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“Bundle” Practices and Ventilator-Associated Events: Not Enough

Published online by Cambridge University Press:  19 September 2016

John C. O’Horo ,
Haitao Lan ,
Charat Thongprayoon ,
Louis Schenck ,
Adil Ahmed ,
Mikhail Dziadzko ,
Ognjen Gajic  and
Priya Sampathkumar
John C. O’Horo*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States Multidisciplinary Epidemiology and Translational Research in Intensive Care, Emergency and Perioperative Medicine (METRIC-EPM) Group, Mayo Clinic, Rochester, Minnesota, United States
Haitao Lan
Affiliation:
Multidisciplinary Epidemiology and Translational Research in Intensive Care, Emergency and Perioperative Medicine (METRIC-EPM) Group, Mayo Clinic, Rochester, Minnesota, United States Guang’anmen Hospital, China Academy of Chinese Medicine Sciences, Beijing, China
Charat Thongprayoon
Affiliation:
Multidisciplinary Epidemiology and Translational Research in Intensive Care, Emergency and Perioperative Medicine (METRIC-EPM) Group, Mayo Clinic, Rochester, Minnesota, United States
Louis Schenck
Affiliation:
Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, United States
Adil Ahmed
Affiliation:
North Central Texas Medical Foundation, Wichita Falls Family Practice Residency Program, Wichita Falls, Texas, United States
Mikhail Dziadzko
Affiliation:
Division of Critical Care, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, United States
Ognjen Gajic
Affiliation:
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States
Priya Sampathkumar
Affiliation:
Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States
*
Address correspondence to John C. O’Horo, MD, MPH, Assistant Professor of Medicine, Division of Infectious Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 ([email protected]).
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Abstract

OBJECTIVE

Ventilator-associated events (VAEs) are nosocomial events correlated with length of stay, costs, and mortality. Current ventilator bundle practices target the older definition of ventilator-associated pneumonia and have not been systematically evaluated for their impact on VAEs.

DESIGN

Retrospective cohort study.

SETTING

Tertiary medical center between January 2012 and August 2014.

PARTICIPANTS

All adult patients ventilated for at least 24 hours at our institution.

INTERVENTIONS

We conducted univariate analyses for compliance with each element; we focused on VAEs occurring within a 2-day window of failure to meet any ventilator bundle element. We used Cox proportional hazard models to assess the effect of stress ulcer prophylaxis, deep vein thrombosis (DVT) prophylaxis, oral care, and sedation breaks on VAEs. We adjusted models for gender, age, and Acute Physiology and Chronic Health Evaluation (APACHE) III scores.

RESULTS

Our cohort comprised 2,660 patients with 16,858 ventilator days and 77 VAEs. Adjusting for APACHE score and gender, only oral care was associated with a reduction in the risk of VAE (hazard ratio [HR], 0.44; 95% confidence interval [CI], 0.26–0.77). The DVT prophylaxis and sedation breaks did not show any significant impact on VAEs. Stress ulcer prophylaxis trended toward an increased risk of VAE (HR, 1.59; 95% CI, 1.00–2.56).

CONCLUSION

Although limited by a low baseline rate of VAEs, existing ventilator bundle practices do not appear to target VAEs well. Oral care is clearly important, but the impact of DVT prophylaxis, sedation breaks, and especially stress ulcer prophylaxis are questionable at best.

Infect Control Hosp Epidemiol 2016;1453–1457

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 12 , December 2016 , pp. 1453 - 1457
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

a

Authors with equal contribution.

*

Authors’ names have been added since original publication. An erratum notice detailing this change was also published (DOI: 10.1017/ice.2017.132).

References

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