title: Impact of the ventilator bundle on ventilator-associated pneumonia in intensive care unit.
abstract: 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.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  Four hundred and fifteen ICUs from 250 US hospitals.
  
  
  METHODS
  Managers/directors of infection prevention and control departments.
  
  
  METHODS
  Adoption and compliance with ventilator bundle elements.
  
  
  METHODS
  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.
authors.affiliation: Columbia University School of Nursing, Mailman School of Public Health, New York, NY 10032, USA. mp2422@columbia.edu
authors.forename: Monika
authors.initials: M
authors.lastname: Pogorzelska
authors.forename: Patricia W
authors.initials: PW
authors.lastname: Stone
authors.forename: E Yoko
authors.initials: EY
authors.lastname: Furuya
authors.forename: Eli N
authors.initials: EN
authors.lastname: Perencevich
authors.forename: Elaine L
authors.initials: EL
authors.lastname: Larson
authors.forename: Donald
authors.initials: D
authors.lastname: Goldmann
authors.forename: Andrew
authors.initials: A
authors.lastname: Dick
mesh_terms: D002487:Centers for Disease Control and Prevention, U.S.; D003428:Cross Infection / Q000517:prevention & control*; D019983:Guideline Adherence / Q000706:statistics & numerical data; D017408:Guidelines as Topic; D019538:Health Care Surveys; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data; D010043:Outcome and Process Assessment, Health Care; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000592:standards; D014481:United States; D012122:Ventilators, Mechanical / Q000009:adverse effects* / Q000592:standards