20 Incidence of ventilator-associated pneumonia (VAP) in a tertiary- care center: comparison between the pre- and post-VAP prevention bundle

Abstract

Background Ventilator-associated pneumonia (VAP) is a nosocomial infection that develops 48 hours after the initiation of mechanical ventilatory support. Current evidence-based guidelines demonstrate that VAP prevention is feasible through the simultaneous implementation of certain VAP prevention bundle interventions. In this study we aimed to investigate the effect of VAP prevention before and after implementation. Methods This was a single-center cohort study that took place at the Pediatric Intensive Care Unit (PICU) of King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia, from March 2015 to March 2018, and assessed the rate of VAP before and after implementation of the bundle. Results The study included 141 children, of whom 95 were included in the pre-bundle group and 36 in the bundle group. VAP developed in 35% of the pre-bundle group compared with 31% of the bundle group, with incidence rates of 18 and 12 per 1000 ventilator-days, respectively. Multivariate logistic regression found that high positive end-expiratory pressure (PEEP), high fever (more than 38 °C), and high white blood cell count were significant indicators of VAP in our patient population. Conclusion This study found that the VAP bundle did not significantly reduce VAP rate in the PICU. Further large prospective multicenter studies with longer duration of intervention are needed to investigate the benefits of VAP prevention bundle use.