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.