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Volume 48, Number 3, June 2015

Efficacy of ventilator-associated pneumonia care bundle for prevention of ventilator-associated pneumonia in the surgical intensive care units of a medical center 

Kim-Peng Lim, Shuenn-Wen Kuo, Wen-Je Ko, Wang-Huei Sheng, Ying-Ying Chang, Mei-Chaun Hong, Chun-Chuan Sun, Yee-Chun Chen, Shan-Chwen Chang

Received: April 30, 2013    Revised: August 18, 2013    Accepted: August 31, 2013   


Corresponding author:

Wang-Huei Sheng
Center for Infection Control, National Taiwan University Hospital, Taipei, Taiwan
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
Corresponding author. Department of Internal Medicine, National Taiwan University Hospital, Number 7, Chung-Shan South Road, Taipei 100, Taiwan. 


Background and purpose: 

Ventilator-associated pneumonia (VAP) is one of the most serious treatment-related infections resulting in high mortalities and costs. Our hospital has implemented bundle care in the intensive care units (ICUs) with special focus on VAP prevention. This is a retrospective study to evaluate its efficacy. 



We implemented a six-item VAP care bundle modified from that of the Institute for Healthcare Improvement at five surgical ICUs (SICUs) in the National Taiwan University Hospital. A multidisciplinary teamwork was involved in this bundle care. This study analyses the SICU utilization, ventilator utilization, and VAP incidence between January 2006 and March 2013 to assess the impact of VAP bundle in a clinical setting.



A total of 28,454 SICU patients were analyzed in this study and patients under the age of 18 were excluded (n = 1329); eventually, 27,125 patients were enrolled, with 12,913 patients from the pre-VAP bundle phase and 14,212 from the post-VAP bundle phase. Patients from the post-VAP phase tended to be older (p = 0.024) and with shorter SICU stay (p = 0.006), and disease severity scores (Therapeutic Intervention Scoring System, Glasgow Coma Scale, and Acute Physiology and Chronic Health Evaluation II score) were lower in the post-VAP bundle phase (p < 0.001), except the Injury Severity Score (p = 0.729). In response to VAP bundle interventions, no difference in SICU utilization (p = 0.982) between the pre-VAP and post-VAP bundle phases was noted, whereas the ventilator utilization was significantly decreased, from 1148.5 ventilator days to 956.1 ventilator days (p < 0.001) monthly; the VAP density had remarkably decreased from 3.3 to 1.4 cases per 1000 ventilator days (p < 0.001). 



Implementation of VAP bundle care decreases the incidence of VAP at SICU. Multidisciplinary teamwork, education, and a comprehensive checklist to improve health-care workers' compliance are the keys to success.