Effectiveness of a Revised Ventilator-Associated Pneumonia Prevention Bundle in an Intensive Care Unit : A Retrospective Cohort Study

Purpose : This study aimed to evaluate the effectiveness of a revised prevention bundle in reducing the incidence of ventilator-associated pneumonia in the intensive care unit of a tertiary hospital in South Korea. Methods : A retrospective cohort design was used to analyze the electronic medical records of patients who received mechanical ventilation for more than 48 hours. The control group (n=134) was admitted between April and September 2022, while the intervention group (n=143) was admitted between April and September 2023. The revised bundle consisted of head-of-bed elevation, oral care with normal saline, regular sedation assessment, daily evaluation for ventilator weaning, early initiation of nutritional support, and ventilator circuit management following updated evidence-based guidelines. Statistical analyses included descriptive statistics, chi-square tests, independent t-tests, and the calculation of odds ratios. Results : The incidence of ventilator-associated pneumonia significantly decreased from 9.053 to 3.493 per 1,000 ventilator days (p =.043). It also decreased from 8.208% to 2.797% per 100 patients. Despite the higher rate of central venous catheter use in the intervention group, the infection rate was lower, suggesting that consistent and structured nursing interventions play a critical role. The revised bundle was effective even without chlorhexidine, supporting the feasibility of basic oral hygiene practices and early nutritional support for preventing pneumonia. Conclusion : The revised prevention bundle significantly reduced the incidence of ventilator-associated pneumonia and can be recommended for implementation in intensive care units to enhance patient safety and care outcomes.