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The utility of the best care always bundle for the prevention of ventilator associated pneumonia in patients with severe traumatic brain injury
Introduction Severe traumatic brain injury (STBI) is a risk factor for ventilator-associated pneumonia (VAP). In STBI, VAP is associated with worse neurological outcomes. Aim Quantify the impact of the “Best Care Always Bundle” (BCAB) on VAP-rate in STBI patients. Methods Retrospective review of STB...
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| Format: | Thesis |
| Language: | English |
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Division of General Surgery
2026
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| _version_ | 1867613288614854656 |
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| access_status_str | Open Access |
| author | Kruger, Andries |
| author2 | Semple, Patrick |
| author_browse | Kruger, Andries Semple, Patrick |
| author_facet | Semple, Patrick Kruger, Andries |
| author_sort | Kruger, Andries |
| collection | Thesis |
| description | Introduction Severe traumatic brain injury (STBI) is a risk factor for ventilator-associated pneumonia (VAP). In STBI, VAP is associated with worse neurological outcomes. Aim Quantify the impact of the “Best Care Always Bundle” (BCAB) on VAP-rate in STBI patients. Methods Retrospective review of STBI patients 12-months before (cohort 1) and after (cohort 2) implementation of the VAP-BCAB. Primary outcome: VAP incidence after implementation of BCAB. Secondary outcomes: duration of mechanical ventilation (MV), Neurocritical care unit (NCCU) and hospital length of stay (LoS), mortality, tracheostomy rate, re-intubation rate, and antibiotic use. Adherence to VAP-BCAB and correlation with VAP-rate was also analysed. Results Incidence of VAP were 24,7% and 18,6% in cohort 1 and 2 respectively (p=0.163). Duration of MV 6,7 days (5,4-7,9) and 7,3 days (6,1-8,4) in cohort 1 and 2 respectively (p=0.520). NCCU LoS 10,7 days (8,9-12,4) and 10,4 days (8,9-11,8) in cohort 1 and 2 respectively (p=0.797). Hospital LoS 21,5 days (16,2-26,9) and 18,0 days (15,3-20,6) in cohort 1 and 2 respectively (p=0.246). Thirty tracheostomies (37,5%) were recorded in cohort 1, 33 (31,7%) in cohort 2 (p=0.219). Thirteen re-intubations (20%) were recorded in cohort 1, nine (10,2%) in cohort 2 (p=0.055). Patients with VAP were fewer (7%) in months with high adherence to the VAP-BCAB, compared to low adherence months (28%) (p=0.003). Conclusion The clinical utility of the VAP-BCAB for the prevention of VAPs in STBI patients was clear in this study but the significance could only be shown where adherence to the VAP-BCAB was high. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/43125 |
| institution | University of Cape Town (South Africa) |
| language | eng |
| last_indexed | 2026-06-10T12:33:45.686Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2026 |
| publishDateRange | 2026 |
| publishDateSort | 2026 |
| publisher | Division of General Surgery |
| publisherStr | Division of General Surgery |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/43125 The utility of the best care always bundle for the prevention of ventilator associated pneumonia in patients with severe traumatic brain injury Kruger, Andries Semple, Patrick General Surgery Introduction Severe traumatic brain injury (STBI) is a risk factor for ventilator-associated pneumonia (VAP). In STBI, VAP is associated with worse neurological outcomes. Aim Quantify the impact of the “Best Care Always Bundle” (BCAB) on VAP-rate in STBI patients. Methods Retrospective review of STBI patients 12-months before (cohort 1) and after (cohort 2) implementation of the VAP-BCAB. Primary outcome: VAP incidence after implementation of BCAB. Secondary outcomes: duration of mechanical ventilation (MV), Neurocritical care unit (NCCU) and hospital length of stay (LoS), mortality, tracheostomy rate, re-intubation rate, and antibiotic use. Adherence to VAP-BCAB and correlation with VAP-rate was also analysed. Results Incidence of VAP were 24,7% and 18,6% in cohort 1 and 2 respectively (p=0.163). Duration of MV 6,7 days (5,4-7,9) and 7,3 days (6,1-8,4) in cohort 1 and 2 respectively (p=0.520). NCCU LoS 10,7 days (8,9-12,4) and 10,4 days (8,9-11,8) in cohort 1 and 2 respectively (p=0.797). Hospital LoS 21,5 days (16,2-26,9) and 18,0 days (15,3-20,6) in cohort 1 and 2 respectively (p=0.246). Thirty tracheostomies (37,5%) were recorded in cohort 1, 33 (31,7%) in cohort 2 (p=0.219). Thirteen re-intubations (20%) were recorded in cohort 1, nine (10,2%) in cohort 2 (p=0.055). Patients with VAP were fewer (7%) in months with high adherence to the VAP-BCAB, compared to low adherence months (28%) (p=0.003). Conclusion The clinical utility of the VAP-BCAB for the prevention of VAPs in STBI patients was clear in this study but the significance could only be shown where adherence to the VAP-BCAB was high. 2026-04-23T09:27:52Z 2026-04-23T09:27:52Z 2023 2026-04-23T07:47:06Z Thesis / Dissertation Masters Masters http://hdl.handle.net/11427/43125 eng application/pdf Division of General Surgery Faculty of Health Sciences University of Cape Town |
| spellingShingle | General Surgery Kruger, Andries The utility of the best care always bundle for the prevention of ventilator associated pneumonia in patients with severe traumatic brain injury |
| thesis_degree_str | Master's |
| title | The utility of the best care always bundle for the prevention of ventilator associated pneumonia in patients with severe traumatic brain injury |
| title_full | The utility of the best care always bundle for the prevention of ventilator associated pneumonia in patients with severe traumatic brain injury |
| title_fullStr | The utility of the best care always bundle for the prevention of ventilator associated pneumonia in patients with severe traumatic brain injury |
| title_full_unstemmed | The utility of the best care always bundle for the prevention of ventilator associated pneumonia in patients with severe traumatic brain injury |
| title_short | The utility of the best care always bundle for the prevention of ventilator associated pneumonia in patients with severe traumatic brain injury |
| title_sort | utility of the best care always bundle for the prevention of ventilator associated pneumonia in patients with severe traumatic brain injury |
| topic | General Surgery |
| url | http://hdl.handle.net/11427/43125 |
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