title: The impact of a ventilator bundle on preventing ventilator-associated pneumonia: a multicenter study.
abstract: BACKGROUND
  For prevention of ventilator-associated pneumonia (VAP), a bundle approach was applied to patients receiving mechanical ventilation in intensive care units. The incidence of VAP and the preventive efficacy of the VAP bundle were investigated.
  
  
  METHODS
  A quasi-experimental study was conducted in adult intensive care units of 6 university hospitals with similar VAP rates. We implemented the VAP bundle between March 2011 and June 2011, then compared the rate of VAP after implementation of the VAP bundle with the rate in the previous 8 months. Our ventilator bundle included head of bed elevation, peptic ulcer disease prophylaxis, deep venous thrombosis prophylaxis, and oral decontamination with chlorhexidine 0.12%. Continuous aspiration of subglottic secretions was an option.
  
  
  RESULTS
  Implementation of the VAP bundle reduced the VAP rate from a mean of 4.08 cases per 1,000 ventilator-days to 1.16 cases per 1,000 ventilator-days. The incidence density ratio (rate) was 0.28 (95% confidence interval, 0.275-0.292).
  
  
  CONCLUSIONS
  Implementing the appropriate VAP bundle significantly decreased the incidence of VAP in patients with mechanical ventilation.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea.
authors.forename: Joong Sik
authors.initials: JS
authors.lastname: Eom
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, South Korea.
authors.forename: Mi-Suk
authors.initials: MS
authors.lastname: Lee
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, South Korea.
authors.forename: Hee-Kyung
authors.initials: HK
authors.lastname: Chun
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Ewha Woman's University School of Medicine, Seoul, South Korea.
authors.forename: Hee Jung
authors.initials: HJ
authors.lastname: Choi
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Ewha Woman's University School of Medicine, Seoul, South Korea.
authors.forename: Sun-Young
authors.initials: SY
authors.lastname: Jung
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, South Korea.
authors.forename: Yeon-Sook
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, South Korea.
authors.forename: Seon Jin
authors.initials: SJ
authors.lastname: Yoon
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Inje University College of Medicine, Ilsan, South Korea.
authors.forename: Yee Gyung
authors.initials: YG
authors.lastname: Kwak
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Inje University College of Medicine, Ilsan, South Korea.
authors.forename: Gang-Bok
authors.initials: GB
authors.lastname: Oh
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, South Korea.
authors.forename: Min-Hyok
authors.initials: MH
authors.lastname: Jeon
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, South Korea.
authors.forename: Sun-Young
authors.initials: SY
authors.lastname: Park
authors.affiliation: Centers for Infectious Disease Surveillance and Response, Korea Centers for Disease Prevention and Control, Osong, South Korea.
authors.forename: Hyun-Sook
authors.initials: HS
authors.lastname: Koo
authors.affiliation: Department of Occupation & Environmental Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea.
authors.forename: Young-Su
authors.initials: YS
authors.lastname: Ju
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea. Electronic address: rem324@naver.com.
authors.forename: Jin Seo
authors.initials: JS
authors.lastname: Lee
mesh_terms: D000328:Adult; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D064872:Patient Care Bundles / Q000379:methods*; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology* / Q000517:prevention & control*
keywords: Infection control; Intensive care units; Lung diseases