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Observational Study
. 2021 Jun;41(6):1467-1473.
doi: 10.1038/s41372-021-01086-7. Epub 2021 May 25.

Preventive bundle approach decreases the incidence of ventilator-associated pneumonia in newborn infants

Alejandro Pinilla-González  1 , Álvaro Solaz-García  1 , Anna Parra-Llorca  1 , Inmaculada Lara-Cantón  1 , Ana Gimeno  1   2 , Isabel Izquierdo  1   2 , Máximo Vento  3   4 , María Cernada  5   6
Affiliations
Observational Study

Preventive bundle approach decreases the incidence of ventilator-associated pneumonia in newborn infants

Alejandro Pinilla-González et al. J Perinatol. 2021 Jun.

Abstract

Objective: We hypothesized that the implementation of evidence-based interventions shaping a bundle approach could significantly reduce the incidence of ventilator-associated pneumonia (VAP) in the neonatal intensive care unit.

Study design: We conducted a prospective observational cohort study including neonates undergoing mechanical ventilation >48 h. VAP rate and endotracheal intubation ratio were compared before (pre-period) and after (post-period) applying VAP prevention bundle strategies.

Result: One hundred seventy-four neonates were included in pre-period (30 months) and 106 in post-period (17 months). Demographic characteristics were comparable and device use ratios were similar. Twenty-eight VAP episodes were diagnosed, 25 in the first period and 3 after the implementation of prevention bundle. This represents a reduction in the incidence rate from 11.79 to 1.93 episodes/1000 ventilator days (p < 0.01).

Conclusion: The implementation of an educational evidence-based program using a bundle approach to prevent VAP has shown a statistically significant reduction in its incidence density.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Flow chart shows the intervention across time.
Pre-period consisted in an observational period from January 2016 to June 2018. Post-period, after the bundle application, from July 2018 to December 2019. Educational intervention was performed in a wash-out period of 1 month in July 2018.
Fig. 2
Fig. 2. Ventilator-associated pneumonia (VAP rates) (episodes per 1000 ventilator days) and endotracheal tube (ETT) use ratio in %.
The vertical line separates the pre- and post-bundle approach application.
Fig. 3
Fig. 3. Freedom from VAP in pre-intervention period (n = 175 patients) compared to the post-intervention period (n = 106 patients).
MV hours indicates time expressed in hours in which patients were exposed to MV. NNT number needed to treat.
See this image and copyright information in PMC

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