PURPOSE: Ventilator-Associated Pneumonia (VAP) is the second most common hospital-acquired infections in the Pediatric Intensive Care Unit (PICU) after catheter-related bloodstream infections. VAP is defined as the development of a new pneumonia at least 48hrs after initiation of mechanical ventilation. This study was designed to evaluate the incidence of VAP in the PICU of University Pediatric Hospital and compare it to the national mean. In addition, we assessed the compliance of VAP prevention strategies and what are the reasons for failure to its practice in the PICU.
METHODS: We conducted an observational cohort study on June 2010 evaluating for ten consecutive days the PICU compliance of prevention strategies versus hospital VAP prevention strategies. We evaluated the use of the following interventions model: elevation of head to bed (HOB), daily sedation holidays/readiness for extubation, peptic ulcer disease (PUD) and deep vein thrombosis (DVT) prophylaxis, oral care with chlorhexidine, and adequate cuff inflation.
RESULTS: Total patient ventilator days evaluated were 37 in 9 patients. Current PICU interventions are HOB elevation, PUD prophylaxis, and cuff inflation. We used an average of 2.1/3 (70%) of the interventions daily per patient. When compared with the proposed interventions model, we found an average daily use of 2.7/6 (47%). The highest intervention used was PUD prophylaxis (100%) and the least was prophylaxis for DVT (9/37 ventilator days, 24%). Based on our findings and to improve patient care we developed a pediatric VAP Prevention Protocol to decrease its rate. The protocol addresses the identified barriers for use of the prevention strategies, and tailors the guidelines to the pediatric population.
CONCLUSIONS: After implementing the VAP Prevention Protocol, we provided education to PICU staff and continuously monitoring the compliance of the VAP prevention strategies. In the next 3 months we expect a decrease in the VAP rate at our PICU of 20%. In the next six months after we expect that our VAP rate to be below national average and publish the quality improvement results.
CLINICAL IMPLICATIONS: Determining VAP incidence and establish a VAP Prevention Protocol in the PICU will help to decrease VAP rate and keep it below national average.
DISCLOSURE: The following authors have nothing to disclose: Manuel Iglesias, Alicia Fernández-Sein, Anabel Puig-Ramos, Ricardo García-De Jesús
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