Critical Care and Shock

Ventilator Bundle Compliance: Report from a Neurosurgical Intensive Care Unit

Abstract

Objective and Setting: Ventilator associated pneumonia (VAP) is the leading cause of mortality of hospital-acquired infections. One strategy for addressing this issue has been the ventilator bundle. This intervention was implemented in the University District Hospital (UDH) as part of an initiative to improve health care in the neurosurgical intensive care unit (NSICU) of an academic centre.

Design and Interventions: From July 2007 to December 2007 educational strategies consisting of monthly lectures, bed pamphlets and card reminders were used to educate the health care team. Ventilator bundle intervention compliance was evaluated daily in random shifts during a 14-day period during July-August 2007 and December 2007.

Measurements and Results: Pre-educational compliance was recorded at 6%. Individual component compliance was (1) Head of bed (HOB)>30° – 14%, (2) Withdrawal of sedation – 67%, (3) Peptic ulcer (PUD) prophylaxis – 93%, (4) Deep venous thrombosis (DVT) prophylaxis – 87%. Post-educational compliance was 59% with individual compliances of 74%, 72%, 95%, 92% respectively. A statistically significant increase in compliance was observed in ventilator bundle compliance and HOB elevation (p<0.01).

Conclusions: A simple educational strategy can improve compliance of the ventilator bundle. This in turn and although not demonstrated can subsequently effect the mortality of patients. Collaborative work between team members of the unit is the key to compliance.

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