Using Bundles to Prevent Ventilator-Associated Pneumonia in Intubated Adult ICU Patients
Abstract
V AP is a pneumonia which occurs within 48 hours of intubation. The nature of intubation itself, comorbidities and aspiration all contribute to development of V AP. V AP increases health care costs as well as patient morbidity and mortality. Prevention is necessary to protect patients and decrease incidence of V AP in intubated adult intensive care patients. Implementation of V AP bundles can help reduce risk and improve patient outcomes.
A bundle is a grouping of interventions aimed at a common cause. Ventilator bundles were originally implemented as a way to decrease complications occurring in intubated patients. Interventions such as sequential devices for deep vein thrombosis (DVT) prophylaxis, H2 antagonists to decrease threat of peptic ulcer disease (PUD), and head of bed (HOB) elevation to reduce risk of aspiration are all important steps to prevent complications in the very ill intubated population. The addition of other interventions aimed more specifically at V AP prevention which may be components of a V AP bundle include: sedation vacations, limiting use of saline suctioning, frequent oral care, subglottal suctioning, tooth brushing, frequent suctioning and decreasing contamination of ventilator circuits
Implementation of V AP bundles in the Intensive Care Unit (ICU) can be challenging. The first step is providing nurses education about V AP. Providing facts through the presentation of evidenced-based practice gives nurses guidance on why and how to change their own practice. Understanding how adults learn can help the educator to develop strategies to implement V AP bundles and reduce patient morbidity and mortality