Using a bundle approach to improve ventilator care processes and reduce ventilator-associated pneumonia

Jt Comm J Qual Patient Saf. 2005 May;31(5):243-8. doi: 10.1016/s1553-7250(05)31031-2.


Background: A "bundle" of ventilator care processes (peptic ulcer disease prophylaxis, deep vein thrombosis prophylaxis, elevation of the head of the bed, and a sedation vacation), which may also reduce ventilator-associated pneumonia (VAP) rates, can serve as a focus for improvement strategies in intensive care units (ICUs). Between July 2002 and January 2004, teams of critical care clinicians from 61 health care organizations participated in a collaborative on improving care in the ICU.

Methods: ICU team members posted data monthly on a Web-based extranet and submitted narrative descriptions describing the changes tested and the strategies implemented.

Results: For the 35 units that consistently collected data on ventilator bundle element adherence and VAP rates, an average 44.5% reduction of VAP was observed.

Discussion: The goal-oriented nature of the bundle appears to demand development of the teamwork necessary to improve reliability. The observations seem sufficiently robust to support implementing the ventilator bundles to provide a focus for additional change in ICUs.

MeSH terms

  • Canada / epidemiology
  • Data Collection
  • Evidence-Based Medicine
  • Health Services Research
  • Humans
  • Intensive Care Units / organization & administration
  • Joint Commission on Accreditation of Healthcare Organizations
  • Pneumonia / epidemiology
  • Pneumonia / etiology
  • Pneumonia / prevention & control*
  • Respiration, Artificial / adverse effects
  • Respiration, Artificial / methods*
  • Respiration, Artificial / standards
  • United States / epidemiology