Ventilator Bundle Compliance and Risk of Ventilator-Associated Events

OBJECTIVE Ventilator bundles encompass practices that reduce the risk of ventilator complications, including ventilator-associated pneumonia. The impact of ventilator bundles on the risk of developing ventilator-associated events (VAEs) is unknown. We sought to determine whether decreased compliance to the ventilator bundle increases the risk for VAE development. DESIGN Nested case-control study. SETTING This study was conducted at 6 adult intensive care units at an academic tertiary-care center in Tennessee. PATIENTS In total, 273 patients with VAEs were randomly matched in a 1:4 ratio to controls by mechanical ventilation duration and ICU type. METHODS Controls were selected from the primary study population at risk for a VAE after being mechanically ventilated for the same number of days as a specified case. Using conditional logistic regression analysis, overall cumulative compliance, and compliance with individual components of the bundle in the 3 and 7 days prior to VAE development (or the control match day) were examined. RESULTS Overall bundle compliance at 3 days (odds ratio [OR], 1.15; P =.34) and 7 days prior to VAE diagnosis (OR, 0.96; P =.83) were not associated with VAE development. This finding did not change when limiting the outcome to infection-related ventilator-associated complications (IVACs) and after adjusting for age and gender. In the examination of compliance with specific bundle components increased compliance with chlorhexidine oral care was associated with increased risk of VAE development in all analyses. CONCLUSIONS Ventilator bundle compliance was not associated with a reduced risk for VAEs. Higher compliance with chlorhexidine oral care was associated with a greater risk for VAE development. Infect Control Hosp Epidemiol 2018;39:637–643