Authors (including presenting author) :
Kam MW (2), Lee CH (1), Mak WY Crystal (1), Or DK (1)
Affiliation :
(1) Acute Medical ward, Yan Chai Hospital, (2) Special Diagnostic Centre, Department of Medicine of Yan Chai Hospital.
Keyword 1: :
VAP bundle of care
Keyword 2: :
VAP bundle in medical department
Introduction :
Ventilator-associated pneumonia (VAP) is a hospital-acquired pneumonia occurring more than 48 hours after endotracheal intubation and is associated with increased morbidity and mortality.
Evidence-based ventilator care bundles are widely adopted to prevent VAP. However, their effectiveness depends largely on nurses’ knowledge and compliance. Most VAP bundle studies focus on intensive care units, while research in general medical settings remains limited. In YCH, medical nurses are increasingly required to care for intubated patients, yet the absence of a standardized VAP bundle protocol for the medical department limits consistent implementation of preventive measures.
Objectives :
This project aimed to: (1) identify knowledge gaps regarding VAP prevention among medical nurses; (2) enhance nurses’ knowledge, competency, and compliance with VAP bundle care; (3) formulate a VAP bundle tailored for the YCH medical unit; (4) provide practical guidelines and tools to support standardized implementation; and (5) promote high-quality nursing care to improve outcomes of ventilated patients.
Methodology :
A CQI project was conducted from July to September 2025 in 4 acute medical wards of YCH. Using convenience sampling, 40 full-time medical nurses involved in the care of ventilated patients were recruited. The project comprised pre-intervention knowledge assessment and practice observation, an educational program, and post-intervention reassessment.
A 7-item VAP bundle tailored to the medical setting was developed based on international guidelines, Centre for Health Protection recommendations, and the existing YCH ICU protocol, with endorsement from the Medical Respiratory Team. Bundle components included head-of-bed elevation, endotracheal tube (ETT) cuff pressure monitoring, daily oral care with normal saline, daily ETT position checking and fixation strap change, early mobilization, early enteral nutrition, and hand hygiene.
Educational interventions included 15-minute face-to-face mini-lectures in small groups, ward-based posters summarizing the bundle, and visual cues using red tape on bedside rails to indicate correct head-of-bed elevation. Knowledge was assessed using a multiple-choice questionnaire, while compliance was evaluated through standardized observation audits
Result & Outcome :
Post-intervention results demonstrated substantial improvement in nurses’ knowledge, particularly in the definition of VAP (+60%), rationale for fixation strap changes (+55%), and appropriate oral care solution (+50%). Compliance with nearly all VAP bundle components improved significantly, especially in daily oral care with normal saline (+35%), head-of-bed elevation (+35%), and daily fixation strap changes (+17%).
