1. Among mechanically-ventilated patients, how does the use of the ventilator bundle
affect Ventilator Acquired Pneumonia (VAP) rates when compared to not
implementing the ventilator bundle during hospitalization?
Aubrey Berg, Brooke Borg, Emily Copus, Morgan Karras, Kendra Mele, Nick Mele, Rashidat Momoh, Josh Steinhorst
Viterbo University
Using Evidence-Based Practice to Prevent
Ventilator-Associated Pneumonia
Purpose: To develop a ventilator bundle and care
practices for nurses in critical care units to reduce the
rate of ventilator associated pneumonia.
Design: Case Study
Sample: A total of 4709 ventilator days were audited for
the project from January 2009 through December 2009 in
the ICU at Lankenau Hospital.
Results: Using prophylaxis for peptic ulcer disease and
deep-vein thrombosis, interruption of sedation, elevation
of head of bed and oral care led to a decrease from 9.4 to
1.9 cases per 1000 ventilator days. The decrease in
ventilator-associated pneumonia produced an estimated
savings of approximately $1.5 million.
Sedwick, M. B., Lance-Smith, M., Reeder, S. J., & Nardi, J. (2012).
Using Evidence-Based Practice to Prevent Ventilator-Associated
Pneumonia. Critical Care Nurse, 32(4), 41-51.
Limitations
• Not all articles were blind studies and they were not
completely randomized studies
• No causal links because ventilator bundles have multiple
interventions that make it challenging to know the cause and
effect
• Threats to validity regarding original data collection
Nursing Responsibilities
• Review of literature done using CINAHL and included search
terms such as: “VAP”, “VAP care bundle”, “critically ill”
• Nurses should uphold compliance with the VAP bundle or
hospital protocol.
• Nurses should be educated on the latest and best practice in
reducing VAP.
• Nurses will monitor patients for signs and symptoms of VAP
and report to physician.
Recommendation: Nurses will incorporate evidence based
research into their care when treating a patient who is critically
ill and is ventilated.
Outcome: Hospitals will incorporate evidence based training
courses specific to VAP and the VAP bundle and use during
practice to decrease the amount of VAP in the hospital.
Recommendation: Facility will develop a method of keeping
track when the VAP bundle is used in critically ill ventilated
patients and ensuring that employees are performing the VAP
bundle.
Outcome: The facility staff will implement a checklist with the
VAP bundle components and times. The employees will use
this to track when components of the VAP bundle are done. An
employee will also be designated to ensure that the VAP
bundle is implemented and completed correctly on
mechanically-ventilated patients.
The ventilator care bundle and its impact on
ventilator-associated pneumonia: a review of the
evidence
Purpose: To research the correlation between ventilator care
bundle and the impact on VAP.
Design: Meta-analysis
Sample: Adult intensive care units across the United States,
Canada, Thailand, and the United Kingdom. Specific
population number unknown.
Results: Increased compliance with the ventilator care bundle
resulted in reduced mortality, ICU length of stay, and costs.
The VAP rate fell 19.3 cases per 1000 to 7.3 cases per 1000
with extra education on compliance.
Lawrence, P., & Fulbrook, P. (2011). The ventilator care bundle and its
impact on ventilator-associated pneumonia: a review of the evidence.
Nursing In Critical Care, 16(5), 222-234.
Association of compliance of ventilator bundle with
incidence of ventilator-associated pneumonia and
ventilator utilization among critical patients over 4
years
Purpose: To decrease the morbidity and mortality from VAP
by implementing the VAP bundle among critically ventilated
patients.
Design: Cross-sectional
Sample: Adult critical patients in Saudi Arabia. Two different
ICUs were used in this study a 900-bed tertiary care facility
and a 21-bed closed medical-surgical-trauma unit.
Results: Ventilator bundle compliance increased from 90% in
2010 to 97% in 2013. Vap rates decreased from 3.6 (per
1,000 ventilator days) to 1. There was a 70% improvement of
VAP rates and a 20% improvement of ventilator compliance.
Al-Thaqafy, M. S., El-Saed, A., Arabi, Y. M., & Balkhy, H. H. (2014).
Association of compliance of ventilator bundle with incidence of ventilator-
associated pneumonia and ventilator utilization among critical patients
over 4 years. Annals Of Thoracic Medicine, 9(4), 221-226.
A Successful VAP Prevention Program Quality
improvement initiative results in a successful
VAP prevention bundle
Purpose: A VAP prevention quality improvement project
was initiated in an attempt to reduce the incidence of
ventilator-acquired pneumonia.
Design: Retrospective Statistical Analysis Study
Sample: Two 16-bed ICUs
Results: The ventilator-acquired pneumonia rate
decreased from 1.9 cases per 1000 ventilator days to
0.28 cases per 1000 ventilator days.
DeJulio, P. A., Rivera, S. J., & Huml, J. P. (2012). A Successful VAP
Prevention Program. RT: The Journal For Respiratory Care
Practitioners, 25(6), 26-29.