title: "Bundle" Practices and Ventilator-Associated Events: Not Enough.
abstract: OBJECTIVE Ventilator-associated events (VAEs) are nosocomial events correlated with length of stay, costs, and mortality. Current ventilator bundle practices target the older definition of ventilator-associated pneumonia and have not been systematically evaluated for their impact on VAEs. DESIGN Retrospective cohort study. SETTING Tertiary medical center between January 2012 and August 2014. PARTICIPANTS All adult patients ventilated for at least 24 hours at our institution. INTERVENTIONS We conducted univariate analyses for compliance with each element; we focused on VAEs occurring within a 2-day window of failure to meet any ventilator bundle element. We used Cox proportional hazard models to assess the effect of stress ulcer prophylaxis, deep vein thrombosis (DVT) prophylaxis, oral care, and sedation breaks on VAEs. We adjusted models for gender, age, and Acute Physiology and Chronic Health Evaluation (APACHE) III scores. RESULTS Our cohort comprised 2,660 patients with 16,858 ventilator days and 77 VAEs. Adjusting for APACHE score and gender, only oral care was associated with a reduction in the risk of VAE (hazard ratio [HR], 0.44; 95% confidence interval [CI], 0.26-0.77). The DVT prophylaxis and sedation breaks did not show any significant impact on VAEs. Stress ulcer prophylaxis trended toward an increased risk of VAE (HR, 1.59; 95% CI, 1.00-2.56). CONCLUSION Although limited by a low baseline rate of VAEs, existing ventilator bundle practices do not appear to target VAEs well. Oral care is clearly important, but the impact of DVT prophylaxis, sedation breaks, and especially stress ulcer prophylaxis are questionable at best. Infect Control Hosp Epidemiol 2016;1453-1457.
authors.affiliation: 1Division of Infectious Diseases,Department of Medicine,Mayo Clinic,Rochester,Minnesota,United States.
authors.forename: John C
authors.initials: JC
authors.lastname: O'Horo
authors.affiliation: 2Multidisciplinary Epidemiology and Translational Research in Intensive Care,Emergency and Perioperative Medicine (METRIC-EPM) Group,Mayo Clinic,Rochester,Minnesota,United States.
authors.forename: Haitao
authors.initials: H
authors.lastname: Lan
authors.affiliation: 2Multidisciplinary Epidemiology and Translational Research in Intensive Care,Emergency and Perioperative Medicine (METRIC-EPM) Group,Mayo Clinic,Rochester,Minnesota,United States.
authors.forename: Charat
authors.initials: C
authors.lastname: Thongprayoon
authors.affiliation: 4Department of Biomedical Statistics and Informatics,Mayo Clinic,Rochester,Minnesota,United States.
authors.forename: Louis
authors.initials: L
authors.lastname: Schenck
authors.affiliation: 5North Central Texas Medical Foundation,Wichita Falls Family Practice Residency Program,Wichita Falls,Texas,United States.
authors.forename: Adil
authors.initials: A
authors.lastname: Ahmed
authors.affiliation: 6Division of Critical Care,Department of Anesthesiology,Mayo Clinic,Rochester,Minnesota,United States.
authors.forename: Mikhail
authors.initials: M
authors.lastname: Dziadzko
authors.forename: Ognjen
authors.initials: O
authors.lastname: Gajic
authors.forename: Priya
authors.initials: P
authors.lastname: Sampathkumar
mesh_terms: D018806:APACHE; D000368:Aged; D002710:Chlorhexidine / Q000627:therapeutic use; D003422:Critical Care / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D009067:Mouthwashes / Q000627:therapeutic use; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D018571:Sentinel Surveillance; D062606:Tertiary Care Centers; D012122:Ventilators, Mechanical / Q000009:adverse effects*
chemical_list: D009067:Mouthwashes; D002710:Chlorhexidine