Investigation of implementation care bundle to the ventilator associated pneumonia rates

It is aimed to investigate of implementation care bundle to the ventilator associated pneumonia (VAP) rates in this quasi experimental study. In this study VAP Care Bundle consisted of "hand hygiene, oral care, head of bed elevation, cuff pressure monitoring, peptic ulcer prophylaxis, deep vein thrombosis prophylaxis, daily sedative interruption and daily assessment of readiness to extubate" parameters. A hundred and twenty eight inpatients receiving invasive mechanical ventilatory therapy at the Ege University Medical Faculty Hospital Anesthesiology ICU between April 7 and October 31 2014, allowed to participate by their relatives and over 18 years of age were included in the study. The protocol of this study was consisted of three phases. In the initial phase observations were done intended for determinating VAP Care Bundle adherence of intensive care unit (ICU) nurses. In the second phase education was given to ICU nurses on the subject of VAP Care Bundle. As to third phase the effect of VAP Care Bundle adherence on VAP rates after education were investigated. Data obtained from study were analyzed with Statistical Package for the Social Sciences (SPSS) for Windows 21.0 programme. In analyzing data number, percentage, Fisher's Exact Test, Mann Whitney-U Test were used. For all results p<0.05 value were approved as statistically significant. The nurses hand hygiene adherence improved after education from 81.7% (n:1151) to 97.6% (n:1440). It was determined that the nurses hand hygiene adherence after education showed statistically significant improvement (p:0.0001 p<0.05). The nurses oral care adherence improved after education from 36.3% (n:511) to 98.4% (n:1451). It was determined that the nurses oral care adherence after education showed statistically significant improvement (p:0.0001 p<0.05). The nurses head of bed elevation adherence improved after education from 60.0% (n:846) to 94.6% (n:1396). It was determined that the nurses head of bed elevation adherence after education showed statistically significant improvement (p:0.0001 p<0.05). The nurses cuff pressure monitoring adherence improved after education from 61.5% (n:866) to 97.4% (n:1437). It was determined that the nurses oral care adherence after education showed statistically significant improvement (p:0.0001 p<0.05). The nurses peptic ulcer prophylaxis adherence improved after education from 99.9% (n:1408) to 100.0% (n:1475). There was not significantly difference between nurses peptic ulcer prophylaxis before and after education (p:0.489 p>0.05). The nurses deep vein thrombosis prophylaxis adherence improved after education from 70.0% (n:986) to 75.5% (n:1113). The nurses deep vein thrombosis prophylaxis adherence after education showed statistically significant improvement (p:0.001 p<0.05). The nurses daily sedative interruption and daily assessment of readiness to extubate adherence was found as 100.0% (n:1475) before education, 100.0% (n:1409) after education. The nurses VAP Care Bundle adherence improved after education from 10.8% (n:152) to 89.8% (n:1324). The nurses VAP Care Bundle adherence after education showed statistically significant improvement (p:0.0001 p<0.05). In this study VAP rates were determined as 15.91/103 before education and 8.50/103 ventilator days after education. It was found that the VAP rates after education period were statistically significant lower than the VAP rates before education. In conclusion VAP Care Bundle implementation with education prepared according to evidence based guidelines decreases the VAP rates. Therefore it is recommended implementation of VAP Care Bundle on mechanically ventilated patients care.