title: Adherence to ventilator-associated pneumonia bundle and incidence of ventilator-associated pneumonia in the surgical intensive care unit.
abstract: OBJECTIVE
  To examine the impact of adherence to a ventilator-associated pneumonia (VAP) bundle on the incidence of VAP in our surgical intensive care units (SICUs).
  
  
  METHODS
  Prospectively collected data were retrospectively examined from our Infection Control Committee surveillance database of SICU patients over a 38-month period. Cost of VAP was estimated at $30,000 per patient stay.
  
  
  METHODS
  Two SICUs at a tertiary care academic level I trauma center.
  
  
  METHODS
  Ventilated patients admitted to a SICU.
  
  
  METHODS
  The Institute for Healthcare Improvement VAP bundle was instituted at the beginning of the study and included head-of-bed elevation, extubation assessment, sedation break, peptic ulcer prophylaxis, and deep vein thrombosis prophylaxis. A daily checklist was considered compliant if all 5 items were performed for each patient.
  
  
  METHODS
  Patients were assessed for VAP. Staff were assessed for compliance with the VAP bundle.
  
  
  RESULTS
  Prior to initiation of the bundle, VAP was seen at a rate of 10.2 cases/1000 ventilator days. Compliance with the VAP bundle increased over the study period from 53% and 63% to 91% and 81% in each respective SICU. The rate of VAP decreased to 3.4 cases/1000 ventilator days. A cost savings of $1.08 million was estimated.
  
  
  CONCLUSIONS
  Initiation of the VAP bundle is associated with a significantly reduced incidence of VAP in patients in the SICU and with cost savings. Initiation of a VAP bundle protocol is an effective method for VAP reduction when compliance is maintained.
authors.affiliation: Department of Surgery, Boston Medical Center, 88 E Newton St, Boston, MA 02118, USA. dorothy.bird@bmc.org
authors.forename: Dorothy
authors.initials: D
authors.lastname: Bird
authors.forename: Amanda
authors.initials: A
authors.lastname: Zambuto
authors.forename: Charles
authors.initials: C
authors.lastname: O'Donnell
authors.forename: Julie
authors.initials: J
authors.lastname: Silva
authors.forename: Cathy
authors.initials: C
authors.lastname: Korn
authors.forename: Robert
authors.initials: R
authors.lastname: Burke
authors.forename: Peter
authors.initials: P
authors.lastname: Burke
authors.forename: Suresh
authors.initials: S
authors.lastname: Agarwal
mesh_terms: D002985:Clinical Protocols; D015331:Cohort Studies; D017046:Cost Savings; D003422:Critical Care / Q000458:organization & administration*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D017063:Outcome Assessment, Health Care; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology* / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D012189:Retrospective Studies