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head of bed elevation, multidisciplinary team, rapid cycle improvement, VAP, ventilator-associated pneumonia



  1. Laux, Lori MSN, RN
  2. Dysert, Karen MS, RN
  3. Kiely, Sharon MD
  4. Weimerskirch, Jeff RRT, AS


The prevention of ventilator-associated pneumonia (VAP) has been a challenge within many healthcare organizations. The initial efforts for VAP prevention focused on compliance with "ventilator bundles." VAP rates initially improved with implementation of the bundles but then reached a plateau. The trauma surgical intensive care unit (ICU) was interested in investigating measures to further improve the prevention of VAP after bundle implementation. A multidisciplinary team was formed to investigate innovative strategies to prevent VAP. The group identified their initial focus as head of bed (HOB) elevation intervention within and outside of the ICU through HOB audits and a transport checklist. Through these efforts, the VAP rate within the trauma surgical ICU dropped to the lowest level in 4 years.