Tinjauan Literatur: Implementasi Ventilator Bundle dalam Mencegah Kejadian Ventilator-Associated Pneumonia (VAP) di Intensive Care Unit (ICU)

Background: Ventilator-associated pneumonia (VAP) is defined as pneumonia occurring after
48 hours following mechanical ventilation. VAP is among the most common nosocomial
infections for critical care patients that contributes to mortality and morbidity, especially in
the intensive care unit (ICU). The ventilator bundle was introduced by the Institute for
Healthcare Improvement (IHI) as one of prevention of VAP incident.
Objective: This study aimed to determine the impact of ventilator bundle implementation in
preventing the incidence of VAP in ICU, also to determine the compliance of health-workers
in implementing ventilator bundle based on existing literatures.
Method: The design used was literature review. Articles were collected using databeses,
including PUBMED, Sage Journals and Google Scholar that published between 2011 and
2021. We found 11 articles were suitable to review according to inclusion and exclusion
criteria.
Results: Based on 11 (100%) articles were reviewed, all of the articles have proven that of
ventilator bundle implementation can reduce the incidence of VAP. There are 3 (27.2%)
articles that still use the old version of the ventilator bundle from the Institute for Healthcare
Improvement (IHI) in 2004. Meanwhile, 4 (36.3%) articles used ventilator bundle which was
updated by IHI in 2010 with the addition of an oral care hygiene component with
chlorhexidine. Then 4 (36.3%) other articles modified the ventilator bundle components from
IHI that were used by adding several other components such as Continuous Aspiration of
Subglottic Secretions (CASS) dan Control of Cuff Pressure between 20-30 cmH2O. There are
9 (90.9%) articles that evaluate compliance rates in bundle implementation. All of the articles
showed an increase in compliance rates after implementation, but some articles have not
reached the standard (≥95%) according to the IHI recommendation.
Conclusion: The implementation of ventilator bundle significantly decreased the incidence of
VAP in ICU. The compliance of ventilator bundle was increased but not well implemented in
some articles.