title: The impact of implementing multifaceted interventions on the prevention of ventilator-associated pneumonia.
abstract: BACKGROUND
  Ventilator-associated pneumonia (VAP) is a frequent hospital acquired infections among intensive care unit patients. The Institute for Healthcare Improvement has suggested a "care bundle" approach for the prevention of VAP. This report describes the effects of implementing this strategy on VAP rates.
  
  
  METHODS
  All mechanically ventilated patients admitted to the intensive care unit between 2008 and 2013 were prospectively followed for VAP development according to the National Healthcare Safety Network criteria. In 2011, a 7-element care bundle was implemented, including head-of-bed elevation 30°-45°, daily sedation vacation and assessment for extubation, peptic ulcer disease prophylaxis, deep vein thrombosis prophylaxis, oral care with chlorhexidine, endotracheal intubation with in-line suction and subglottic suctioning, and maintenance of endotracheal tube cuff pressure at 20-30 mmHg. The bundle compliance and VAP rates were then followed.
  
  
  RESULTS
  A total of 3665 patients received mechanical ventilation, and there were 9445 monitored observations for bundle compliance. The total bundle compliance before and after initiation of the VAP team was 90.7% and 94.2%, respectively (P < .001). The number of VAP episodes decreased from 144 during 2008-2010 to only 14 during 2011-2013 (P < .0001). The rate of VAP decreased from 8.6 per 1000 ventilator-days to 2.0 per 1000 ventilator-days (P < .0001) after implementation of the care bundle.
  
  
  CONCLUSIONS
  This study suggests that systematic implementation of a multidisciplinary team approach can reduce the incidence of VAP. Further sustained improvement requires persistent vigilant inspections.
authors.affiliation: Intensive Care Department, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. Electronic address: raymondkhan@yahoo.com.
authors.forename: Raymond
authors.initials: R
authors.lastname: Khan
authors.affiliation: Intensive Care Department, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
authors.forename: Hasan M
authors.initials: HM
authors.lastname: Al-Dorzi
authors.affiliation: Anaesthesia Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
authors.forename: Khalid
authors.initials: K
authors.lastname: Al-Attas
authors.affiliation: Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
authors.forename: Faisal Wali
authors.initials: FW
authors.lastname: Ahmed
authors.affiliation: Quality Management Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
authors.forename: Abdellatif M
authors.initials: AM
authors.lastname: Marini
authors.affiliation: Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
authors.forename: Shihab
authors.initials: S
authors.lastname: Mundekkadan
authors.affiliation: King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Infection Prevention and Control Program, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
authors.forename: Hanan H
authors.initials: HH
authors.lastname: Balkhy
authors.affiliation: Infection Prevention and Control Program, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
authors.forename: Joseph
authors.initials: J
authors.lastname: Tannous
authors.affiliation: Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
authors.forename: Adel
authors.initials: A
authors.lastname: Almesnad
authors.affiliation: Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
authors.forename: Dianne
authors.initials: D
authors.lastname: Mannion
authors.affiliation: Epidemiology and Biostatistics, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
authors.forename: Hani M
authors.initials: HM
authors.lastname: Tamim
authors.affiliation: Intensive Care Department, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Respiratory Services, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
authors.forename: Yaseen M
authors.initials: YM
authors.lastname: Arabi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D064872:Patient Care Bundles; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000517:prevention & control*
keywords: Care bundles; Infection control; Quality improvement; Ventilator-associated pneumonia