Paliwal Naveen, Bihani Pooja, Jaju Rishabh, Mohammed Sadik, Prakash Prabhu, Tharu Vidya
Department of Anesthesiology, Dr. S.N. Medical College, Jodhpur, India.
Department of Anesthesiology, All India Institute of Medical Sciences, Deoghar, India.
Acute Crit Care. 2024 Nov;39(4):535-544. doi: 10.4266/acc.2024.00101. Epub 2024 Nov 12.
Ventilator-associated pneumonia (VAP) is a significant nosocomial infection in intensive care units (ICUs). Ventilator bundle (VB) implementation has been shown to decrease the incidence of VAP. This study presents a 1-year quality improvement (QI) project conducted in the ICU of a tertiary care hospital with the goal of increasing VB compliance to greater than 90% and evaluating its impact on VAP incidence and ICU length of stay.
A series of Plan-Do-Study-Act (PDSA) cycles, including educational boot camps, checklist implementation, and simulation-based training, was implemented. Emphasis on standardization and documentation for each VB component further improved compliance. Data were compared using a chi-square test, unpaired t-test, or Mann-Whitney U-Test, as appropriate. A P-value <0.05 was considered statistically significant.
The initial observed compliance was 40.7%, with a significant difference between knowledge and implementation. The compliance increased to 90% after the second PDSA cycle. In the third PDSA cycle, uniformity and standardization of all components of VAP were ensured. After increasing the VB compliance at greater than 90%, there was a significant decline in the incidence of VAP, from 62.4/1,000 ventilatory days to 25.7/1,000 ventilatory days, with a 2.34 times risk reduction in the VAP rate (P= 0.004).
The study highlights the effectiveness of a structured QI approach in enhancing VB compliance and reducing VAP incidence. There is a need for continued education, protocol standardization, and continuous monitoring to ensure the sustainability of this implementation.
呼吸机相关性肺炎（VAP）是重症监护病房（ICU）中一种重要的医院感染。实施呼吸机集束化方案（VB）已被证明可降低VAP的发生率。本研究展示了在一家三级医院的ICU中开展的为期1年的质量改进（QI）项目，其目标是将VB依从性提高到90%以上，并评估其对VAP发生率和ICU住院时间的影响。
实施了一系列计划-实施-研究-改进（PDSA）循环，包括教育训练营、检查表实施和基于模拟的培训。对每个VB组件的标准化和文件记录的强调进一步提高了依从性。根据情况，使用卡方检验、非配对t检验或曼-惠特尼U检验对数据进行比较。P值<0.05被认为具有统计学意义。
最初观察到的依从性为40.7%，知识与实施之间存在显著差异。在第二个PDSA循环后，依从性提高到了90%。在第三个PDSA循环中，确保了VAP所有组件的一致性和标准化。将VB依从性提高到90%以上后，VAP的发生率显著下降，从每1000个通气日62.4例降至每1000个通气日25.7例，VAP发生率降低了2.34倍（P=0.004）。
该研究强调了结构化QI方法在提高VB依从性和降低VAP发生率方面的有效性。需要持续进行教育、方案标准化和持续监测，以确保该实施的可持续性。
