Top

Intensive Care Medicine

Published in:

01-05-2010 | Original

A European care bundle for prevention of ventilator-associated pneumonia

Authors: Jordi Rello, Hartmut Lode, Giuseppe Cornaglia, Robert Masterton, The VAP Care Bundle Contributors

Published in: Intensive Care Medicine | Issue 5/2010

Abstract

Background

One recent approach to facilitating guideline implementation involves the use of care bundles.

Methods

This document presents a care bundle package addressing VAP prevention in an attempt to promote guideline-compliant practices. Uniquely, the development of these care bundles used a formalised methodology to assess the supporting data, based on multi-criteria decision analysis.

Results

The resulting VAP care bundles for prevention were: non-ventilatory circuit changes unless specifically indicated, alcohol hand hygiene, appropriately educated and trained staff, incorporation of sedation control and weaning protocols into patient care, and oral care with clorhexidine.

Conclusion

Adoption of these care bundles should rationalise VAP prevention practises and improve outcomes, such as length of stay.

Available only for authorised users

Chastre J, Fagon JY (2002) Ventilator-associated pneumonia. Am J Respir Crit Care Med 165:867–903PubMed

Grossman RF, Fein A (2000) Evidence-based assessment of diagnostic tests for ventilator-associated pneumonia. Chest 117(4 supp 2):177S–181SCrossRefPubMed

Safdar N, Dezfulian C, Collard HR, Saint S (2005) Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Crit Care Med 33:2184–2193CrossRefPubMed

Rello J, Ollendorf DA, Oster G, Vera-Llonch M, Bellm L, Redman R, Kollef MH, VAP Outcomes Scientific Advisory Group (2002) Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest 122:2115–2121CrossRefPubMed

Fulbrook P, Mooney S (2003) Care bundles in critical care: a practical approach to evidence-based practice. Nurs Crit Care 8:249–255CrossRefPubMed

Cinel I, Dellinger RP (2006) Guidelines for severe infections: are they useful? Curr Opin Crit Care 12:483–488CrossRefPubMed

Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, Sexton B, Hyzy R, Welsh R, Roth G, Bander J, Kepros J, Goeschel C (2006) An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 355:2725–2732CrossRefPubMed

Resar R, Pronovost P, Haraden C, Simmonds T, Rainey T, Nolan T (2005) Using a bundle approach to improve ventilator care processes and reduce ventilator-associated pneumonia. Jt Comm J Qual Patient Saf 31:243–248PubMed

Crunden E, Boyce C, Woodman H, Bray B (2005) An evaluation of the impact of the ventilator care bundle. Nurs Crit Care 10:242–246CrossRefPubMed

10.

Burger CD, Resar RK (2006) “Ventilator bundle” approach to prevention of ventilator-associated pneumonia. Mayo Clin Proc 81:849–850CrossRefPubMed

11.

Fox MY (2006) Toward a zero VAP rate: personal and team approaches in the ICU. Crit Care Nurs Q 29:108–114PubMed

12.

Lai KK, Baker SP, Fontecchio SA (2003) Impact of a program of intensive surveillance and interventions targeting ventilated patients in the reduction of ventilator-associated pneumonia and its cost-effectiveness. Infect Control Hosp Epidemiol 24:859–863CrossRefPubMed

13.

Laux L, Herbert C (2006) Decreasing ventilator-associated pneumonia: getting on board. Crit Care Nurs Q 29:253–258PubMed

14.

Masterton R, Craven D, Rello J, Struelens M, Frimodt-Moller N, Chastre J, Ortqvist A, Cornaglia G, Lode H, Giamarellou H, Bonten MJ, Eraksoy H, Davey P (2007) Hospital-acquired pneumonia guidelines in Europe: a review of their status and future development. J Antimicrob Chemother 60:206–213CrossRefPubMed

15.

Belton V, Stewart TJ (2002) Multiple criteria decision analysis: an integrated approach. Kluwer, Boston

16.

Dodek P, Keenan S, Cook D, Heyland D, Jacka M, Hand L, Muscedere J, Foster D, Mehta N, Hall R, Brun-Buisson C, Canadian Critical Care Trials Group, Canadian Critical Care Society (2004) Evidence-based clinical practice guideline for the prevention of ventilator-associated pneumonia. Ann Intern Med 141:305–313PubMed

17.

Kollef MH, Shapiro SD, Fraser VJ, Silver P, Murphy DM, Trovillion E, Hearns ML, Richards RD, Cracchilo L, Hossin L (1995) Mechanical ventilation with or without 7-day circuit changes. A randomized controlled trial. Ann Intern Med 123:168–174PubMed

18.

Long MN, Wickstrom G, Grimes A, Benton CF, Belcher B, Stamm AM (1996) Prospective, randomized study of ventilator-associated pneumonia in patients with one versus three ventilator circuit changes per week. Infect Control Hosp Epidemiol 17:14–19CrossRefPubMed

19.

Boyce JM, Pittet D, Healthcare Infection Control Practices Advisory Committee, Society for Healthcare Epidemiology of America, Association for Professionals in Infection Control, Infectious Diseases Society of America, Hand Hygiene Task Force (2002) Guideline for Hand Hygiene in Health-Care Settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Infect Control Hosp Epidemiol 23:S3–S40CrossRefPubMed

20.

Pittet D, Hugonnet S, Harbarth S, Mourouga P, Sauvan V, Touveneau S, Perneger TV (2000) Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme. Lancet 356:1307–1312CrossRefPubMed

21.

Adams BG, Marrie TJ (1982) Hand carriage of aerobic Gram-negative rods by health care personnel. J Hyg (Lond) 89:23–31

22.

Adams BG, Marrie TJ (1982) Hand carriage of aerobic gram-negative rods may not be transient. J Hyg (Lond) 89:33–46

23.

Doebbeling BN, Pfaller MA, Houston AK, Wenzel RP (1988) Removal of nosocomial pathogens from the contaminated glove. Implications for glove reuse and handwashing. Ann Intern Med 109:394–398PubMed

24.

Salahuddin N, Zafar A, Sukhyani L, Rahim S, Noor MF, Hussain K, Siddiqui S, Islam M, Husain SJ (2004) Reducing ventilator-associated pneumonia rates through a staff education programme. J Hosp Infect 57:223–227CrossRefPubMed

25.

Zack JE, Garrison T, Trovillion E, Clinkscale D, Coopersmith CM, Fraser VJ, Kollef MH (2002) Effect of an education program aimed at reducing the occurrence of ventilator-associated pneumonia. Crit Care Med 30:2407–2412CrossRefPubMed

26.

Baxter AD, Allan J, Bedard J, Malone-Tucker S, Slivar S, Langill M, Perreault M, Jansen O (2005) Adherence to simple and effective measures reduces the incidence of ventilator-associated pneumonia. Can J Anaesth 52:535–541CrossRefPubMed

27.

Needleman J, Buerhaus P, Mattke S, Stewart M, Zelevinsky K (2002) Nurse-staffing levels and the quality of care in hospitals. N Engl J Med 346:1715–1722CrossRefPubMed

28.

Kress JP, Pohlman AS, O’Connor MF, Hall JB (2000) Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 342:1471–1477CrossRefPubMed

29.

Marelich GP, Murin S, Battistella F, Inciardi J, Vierra T, Roby M (2000) Protocol weaning of mechanical ventilation in medical and surgical patients by respiratory care practitioners and nurses: effect on weaning time and incidence of ventilator-associated pneumonia. Chest 118:459–467CrossRefPubMed

30.

Brook AD, Ahrens TS, Schaiff R, Prentice D, Sherman G, Shannon W, Kollef MH (1999) Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation. Crit Care Med 27:2609–2615CrossRefPubMed

31.

DeRiso AJ II, Ladowski JS, Dillon TA, Justice JW, Peterson AC (1996) Chlorhexidine gluconate 0.12% oral rinse reduces the incidence of total nosocomial respiratory infection and nonprophylactic systemic antibiotic use in patients undergoing heart surgery. Chest 109:1556–1561CrossRefPubMed

32.

Yoneyama T, Yoshida M, Ohrui T, Mukaiyama H, Okamoto H, Hoshiba K, Ihara S, Yanagisawa S, Ariumi S, Morita T, Mizuno Y, Ohsawa T, Akagawa Y, Hashimoto K, Sasaki H (2002) Oral Care Working Group. Oral care reduces pneumonia in older patients in nursing homes. J Am Geriatr Soc 50:430–433CrossRefPubMed

33.

Pittet D, Boyce JM (2003) Revolutionising hand hygiene in health-care settings: guidelines revisited. Lancet Infect Dis 3:269–270CrossRefPubMed

34.

Pratt RJ, Pellowe C, Loveday HP, Robinson N, Smith GW, Barrett S, Davey P, Harper P, Loveday C, McDougall C, Mulhall A, Privett S, Smales C, Taylor L, Weller B, Wilcox M; Department of Health (England) (2001) The epic project: developing national evidence-based guidelines for preventing healthcare associated infections. Phase I: guidelines for preventing hospital-acquired infections. Department of Health (England). J Hosp Infect 47(suppl):S3–S82

35.

Garner JS (1996) Guideline for isolation precautions in hospitals. The Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 17:53–80CrossRefPubMed

36.

Masterton RG, Galloway A, French G, Street M, Armstrong J, Brown E, Cleverley J, Dilworth P, Fry C, Gascoigne AD, Knox A, Nathwani D, Spencer R, Wilcox M (2008) Guidelines for the management of hospital-acquired pneumonia in the UK: report of the working party on hospital-acquired pneumonia of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother 62:5–34CrossRefPubMed

37.

American Thoracic Society (2005) Guidelines for the management of adults with hospital acquired, ventilator-associated, and healthcare-assisted pneumonia. Am J Respir Crit Care Med 171:388–416CrossRef

38.

Richens Y, Rycroft-Malone J, Morrell C (2004) Getting guidelines into practice: a literature review. Nursing Standard 18:33–37

39.

Cocanour CS, Peninger M, Domonoske BD, Li T, Wright B, Valdivia A, Luther KM (2006) Decreasing ventilator-associated pneumonia in a trauma ICU. J Trauma 61:122–129CrossRefPubMed

40.

Rosenthal VD, Guzman S, Crnich C (2006) Impact of an infection control program on rates of ventilator-associated pneumonia in intensive care units in 2 Argentinean hospitals. Am J Infect Control 34:58–63CrossRefPubMed

41.

Misset B, Timsit JF, Dumay MF, Garrouste M, Chalfine A, Flouriot I, Goldstein F, Carlet J (2004) A continuous quality-improvement program reduces nosocomial infection rates in the ICU. Intensive Care Med 30:395–400CrossRefPubMed

42.

Nguyen HB, Corbett SW, Steele R, Banta J, Clark RT, Hayes SR, Edwards J, Cho TW, Wittlake WA (2007) Implementation of a bundle of quality indicators for the early management of severe sepsis and septic shock is associated with decreased mortality. Crit Care Med 35:1105–1112CrossRefPubMed

43.

Fong JJ, Cecere K, Unterborn J, Garpestad E, Klee M, Devlin JW (2007) Factors influencing variability in compliance rates and clinical outcomes among three different severe sepsis bundles. Ann Pharmacother 41:929–936CrossRefPubMed

44.

Zilberberg MD, Shorr AF, Kollef MH (2009) Implementing quality improvements in the intensive care unit. Ventilator bundle as an example. Crit Care Med 37:305–309CrossRefPubMed

45.

Coffin SE, Komplas K, Classen D, Arias KM, Podgorny K, Anderson DJ, Busrstin H, Carfee DP, Dubberke DE, Fraser V, Gerdin DN, Griffin FA, Gross P, Kaye KS, Lo E, Marschall J, Mermel LA, Nicolle L, Pegues DA, Perl TM, Saint S, Salgado CD, Weinstein RA, Wise R, Yokoe DS (2008) Strategies to prevent ventilator-associated pneumonia in acute care hospitals. Infect Control Hosp Epidemiol 29:S31–S40CrossRefPubMed

46.

Masterton RG (2009) Sepsis care bundles and clinicians. Intensive Care Med 35:1149–1151CrossRefPubMed

47.

Hawe CS, Ellis KS, Cairns CJS, Longmate A (2009) Reduction of ventilator-associated pneumonia: active versus passive guideline implementation. Intensive Care Med 35:1180–1186CrossRefPubMed

Title: A European care bundle for prevention of ventilator-associated pneumonia
Authors: Jordi Rello
Hartmut Lode
Giuseppe Cornaglia
Robert Masterton
The VAP Care Bundle Contributors
Publication date: 01-05-2010
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 5/2010
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-010-1841-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A European care bundle for prevention of ventilator-associated pneumonia

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 5/2010

Effectiveness of acetazolamide for reversal of metabolic alkalosis in weaning COPD patients from mechanical ventilation

Comparison of high-frequency oscillation and tracheal gas insufflation versus standard high-frequency oscillation at two levels of tracheal pressure

Mechanical ventilation aggravates transfusion-related acute lung injury induced by MHC-I class antibodies

Lipid emulsions in parenteral nutrition of intensive care patients: current thinking and future directions

Airway pressure release ventilation versus assist-control ventilation: a comparative propensity score and international cohort study

Electrocardiographic effects of dexmedetomidine in patients with congenital heart disease