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Implementation and evaluation of the impact of a "ventilator-bundle" at Kinshasa University Clinics: Before and after study

Mavinga NJ, Nsiala MJ, Mafuta ME, Yanga MY, Amisi BE, Ilunga JP, Kilembe MA

Objective: To set up a program of VAP prevention (ventilator-bundle) then to evaluate its impact on morbidity and mortality of the patients under mechanical ventilation in our service. Patient and Methods: Prospective, mono-centric, quasi-experimental study, before-after type; performed in the intensive care unit of University Clinics of Kinshasa in the Democratic Republic of Congo. The study was conducted in two phases, from February 1st, 2014 to February 15th, 2016. All consecutive patients intubated and mechanically ventilated for more than 48 hours were included. Five preventive measures were implemented. In patients suspected of having VAP (CPIS>6), the diagnosis was made when isolating a pathogen at ≥ 104 CFU/mL in the tracheobronchial aspiration culture. The main outcome measures were the incidence of VAP and the mortality rate. Results: We included 44 patients in phase 1 and 58 patients in phase 2. The basic characteristics of patients were similar in both groups. Compliance with all the measures put in place was improved between the two phases from 0 to 32.75%. The incidence density decreased from 33.74 to 18.05 VAP for 1000 day ventilator, but the mortality was similar in both groups (88.6% vs. 86.0%). Conclusion: The implementation of a "ventilator bundle" has significantly reduced the impact of VAP in our service. However, our study failed to show a decline in mortality.