Results of an Evidence-Based Care Bundle for Reducing
Ventilator-Associated Pneumonia (VAP) in
Neurosurgical Patients
Suphannee Triamvisit RN, MSN, APN*, Chatchanee Maneewan RN*, Prapassorn Bunturat RN, MSN*,
Wassana Wongprasert RN*, Kriengsak Limpassatan MD**, Nongyao Kasatpibal RN, PhD***, Juntima Euathrongchit MD****
Affiliation :
* Neurosurgical Critical Care Unit, Nursing Division, Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine,
Chiang Mai University, Chiang Mai, Thailand
** Neurosurgery Unit, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
*** Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
**** Diagnostic Radiology Section, Department of Radiology, Faculty of Medicine,
Chiang Mai University, Chiang Mai, Thailand
Background : Ventilator-associated pneumonia (VAP) is the most common intensive care unit-acquired infection, resulting
in increased morbidity and mortality as well as increased hospital costs.
Objective : To determine the VAP rate before and after using the care bundle.
Material and Method: A pre- and intervention study was conducted in the Neurosurgical Critical Care Unit (NCCU) at a
university hospital between April 2012 and February 2013. This was compared with the twelve-month period before
intervention. The six-element VAP prevention bundle called Suandok Model was implemented. It included 30-degree head
elevation, bedside hand hygiene, oral chlorhexidine mouth care, inflating of the cuff of the endotracheal tube maintaining
20 to 25 mmHg, checking residual gastric content before feeding, and implementing a weaning protocol.
Results : The samples before and after interventions were 66 and 68 cases, respectively. There were no significant differences
between sex, age, GCS, diagnosis, and operation. The incidence rates of VAP in the intervention period showed a significant
decrease (p = 0.001, 39.55 per 1,000 ventilator days vs. 13.30 per 1,000 ventilator days).
Conclusion : The Suandok Model reduced VAP in NCCU patients.
Keywords : Ventilator-associated pneumonia, Care bundle, Neurosurgical patients, NCCU
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