# The Development of a 10-Item Ventilator-Associated Pneumonia Care Bundle in the General Intensive Care Unit of a Tertiary Hospital in Vietnam: Lessons Learned

## TL;DR

A 10-item care bundle was developed to reduce ventilator-associated pneumonia in a Vietnamese hospital, with significant improvement after adding education and communication.

## Contribution

The study introduces a practical VAP care bundle tailored for resource-limited settings and highlights the importance of education in implementation success.

## Key findings

- The initial 10-item VAP care bundle did not significantly reduce VAP incidence.
- Adding interactive communication and education significantly lowered VAP rates to 11.3 per 1000 ventilation days.
- The updated protocol shows promise in multidrug-resistant environments with limited resources.

## Abstract

Objectives and Methods: We developed a 10-item VAP care bundle to address the high incidence of VAP in Vietnamese intensive care units (ICUs), comprising (i) hand hygiene, (ii) head elevation (gatch up 30–45°), (iii) oral care, (iv) oversedation avoidance, (v) breathing circuit management, (vi) cuff pressure control, (vii) subglottic suctioning of secretions, (viii) daily assessment for weaning and a spontaneous breath trial (SBT), (ix) early ambulation and rehabilitation, and (x) prophylaxis of peptic ulcers and deep-vein thrombosis (DVT). The VAP incidence (27.0 per 1000 mechanical ventilation days) slightly and not significantly decreased in the six months after the implementation of the care bundle. Methods and Results: However, the VAP incidence (11.3 per 1000 mechanical ventilation days) significantly decreased when we updated the two-item protocol with interactive communication and education (p < 0.001). Conclusions: Although the effectiveness of the interventions via protocol updates with interactive education needs further study, this intervention can make a VAP care bundle work in a resource-constrained and multidrug-resistant environment.