Quality improvement project for the prevention of VAP using bundle care approach in tertiary care hospital

Background and Aims: Ventilator associated pneumonia (VAP) develops after more than 48 hours of mechanical ventilation. VAP is the leading cause of death among hospital acquired infection and prolongs time spent on the ventilator, length of intensive care unit (ICU) stay and length of hospital stay after discharge from the ICU. The concept of ‘bundles’ which can be defined as groups of evidence based interventions when, performed together, improve outcome. Hence this study was undertaken to assess the incidence of VAP and effectiveness of Bundle to prevent VAP.
Methods: This study was conducted in two phases. Pre-interventional phase (Phase-1) is done for three months by observing the current practices in mechanically ventilated patents and assessing the incidence of VAP. Then in post-interventional phase is conducted for three months by applying the bundle care approach, educating the interns, staff nurses and contact care givers regarding the quality improvement project and then assessing the incidence of VAP.
Results: Total 40 patients were involved in the study with 20 patients in each trial. The incidence of VAP was more in pre-interventional trial and the VAP incidence was reduced in post-interventional trial after implementing bundle care.
Conclusions: VAP prevention can be achieved to a large extent with the use of Bundle care approach .However, a major limitation is the lack of adherence to the set protocols by the health care professional especially in developing countries like India where the still the Patient to Nurse ratio is poor and overworked doctors . But one of the way to improve is by educating them through targeted training and using checklist which will help to improve adherence and ultimately patient outcome.