Effects of the Use of Care Bundles in Preventing Ventilator-Associated Pneumonia: An Integrative Literature Review

Authors

DOI:

https://doi.org/10.15649/cuidarte.1110

Keywords:

Patient Care Bundles, Pneumonia, Ventilator-Associated, Patient Safety, Intensive Care Units

Abstract

Introduction: The ventilator-associated pneumonia is an infection related to health care that predominates in intensive care units and compromises patient safety. Objective: To identify the effects of care bundles in preventing ventilator-associated pneumonia in the Intensive Care Unit (ICU). Materials and Methods: An integrative literature review was conducted based on the studies available in the online databases Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Latin American and Caribbean Health Sciences Literature, Medical Literature Analysis and Retrieval System Online, Scientific Electronic Library Online and Scopus. Articles were selected from these databases between June 2 and July 18, 2018 in English and Portuguese without any publication time limit using DeCS and MeSh descriptors. Two independent researchers carried out the article selection process, from which information related to publication year, country of origin, objective(s), degree of scientific recommendation and type of study, intervention, compliance with the use of care bundles, main results and conclusions was collected. Results: A total of 13 out of 20 publications analyzed were from different countries and in most studies (n=18) the use of care bundles was found to significantly reduce the incidence of ventilator-associated pneumonia, resulting in a reduction in mortality, length of hospital stay and costs. The main components chosen to put together care bundles included head of bed elevation and oral care. Conclusion: Although studies with a higher degree of recommendation are possible, data from several countries suggest that the use of care bundles had a positive effect on ventilator-associated pneumonia, as well as on improving institutional performance by reducing health care costs.

How to cite this article: Maran, Edilaine; Spigolon, Dandara Novakowski;, Matsuda, Laura Misue;  Teston, Elen Ferraz; Oliveira, João Lucas Campos de;  Souza, Verusca Soares de;  Marcon, Sonia Silva.   Efeitos da utilização do bundle na prevenção de pneumonia associada à ventilação mecânica: revisão integrativa Revista Cuidarte. 2021;12(1):e1110. http://dx.doi.org/10.15649/cuidarte.1110    

Author Biographies

Edilaine Maran, Universidade Estadual do Paraná - Paranavaí (PR), Brasil.

Universidade Estadual do Paraná - Paranavaí (PR), Brasil.

Dandara Novakowski Spigolon, Universidade Estadual do Paraná - Paranavaí (PR), Brasil

Universidade Estadual do Paraná - Paranavaí (PR), Brasil

Laura Misue Matsuda, Universidade Estadual de Maringá – Maringá (PR), Brasil

Universidade Estadual de Maringá – Maringá (PR), Brasil

Elen Ferraz Teston, Universidade Federal de Mato Grosso do Sul – Campo Grande (MS), Brasil

Universidade Federal de Mato Grosso do Sul – Campo Grande (MS), Brasil

João Lucas Campos de Oliveira, Universidade Federal do Rio Grande do Sul – Porto Alegre (RS), Brasil

Universidade Federal do Rio Grande do Sul – Porto Alegre (RS), Brasil

Verusca Soares de Souza, Universidade Federal de Mato Grosso do Sul – Coxim (MS), Brasil

Universidade Federal de Mato Grosso do Sul – Coxim (MS), Brasil

Sonia Silva Marcon, Universidade Estadual de Maringá - Maringá (PR), Brasil

Universidade Estadual de Maringá - Maringá (PR), Brasil

References

American Thoracic Society /Infections Diseases Society Of America (ATS /IDSA). Guidelines for the management of adults with hospitalacquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171(4):388-416. https://doi.org/10.1164/rccm.200405-644ST

Kollef MH, Chastre J, Fagon JY, François BMD, Niederman MS, et al. Global prospective epidemiologic and surveillance study of ventilator-associated pneumonia due to Pseudomonas aeruginosa. Crit Care Med. 2014;42(10):2178-87. https://doi.org/10.1097/CCM.0000000000000510

Brasil. Agência Nacional de Vigilância Sanitária. Medidas de Prevenção de Infecção Relacionada à Assistência à Saúde. – Brasília: Anvisa, 2017.

Mitharwal SM, Yaddanapudi S, Bhardwaj N, Gautam V, Biswal M, Yaddanapudi L. Intensive care unitacquired infections in a tertiary care hospital: An epidemiologic survey and influence on patient outcomes. Am J Infect Control. 2016;44(7):e113‐e7. https://doi.org/10.1016/j.ajic.2016.01.021

Rahmqvist M, Samuelsson A, Bastami S, Rutberg H. Direct health care costs and length of hospital stay related to health care-acquired infections in adult patients based on point prevalence measurements. Am J Infect Control. 2016;44:500-6. https://doi.org/10.1016/j.ajic.2016.01.035

Ego A, Preiser JC, Vincent JL. Impact of diagnostic criteria on the incidence of ventilator associated pneumonia. Chest. 2015;147(2):347-55. https://doi.org/10.1378/chest.14-0610

Cardoso VB. Entendimento dos enfermeiros intensivistas sobre as formas de prevenção de pneumonia associada à ventilação mecânica invasiva: uma revisão da literatura. Revista Atualiza Saúde [Internet]. 2015[acesso em 2018 Jun 27];1(1):25-34. Disponível em: http://atualizarevista.com.br/wp-content/uploads/2015/01/ENTENDIMENTO-DOS-ENFERMEIROS-INTENSIVISTAS-SOBRE-AS-FORMAS-DE-PREVEN%C3%87%C3%83O-DE-PNEUMONIA-ASSOCIADA-A-VENTILA%C3%87%C3%83O-MECANICA-INVASIVA-UMA-REVISAO-DA-LITERATURA-revista-atualiza-saude-v1-n1.pdf

Centers For Disease Control and Prevention – CDC. Guidelines for preventing healthcare- associated pneumonia 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee- MMWR. [Internet] 2004; [cited 2018 Jun 12]; 53(RR-3): [aprox. 36 telas]. Available from: https://www.cdc.gov/hicpac/pdf/ guidelines/HApneu2003guidelines.pdf

Nascimento TBP, Ramos CH, Silva TS, Torres, VPS. Efetividade das medidas de prevenção e controle de pneumonia associada à ventilação mecânica na UTI. Perspectivas Online Biológicas e Saúde. 2017;7(25):1-24. https://doi.org/10.25242/886872520171136

Dixon-Woods M, Pronovost PJ. Patient safety and the problem of many hands. BMJ Qual Saf. 2016;25(7):485-8. https://doi.org/10.1136/bmjqs-2016-005232

Araújo MAN, Lunardi Filho WD, Silveira RS, Souza JC, Barlem ELD, Teixeira NS. Segurança do paciente na visão de enfermeiros: uma questão multiprofissional. Enferm. Foco. 2017;8(1):52-6. https://doi.org/10.21675/2357-707X.2017.v8.n1.984

Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med. 2009; 6(7): e1000097. https://doi.org/10.1371/journal.pmed.1000097.t001

Galvão TF, Pansani TDSA, Harrad D. Principais itens para relatar revisões sistemáticas e meta-análises: a recomendação PRISMA. Serv. Saúde. 2015;24(2):335-42. https://doi.org/10.5123/S1679-49742015000200017

Whittemore R, Knafl K. The integrative review: updated methodology. J Adv Nurs. 2005;52(5):546-53. https://doi.org/10.1111/j.1365-2648.2005.03621.x

Santos CMDC, Pimenta CADM, Nobre MRC. The PICO strategy for the research question construction and evidence search. Rev. Latino-Am. Enfermagem. 2007;15(3):508-11. https://doi.org/10.1590/S0104-11692007000300023

Oxford Centre for Evidence-based Medicine – Levels of Evidence [Internet] March 2009 [cited 2018 Jul 18] Available from: https://www.cebm.net/2009/06/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/

Ding S, Kilickaya O, Senkal S, Gajic O, Hubmayr RD, Li G. Temporal Trends of Ventilator-Associated Pneumonia Incidence and the Effect of Implementing Health-care Bundles in a Suburban Community. Chest. 2013;144(5):1461-8. https://doi.org/10.1378/chest.12-1675

Eom JS, Lee MS, Chun HK, Choi HJ, Jung SY, Kim YS, et al. The impact of a ventilator bundle on preventing ventilator-associated pneumonia: A multicenter study. Am J Infect Control. 2014;42(1):34-7. https://doi.org/10.1016/j.ajic.2013.06.023

Tao L, Hu B, Rosenthal VD, Zhang Y, Gao X, He L. Impact of a multidimensional approach on ventilator-associated pneumonia rates in a hospital of Shanghai: Findings of the International Nosocomial Infection Control Consortium. J Crit Care. 2012;27(5):440-6. https://doi.org/10.1016/j.jcrc.2011.12.018

Guanche-Garcell H, Morales-Pérez C, Rosenthal VD. Effectiveness of a multidimensional approach for the prevention of ventilator-associated pneumonia in an adult intensive care unit in Cuba: findings of the International Nosocomial Infection Control Consortium (INICC). J Infect Public Health. 2013;6(2):98-107. https://doi.org/10.1016/j.jiph.2012.11.009

Perugini MRE, Perugini VH, Figueira FD, Fontana LMS, Diniz JJ, Santos DL, et al. Impacto de um bundle nas taxas de pneumonia associada à ventilação mecânica (PAV) em uma unidade de terapia intensiva pediátrica em Londrina-PR. Semina: Ciênc. Biol. Saúde. 2015;36(1)supl:259-66. http://dx.doi.org/10.5433/1679-0367.2015v36n1Suplp259

Rodrigues AN, Fragoso LVC, Beserra FM, Ramos IC. Determining impacts and factors in ventilator-associated pneumonia bundle. Rev Bras Enferm. 2016;69(6):1045-51. https://doi.org/10.1590/0034-7167-2016-0253

DeLuca LA Jr, Walsh P, Davidson DD Jr, Stoneking LR, Yang LM, Grall KJ, et al. Impact and feasibility of an emergency department-based ventilator-associated pneumonia bundle for patients intubated in an academic emergency department. Am J Infect Control. 2017;45(2):151-7. https://doi.org/10.1016/j.ajic.2016.05.037

Álvarez-Lerma F, Palomar-Martínez M, Sánchez-García M, Martínez-Alonso M, Álvarez-Rodríguez J, Lorente L, et al. Prevention of Ventilator-Associated Pneumonia: The Multimodal Approach of the Spanish ICU "Pneumonia Zero" Program. Crit Care Med. 2018;46(2):181-8. https://doi.org/10.1097/CCM.0000000000002736

Alcan AO, Korkmaz FD, Uyar M. Prevention of ventilator-associated pneumonia: Use of the care bundle approach. Am J Infect Control. 2016;44(10):e173-6. https://doi.org/10.1016/j.ajic.2016.04.237

Lim KP, Kuo SW, Ko WJ, Sheng WH, Chang YY, Hong MC, et al. Efficacy of ventilator-associated pneumonia care bundle for prevention of ventilator-associated pneumonia in the surgical intensive care units of a medical center. J Microbiol Immunol Infect. 2015 48(3):316-21. https://doi.org/10.1016/j.jmii.2013.09.007

Parisi M, Gerovasili V, Dimopoulos S, Kampisiouli E, Goga C, Perivolioti E, et al. Use of Ventilator Bundle and Staff Education to Decrease Ventilator-Associated Pneumonia in Intensive Care Patients. Crit Care Nurse. 2016;36(5):e1-e7. https://doi.org/10.4037/ccn2016520

Righi E, Aggazzotti G, Ferrari E, Giovanardi C, Busani S, Rinaldi L, et al. Trends in ventilator-associated pneumonia: impact of a ventilator care bundle in an Italian tertiary care hospital intensive care unit. Am J Infect Control. 2014;42(12):1312-6. https://doi.org/10.1016/j.ajic.2014.08.009

Peña-López Y, Pujol M, Campins M, González-Antelo A, Rodrigo JÁ, Balcells J, et al. Implementing a care bundle approach reduces ventilator-associated pneumonia and delays ventilator-associated tracheobronchitis in children: differences according to endotracheal or tracheostomy devices. Int J Infect Dis. 2016;52:43-48. https://doi.org/10.1016/j.ijid.2016.09.021

Al-Thaqafy MS, El-Saed A, Arabi YM, Balkhy HH. Association of compliance of ventilator bundle with incidence of ventilator-associated pneumonia and ventilator utilization among critical patients over 4 years. Ann Thorac Med. 2014;9(4):221-6. https://doi.org/10.4103/1817-1737.140132

Samra SR, Sherif DM, Elokda SA. Impact of VAP bundle adherence among ventilated critically ill patients and its effectiveness in adult ICU. Egypt J Chest Dis Tuberc. 2017;66(1):81-6. http://dx.doi.org/10.1016/j.ejcdt.2016.08.010

Ferreira CR, de Souza DF, Cunha TM, Tavares M, Reis SS, Pedroso RS, et al. The effectiveness of a bundle in the prevention of ventilator-associated pneumonia. Braz J Infect Dis. 2016;20(3):267-71. http://dx.doi.org/10.1016/j.bjid.2016.03.004

Sedwick MB, Lance-Smith M, Reeder SJ, Nardi J. Using evidence-based practice to prevent ventilator-associated pneumonia. Crit Care Nurse. 2012;32(4):41-51. https://doi.org/10.4037/ccn2012964

Bird D, Zambuto A, O'Donnell C, Silva J, Korn C, Burke R, et al. Adherence to ventilator-associated pneumonia bundle and incidence of ventilator-associated pneumonia in the surgical intensive care unit. Arch Surg. 2010;145(5):465-70. https://doi.org/10.1001/archsurg.2010.69

Azab SF, Sherbiny HS, Saleh SH, Elsaeed WF, Elshafiey MM, Siam AG, et al. Reducing ventilator-associated pneumonia in neonatal intensive care unit using "VAP prevention Bundle": a cohort study. BMC Infect Dis. 2015;15:314-20. https://doi.org/10.1186/s12879-015-1062-1

Morris AC, Hay AW, Swann DG, Everingham K, McCulloch C, McNulty J, et al. Reducing ventilator-associated pneumonia in intensive care: impact of implementing a care bundle. Crit Care Med. 2011;39(10):2218-24. https://doi.org/10.1097/CCM.0b013e3182227d52

Chicayban LM, Terra ELVS, Ribela JS, & Barbosa PF. Bundles de prevenção de pneumonia associada à ventilação mecânica: a importância da multidisciplinaridade. Biológicas & Saúde. 2017;7(25):25-35. https://doi.org/10.25242/886872520171200

Institute for Healthcare Improvement (IHI) - 100,000 Lives Campaign- How-to Guide: Prevent Ventilator-Associated Pneumonia. Cambridge, MA: Institute for Healthcare Improvement; 2012. https://www.chpso.org/sites/main/files/file-attachments/ihi_howtoguidepreventvap.pdf

Klomplas M, Branson R, Eichenwald EC, Greene LR, Howell MD, Lee G, et al. Strategies to Prevent Ventilator- Associated Pneumonia in Acute Care Hospitals: 2014 Update. Infection Control and Hospital Epidemiology 2014;35(S2):S133-54. https://doi.org/10.1017/S0899823X00193894

Tereza DM, Santos MM; Fortunato MM. Relevância da equipe de enfermagem relacionada ao bundle de prevenção de pneumonia associada à ventilação mecânica. Nursing (São Paulo) [Internet] 2017 [acesso em 2018 Jul 18]; 20(232):1816-20. Disponível em: http://bases.bireme.br/cgi-bin/wxislind.exe/iah/online/?IsisScript=iah/iah.xis&src=google&base=BDENF&lang=p&nextAction=lnk&exprSearch=31485&indexSearch=ID

Nam-Ju Lee, Haena Jang, Su-Yeon Park. Patient safety education and baccalaureate nursing students’ patient safety competency: A cross-sectional study. Nurs. health sci. 2016;18:163-71. https://doi.org/10.1111/nhs.12237

Melleiro MM, Tronchin DMR, Lima MOP, Garzin ACA, Martins MS, Cavalcante MBG, et al. Temática segurança do paciente nas matrizes curriculares de escolas de graduação em enfermagem e obstetrícia. Rev. baiana enferm. 2017;31(2):e16814-21. http://dx.doi.org/10.18471/rbe.v31i2.16814

Maran E, Spigolon DN, Melo WA, Barreto MS, Tostes MFP, Teston EF. Prevenção da pneumonia associada à ventilação mecânica sob a ótica de acadêmicos de enfermagem. Rev Fun Care Online. 2019;11(1):118-123. http://dx.doi.org/10.9789/2175-5361.2019.v11i1.118-123

Published

2020-11-13

How to Cite

1.
Maran E, Spigolon DN, Matsuda LM, Teston EF, Oliveira JLC de, Souza VS de, et al. Effects of the Use of Care Bundles in Preventing Ventilator-Associated Pneumonia: An Integrative Literature Review. Revista Cuidarte [Internet]. 2020 Nov. 13 [cited 2024 Jul. 22];12(1). Available from: https://revistas.udes.edu.co/cuidarte/article/view/1110

Altmetrics

Downloads

Download data is not yet available.

Most read articles by the same author(s)