Objectives To evaluate the effectiveness of a modified bundle of preventative measures to decrease ventilator-associated pneumonia (VAP) in chronically ventilated long-term care facility (LTCF) residents. Design Cohort before-and-after study. Setting Geriatric hospital ward. Participants LTCF residents on long-term ventilation. Intervention The modified bundle included hand hygiene before patient care, elevation of the head of the bed to more than 30° for individuals who are supine, chlorhexidine oral care at the beginning of each nursing shift, keeping tracheostomy cannula balloon pressure at 20 to 30 cm H2O, and measuring nasogastric food remnants before every meal for individuals fed through a nasogastric tube. Measurements Number of VAP episodes was determined prospectively, and rates were calculated as episodes per 1,000 ventilation days. Results VAP rate decreased from 5.97 before the intervention to 2.34 after the intervention (P <.001). The use of broad-spectrum antibiotics decreased from 1,788 defined daily doses before the intervention to 1,093 after (P =.04). Conclusion A modified bundle successfully decreased VAP rates in chronically ventilated elderly LTCF residents.
- long-term care facility
- long-term ventilation
- ventilation-associated pneumonia