Ventilator-Associated Pneumonia

Ventilator-associated pneumonia (VAP) in a critically ill patient significantly increases risk of mortality and, at a minimum, increases ventilator time, length of stay, and cost of care. It is a complex condition not only to diagnose but also to treat, thus prevention is extremely important.

Many hospitals have achieved significant reductions in VAP rates in their critical care units, some even reaching zero by taking a comprehensive and multidisciplinary approach to ventilator care. The IHI Ventilator Bundle — a grouping of best practices that, when applied together, may result in substantially greater improvement — has been implemented in many ICUs, along with teamwork and communication strategies such as structured multidisciplinary rounds and daily goal setting, to wean and remove patients from ventilators as quickly as possible, while providing evidence-based care.

How-to Guide: Multidisciplinary Rounds
This guide describes the key components of multidisciplinary rounds, potential impact on outcomes, examples of success, and tips for successful implementation.
How-to Guide: Prevent Ventilator-Associated Pneumonia
This How-to Guide describes key evidence-based care components of the IHI Ventilator Bundle which has been linked to prevention of ventilator-associated pneumonia.
Implement Daily Goals Assessment
Daily goals assessment allows teams to keep track of plans established either on patient care rounds and/or multidisciplinary rounds and to verify their completion.

Getting Started: How to Improve

Learn about the Model for Improvement, forming the improvement team, setting aims, establishing measures, and selecting and testing changes. Go to How to Improve.

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Ventilator Bundle Compliance

Compliance with the Ventilator Bundle is defined as the percentage of intensive care patients on mechanical ventilation for whom all four of the elements of the Ventilator Bundle are documented on daily goals sheets and/or elsewhere in the medical record.
Ventilator-Associated Pneumonia (VAP) Rate per 1,000 Ventilator Days

Ventilator-associated pneumonia (VAP) is defined as pneumonia in a patient intubated and ventilated at the time of or within 48 hours before the onset of the event. (There is no minimum period of time that the ventilator must be in place in order for the pneumonia to be considered ventilator-associated.) The VAP rate is defined as the number of ventilator-associated pneumonias per 1,000 ventilator days

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Sedation Interruption Protocol

This nurse-driven algorithm provides inclusion and exclusion criteria for implementing appropriate daily sedation interruption for patients on continuous sedation.
Medical-Surgical Intensive Care Unit Daily Sedation Vacation Protocol

This protocol is used by staff in medical-surgical intensive care units to remove patients from continuous IV drip sedation as soon as is medically feasible
How-to Guide: Prevent Ventilator-Associated Pneumonia

This How-to Guide describes key evidence-based care components of the IHI Ventilator Bundle which has been linked to prevention of ventilator-associated pneumonia.
Ventilator Bundle Checklist

This checklist helps track compliance with implementing each element of the IHI Ventilator Bundle.
Mechanical Ventilation Liberation Protocol

This Respiratory Therapist-driven protocol provides assessment criteria for readiness to implement a Spontaneous Breathing Trial.

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Understanding Bundles: An IHI Faculty Conversation

IHI faculty for the Rethinking Critical Care seminar discuss and try to clarify some important and often misunderstood points about implementing care bundles (such as the Ventilator Bundle and the Central Line Bundle).
Effect of Nonpayment for Preventable Infections in US Hospitals

This study examined rates of healthcare-associated infections deemed preventable by the Centers for Medicare & Medicaid Services, such as catheter-associated bloodstream infections, catheter-associated urinary tract infections, and ventilator-associated pneumonias.
Profiles in Improvement: Katharine Luther, Vice President, IHI

IHI Vice President Kathy Luther describes her career in health care quality improvement, and how her current IHI work includes getting finance and clinicians to work together to impact cost and quality.
Using Care Bundles to Improve Health Care Quality

This IHI white paper describes the history, theory of change, design concepts, and outcomes associated with the development and use of bundles — a small set of evidence-based interventions for a defined patient population and care setting — and reflects on learning over the past decade.
A Team Gives Mobility to Ventilated Patients

Patients in critical care are usually kept immobile and heavily sedated, but there’s growing evidence that mobility can help a patient's long-term recovery.

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