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Multifaceted bundle interventions

shown effective in reducing ventilator associated pneumonia rates

Published quality improvement report by BMJ

A multidisciplinary ventilator associated pneumonia team was created with an aim to improve compliance with the bundle, and subsequently reduce VAP rates.

Ventilator associated pneumonia (VAP) remains a worldwide harm associated with hospital acquired infection.

King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia, was established by a royal decree in May 1983. With a bed capacity of 1, 220 operational beds, KAMC is a leading medical centre accredited by Joint Commission International, and provides all types of care to National Guard personnel, their dependents, and other eligible patients, starting from primary health care up to tertiary specialized care.

The VAP rate at KAMC was averaging 4.0 per 1 000 patient days between 2012 and 2013. The hospital administration considered VAP as a “big dot” quality indicator, and hence was perceived as an opportunity to revise and improve our interventions for VAP prevention in the ICUs.

A multidisciplinary VAP team was created with an aim to improve compliance with the VAP bundle, and subsequently reduce VAP rates.

A multidisciplinary team was initiated in October 2012, and included a physician leader, infection control practitioner, nurses, respiratory therapist (RT), and performance improvement specialist. Our team members were all trained in othe science of improvement, and were coached by quality professionals to write the project charter and develop the driver diagram along with primary and secondary drivers, and choose the change ideas.

After thorough review of the literature, the team agreed on a modified IHI VAP prevention care bundle. Which included; elevation of the head of the bed between 30° and 45°, daily “sedation vacations” and assessment of readiness to extubate, peptic ulcer disease prophylaxis, deep venous thrombosis prophylaxis, daily oral care with chlorhexidine, endotracheal tube with inline and subglottic suctioning and cuff pressure between 25cm and 30cm H2O.

Due to the use of the IHI Vap prevention care bundle compliance was increased and sustain it above 95% for more than one year. This translated in a decrease in the VAP rate from 4.0 to 0.8 in all different multidisciplinary ICUs.

quoteBMJ Quality Improvement Reports publishes quality improvement work, original research and reviews. The online-only, open access journal covers all aspects of quality and patient safety in healthcare.