Efficacy of compliance with ventilator-associated pneumonia care bundle: A 24-month longitudinal study at Bach Mai Hospital, Vietnam

Hoan Minh Hoang; Co Xuan Dao; Hoang Huy Ngo; Tatsuya Okamoto; Chieko Matsubara; Son Ngoc Do; Giang Thi-Huong Bui; Han Quang Bui; Nguỵen Thi Duong; Ngoan Thi Nguyen; Toan Xuan Vuong; Kham Van Vu; Thach The Phạm; Cuong Van Bui

doi:10.1177/20503121231223467

Efficacy of compliance with ventilator-associated pneumonia care bundle: A 24-month longitudinal study at Bach Mai Hospital, Vietnam

SAGE Open Med. 2024 Jan 18:12:20503121231223467. doi: 10.1177/20503121231223467. eCollection 2024.

Authors

Hoan Minh Hoang^{1

2}, Co Xuan Dao^{1

3}, Hoang Huy Ngo², Tatsuya Okamoto⁴, Chieko Matsubara⁵, Son Ngoc Do^{1

3}, Giang Thi-Huong Bui^{1

6}, Han Quang Bui¹, Nguỵen Thi Duong¹, Ngoan Thi Nguyen¹, Toan Xuan Vuong¹, Kham Van Vu¹, Thach The Phạm¹, Cuong Van Bui¹

Affiliations

¹ Bach Mai Hospital, Hanoi, Vietnam.
² Nam Dinh University of Nursing, Nam Dinh, Vietnam.
³ Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam.
⁴ National Center for Global Health and Medicine Research Institute, Tokyo, Japan.
⁵ The University of Tokyo Bunkyo-ku, Tokyo, Japan.
⁶ Ha Noi Medical University, Hanoi, Vietnam.

Abstract

Introduction: To decrease the risk of complications from ventilator-associated pneumonia, it is essential to implement preventative measures in all ICU patients. Since 2018, with the help of Japanese experts, we have applied a ventilator-associated pneumonia care bundle with 10 basic standards in patient care and monitoring. Therefore, we conducted a study to evaluate the results of applying 10 solutions to prevent ventilator-associated pneumonia over 24 months.

Methods: A cross-sectional descriptive study with longitudinal follow-up for 24 months on 170 mechanically ventilated patients at the Center for Critical Care Medicine, Bach Mai Hospital. According to the Centers for Disease Control (CDC, 2021), the diagnosis of ventilator-associated pneumonia is when pneumonia appears 48 h after intubation by confirmation by at least two doctors. Evaluate compliance with each solution in the care bundle through camera monitoring, medical records, and directly on patients daily.

Results: The rate of ventilator-associated pneumonia is 12.9%, the frequency of occurrence is 16.54 of 1000 days. The compliance rate for complete compliance with a 10-item ventilator-associated pneumonia was only 1.8%, while the average value was 84.1%. Average values of compliance with each solution for hand hygiene, head elevation 30-45 degrees, oral hygiene, stopping sedation, breathing circuit management, cuff pressure management, hypoplastic suction, Spontaneous breathing trial (SBT) daily and assessed extubation, mobilization and early leaving bed, ulcer and thrombosis prevention were 96.9%, 97.3%, 99.4%, 81.5%, 99.9%, 99.9%, 86.3%, 83.5%, 49.3%, and 46.4%, respectively. The time to appear ventilator-associated pneumonia in the high compliance group was 46.7 ± 5.0 days, higher than in the low compliance group, 10.3 ± 0.7 days, p < 0.001.

Conclusions: A 10-item ventilator-associated pneumonia care bundle has helped reduce the incidence of ventilator-associated pneumonia. To reduce the risk of ventilator-associated pneumonia and shorten ICU and hospital stays, it is essential to fully adhere to subglottic secretion suction, daily SBT, and early mobilization and leaving the bed.

Keywords: Ventilator-associated pneumonia; care bundle.