title: Application of ventilator care bundle and its impact on ventilator associated pneumonia incidence rate in the adult intensive care unit.
abstract: OBJECTIVE
  To reduce ventilator associated pneumonia (VAP) incidence rate, lessen the cost of care, and correlate VAP bundles compliance with VAP incidence rate.
  
  
  METHODS
  This study was a prospective longitudinal study conducted on adult intensive care unit (ICU) patients at Hera General Hospital, Makkah, Kingdom of Saudi Arabia from January to December 2010. The following Institute for Healthcare Improvement VAP prevention bundle was applied: head-of-bed elevation; daily sedation-vacation along with a readiness-to-wean assessment; peptic ulcer disease (PUD) prophylaxis; and deep venous thrombosis (DVT) prophylaxis.
  
  
  RESULTS
  Among a total of 2747 patients, the bundle compliance rate in January 2010 was 30%, and reached to 100% in December 2010, while the overall rate was 78.9%. The individual bundle compliance rates were as follows: head-of-bed elevation - 99.9%; daily sedation vacation - 88.9%; PUD prophylaxis - 94.9%; and DVT prophylaxis - 85.7%. At the beginning, VAP rate was 2.5/1000 ventilator days, and reduced to 0.54 in the next month. The overall VAP incidence rate in 2010 was found to be 1.98 with a reduction of 1.41 by comparing with the same data of year 2009 collected retrospectively. The  total reduction cost in one year was $154,930. A significant correlation was found between the VAP rate and its bundle compliance (p=0.001). Most frequent pathogens found were Pseudomonas aeruginosa (30.8% of all isolates) followed by Acinetobacter baumannii (27.7%), and methicillin-resistant Staphylococcus aureus (15.4%).
  
  
  CONCLUSIONS
  Application of VAP prevention bundle reduced the VAP incidence rate and lowered the cost of care.
authors.affiliation: Department of Infection Prevention and Control, Hera General Hospital, Makkah, Kingdom of Saudi Arabia. zahidbukhari100@msn.com
authors.forename: Syed Z
authors.initials: SZ
authors.lastname: Bukhari
authors.forename: Waleed M
authors.initials: WM
authors.lastname: Hussain
authors.forename: Abdulhakeem A
authors.initials: AA
authors.lastname: Banjar
authors.forename: Mohammad I
authors.initials: MI
authors.lastname: Fatani
authors.forename: Talal M
authors.initials: TM
authors.lastname: Karima
authors.forename: Ahmad M
authors.initials: AM
authors.lastname: Ashshi
mesh_terms: D000328:Adult; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008137:Longitudinal Studies; D011014:Pneumonia / Q000453:epidemiology* / Q000209:etiology; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects*; D012529:Saudi Arabia / Q000453:epidemiology