Efficacy of a bundle approach in preventing the incidence ventilation acquire pneumonia among ventilated critically ill patients in Respiratory Intensive Care Unit and Medical Intensive Care Unit, Uttaradit hospital

Abstract

           The aim of this study was to compare the efficacy of a ventilation - acquire pneumonia (VAP) prevention bundle between group of using the traditional VAP bundle procedures and intensive VAP bundle procedures. The interrupted time design was undertaken through this study. This study was conducted among critical patients who on ventilated during October 2016 to April 2018 were recruited. The samples were divided into two groups. A control group was designed to use the traditional VAP bundle procedures and the experimental group was designed to use the strict VAP bundle procedures. All data were analyzed by using the descriptive statistic (percentage, mean, and SD). The proportion of the data were analyzed by using exact probability test and test the efficacy of intensive VAP bundle procedures used a Cox’s regression Model. 

        A total of 164 patient were recruited and divided into experimental group (n=81) 49.4% and control group (n=83) 50.6% which included gender, age, diagnosis, co-morbidity, GCS, APACHE II, Length of ICU, Length of Ventilator, antibiotic, steroid, NASIADs, pain killer and sleeping pill were no difference between group. The experimental groups were intensive VAP bundle procedure than the control groups statistically significant (p<0.001). The incidence rate per 1,000 day on ventilated were lower than the control group and statistically significant (3.00/1,000 ventilator-days and 18.30/1,000 ventilator-days p= 0.001). Also, the incidence VAP among experiment groups were statistically significant decrease (HR=0.13, 95%CI =0.03 – 0.49, p=0.003). Using a intensive VAP bundle, follow-up and coaching are recommended for reducing the VAP. It is recommended to use the intensive VAP bundle for all patients who on ventilated.