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Impact of Education of the Ventilator Associated Pneumonia (VAP) Prevention Bundle on the Incidence of VAP Infections in the Intensive Care Unit (ICU)

Dr Sara Mary Thomas, Assistant Professor, Department of anesthesia, Sumandeep Vidyapeeth Deemed to be university, Piperiya, Vadodara, Gujarat 391760, India. , Jubin John1 , Sara M. Thomas2 , Ashu S. Mathai3 , Arti Rajkumar4

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Indian Journal of Anesthesia and Analgesia 5(6):p 1017-1021, June 2018. | DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.5618.22

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Abstract

Introduction: Ventilator Associated Pneumonia (VAP) is reported to be one of the most common nosocomial infection among patients who are mechanically ventilated in the Intensive Care Unit (ICU). The aim of the present study was to evaluate the effectiveness of implementation of VAP prevention bundle on the incidence of VAP and also to assess the microbiological profile of VAP infection.

Material and Methods: This thirteen-month study was conducted in the ICU of a tertiary care hospital in Northern India. First month was used for introducing the VAP bundle in the unit through education sessions and the remaining 12 months were used for assessing the effect of the VAP bundle on the rates of VAP infections. VAP bundle included head-ofbed elevation (between 30° to 45°), daily sedation interruptions and assessment of readiness to wean, maintenance of endotracheal cuff pressures of 20-30 cm of H2O, daily oral care with Chlorhexidine 2%, use of endotracheal tubes with subglottic suctioning system, peptic ulcer prophylaxis and deep vein thrombosis prophylaxis. VAP bundle compliance chart had to be filled daily. Patients aged more than 18 years and who were mechanically ventilated for more than 48 hours in the ICU were enrolled in the study. Patients who were intubated or on mechanical ventilation for more than twelve hours in areas outside the ICU, prior to admission, were excluded from the study. VAP was diagnosed by Clinical Pulmonary Infection Score (CPIS) and microbiological study of their sterile endotracheal aspirates.

Results: The overall incidence of VAP was found to be 23.2 VAP episodes per 1000 ventilator days which was low as compared to the VAP incidence before VAP prevention bundle implementation. The most predominant pathogen was found to be Acinetobacter species (48.21%). 48.21% isolates were Multi Drug Resistant (MDR) with Acinetobacter being the most common isolate.

Conclusion: Education and compliance with VAP bundle implementation helps to decrease the rate of VAP incidence. VAP with MDR organisms affects a significant proportion of patients who are mechanically ventilated in the ICU.

 

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DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.5618.22

Keywords

Ventilator Associated Pneumonia; VAP Bundle; Intensive Care Unit; Mechanical Ventilation; MDR.

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