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973 The Elimination of Ventilator-associated Pneumonia for 42 Months using Ventilator Bundle and Early Extubation in the Adult Intensive Care Unit

Sunday, March 21, 2010
Grand Hall (Hyatt Regency Atlanta)
Jeremias Murillo, MD , Saint Barnabas Health Care System, West Orange, NJ
Jennifer LaRosa, MD , Newark Beth Israel Medical Center, Newark, NJ
Sudheer Nambiar, MD , Newark Beth Israel Medical Center, Newark, NJ
Deeba Siddiqui, RN , Newark Beth Israel Medical Center, Newark, NJ
Robert Sigler, RRT , Newark Beth Israel Medical Center, Newark, NJ
Renita Larang, RN , Newark Beth Israel Medical Center, Newark, NJ
Background: There is increasing evidence that the use of ventilator bundle significantly reduce ventilator-associated pneumonia (VAP) in critically ill patients. We investigated the effect of using ventilator bundle and early extubation protocol on the incidence of ventilator-associated pneumonia.

Objective: To determine the effect of using ventilator bundle and early extubation on the rate of ventilator-associated pneumonia.

Methods: VAP infection rates were compared before and after the introduction of ventilator bundle and also compared with combined ventilator bundle and early extubation protocol in a 15-bed adult intensive care unit in a tertiary-care, inner-city medical center from January 2003 to July 2009.  The pre-bundle period (Period A) from January 2003 to September 2003 was compared with ventilator bundle without early extubation protocol (Period B) from October 2003 to December 2005 and the combined ventilator bundle and early extubation (Period C) from January 2006 to July 2009. VAP was identified using standard Center for Disease Control (CDC) definitions. Significant differences were calculated using chi square and student t statistics.

Results: A total of 2143 ventilator patients were reviewed in this analysis that included 231 patients in Period A, 702 patients in Period B and 1210 patients in Period C. The VAP rate in Period A (2.6%) was significantly higher compared to Period B (0.3%) p<0.001. There was no VAP for 42 months during Period C. There was a significant difference in ventilator days before (Period A+B) and after implementation (Period C) of early extubation protocol, mean 5.35, median 5.30 (95% CI 4.97-5.73) versus mean 2.2, median 2.14 (95% CI 1.87-2.53), p<0.0001.

Conclusions: The use of ventilator bundle combined with early extubation protocol resulted in the elimination of ventilator-associated pneumonia for 42 months in an adult intensive care unit.