Intervention to Reduce Ventilator-Associated Pneumonia in Individuals on Long-Term Ventilation by Introducing a Customized Bundle.
OBJECTIVE
To evaluate the effectiveness of a modified bundle of preventative measures to decrease ventilator-associated pneumonia (VAP) in chronically ventilated long-term care facility (LTCF) residents.


METHODS
Cohort before-and-after study.


METHODS
Geriatric hospital ward.


METHODS
LTCF residents on long-term ventilation.


METHODS
The modified bundle included hand hygiene before patient care, elevation of the head of the bed to more than 30° for individuals who are supine, chlorhexidine oral care at the beginning of each nursing shift, keeping tracheostomy cannula balloon pressure at 20 to 30 cm H2 O, and measuring nasogastric food remnants before every meal for individuals fed through a nasogastric tube.


METHODS
Number of VAP episodes was determined prospectively, and rates were calculated as episodes per 1,000 ventilation days.


RESULTS
VAP rate decreased from 5.97 before the intervention to 2.34 after the intervention (P < .001). The use of broad-spectrum antibiotics decreased from 1,788 defined daily doses before the intervention to 1,093 after (P = .04).


CONCLUSIONS
A modified bundle successfully decreased VAP rates in chronically ventilated elderly LTCF residents.
Infectious Diseases Unit, Meir Medical Center, Kfar Saba, Israel.|Sackler Medical School, Tel Aviv University, Ramat Aviv, Israel.
Pnina
P
Shitrit
Chronic Ventilation Department, Natania, Israel.
Michal
M
Meirson
Dorot Geriatric Center, Natania, Israel.
Gad
G
Mendelson
Infectious Diseases Unit, Meir Medical Center, Kfar Saba, Israel.|Sackler Medical School, Tel Aviv University, Ramat Aviv, Israel.
Michal
M
Chowers
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002710:Chlorhexidine / Q000627:therapeutic use; D002985:Clinical Protocols; D015331:Cohort Studies; D004363:Drug Utilization / Q000639:trends; D005260:Female; D006235:Hand Disinfection; D006801:Humans; D007441:Intubation, Gastrointestinal; D007557:Israel / Q000453:epidemiology; D008134:Long-Term Care; D008297:Male; D008365:Manometry; D009067:Mouthwashes / Q000627:therapeutic use; D056888:Patient Positioning; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000517:prevention & control*; D014139:Tracheostomy / Q000295:instrumentation
D000900:Anti-Bacterial Agents; D009067:Mouthwashes; D002710:Chlorhexidine
bundle; long-term care facility; long-term ventilation; ventilation-associated pneumonia