ORIGINAL RESEARCH article
Front. Public Health
Sec. Infectious Diseases: Epidemiology and Prevention
EFFECT OF HUMIDIFICATION INTERVENTION COMBINED WITH CLUSTER NURSING ON VENTILATOR-ASSOCIATED PNEUMONIA IN ICU PATIENTS
Provisionally accepted
- Nanjing medical university, Nanjing, China
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Background: Ventilator-associated pneumonia (VAP) is a serious complication in mechanically ventilated patients, increasing morbidity, mortality, and antibiotic use. Although cluster nursing and humidification methods independently reduce VAP risk, their combined effect has not been rigorously evaluated. Objective: To determine whether combining dual humidification (heated humidifier plus heat-and-moisture exchanger) with a structured cluster nursing bundle reduces VAP incidence in Intensive Care Unit (ICU) patients. Methods: In this single-center cross-sectional observational study, 240 adult ICU patients expected to require ventilation for >48 hours were observed under either enhanced care (dual humidification plus cluster nursing) or standard care. The cluster nursing bundle included head-of-bed elevation (30– 45°), chlorhexidine oral care every 4 hours, daily sedation breaks with weaning assessment, subglottic suctioning, enteral nutrition with prophylaxis, thrombosis prevention, and strict hand hygiene. The primary outcome was VAP incidence defined by CDC/NHSN criteria. Secondary outcomes included ventilator duration, ICU length of stay, antibiotic use, and mortality. Results: VAP incidence was significantly lower in the enhanced care cohort (10.0%) compared with standard care (30.0%) (P < 0.001), representing a 67% relative risk reduction (number-needed-to-treat = 5). Enhanced care patients had shorter ventilation duration (7.4 vs. 9.1 days, P = 0.003), shorter ICU stays (10 vs. 13 days, P = 0.01), fewer antibiotic days (6.8 vs. 10.7, P < 0.001), and delayed VAP onset (7.5 vs. 5.0 days, P = 0.04). Mortality was lower (18.3% vs. 25.8%) but not statistically significant. No tube occlusions or adverse respiratory events occurred. Conclusion: A dual humidification strategy combined with a high-compliance cluster nursing bundle significantly reduced VAP incidence and improved ICU outcomes. This cost-effective approach supports implementation to enhance patient safety and reduce antimicrobial resistance.
Keywords: ventilator-associated pneumonia, ICU nursing care, Humidification, Cluster intervention, Heat-and-moisture exchanger, mechanical ventilation
Received: 19 Jul 2025; Accepted: 06 Nov 2025.
Copyright: © 2025 Liu, Liu and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Ying Liu, liu370.qq@outlook.com
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