IMPLEMENTASI VENTILATOR BUNDLE DAN RISIKO KEJADIAN INFEKSI NOSOKOMIAL PNEUMONIA DI RUANG PERAWATAN INTENSIF RUMAH SAKIT SURAKARTA

COMPLIANCE VENTILATOR BUNDLE AND RISK EVENTS NOSOCOMIAL PNEUMONIA IN INTENSIVE CARE UNIT OF SURAKARTA HOSPITAL

Abstract

Background: Ventilator-associated pneumonia (VAP) in
ventilator assisted breathing patients is one of the main
concerns in intensive care unit (ICU) because of its relation with
high incidence and mortality rate. National infection surveillance
in France found 12.4% of intubated patients during go infected
with VAP, with mortality rate of 40-50%. Pneumonia could be
prevented by implementing the right precaution, investigations
show that with good management, VAP could be reduced until
70%.

Methods: Quantitative study using observational analysis with
cohort design. Data collected by observing compliance of
ventilator-bundle in adult ICU with checklist. Implementation of
ventilator-bundle could be observed directly and by checking
patient's hemodynamic record. Ventilator-bundle consist of
hand hygiene, oral care with antiseptic, patient's body position
at ≥30° angle, sedation vacation, and weaning assessment,
peptic ulcer prophylaxis, and prevention of deep vein
thrombosis (DVT). This study use CPIS (clinical pulmonary
infection score) to diagnose pneumonia.

Results: Ventilator-bundle compliance rate are recorded on
82.9% and VAP on 11.1%, or 26.7 per 1000 ventilator days.
Compliance with the ventilator bundle has no relationship with
the incidence of VAP. By using the odds ratio of noncompliance
with peptic ulcer prophylaxis has 8,5x risk of VAP (95% CI: 1.164
to 62.094). This study proves the existence of the patients'
factors associated with VAP which are duration of ventilation
and incidence of spontaneous ETT pulling. Installation of
ventilator for more than 5 days has 36 times greater risk of VAP
(95% CI: 3.193 to 405.897). Spontaneous ETT pulling has 26
times greater risk of VAP (95% CI: 1.796 to 376.303).

between ventilatorbundle compliance with VAP incidence. This
result caused by the limited subjects involves. Sample size of
the study was limited because of the short duration of the study.