Indian Journal of Respiratory Care (Jun 2023)

VAP Bundle Components and Their Compliance in a Tertiary Intensive Care Unit

  • Haishwarya Raghavi,
  • Samundeeswari Premkumar,
  • Ramesh Venkataraman,
  • Nagarajan Ramakrishnan,
  • Ajay Padmanaban

DOI
https://doi.org/10.5005/jp-journals-11010-1032
Journal volume & issue
Vol. 12, no. 2
pp. 127 – 130

Abstract

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Introduction: Ventilator-associated pneumonia (VAP) adversely increases cost and outcomes in the intensive care unit (ICU). VAP bundle is regularly practiced in ICUs to prevent VAP. While the VAP bundle is routinely utilized, the degree of adherence to its various components is often a suboptimal variable, and definite data is lacking. Identification of bundle components with poor compliance and implementation of specific processes to improve them may have a significant impact on overall VAP rates. Aim: To conduct an audit to evaluate the compliance rates of individual elements of the VAP bundle in a tertiary ICU. Materials and methods: The audit was performed in a 24-bedded tertiary level ICU by a single designated respiratory therapist (RT). The audited VAP bundle comprised six evidence-based components. Before implementation, the eligibility of each VAP bundle component was ensured first, and then the compliance rate of each of the components was checked by RT once a day at random times, either during morning or afternoon shifts. Results: A total of 97 patients were audited for VAP bundle compliance during the study period (564 ventilator days). The eligibility for most of the VAP bundle elements was >90%, except for subglottic suction drainage (80.4% eligibility) and daily sedation vacation (59.1% eligibility). The bundle compliance rates of each component were—head of bed (HOB) elevation—96.7%, endotracheal (ET) cuff pressure measurement—95.5%, daily sedation vacation—93.6%, hand hygiene—87.1%, subglottic suction drainage—84.1%, and oral hygiene—81.1%, respectively. Overall, VAP bundle compliance was 89.6%. Our study found a VAP rate of 7.09/1,000 ventilator days. Conclusion: The compliance rate of the VAP bundle was high. However, the adherence to the practice of individual components varied, with the least compliance found in oral hygiene and subglottic suctioning practices. Many patients were not candidates for daily sedation vacation due to medical acuity. Clinical significance: Focused interventions targeting components with lower compliance rates may augment the efficacy of the VAP bundle.

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