Root cause analysis of ventilator-associated pneumonia andthe effect of analysis of expanded ventilator bundle of care

ObjectivesThe study had the following aims: (i) assess the risk factors and causes of ventilator-associated pneumonia (VAP) by means of the root cause analysis (RCA) module; (ii) compare the compliance with expanded ventilator bundle (EVB) and the effect of EVB on VAP rate, length of ICU stay (LOS), and mortality rate before and after bundle implementation; and (iii) suggest an action plan to reduce VAP.Patients and methodsAn 18-month study was conducted on all ventilated patients in our ICU. The preinterventional period was 9 months before implementing the bundle. We analyzed the causes and risk factors of VAP by using the RCA module. The postinterventional period was 9 months after implementing the bundle. Compliance with EVB was compared before and after implementing the bundle on a quarterly basis. We analyzed the effect of the bundle on VAP rate, LOS, and mortality rate. We suggested an action plan to reduce the VAP rate.ResultsThere was lower compliance with the bundle in the preinterventional period than in the postinterventional period (P 0.001). There were highly statistically significant reductions in VAP rate, LOS, and mortality rate after implementation of EVB (P 0.001).ConclusionEVB was associated with effective and significant reductions in VAP rate, LOS, and mortality rate. Implementation of the RCA module was helpful in suggesting a new action plan thatwould improve bundle of care and its compliance.