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Effect of Training and Checklist Based Use of Ventilator Associated Pneumonia (VAP) Prevention Bundle Protocol on Patient Outcome: A Tertiary Care Centre Study.

OBJECTIVE
VAP prevention bundle includes daily sedation free interval, DVT prophylaxis, raising head end of bed, use of orogastric rather than nasogastric tube. This study aims to study the practices regarding VAP prevention bundle and its compliance, educating about the practices and effects on patients outcome.


DESIGN
Quasi-experimental study, conducted in 3 phases.


SETTING
Hospital based.


PARTICIPANTS
Invasive Mechanically ventilated patients in the Department of Medicine of a tertiary care hospital. 50 patients included in phase 1 and 3.


INTERVENTION
Phase 1 and Phase 3 were pre and post intervention phases respectively when compliance to VAP prevention bundle was assessed with intermediate Phase 2, the intervention phase where the residents and nurses were educated about VAP bundle through various means. A checklist was attached to patient records.


OUTCOME MEASURES
Incidence of VAP, total hospital and ICU stay, duration of mechanical ventilation and mortality.


RESULTS
On comparing the 2 phases, it was found that there was increase in the compliance to VAP bundle(p<0.001), use of orogastric tube (p<0.001) and use of daily sedation free interval (p<0.001). Statistically insignificant increase in the use of DVT prophylaxis (p= 0.996) and raising the head end of the bed (p=0.513), and decline in the number of days of ICU(p=0.804) and hospital stay(p=0.907), the duration of mechanical ventilation(p=0.909), mortality(p=0.315) and incidence of VAP(p=0.715) was noted. Among those who developed VAP, there was lower compliance to bundle.


CONCLUSIONS
Practices like use of VAP prevention bundle improve on teaching efforts and use of checklist which improves patient care.