One recent approach to facilitating guideline implementation involves the use of care bundles.
This document presents a care bundle package addressing VAP prevention in an attempt to promote guideline-compliant practices. Uniquely, the development of these care bundles used a formalised methodology to assess the supporting data, based on multi-criteria decision analysis.
The resulting VAP care bundles for prevention were: non-ventilatory circuit changes unless specifically indicated, alcohol hand hygiene, appropriately educated and trained staff, incorporation of sedation control and weaning protocols into patient care, and oral care with clorhexidine.
Adoption of these care bundles should rationalise VAP prevention practises and improve outcomes, such as length of stay.
Ventilator-associated pneumonia (VAP) is a serious health care-acquired infection that occurs in up to about 30% of mechanically ventilated patients . VAP is defined as pneumonia occurring more than 48 h after the initiation of mechanical ventilation . The occurrence of VAP increases patient mortality to an estimated 20–55% and increases the duration of hospital stay by approximately 6 days [1, 3]; cost has been estimated to be above $40,000 .
One recent approach to facilitating guideline implementation involves the use of care bundles. A care bundle identifies a set of key interventions from evidence-based guidelines that, when implemented, are expected to improve patient outcome [5, 6]. The aim of care bundles is to change patient care processes and thereby encourage guideline compliance. Care bundles have been used in a number of clinical settings. Pronovost et al.  described a care bundle that significantly reduced the incidence of catheter-related bloodstream infections within 3 months of implementation (from 2.7 to 0 infections per 1,000 catheter days), with improvement being sustained over an 18-month assessment period.
The care bundle approach has also been investigated in the VAP setting. The 100k Lives Campaign (http://www.ihi.org) defined a four-component ventilator bundle  designed to reduce the incidence of clinical complications in patients with VAP. In a large multi-centre study compliance with the care bundle was associated with a lower incidence of VAP, with units achieving ≥95% bundle compliance experiencing a 59% reduction in VAP rate . Smaller studies, using the same care bundle, have reported reductions in the length of time patients require mechanical ventilation and the length of ICU stay [9, 10]. Other reports, using slightly different intervention packages, have also shown compliance to be associated with a reduction in the incidence of VAP [11–13]. Though these care bundle packages have been shown to be clinically effective, their impact may be limited because the interventions prioritised are not always those identified by the evidence-based treatment guidelines. This publication aims to redress these limitations by developing a comprehensive care bundle package using a formalised evidence-based methodology.
VAP care bundle development methodology
This VAP care bundle was developed by a pan-European committee of 12 participants representing different disciplines (microbiology, infectious diseases, infection control, epidemiology, nursing, pneumology and critical care). It was based on the findings of a previous review of the hospital-acquired pneumonia (HAP) and VAP guidelines across Europe . The methodology used during development of the VAP care bundle comprised multi-criteria decision analysis (MCDA), an established technique that supports decision making when numerous and conflicting evaluations are being assessed . Multi-criteria decision analysis, sometimes called multi-criteria decision making, is a discipline aimed at supporting decision makers who are faced with making numerous and conflicting evaluations. MCDA aims at highlighting these conflicts and deriving a way to come to a compromise in a transparent process. Unlike methods that assume the availability of measurements, measurements in MCDA are derived or interpreted subjectively as indicators of the strength of various preferences. Preferences differ from decision maker to decision maker, so the outcome depends on who is making the decision and what their goals and preferences are.
The MCDA method used to develop the VAP care bundle followed a recognised process of “weighting and scoring”; more details of this process are given below. The model is described by a mathematical equation (Criteria A Weight × mean value + Criteria B Weight × mean value + ⋯), which generates an average weighted score for each care bundle intervention being assessed. Details of the equation and process are detailed elsewhere . The process identifies nine criteria (Table 1) against which interventions are assessed. The criteria are weighted to demonstrate their relative importance to each other, and the interventions are scored to reflect their performance against each criterion. These weights and scores are used to generate a weighted benefit score for each intervention. By involving numerous participants, a range of opinions is illustrated in the weighting and scoring. Contributors were invited by the chairman based on publications and diversity of nationalities, and were multi-disciplinary. MCDA rates the concordance of opinion on each intervention, with a high level of concordance resulting in a high score and adding weight to the applicability of a particular recommendation.
VAP interventions considered for inclusion in the care bundle
A comprehensive list of interventions was produced based on those discussed in ten HAP/VAP guideline documents published in Europe since 2002 . Suitable interventions for VAP prevention consisted of: semi-recumbent patient positioning, sedation vacation and use of a weaning protocol, strict hand hygiene using alcohol, use of non-invasive ventilation, oral care with chlorhexidine, no ventilatory circuit tube changes unless specifically indicated, appropriately educated and trained staff, cuff pressure control at least every 24 h, enteral feeding, use of heat moisture exchangers, avoidance of stress ulcer prophylaxis, use of sucralfate where stress ulcer prophylaxis is required, unit-specific microbiological surveillance, use of endotracheal tubes and a restricted transfusion trigger policy and selective digestive tract decontamination.
Definition and weighting of the assessment criteria
Nine assessment criteria were defined and independently weighted by the 12 committee members according to their relative importance to each other. The criteria and their definitions are provided in Table 1 along with the mean weights attributed to each criterion. Average weight was obtained by voting on the importance of each criterion by 12 contributors within a range of 0–20. The most important criteria were perceived to be ease of implementation, clinical effectiveness and the strength of the supporting data, all of which are key to optimising acceptance of any care bundle package.
Scoring of VAP interventions
The meeting participants individually scored each VAP intervention on a 10-point scale assessing its performance against each criterion. The individual scores for each intervention were then weighted using each criterion’s weight as specified in Table 1. The weighted scores for each participant were then combined to generate a mean weighted score for each intervention, and the interventions were then ranked based on these scores. An example is provided as Supplementary electronic material. To check that agreement had been reached, participants were asked to review the ranked list and to agree that it reflected a consensus opinion of preference for interventions.
Role of the sponsor
Wyeth International had no control over and made no comments about the study design or the methods chosen, analysis of results, interpretation of findings or drafting of the paper. One representative attended, observing and listening, without participation in the investigators’ discussions.
The overall ranking of the VAP prevention intervention scores is presented in Fig. 1. An evident breakpoint in the scores occurred after the top five interventions and, as such, those most appropriate for inclusion as VAP care bundle recommendations were as follows:
Not implementing ventilatory circuit changes unless specifically indicated [16–18].
The use of appropriately educated and trained staff [24–27].
The incorporation of sedation vacation and weaning protocols into patient care [27–30].
Interventions such as the one stipulating good hand hygiene comprise general infection control procedures and should already be in place under national and local initiatives [33–35]. However, their inclusion in the VAP care bundle represents an opportunity to audit compliance and optimise the quality of hand hygiene practises. In addition, the requirement not to change ventilatory circuits unless indicated should represent an accepted care practice; however, the inclusion of this established intervention remains appropriate by emphasising its importance. The VAP prevention care bundle can be considered as emphasising certain generic infection control measures and adding other interventions that are specific to VAP.
Care bundles generally specify interventions that can be applied to the care of an individual patient at a particular time and place, ensuring their deliverability and accessibility. However, the intervention specifying the need for appropriately educated and trained staff does not fit this definition. Appropriate education/training is a key requirement, but may be better viewed as a tool to be built into the VAP care bundle implementation methodology.
This document represents the first VAP prevention care bundle based on MDSA and is designed to be adaptable to the variable VAP treatment settings. Most of the interventions recommended in the care bundle packages presented here are broadly consistent with the comprehensive HAP/VAP management guidelines published by the British Society for Antimicrobial Chemotherapy  and the American Thoracic Society/Infectious Diseases Society of America . However, there are some notable exceptions:
The BSAC HAP guidelines graded their recommendations from A–D, with a Grade A recommendation being supported by the best quality evidence. In general the HAP prevention and treatment interventions specified in this document were ranked as Grades A or B. In the BSAC HAP prevention guidelines, hand hygiene practises were recommended as a good practise point as the supporting evidence was not specific to the treatment of HAP or VAP. The BSAC guidelines did not address oral care with chlorhexidine.
In the ATS/IDSA guidelines most of the interventions recommended here were given a high or moderate recommendation based on the available evidence. However, though it was noted that the frequency of ventilator circuit changes does not impact on the incidence of VAP, no formal guidance was given on this point. In addition, oral care with chlorhexidine was not recommended based on a perceived lack of supporting evidence. Newer updates use the GRADE system approach, which also includes additional considerations besides the strength of evidence, including applicability and costs.
A number of different care bundles have previously been implemented to prevent VAP. The most commonly used is supported by the 100k Lives Campaign and comprises interventions of: peptic ulcer disease prophylaxis, deep vein thrombosis prophylaxis, head of the bed elevation and sedation vacation. This care bundle has reported considerable success in reducing the incidence of VAP [8, 38]. Despite the demonstrated efficacy of this care bundle, certain recommended interventions are not strongly supported by the available evidence base or do not directly target VAP. As such we acknowledge that in some cases certain bundle elements may be medically contra-indicated. Other care bundles focusing on the management of ventilatory equipment have reported variable effectiveness with respect to reducing the incidence of VAP [12, 13, 40, 41]. The MCDA method used to develop the VAP care bundle followed a recognised process of “weighting and scoring” that was not used by the IHI bundle.
The implementation of care bundles aims to promote beneficial changes in care processes . Adoption of care bundle packages requires that local units define suitable assessment parameters for each intervention, the details of which should be customised according to the local treatment setting. It should be emphasised that the interventions need to be viewed as a package, with compliance being assessed for the bundle as a whole. As such, non-completion of a single intervention equates to failure of the whole bundle at a particular assessment. The goal for prevention care bundles is to routinely achieve 100% compliance on a per patient per day basis.
The details of how best to implement particular interventions should be tailored to the local situation, with practical details being specified for each intervention to ensure deliverability , and should encourage participation from all individuals involved in patient care [38–41]. Specific interventions requiring further definition include:
Hand hygiene procedures should be modified when protective gloves are used to stipulate glove changes between patient contacts .
Each intervention needs to be readily assessable, and appropriate measurement parameters should be specified . It is important to use simple measures that can be monitored for every patient and formulated into a simple document. The interventions should be readily assessable in terms of a yes/no answer to the question ‘Was the intervention performed during a particular assessment period?’ If the intervention was considered but there was a valid reason for not implementing it, that parameter can be classified as an exclusion rather than non-compliance. Ideally one individual should be able to assess compliance simply and quickly, without input from numerous sources. Example assessment tools include daily goals sheets, pocket guidance cards and compliance checklists [7, 42] that serve as a both a reminder to perform the intervention and as a detailed record of the patient care process .
Effective auditing of care bundle compliance facilitates the generation of real-time data, and implementation is highly dependent on the audit and feedback process . This allows rapid feedback to staff as to whether their performance is in line with the care bundle and how it impacts on the quality of patient care , and this helps to promote the cultural changes required to attain uniform and optimal care processes . Generating reliable data also allows improvements in care processes to be correlated with patient outcome measures to identify clinical benefits.
The evidence base used during the development of these care bundle packages was derived from European HAP guidelines produced between 2002 and 2006 . Since 2006, various new studies have been reported that either support or contradict the previous data for certain interventions. New data were not considered after the intervention ranking process had been completed (April 2008), and considerable discussion centred on the omission of certain of these lines of evidence. However, it was of note that new data generally pertained to more controversial interventions and that these parameters did not score highly during the ranking process. This finding serves to further validate the use of MCDA for identifying key interventions for inclusion in these care bundles, as parameters for which the evidence base was weak or controversial ranked poorly. Identifying interventions is generally accepted as being able to improve patient care processes, which is important in promoting widespread acceptance of a care bundle package. Numerous studies have shown the care bundle approach to be feasible and effective in improving both patient care processes and patient outcome . It has been noted, however, that the availability of a number of different care bundles addressing the same condition is likely to confuse practitioners and confound implementation [43–47]. Interestingly, a recent report from SHEA is consistent with our variables in the core elements of a preventive bundle. Interestingly, our report did not retain semi-recumbency because it did not have a high enough priority in the score (Fig. 1). Anyway, the effect of the proposed interventions in changing outcomes and processes of care needs further validation in a prospective study, which is ongoing.
Feeding analgesia sedation thromboembolic ulcer glucose
Intensive care medicine
Multi-criteria decision analysis
Clinical Pulmonary Infection Score
American Thoracic Society
Infectious Disease Society of America
British Society for Antimicrobial Chemotherapy
Society of Healthcare Epidemiologists of America
Chastre J, Fagon JY (2002) Ventilator-associated pneumonia. Am J Respir Crit Care Med 165:867–903
Grossman RF, Fein A (2000) Evidence-based assessment of diagnostic tests for ventilator-associated pneumonia. Chest 117(4 supp 2):177S–181S
Safdar N, Dezfulian C, Collard HR, Saint S (2005) Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Crit Care Med 33:2184–2193
Rello J, Ollendorf DA, Oster G, Vera-Llonch M, Bellm L, Redman R, Kollef MH, VAP Outcomes Scientific Advisory Group (2002) Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest 122:2115–2121
Fulbrook P, Mooney S (2003) Care bundles in critical care: a practical approach to evidence-based practice. Nurs Crit Care 8:249–255
Cinel I, Dellinger RP (2006) Guidelines for severe infections: are they useful? Curr Opin Crit Care 12:483–488
Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, Sexton B, Hyzy R, Welsh R, Roth G, Bander J, Kepros J, Goeschel C (2006) An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 355:2725–2732
Resar R, Pronovost P, Haraden C, Simmonds T, Rainey T, Nolan T (2005) Using a bundle approach to improve ventilator care processes and reduce ventilator-associated pneumonia. Jt Comm J Qual Patient Saf 31:243–248
Crunden E, Boyce C, Woodman H, Bray B (2005) An evaluation of the impact of the ventilator care bundle. Nurs Crit Care 10:242–246
Burger CD, Resar RK (2006) “Ventilator bundle” approach to prevention of ventilator-associated pneumonia. Mayo Clin Proc 81:849–850
Fox MY (2006) Toward a zero VAP rate: personal and team approaches in the ICU. Crit Care Nurs Q 29:108–114
Lai KK, Baker SP, Fontecchio SA (2003) Impact of a program of intensive surveillance and interventions targeting ventilated patients in the reduction of ventilator-associated pneumonia and its cost-effectiveness. Infect Control Hosp Epidemiol 24:859–863
Laux L, Herbert C (2006) Decreasing ventilator-associated pneumonia: getting on board. Crit Care Nurs Q 29:253–258
Masterton R, Craven D, Rello J, Struelens M, Frimodt-Moller N, Chastre J, Ortqvist A, Cornaglia G, Lode H, Giamarellou H, Bonten MJ, Eraksoy H, Davey P (2007) Hospital-acquired pneumonia guidelines in Europe: a review of their status and future development. J Antimicrob Chemother 60:206–213
Belton V, Stewart TJ (2002) Multiple criteria decision analysis: an integrated approach. Kluwer, Boston
Dodek P, Keenan S, Cook D, Heyland D, Jacka M, Hand L, Muscedere J, Foster D, Mehta N, Hall R, Brun-Buisson C, Canadian Critical Care Trials Group, Canadian Critical Care Society (2004) Evidence-based clinical practice guideline for the prevention of ventilator-associated pneumonia. Ann Intern Med 141:305–313
Kollef MH, Shapiro SD, Fraser VJ, Silver P, Murphy DM, Trovillion E, Hearns ML, Richards RD, Cracchilo L, Hossin L (1995) Mechanical ventilation with or without 7-day circuit changes. A randomized controlled trial. Ann Intern Med 123:168–174
Long MN, Wickstrom G, Grimes A, Benton CF, Belcher B, Stamm AM (1996) Prospective, randomized study of ventilator-associated pneumonia in patients with one versus three ventilator circuit changes per week. Infect Control Hosp Epidemiol 17:14–19
Boyce JM, Pittet D, Healthcare Infection Control Practices Advisory Committee, Society for Healthcare Epidemiology of America, Association for Professionals in Infection Control, Infectious Diseases Society of America, Hand Hygiene Task Force (2002) Guideline for Hand Hygiene in Health-Care Settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Infect Control Hosp Epidemiol 23:S3–S40
Pittet D, Hugonnet S, Harbarth S, Mourouga P, Sauvan V, Touveneau S, Perneger TV (2000) Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme. Lancet 356:1307–1312
Adams BG, Marrie TJ (1982) Hand carriage of aerobic Gram-negative rods by health care personnel. J Hyg (Lond) 89:23–31
Adams BG, Marrie TJ (1982) Hand carriage of aerobic gram-negative rods may not be transient. J Hyg (Lond) 89:33–46
Doebbeling BN, Pfaller MA, Houston AK, Wenzel RP (1988) Removal of nosocomial pathogens from the contaminated glove. Implications for glove reuse and handwashing. Ann Intern Med 109:394–398
Salahuddin N, Zafar A, Sukhyani L, Rahim S, Noor MF, Hussain K, Siddiqui S, Islam M, Husain SJ (2004) Reducing ventilator-associated pneumonia rates through a staff education programme. J Hosp Infect 57:223–227
Zack JE, Garrison T, Trovillion E, Clinkscale D, Coopersmith CM, Fraser VJ, Kollef MH (2002) Effect of an education program aimed at reducing the occurrence of ventilator-associated pneumonia. Crit Care Med 30:2407–2412
Baxter AD, Allan J, Bedard J, Malone-Tucker S, Slivar S, Langill M, Perreault M, Jansen O (2005) Adherence to simple and effective measures reduces the incidence of ventilator-associated pneumonia. Can J Anaesth 52:535–541
Needleman J, Buerhaus P, Mattke S, Stewart M, Zelevinsky K (2002) Nurse-staffing levels and the quality of care in hospitals. N Engl J Med 346:1715–1722
Kress JP, Pohlman AS, O’Connor MF, Hall JB (2000) Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 342:1471–1477
Marelich GP, Murin S, Battistella F, Inciardi J, Vierra T, Roby M (2000) Protocol weaning of mechanical ventilation in medical and surgical patients by respiratory care practitioners and nurses: effect on weaning time and incidence of ventilator-associated pneumonia. Chest 118:459–467
Brook AD, Ahrens TS, Schaiff R, Prentice D, Sherman G, Shannon W, Kollef MH (1999) Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation. Crit Care Med 27:2609–2615
DeRiso AJ II, Ladowski JS, Dillon TA, Justice JW, Peterson AC (1996) Chlorhexidine gluconate 0.12% oral rinse reduces the incidence of total nosocomial respiratory infection and nonprophylactic systemic antibiotic use in patients undergoing heart surgery. Chest 109:1556–1561
Yoneyama T, Yoshida M, Ohrui T, Mukaiyama H, Okamoto H, Hoshiba K, Ihara S, Yanagisawa S, Ariumi S, Morita T, Mizuno Y, Ohsawa T, Akagawa Y, Hashimoto K, Sasaki H (2002) Oral Care Working Group. Oral care reduces pneumonia in older patients in nursing homes. J Am Geriatr Soc 50:430–433
Pittet D, Boyce JM (2003) Revolutionising hand hygiene in health-care settings: guidelines revisited. Lancet Infect Dis 3:269–270
Pratt RJ, Pellowe C, Loveday HP, Robinson N, Smith GW, Barrett S, Davey P, Harper P, Loveday C, McDougall C, Mulhall A, Privett S, Smales C, Taylor L, Weller B, Wilcox M; Department of Health (England) (2001) The epic project: developing national evidence-based guidelines for preventing healthcare associated infections. Phase I: guidelines for preventing hospital-acquired infections. Department of Health (England). J Hosp Infect 47(suppl):S3–S82
Garner JS (1996) Guideline for isolation precautions in hospitals. The Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 17:53–80
Masterton RG, Galloway A, French G, Street M, Armstrong J, Brown E, Cleverley J, Dilworth P, Fry C, Gascoigne AD, Knox A, Nathwani D, Spencer R, Wilcox M (2008) Guidelines for the management of hospital-acquired pneumonia in the UK: report of the working party on hospital-acquired pneumonia of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother 62:5–34
American Thoracic Society (2005) Guidelines for the management of adults with hospital acquired, ventilator-associated, and healthcare-assisted pneumonia. Am J Respir Crit Care Med 171:388–416
Richens Y, Rycroft-Malone J, Morrell C (2004) Getting guidelines into practice: a literature review. Nursing Standard 18:33–37
Cocanour CS, Peninger M, Domonoske BD, Li T, Wright B, Valdivia A, Luther KM (2006) Decreasing ventilator-associated pneumonia in a trauma ICU. J Trauma 61:122–129
Rosenthal VD, Guzman S, Crnich C (2006) Impact of an infection control program on rates of ventilator-associated pneumonia in intensive care units in 2 Argentinean hospitals. Am J Infect Control 34:58–63
Misset B, Timsit JF, Dumay MF, Garrouste M, Chalfine A, Flouriot I, Goldstein F, Carlet J (2004) A continuous quality-improvement program reduces nosocomial infection rates in the ICU. Intensive Care Med 30:395–400
Nguyen HB, Corbett SW, Steele R, Banta J, Clark RT, Hayes SR, Edwards J, Cho TW, Wittlake WA (2007) Implementation of a bundle of quality indicators for the early management of severe sepsis and septic shock is associated with decreased mortality. Crit Care Med 35:1105–1112
Fong JJ, Cecere K, Unterborn J, Garpestad E, Klee M, Devlin JW (2007) Factors influencing variability in compliance rates and clinical outcomes among three different severe sepsis bundles. Ann Pharmacother 41:929–936
Zilberberg MD, Shorr AF, Kollef MH (2009) Implementing quality improvements in the intensive care unit. Ventilator bundle as an example. Crit Care Med 37:305–309
Coffin SE, Komplas K, Classen D, Arias KM, Podgorny K, Anderson DJ, Busrstin H, Carfee DP, Dubberke DE, Fraser V, Gerdin DN, Griffin FA, Gross P, Kaye KS, Lo E, Marschall J, Mermel LA, Nicolle L, Pegues DA, Perl TM, Saint S, Salgado CD, Weinstein RA, Wise R, Yokoe DS (2008) Strategies to prevent ventilator-associated pneumonia in acute care hospitals. Infect Control Hosp Epidemiol 29:S31–S40
Masterton RG (2009) Sepsis care bundles and clinicians. Intensive Care Med 35:1149–1151
Hawe CS, Ellis KS, Cairns CJS, Longmate A (2009) Reduction of ventilator-associated pneumonia: active versus passive guideline implementation. Intensive Care Med 35:1180–1186
The European VAP care bundle meetings were supported by an unrestricted grant from Wyeth International. Dr Rello's contribution is supported in part by a grant from Instituto Salut Carlos III (FISS 06/0060). Wyeth International had no control over and did not comment on the study design or the methods chosen, analysis of results, interpretation of findings or drafting the paper. One representative attended, observing and listening, without participating in the investigators’ discussions. We thank J. Eastgate for assisting with manuscript preparation of the first draft of the manuscript. J. Eastgate received compensation from Wyeth International. A. Pares (Tarragona, Spain) assisted with the final draft of the manuscript. She is funded by CIBERes.
Conflicts of interest statements
RM has received speaker honoraria from Astra Zeneca and Wyeth; JR has received speaker honoraria and/or research funding from Pfizer, Johnson & Johnson, Merck, Astra Zeneca and Wyeth. He is a member of the advisory boards of Johnson & Johnson, Pfizer and Wyeth Pharmaceuticals; MS has received speaker honoraria and/or research funding from Pfizer, Roche Diagnostics, Becton-Dickinson, Chiron-Novartis, Wyeth, Astra Zeneca, Johnson & Johnson, GeneOhm and BioMérieux. He has served on advisory boards for Pfizer, Chiron-Novartis, Wyeth, Johnson & Johnson, Glaxo-SmithKline and 3M, and is a member of the Glaxo-SmithKline-supported Belgian Sanford Guide Working Party on Antimicrobial Therapy and their Infectious Diseases Advisory Board; JC serves on the Nektar advisory board and has received speaker honoraria from Pfizer, Astra Zeneca, Wyeth, Pharm-Olam, and Brahms; GC has received speaker honoraria from Pfizer, Wyeth, Merck and Glaxo-SmithKline; HL has received speaker honoraria research funding and/or consulting fees from Bayer, Pfizer, Sanofi-Aventis, Wyeth, Johnson & Johnson, Intermune, and Daiichi and Astellas; HG has received speaker honoraria and/or research funding from Wyeth, Glaxo-SmithKline, Pfizer, Merck and Sanofi-Aventis; PD has received speaker honoraria and/or research funding from Pfizer, Wyeth, Glaxo-SmithKline and Boehringer Ingelheim, and is a member of the Johnson & Johnson global anti-infective advisory board; AO, HE, DC and KD have no conflicts of interest to declare. This study, including working meetings and secretarial assistance, was supported by an unrestricted grant from Wyeth International.
VAP Care Bundle Contributors are detailed in the Appendix.
Electronic supplementary material
Below is the link to the electronic supplementary material.
VAP Care Bundles Contributors
VAP Care Bundles Contributors
Robert Masterton (Chairman)
Ayrshire & Arran NHS Board, The Ayr Hospital, Scotland
Vall d’Hebrón University Hospital, Institut de Recerca Vall d’Hebrón-UAB, CIBER Enfermedades Respiratorias (CIBERes), Barcelona, Spain
Université Libre de Bruxelles-Hôpital Erasme, Brussels, Belgium
GH Pitié-Salpêtrière, AP-HP, Paris, France
Karolinska Institutet Stockholm, Stockholm, Sweden
University of Verona, Verona, Italy
City Hospital, Berlin, Germany
Attikon University Hospital, Athens, Greece
Istanbul University, Istanbul, Turkey
University of Dundee, Scotland
Ayrshire & Arran NHS Board, Scotland.
Tayside NHS Board, Scotland.
Rights and permissions
About this article
Cite this article
Rello, J., Lode, H., Cornaglia, G. et al. A European care bundle for prevention of ventilator-associated pneumonia. Intensive Care Med 36, 773–780 (2010). https://doi.org/10.1007/s00134-010-1841-5
- Ventilator-associated pneumonia
- Care bundles