title: A systematic approach for developing a ventilator-associated pneumonia prevention bundle.
abstract: Ventilator-associated pneumonia (VAP) is among the most common type of health care-associated infection in the intensive care unit and is associated with significant morbidity and mortality. Existing VAP prevention intervention bundles vary widely on the interventions included and in the approaches used to develop these bundles. The objective of this study was to develop a new VAP prevention bundle using a systematic approach that elicits clinician perceptions on which interventions are most important and feasible to implement.
  
  
  
  We identified potential interventions to include through a review of current guidelines and literature. We implemented a 2-step modified Delphi method to gain consensus on the final list of interventions. An interdisciplinary group of clinical experts participated in the Delphi process, which was guided by a technical expert panel.
  
  
  
  We identified 65 possible interventions. Through the Delphi method, we narrowed that list to 19 interventions that included 5 process and 14 structural measures.
  
  
  
  We described a structured approach for developing a new VAP prevention bundle. Obtaining clinician input on what interventions to include increases the likelihood that providers will adhere to the bundle.
authors.affiliation: Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: kspeck2@jhmi.edu.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Speck
authors.affiliation: Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Johns Hopkins Community Physicians, Baltimore, MD.
authors.forename: Nishi
authors.initials: N
authors.lastname: Rawat
authors.affiliation: Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Noah C
authors.initials: NC
authors.lastname: Weiner
authors.affiliation: Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Haddis G
authors.initials: HG
authors.lastname: Tujuba
authors.affiliation: Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Donna
authors.initials: D
authors.lastname: Farley
authors.affiliation: Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Sean
authors.initials: S
authors.lastname: Berenholtz
mesh_terms: D006801:Humans; D017053:Infection Control / Q000379:methods*; D064872:Patient Care Bundles / Q000379:methods*; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*
keywords: Ventilator-associated pneumonia; bundle; prevention; quality improvement