The effect of increasing compliance with the ventilator related pneumonia prevention package on ventilator related pneumonia

Introduction: Ventilator Associated Pneumonia (VAP) is a nasocomial pneumonia that can be prevented and prevented after initiation of the Mechanical Ventilator (MV) support in patients admitted to the intensive care unit. Because of prolonged hospitalization, VIP is the cause of high mortality and cost. Some applications have shown that VAP can be prevented. However, the incidence of VAP is still high in our country. In this study, we aimed to investigate the effects of VAP Prevention Package (VÖP) training on healthcare personnel with VAP incidence, duration of mechanical ventilation, duration of intensive care unit stay and mortality. Material method: Our study was a prospective case control study and it was initiated after the consent of the Ethics Committee of the Medical Faculty of Van Yüzüncü Yıl University (VYYÜ). The study was performed between November 2017 and June 2018 at the Anesthesiology and Reanimation Intensive Care Unit of the Medical Faculty Dursun Odabaş Medical Center. The study included 68 patients who were included in the study. The control group consisted of 100 patients who underwent VÖP package between January 2016 and June 2017. The Centers for Disease Control (CDC) criteria were used for the diagnosis of VAP. In both groups, the difference between the compliance of the package, the frequency of VAP, the duration of hospitalization and the mortality rates were compared statistically. Results: Demographic data of the patients were similar in terms of patient hospitalization and microorganisms which were replicated in culture in patients with VAP and there was no statistically significant difference. The four parameters (SSD-ETTs, 0.12% chlorhexidine oral care, peptic ulcer prophylaxis, and DVT prophylaxis) on the VIP precaution package were the mean fit; the effect of these parameters could not be evaluated separately. VAP precaution package parameters fit to keep the head of the bed at 300-450 fit 100% in the VÖP group average fit in the control group was 90.67% (85-100%). The relationship between the development of VAP was statistically significant between the groups (p = 0.036). The compliance of ETT cuff pressure between 20-25 cmH2O was 97.96% in the VÖP group and 93.13% in the control group. There was a statistically significant difference between this application and the development of VAP (p = 0.01). In our study, VAP (17.6%) developed in 12 patients. When VIP patients were compared with 9 (9%) patients in the control group, the number of days related to MV was 44.83 ± 0.84 / 82.22 ± 55.43, but the results were not statistically significant. Despite the increase in the rate of VAP, mortality rates were not statistically significant. However, mortality rates were significantly lower in patients without VAP compared to the control group (P <0.05). The mean day of application of tracheostomy was 11.64 ± SD in the VÖP group and 21.86 ± SD in the control group. This difference between the groups was statistically significant. No statistically significant difference was found between the groups on the day of mechanical ventilation support (30,25 ± SD / 26,11 ± SD). There was no VAP attack that developed early in both groups (first 4 days after MV support). It was determined that all VAP attacks occurred after the 5th day of MV support. In terms of VAP rates, the VAP rate was found to be 13.1 in the VÖP group and 4.29 in the V group in the 1000 ventilator days. This difference was not statistically significant (p = 0.96). Conclusion: VAS did not decrease the incidence of VAP in our clinic. In order to reduce the incidence of VAP in ICUs in intensive care units, we determined that strict compliance with all parameters of this package should be ensured.