National bundle care program implementation to reduce ventilator-associated pneumonia in intensive care units in Taiwan |
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| Authors: | Chin-Chuan Kao Hsiu-Tzy Chiang Chih-Yu Chen Ching-Tzu Hung Ying-Chun Chen Li-Hsiang Su Zhi-Yuan Shi Jein-Wei Liu Chang-Pan Liu Yin-Ching Chuang Wen-Chien Ko Yen-Hsu Chen Shu-Hui Tseng Chun-Ming Lee Min-Chi Lu Po-Ren Hsueh |
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| Institution: | 1. Division of Infectious Disease, Department of Internal Medicine, Tungs'' Taichung Metroharbor Hospital, Taichung, Taiwan;2. Infection Control Centre, MacKay Memorial Hospital, Taipei, Taiwan;3. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan;4. Center of Infection Control, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan;5. Center of Infection Control, Taichung Veterans General Hospital, Taichung, Taiwan;6. Center of Infection Control, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan;7. Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan;8. Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan;9. Division of Infectious Disease, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan;11. Department of Internal Medicine, Chi Mei Hospital, Liouying, Taiwan;12. Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan;13. Center of Infection Control, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan;14. Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan;15. School of Medicine, Graduate Institute of Medicine, Sepsis Research Centre, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan;p. Center for Disease Control, Ministry of Health and Welfare, Taiwan;q. Department of Internal Medicine, St. Joseph''s Hospital, Yunlin County, Taiwan;r. MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan;s. Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan;t. Department of Microbiology and Immunology, School of Medicine, China Medical University, Taichung, Taiwan;u. Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan;v. Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan |
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| Abstract: | Background/purposeThis study investigated the impact of implementing ventilator-associated pneumonia (VAP) bundle care on the rates of VAP in intensive care units (ICUs) in Taiwan.MethodsA total of 10 ICUs (bed number, 170), including surgical (SICUs) (n = 7), cardiovascular/surgical (CV/S-ICUs) (n = 1), and medical ICUs (MICUs) (n = 2) from 10 hospitals (7 medical center hospitals and 3 regional hospitals) were enrolled in this quality-improvement project. This study was divided into the pre-intervention phase (1st January, 2012–31st July, 2013) and the intervention phase (1st August, 2013–31st October, 2014).ResultsAmong the 10 hospitals, the overall rates (cases per 1000 ventilator-days) of VAP declined significantly (p = 0.005; rate ratio, 0.71) from 1.9 in the pre-intervention period to 1.5 in the intervention period. Significant difference in VAP rates between these periods was found in the regional hospitals (from 1.6 to 0.7; p < 0.001) and the SICUs (from 2.1 to 1.4; p < 0.001), but not in the medical centers (2.0 vs. 1.9; p = 0.0667) or CV/S-ICUs (4.5 vs. 4.5; p = 0.5391). However, VAP rate increased significantly (cases per 1000 ventilator-days) in the MICUs between the two periods (from 0.5 to 1.0; p = 0.0489). For the VAP bundle care elements, the overall compliance rate was 87.7% with 83.6% and 97.9% in the medical centers and regional hospitals, respectively.ConclusionsImplementing VAP bundle care has effectively reduced VAP in Taiwanese ICUs, but differences in performance and compliance rates of VAP bundle care among the different ICUs and hospital categories did exist. |
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| Keywords: | for the Infection Control Society of Taiwan Ventilator-associated pneumonia Bundle care Infection rate Taiwan |
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