title: Efficacy of ventilator-associated pneumonia care bundle for prevention of ventilator-associated pneumonia in the surgical intensive care units of a medical center.
abstract: BACKGROUND
  Ventilator-associated pneumonia (VAP) is one of the most serious treatment-related infections resulting in high mortalities and costs. Our hospital has implemented bundle care in the intensive care units (ICUs) with special focus on VAP prevention. This is a retrospective study to evaluate its efficacy.
  
  
  METHODS
  We implemented a six-item VAP care bundle modified from that of the Institute for Healthcare Improvement at five surgical ICUs (SICUs) in the National Taiwan University Hospital. A multidisciplinary teamwork was involved in this bundle care. This study analyses the SICU utilization, ventilator utilization, and VAP incidence between January 2006 and March 2013 to assess the impact of VAP bundle in a clinical setting.
  
  
  RESULTS
  A total of 28,454 SICU patients were analyzed in this study and patients under the age of 18 were excluded (n = 1329); eventually, 27,125 patients were enrolled, with 12,913 patients from the pre-VAP bundle phase and 14,212 from the post-VAP bundle phase. Patients from the post-VAP phase tended to be older (p = 0.024) and with shorter SICU stay (p = 0.006), and disease severity scores (Therapeutic Intervention Scoring System, Glasgow Coma Scale, and Acute Physiology and Chronic Health Evaluation II score) were lower in the post-VAP bundle phase (p < 0.001), except the Injury Severity Score (p = 0.729). In response to VAP bundle interventions, no difference in SICU utilization (p = 0.982) between the pre-VAP and post-VAP bundle phases was noted, whereas the ventilator utilization was significantly decreased, from 1148.5 ventilator days to 956.1 ventilator days (p < 0.001) monthly; the VAP density had remarkably decreased from 3.3 to 1.4 cases per 1000 ventilator days (p < 0.001).
  
  
  CONCLUSIONS
  Implementation of VAP bundle care decreases the incidence of VAP at SICU. Multidisciplinary teamwork, education, and a comprehensive checklist to improve health-care workers' compliance are the keys to success.
authors.affiliation: Center for Infection Control, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Kim-Peng
authors.initials: KP
authors.lastname: Lim
authors.affiliation: Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Shuenn-Wen
authors.initials: SW
authors.lastname: Kuo
authors.affiliation: Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Wen-Je
authors.initials: WJ
authors.lastname: Ko
authors.affiliation: Center for Infection Control, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: whsheng@ntu.edu.tw.
authors.forename: Wang-Huei
authors.initials: WH
authors.lastname: Sheng
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Ying-Ying
authors.initials: YY
authors.lastname: Chang
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Mei-Chaun
authors.initials: MC
authors.lastname: Hong
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chun-Chuan
authors.initials: CC
authors.lastname: Sun
authors.affiliation: Center for Infection Control, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Yee-Chun
authors.initials: YC
authors.lastname: Chen
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Shan-Chwen
authors.initials: SC
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003422:Critical Care / Q000379:methods*; D005260:Female; D006302:Health Services Research; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods*; D008297:Male; D008875:Middle Aged; D064872:Patient Care Bundles / Q000379:methods*; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult
keywords: Surgical intensive care unit; Ventilator-associated pneumonia care bundle