• Dorothy Bird, Amanda Zambuto, Charles O'Donnell, Julie Silva, Cathy Korn, Robert Burke, Peter Burke, and Suresh Agarwal.
• Department of Surgery, Boston Medical Center, 88 E Newton St, Boston, MA 02118, USA. dorothy.bird@bmc.org
• Arch Surg. 2010 May 1;145(5):465-70.

ObjectiveTo examine the impact of adherence to a ventilator-associated pneumonia (VAP) bundle on the incidence of VAP in our surgical intensive care units (SICUs).DesignProspectively collected data were retrospectively examined from our Infection Control Committee surveillance database of SICU patients over a 38-month period. Cost of VAP was estimated at $30,000 per patient stay.SettingTwo SICUs at a tertiary care academic level I trauma center.PatientsVentilated patients admitted to a SICU.InterventionThe Institute for Healthcare Improvement VAP bundle was instituted at the beginning of the study and included head-of-bed elevation, extubation assessment, sedation break, peptic ulcer prophylaxis, and deep vein thrombosis prophylaxis. A daily checklist was considered compliant if all 5 items were performed for each patient.Main Outcome MeasuresPatients were assessed for VAP. Staff were assessed for compliance with the VAP bundle.ResultsPrior to initiation of the bundle, VAP was seen at a rate of 10.2 cases/1000 ventilator days. Compliance with the VAP bundle increased over the study period from 53% and 63% to 91% and 81% in each respective SICU. The rate of VAP decreased to 3.4 cases/1000 ventilator days. A cost savings of $1.08 million was estimated.ConclusionsInitiation of the VAP bundle is associated with a significantly reduced incidence of VAP in patients in the SICU and with cost savings. Initiation of a VAP bundle protocol is an effective method for VAP reduction when compliance is maintained.

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