The Prevention of Ventilator-Associated Pneumonia in Surgical Intensive Care Unit Siriraj Hospital
Chawika Pisitsak MD*, Rachada Cherdrungsi MSc***, Susan Assanasen MD**, Sawita Kanavitoon MD*****, Rungrawee Lawanwong BSN****, Piyaporn Poolaireab BSN****, Onuma Chaiwat MD*****
Affiliation : * Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand ** Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand *** Center for Nosocomial Infection Control, Siriraj Hospital, Mahidol University, Bangkok, Thailand **** Department of Nursing, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ***** Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : To observe the reduction of Ventilator-Associated Pneumonia (VAP) rates after the conduction of educational
program and implementation of VAP care bundles to surgical intensive care units (SICUs) healthcare personnel.
Material and Method: Patients were eligible if they were more than 18 years old and on ventilatory support at SICUs. The
incidence of VAP was observed retrospectively before and prospectively after the implementation of the one-month educational
program. The educational program emphasized VAP prevention. There were 220 patients in the pre-educational group
(Group 1) and 220 patients in post-educational group (Group 2). The adherence rate to VAP care bundles according to the
educational program was also observed.
Results : There were 19.8 and 11.5 episodes of VAP per 1,000 ventilator-days in Group 1 and Group 2, respectively (p = 0.03).
Median ventilator days were statistically decreased from 2 days to 1 day after an educational program (p = 0.01). Furthermore,
the 28-day mortality rate was decreased from 34 cases (15.5%) to 18 cases (8.2%) in Group 1 and Group 2, respectively (p
= 0.01). There was no significant difference in length of ICUs stay, length of hospital stay and antibiotic cost. The adherence
to head of bed elevation was improved from 50.1% in Group 1 to 70.3% in Group 2 after the educational program (p = 0.01).
The adherence to other bundles was remained high with no significant improvement.
Conclusion : The prevention of VAP by implementation of VAP care bundles and the educational program can reduce the VAP
rates, 28-day mortality rate and length of ventilator days in surgical ICUs.
Keywords : VAP, Incidence, Educational program, Bundles
