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  • Quality Improvement Article
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Preventive bundle approach decreases the incidence of ventilator-associated pneumonia in newborn infants

Journal of Perinatology volume 41, pages 1467–1473 (2021)Cite this article

Subjects

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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Fig. 1: Flow chart shows the intervention across time.
Fig. 2: Ventilator-associated pneumonia (VAP rates) (episodes per 1000 ventilator days) and endotracheal tube (ETT) use ratio in %.
Fig. 3: Freedom from VAP in pre-intervention period (n = 175 patients) compared to the post-intervention period (n = 106 patients).

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Acknowledgements

We would like to thank all the doctors and nurses of the staff for their effort and enthusiasm implementing the bundle in our NICU.

Funding

AP-G and IL-C are both research fellows granted by the Instituto de Investigación Sanitaria La Fe; AP-L acknowledges a Rio Hortega predoctoral grant (CM18/00165) from the Instituto de Salud Carlos III (Ministry of Science and Innovation, Spain); MV and AS-G pertain to the RETICS funded by the PN 2018-2021 (Spain), ISCIII—Sub-Directorate General for Research Assessment and Promotion and the European Regional Development Fund (FEDER), reference RD16/0022.

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Authors and Affiliations

  1. Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain

    Alejandro Pinilla-González, Álvaro Solaz-García, Anna Parra-Llorca, Inmaculada Lara-Cantón, Ana Gimeno, Isabel Izquierdo, Máximo Vento & María Cernada

  2. Division of Neonatology, University and Polytechnic Hospital La Fe, Valencia, Spain

    Ana Gimeno, Isabel Izquierdo, Máximo Vento & María Cernada

Authors
  1. Alejandro Pinilla-González
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  2. Álvaro Solaz-García
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  3. Anna Parra-Llorca
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  4. Inmaculada Lara-Cantón
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  5. Ana Gimeno
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  6. Isabel Izquierdo
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  7. Máximo Vento
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  8. María Cernada
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Contributions

AP-G, MC, IL-C, and AP-L designed the data collection instruments, recruited the patients, collected data, and reviewed and revised the manuscript. AP-G, AS-G, and MC carried out the analyses, and reviewed and revised the manuscript. MC, AG, II, and MV conceptualized and designed the study, coordinated and supervised data collection, and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding authors

Correspondence to Máximo Vento or María Cernada.

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The authors declare no competing interests.

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Pinilla-González, A., Solaz-García, Á., Parra-Llorca, A. et al. Preventive bundle approach decreases the incidence of ventilator-associated pneumonia in newborn infants. J Perinatol 41, 1467–1473 (2021). https://doi.org/10.1038/s41372-021-01086-7

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