The Impact of Care Bundles on Ventilator-Associated Pneumonia (VAP) Prevention in Adult ICUs: A Systematic Review

Author:

Mastrogianni Maria12,Katsoulas Theodoros13ORCID,Galanis Petros1ORCID,Korompeli Anna13,Myrianthefs Pavlos13

Affiliation:

1. Department of Nursing, National and Kapodistrian University of Athens, 123 Papadiamantopoulou Str, Goudi, 11527 Athens, Greece

2. Department of Health Policy, Ministry of National Defense, Mesogeion Avenue 227–231, Holargos, 15561 Athens, Greece

3. Intensive Care Unit, General and Oncologic Hospital of Kifissia “AgioiAnargiri”, Kaliftaki 41 Str, Kifissia, 14564 Athens, Greece

Abstract

Ventilator-associated pneumonia (VAP) remains a common risk in mechanically ventilated patients. Different care bundles have been proposed to succeed VAP reduction. We aimed to identify the combined interventions that have been used to by ICUs worldwide from the implementation of “Institute for Healthcare Improvement Ventilator Bundle”, i.e., from December 2004. A search was performed on the PubMed, Scopus and Science Direct databases. Finally, 38 studies met our inclusion criteria. The most common interventions monitored in the care bundles were sedation and weaning protocols, semi-recumbent positioning, oral and hand hygiene, peptic ulcer disease and deep venus thrombosis prophylaxis, subglottic suctioning, and cuff pressure control. Head-of-bed elevation was implemented by almost all studies, followed by oral hygiene, which was the second extensively used intervention. Four studies indicated a low VAP reduction, while 22 studies found an over 36% VAP decline, and in ten of them, the decrease was over 65%. Four of these studies indicated zero or nearly zero after intervention VAP rates. The studies with the highest VAP reduction adopted the “IHI Ventilator Bundle” combined with adequate endotracheal tube cuff pressure and subglottic suctioning. Multifaced techniques can lead to VAP reduction at a great extent. Multidisciplinary measures combined with long-lasting education programs and measurement of bundle’s compliance should be the gold standard combination.

Funder

National and Kapodistrian University of Athens

Publisher

MDPI AG

Subject

Pharmacology (medical),Infectious Diseases,Microbiology (medical),General Pharmacology, Toxicology and Pharmaceutics,Biochemistry,Microbiology

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