# Evidence-Based Practices to Prevent Ventilator-Associated Pneumonia in an Intensive Care Unit in Bangladesh

## TL;DR

This study shows that implementing evidence-based practices in a Bangladeshi ICU significantly reduced ventilator-associated pneumonia rates, though overall ICU mortality remained high.

## Contribution

Demonstrates the effectiveness of nurse-led evidence-based VAP bundles in a low-middle-income country ICU setting.

## Key findings

- VAP incidence decreased significantly in the intervention group (26.9%) compared to the control group (46.1%).
- VAP bundle implementation was associated with a 58.3% reduction in VAP risk (Exp(B) = 0.417).
- Ventilation ≥96 hours was a significant risk factor for VAP (Exp(B) = 2.6).

## Abstract

Background: Ventilator-associated pneumonia (VAP) is a major cause of morbidity and mortality in intensive care units (ICUs), particularly in low- and middle-income countries (LMICs). Evidence-based practice (EBP) bundles have shown effectiveness in reducing VAP; however, the implementation in Bangladesh remains limited. This study aimed to evaluate the effectiveness of EBP to reduce the incidence rate of VAP among adult ICU patients in Bangladesh. Methods: A quasi-experimental study with a historical control group was conducted among 347 eligible ICU patients from October 2024 to April 2025. The intervention included nurse training on VAP bundle practices with advanced equipment support. Data on VAP incidence as a primary endpoint and VAP-related patients’ outcomes were analyzed. Results: The clinically suspected VAP incidence was 30.1 and 51.1 per 1000 ventilator-days, and the prevalence decreased significantly in the intervention group compared to the control group (26.9% vs. 46.1%; p < 0.001), respectively. Logistic regression indicated VAP bundle implementation was associated with reduced VAP (Exp(B) = 0.417, 95% CI: 0.262–0.666), while ventilation ≥96 h was a significant risk factor (Exp(B) = 2.6, 95% CI: 1.385–4.881). Early-onset VAP was reduced (25.0% vs. 10.2%), though late-onset predominated in the intervention group (75.0% vs. 89.8%). Conclusion: Implementation of an EBP-based VAP bundle by trained nurses significantly reduced VAP incidence. However, increased overall ICU mortality highlights the need for broader critical care improvements, including advanced comorbidity management and comprehensive ICU services. This study underscores the feasibility and effectiveness of VAP bundle implementation in the ICU of an LMIC.