Research Article

Association between VAP Bundle Compliance and Ventilator-Associated Pneumonia Incidence: A Single-Center Retrospective Study in an Indonesian ICU

Abstract

Background: Ventilator-associated pneumonia (VAP) is a major source of morbidity and mortality in mechanically ventilated patients, with heterogeneous rates reported across Indonesian ICUs. Although evidence-based prevention bundles reduce VAP, real-world adherence is inconsistent. This study evaluated the association between VAP bundle compliance and VAP incidence among ICU patients at Wahidin Sudirohusodo Hospital in 2024.
Methods: We conducted a retrospective analytical study (January–December 2024) including adults ventilated ≥48 h with complete bundle documentation; patients with pre-existing pneumonia or incomplete records were excluded. VAP was defined by CDC criteria. Compliance with the five-element bundle (head-of-bed elevation, daily sedation interruption/readiness to extubate, stress-ulcer prophylaxis, DVT prophylaxis, and oral chlorhexidine) was recorded daily, calculated as a percentage, and categorized as 60% (3/5 elements), 80% (4/5), or 100% (5/5). Associations with VAP were analyzed statistically.
Results: Of the 385 patients who were on ventilators, 92 (23.9%) developed VAP. Of those, 52 (56.5%) died. The highest adherence was for head-of-bed elevation (91.5%), while the lowest was for DVT prevention (3.1%). In the VAP group (n=92), 65 subject manifested at 60% adherence (70.7%), 24 at 80% (26.1%), and 3 at 100% (3.3%). A higher level of adherence was significantly associated with a lower incidence of VAP (p = 0.001).
Conclusion: Higher adherence to the VAP preventive bundle is associated with a lower VAP rate. To increase bundle adherence and patient outcomes in ICU, targeted interventions are needed. These should include more staff training and regular audits, with an emphasis on DVT prevention and daily weaning.

 

[1] Marshall JC, Bosco L, Adhikari NK, Connolly B, Diaz J V, Dorman T, et al. What is an intensive care unit? A report of the task force of the World Federation of Societies of Intensive and Critical Care Medicine. J Crit Care. 2017;37:270–6.
[2] Tadesse EE, Tilahun AD, Yesuf NN, Nimani TD, Mekuria TA. Mortality and its associated factors among mechanically ventilated adult patients in the intensive care units of referral hospitals in Northwest Amhara, Ethiopia, 2023. Front Med (Lausanne). 2024;11.
[3] Núñez SA, Roveda G, Zárate MS, Emmerich M, Verón MT. Ventilator-associated pneumonia in patients on prolonged mechanical ventilation: Description, risk factors for mortality, and performance of the SOFA score. J Bras Pneumol. 2021;47(3).
[4] Howroyd F, Chacko C, MacDuff A, Gautam N, Pouchet B, Tunnicliffe B, et al. Ventilator-associated pneumonia: pathobiological heterogeneity and diagnostic challenges. Nat Commun. 2024;15(1):6447.
[5] Mastrogianni M, Katsoulas T, Galanis P, Korompeli A, Myrianthefs P. The Impact of Care Bundles on Ventilator-Associated Pneumonia (VAP) Prevention in Adult ICUs: A Systematic Review. Antibiotics (Basel). 2023;12(2):227.
[6] Singh C, Abdullah R. Impact of Ventilator-Associated Pneumonia Preventative Measures and Ventilator Bundle Care in a Tertiary Care Hospital’s Adult Intensive Care Unit. Cureus. 2024; 16(5).
[7] Wulan DR, Kusumajaya H, Meilando R. Faktor-Faktor yang Berhubungan Dengan Kejadian Ventilator Associated Pneumonia (VAP) Pada Pasien Kritis [Internet]. Vol. 1, Tahun. Bangka Belitung; 2024 [cited 2025 Jul 1]. Available from: https://jurnalaltranusamedika.com/index.php/jkai
[8] Jaya Cahyana Y, Baharuddin Pakki I, Ayu Indira Dwika Lestari I, Adrianto R. Analysis of factors related to the incidence of ventilator-associated pneumonia (vap) in the intensive care unit. Available from: https://doi.org/10.37287/ijghr.v7i5.6628.
[9] Damasnyah H, Yunus P, Monoarfa S, Taliki V. Pengaruh VAP Bundle Intervention Dalam Pencegahan VAP Pada Pasien Terpasang Ventilator Mekanik Di Ruangan ICU RSUD Prof. Dr. H. Aloei Saboe Kota Gorontalo. [Internet]. Jurnal Keperawatan Muhammadiyah. Gorontalo; 2024; 9(3), [cited 2024 Dec 20]. Available from: http://journal.um-surabaya.ac.id/index.php/JKM
[10] Li W, Cai J, Ding L, Chen Y, Wang X, Xu H. Incidence and risk factors of ventilator-associated pneumonia in the intensive care unit: a systematic review and meta-analysis. J Thorac Dis. 2024; 16(9):5518–28.
[11] Papazian L, Klompas M, Luyt CE. Ventilator-associated pneumonia in adults: a narrative review. Vol. 46, Intensive Care Medicine. Springer; 2020. p. 888–906.
[12] Burja S, Belec T, Bizjak N, Mori J, Markota A, Sinkovič A. Efficacy of a bundle approach in preventing the incidence of ventilator associated pneumonia (VAP). Bosn J Basic Med Sci. 2018;18(1):105–9.
[13] Bird D, Zambuto A, Silva J, Korn C, Burke R, Burke P, et al. Adherence to Ventilator-Associated Pneumonia Bundle and Incidence of Ventilator-Associated Pneumonia in the Surgical Intensive Care Unit [Internet]. 145, Arch Surg. 2010. Available from: http://archsurg.jamanetwork.com/
[14] Ceccato A, Dominedò C, Ferrer M, Martin-Loeches I, Barbeta E, Gabarrús A, et al. Prediction of ventilator-associated pneumonia outcomes according to the early microbiological response: a retrospective observational study. Eur Respir J. 2022; 59(4):2100620.
Files
IssueArticle in Press QRcode
SectionResearch Article(s)
Keywords
Ventilator Associated Pneumonia (VAP) prevention bundle bundle adherence Intensive Care Units (ICUs) Mortality
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Swardhani A, Nurdin H, Palinrungi A, Salam S, Muchtar F, Tan C. Association between VAP Bundle Compliance and Ventilator-Associated Pneumonia Incidence: A Single-Center Retrospective Study in an Indonesian ICU. Arch Anesth & Crit Care. 2026;.