Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-13T00:54:55.021Z Has data issue: false hasContentIssue false
  • English
  • Français

Ventilator Bundle Compliance and Risk of Ventilator-Associated Events

Published online by Cambridge University Press:  17 May 2018

Bryan D. Harris ,
Gale A. Thomas ,
Matthew H. Greene ,
Steven S. Spires  and
Thomas R. Talbot
Bryan D. Harris*
Affiliation:
Department of Medicine Vanderbilt University Medical Center, Nashville, Tennessee
Gale A. Thomas
Affiliation:
Department of Medicine Vanderbilt University Medical Center, Nashville, Tennessee
Matthew H. Greene
Affiliation:
Department of Medicine Vanderbilt University Medical Center, Nashville, Tennessee
Steven S. Spires
Affiliation:
Department of Medicine Vanderbilt University Medical Center, Nashville, Tennessee
Thomas R. Talbot
Affiliation:
Department of Medicine Vanderbilt University Medical Center, Nashville, Tennessee Department of Health Policy, Vanderbilt University MedicalCenter, Nashville, Tennessee
*
Address correspondence to Bryan D. Harris, MD, MPH, Vanderbilt University Medical Center, A-2200 MCN, 1161 21st Avenue South, Nashville, TN 37232 (bryan.d.harris@vanderbilt.edu).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

Ventilator bundles encompass practices that reduce the risk of ventilator complications, including ventilator-associated pneumonia. The impact of ventilator bundles on the risk of developing ventilator-associated events (VAEs) is unknown. We sought to determine whether decreased compliance to the ventilator bundle increases the risk for VAE development.

DESIGN

Nested case-control study.

SETTING

This study was conducted at 6 adult intensive care units at an academic tertiary-care center in Tennessee.

PATIENTS

In total, 273 patients with VAEs were randomly matched in a 1:4 ratio to controls by mechanical ventilation duration and ICU type.

METHODS

Controls were selected from the primary study population at risk for a VAE after being mechanically ventilated for the same number of days as a specified case. Using conditional logistic regression analysis, overall cumulative compliance, and compliance with individual components of the bundle in the 3 and 7 days prior to VAE development (or the control match day) were examined.

RESULTS

Overall bundle compliance at 3 days (odds ratio [OR], 1.15; P=.34) and 7 days prior to VAE diagnosis (OR, 0.96; P=.83) were not associated with VAE development. This finding did not change when limiting the outcome to infection-related ventilator-associated complications (IVACs) and after adjusting for age and gender. In the examination of compliance with specific bundle components increased compliance with chlorhexidine oral care was associated with increased risk of VAE development in all analyses.

CONCLUSIONS

Ventilator bundle compliance was not associated with a reduced risk for VAEs. Higher compliance with chlorhexidine oral care was associated with a greater risk for VAE development.

Infect Control Hosp Epidemiol 2018;39:637–643

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 6 , June 2018 , pp. 637 - 643
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

PREVIOUS PRESENTATION. These data were presented in part at the Society for Healthcare Epidemiology of America Annual Meeting on May 19, 2016, in Atlanta, Georgia (abstract no. 8116).

References

REFERENCES

1. Wunsch, H, Linde-Zwirble, WT, Angus, DC, Hartman, ME, Milbrandt, EB, Kahn, JM. The epidemiology of mechanical ventilation use in the United States. Crit Care Med 2010;38:1947–1953.Google Scholar
2. Esteban, A, Anzueto, A, Frutos, F, et al. Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA 2002;287:345–355.Google Scholar
3. Kahn, JM, Goss, CH, Heagerty, PJ, Kramer, AA, O’Brien, CR, Rubenfeld, GD. Hospital volume and the outcomes of mechanical ventilation. N Engl J Med 2006;355:41–50.CrossRefGoogle ScholarPubMed
4. Rubenfeld, GD, Caldwell, E, Peabody, E, et al. Incidence and outcomes of acute lung injury. N Engl J Med 2005;353:1685–1693.Google Scholar
5. Mizgerd, JP. Acute lower respiratory tract infection. N Engl J Med 2008;358:716–727.Google Scholar
6. Heyland, DK, Cook, DJ, Griffith, L, Keenan, SP, Brun-Buisson, C. The attributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient. The Canadian Critical Trials Group. Am J Respir Crit Care Med 1999;159:1249–1256.CrossRefGoogle ScholarPubMed
7. Bekaert, M, Timsit, JF, Vansteelandt, S, et al. Attributable mortality of ventilator-associated pneumonia: a reappraisal using causal analysis. Am J Respir Crit Care Med 2011;184:1133–1139.CrossRefGoogle ScholarPubMed
8. Klompas, M. The paradox of ventilator-associated pneumonia prevention measures. Crit Care 2009;13:315.CrossRefGoogle ScholarPubMed
9. Klompas, M. Eight initiatives that misleadingly lower ventilator-associated pneumonia rates. Am J Infect Control 2012;40:408–410.Google Scholar
10. Klompas, M, Platt, R. Ventilator-associated pneumonia—the wrong quality measure for benchmarking. Ann Intern Med 2007;147:803–805.Google Scholar
11. Muscedere, J, Rewa, O, McKechnie, K, Jiang, X, Laporta, D, Heyland, DK. Subglottic secretion drainage for the prevention of ventilator-associated pneumonia: a systematic review and meta-analysis. Crit Care Med 2011;39:1985–1991.CrossRefGoogle ScholarPubMed
12. Zilberberg, MD, Shorr, AF, Kollef, MH. Implementing quality improvements in the intensive care unit: ventilator bundle as an example. Crit Care Med 2009;37:305–309.CrossRefGoogle ScholarPubMed
13. Berenholtz, SM, Pham, JC, Thompson, DA, et al. Collaborative cohort study of an intervention to reduce ventilator-associated pneumonia in the intensive care unit. Infect Control Hosp Epidemiol 2011;32:305–314.Google Scholar
14. Lawrence, P, Fulbrook, P. The ventilator care bundle and its impact on ventilator-associated pneumonia: a review of the evidence. Nurs Crit Care 2011;16:222–234.Google Scholar
15. Ferreira, CR, de Souza, DF, Cunha, TM, et al. The effectiveness of a bundle in the prevention of ventilator-associated pneumonia. Braz J Infect Dis 2016;20:267–271.Google Scholar
16. Sachetti, A, Rech, V, Dias, AS, Fontana, C, Barbosa Gda, L, Schlichting, D. Adherence to the items in a bundle for the prevention of ventilator-associated pneumonia. Rev Bras Ter Intensiva 2014;26:355–359.Google Scholar
17. Sen, S, Johnston, C, Greenhalgh, D, Palmieri, T. Ventilator-associated pneumonia prevention bundle significantly reduces the risk of ventilator-associated pneumonia in critically ill burn patients. J Burn Care Res 2016;37:166–171.CrossRefGoogle ScholarPubMed
18. Al-Thaqafy, MS, El-Saed, A, Arabi, YM, Balkhy, HH. Association of compliance of ventilator bundle with incidence of ventilator-associated pneumonia and ventilator utilization among critical patients over 4 years. Ann Thorac Med 2014;9:221–226.Google Scholar
19. Sulis, CA, Walkey, AJ, Abadi, Y, Campbell Reardon, C, Joyce-Brady, M. Outcomes of a ventilator-associated pneumonia bundle on rates of ventilator-associated pneumonia and other health care-associated infections in a long-term acute care hospital setting. Am J Infect Control 2014;42:536–538.Google Scholar
20. Eom, JS, Lee, MS, Chun, HK, et al. The impact of a ventilator bundle on preventing ventilator-associated pneumonia: a multicenter study. Am J Infect Control 2014;42:34–37.Google Scholar
21. Lim, KP, Kuo, SW, Ko, WJ, et al. Efficacy of ventilator-associated pneumonia care bundle for prevention of ventilator-associated pneumonia in the surgical intensive care units of a medical center. J Microbiol Immunol Infect 2015;48:316–321.Google Scholar
22. Bukhari, SZ, Hussain, WM, Banjar, AA, Fatani, MI, Karima, TM, Ashshi, AM. Application of ventilator care bundle and its impact on ventilator associated pneumonia incidence rate in the adult intensive care unit. Saudi Med J 2012;33:278–283.Google ScholarPubMed
23. Pogorzelska, M, Stone, PW, Furuya, EY, et al. Impact of the ventilator bundle on ventilator-associated pneumonia in intensive care unit. Int J Qual Health Care 2011;23:538–544.CrossRefGoogle ScholarPubMed
24. Morris, AC, Hay, AW, Swann, DG, et al. Reducing ventilator-associated pneumonia in intensive care: impact of implementing a care bundle. Crit Care Med 2011;39:2218–2224.CrossRefGoogle ScholarPubMed
25. Bird, D, Zambuto, A, O’Donnell, C, et al. Adherence to ventilator-associated pneumonia bundle and incidence of ventilator-associated pneumonia in the surgical intensive care unit. Arch Surg 2010;145:465–470.CrossRefGoogle ScholarPubMed
26. Al-Tawfiq, JA, Abed, MS. Decreasing ventilator-associated pneumonia in adult intensive care units using the Institute for Healthcare Improvement bundle. Am J Infect Control 2010;38:552–556.Google Scholar
27. Blamoun, J, Alfakir, M, Rella, ME, et al. Efficacy of an expanded ventilator bundle for the reduction of ventilator-associated pneumonia in the medical intensive care unit. Am J Infect Control 2009;37:172–175.Google Scholar
28. Talbot, TR, Carr, D, Parmley, CL, et al. Sustained reduction of ventilator-associated pneumonia rates using real-time course correction with a ventilator bundle compliance dashboard. Infect Control Hosp Epidemiol 2015;36:1261–1267.Google Scholar
29. Raoof, S, Baumann, MH, Critical Care Societies Collaborative cotlotAAoC-CNtACoCPtATS, the Society of Critical Care M. Ventilator-associated events: the new definition. Am J Crit Care 2014;23:7–9.Google Scholar
30. Klompas, M. Ventilator-associated events surveillance: a patient safety opportunity. Curr Opin Crit Care 2013;19:424–431.Google Scholar
31. Klompas, M, Khan, Y, Kleinman, K, et al. Multicenter evaluation of a novel surveillance paradigm for complications of mechanical ventilation. PLoS One 2011;6:e18062.Google Scholar
32. Price, R, MacLennan, G, Glen, J, Su, DC. Selective digestive or oropharyngeal decontamination and topical oropharyngeal chlorhexidine for prevention of death in general intensive care: systematic review and network meta-analysis. BMJ 2014;348:g2197.Google Scholar
33. Klompas, M, Li, L, Kleinman, K, Szumita, PM, Massaro, AF. Associations between ventilator bundle components and outcomes. JAMA Intern Med 2016;176:1277–1283.Google Scholar
34. Enwere, EN, Elofson, KA, Forbes, RC, Gerlach, AT. Impact of chlorhexidine mouthwash prophylaxis on probable ventilator-associated pneumonia in a surgical intensive care unit. Int J Crit Illn Inj Sci 2016;6:3–8.Google Scholar
35. Klompas, M. Ventilator-associated conditions versus ventilator-associated pneumonia: different by design. Curr Infect Dis Rep 2014;16:430.CrossRefGoogle ScholarPubMed
36. Lewis, SC, Li, L, Murphy, MV, Klompas, M, Epicenters CDCP. Risk factors for ventilator-associated events: a case-control multivariable analysis. Crit Care Med 2014;42:1839–1848.Google Scholar
Supplementary material: File

Harris et al. supplementary material

Tables S1-S2

Download Harris et al. supplementary material(File)
File 17.1 KB