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BMJ Qual Saf. 2013 Apr;22(4):357-61. doi: 10.1136/bmjqs-2012-001372. Epub 2013 Feb 21.

Estimated nursing workload for the implementation of ventilator bundles.

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  • 1Division of Infectious Disease, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.



Ventilator-associated pneumonia is a common healthcare-associated infection with high attributable morbidity and mortality. Prevention strategies, including prevention bundles, have been widely adopted across the USA. However, the nursing resources required to implement these bundles, and their effect on other aspects of intensive care unit patient care, are unknown.


We conducted a survey of all critical care nurses at our institution to determine the time required, and impact of, a prevention bundle at our hospital.


Nurses estimated that the standard ventilator bundle requires a median of 115 min (IQR: 74-182) per patient per day. Although the majority of nurses did not perceive that other patient care tasks were delayed by these prevention activities, this was not universal; 29% (95% CI 21% to 39%) of respondents reported that other patient care tasks were sometimes delayed because time was allocated to ventilator bundle activities.


Our estimates may serve as potentially important inputs for cost-effectiveness and decision analyses related to intensive care unit prevention activities. Further research should include direct observations about nursing time allocation related to prevention activities.

[PubMed - indexed for MEDLINE]
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