- The bundle approach aligns with Sustainable Development Goals for healthcare improvement.
- Targeted interventions for low-compliance areas may further enhance VAP prevention.
Abstract:
Ventilator-associated pneumonia (VAP) is defined as pneumonia occurring after the first 48 hours of intubation and mechanical ventilation and is the most frequent hospital-acquired infection associated with intensive care unit (ICU) admissions. Herein, we defined a novel VAP bundle including 10 preventive items. We analyzed compliance rates and clinical effectiveness associated with this bundle in patients undergoing intubation at our medical center. A total of 684 consecutive patients who underwent mechanical ventilation were admitted to the ICU between June 2018 and December 2020. VAP was diagnosed by at least two physicians based on the relevant United States Centers for Disease Control and Prevention criteria. We retrospectively evaluated associations between compliance and VAP incidence. The overall compliance rate was 77%, and compliance generally remained steady during the observation period. Moreover, although the number of ventilatory days remained unchanged, the incidence of VAP improved statistically significantly over time. Low compliance was identified in four categories: head-of-bed elevation of 30- 45º, avoidance of oversedation, daily assessment for extubation, and early ambulation and rehabilitation. The incidence of VAP was lower in those with an overall compliance rate of ≥ 75% than its incidence in the lower compliance group (15.8 vs. 24.1%, p = 0.018). When comparing low-compliance items between these groups, we found a statistically significant difference only for daily assessment for extubation (8.3 vs. 25.9%, p = 0.011). In conclusion, the evaluated bundle approach is effective for the prophylaxis of VAP and is thus eligible for inclusion in the Sustainable Development Goals.
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