Prevention of ventilator-associated pneumonia: guideline adherence and outcomes

Introduction: Ventilator-Associated Pneumonia (VAP) is one of the leading causes of morbidity and mortality in Intensive Care Units (ICU). VAP has a high incidence rate that can be reduced through the use of bundles, thus ensuring better outcomes. However, its effectiveness is closely related to implementation and dissemination strategies. Objectives: To assess adherence to a VAP prevention bundle; to assess the impact of adherence on outcomes (VAP, mortality rate, hospital length of stay (LOS), and duration of invasive ventilation (IV)). Methods: A quasi-experimental study was conducted, pre-and post-intervention, with historical control in three ICU over 6 months. The bundle was implemented and disseminated based on a multimodal approach, targeting physicians and nurses. The sample comprised patients hospitalized in the ICU aged≥18 years and submitted to endotracheal intubation for more than 48 h. Adherence to the bundle was assessed through auditing by observation. Outcome data were collected daily and entered into an intern database. Results were processed by the Statistical Package for the Social Sciences. The study was approved by the Ethics Committee and the hospital’s Board of Directors following the ethical principles for health research. Results: The sample comprised 828 patients aged between 18 and 95 years (M=61.85; SD=15.8 years). Increasing adherence to most of the recommendations over the course of the study was found, with two being statistically significant (p = 0.014), (p = 0.002). Also, adherence to all interventions simultaneously increased from 83.4% to 88.2% (p = 0.015). These results showed the effectiveness of a multimodal strategy approach. In addition, the statistical analysis confirmed that greater adherence to maintaining endotracheal tube cuff pressure was associated with shorter IV (p<0.001), ICU LOS (p><0.001) and lower mortality rate (p=0.002). On the other hand, results showed that greater adherence to all interventions simultaneously was directly related to fewer in ICU LOS (p=0.004) and fewer IV (p=0.016, p=0.005). Conclusion: From the data obtained on the association between adherence to each recommendation and health outcomes, this study provided a valuable contribution to better understanding the effectiveness of each intervention individually concerning VAP prevention.><0.001), ICU LOS (p<0.001) and lower mortality rate (p=0.002). On the other hand, results showed that greater adherence to all interventions simultaneously was directly related to fewer in ICU LOS (p=0.004) and fewer IV (p=0.016, p=0.005). Conclusion: From the data obtained on the association between adherence to each recommendation and health outcomes, this study provided a valuable contribution to better understanding the effectiveness of each intervention individually concerning VAP prevention.