Sustained Reduction of Ventilator-Associated Pneumonia Through Multimodal Strategies: Impact of a Prevention Program in a Critical Care Unit

Ventilator-associated pneumonia (VAP) is an important healthcare-associated infection, associated with negative outcomes and increased hospital costs. Adoption of prevention bundles, when structured and monitored, has proven impact on reducing VAP density. This study evaluated the effect of a set of preventive interventions on VAP indicators and mechanical ventilation use, between 2022 and 2024, in an ICU of a private hospital in São Paulo. Retrospective observational study, analyzing data before and after implementation of a multiprofessional package of preventive measures. Actions covered improvements in measurement, process, and structure axes, including: hand hygiene adherence; frequent bundle audits; acquisition of modern ventilators; standardization of devices with subglottic suction; use of oral hygiene kits with training; implementation of weaning, safe extubation, non-invasive ventilation, and high-flow protocols; reinforcement of anti-aspiration strategies; use of the Kamishibai method to identify failures; and daily team engagement focused on early de-invasiveness. During the evaluated period, VAP density in the unit decreased from 6.57 (in 2022) to 0 (in 2024). Mechanical ventilation utilization rate also showed a significant reduction, from 12.88 to 4.75. Results coincided with consolidation of a prevention-oriented care culture, evidenced by active professional involvement in daily monitoring and execution of measures. Systematic follow-up of indicators enabled continuous feedback to teams, with progressive process improvements. Also noteworthy was the maturation of the multiprofessional team, which began performing its own audits, identifying intervention opportunities autonomously and proactively. Adoption of structured strategies focusing on VAP prevention and reducing exposure to mechanical ventilation resulted in marked improvement in care indicators in the critical unit. Program effectiveness was directly related to multiprofessional team commitment, process standardization, and systematic monitoring of preventive measures. These results reinforce that sustained VAP control depends on an integrated approach with active surveillance and continuous training.