The Development of a 10-Item Ventilator-Associated Pneumonia Care Bundle in the General Intensive Care Unit of a Tertiary Hospital in Vietnam: Lessons Learned

Abstract

Objectives and Methods: We developed a 10-item VAP care bundle to address the high incidence of VAP in Vietnamese intensive care units (ICUs), comprising (i) hand hygiene, (ii) head elevation (gatch up 30-45°), (iii) oral care, (iv) oversedation avoidance, (v) breathing circuit management, (vi) cuff pressure control, (vii) subglottic suctioning of secretions, (viii) daily assessment for weaning and a spontaneous breath trial (SBT), (ix) early ambulation and rehabilitation, and (x) prophylaxis of peptic ulcers and deep-vein thrombosis (DVT). The VAP incidence (27.0 per 1000 mechanical ventilation days) slightly and not significantly decreased in the six months after the implementation of the care bundle. Methods and Results: However, the VAP incidence (11.3 per 1000 mechanical ventilation days) significantly decreased when we updated the two-item protocol with interactive communication and education (p < 0.001). Conclusions: Although the effectiveness of the interventions via protocol updates with interactive education needs further study, this intervention can make a VAP care bundle work in a resource-constrained and multidrug-resistant environment.

Keywords: care bundle; developing countries; healthcare-associated infection; intensive care unit; prevention; ventilator-associated pneumonia.

Figure 1

Change in VAP incidence over the observation period. VAP: ventilator-associated pneumonia.

Figure 2

Graphs of proportion of VAP patients–ICU days (a) and survival probability–ICU days (b) before and after updates of the VAP care bundle (oral care and breath circuit management) and interactive communication and bedside education. VAP: ventilator-associated pneumonia; ICU: intensive care unit; MST: median survival time.