PURPOSE: In adults, ventilator associated pneumonia (VAP)is associated with prolonged mechanical ventilation, hospital length of stay, and increased mortality. VAP occurs in 5% of mechanically ventilated children and 15% of ventilated adults. The Institute of Medicine has identified VAP prevention as a national priority.
METHODS: A multidisciplinary group including physicians, nurses, and respiratory therapists was convened to implement a pediatric specific VAP bundle. The specific aim was to reduce VAP rates to the 2004 National Nosocomial Infection Surveillance (NNIS) 50th percentile (2.3 infections/1000 vent days). All patients receiving mechanical ventilation in our 25 bed PICU were eligible for study. VAP was identified using standard CDC definitions. The VAP bundle included: change vent circuits only when soiled; drain circuit condensate every 2-4 hours; store oral suction devices in non-sealed plastic bags at bedside; mouth care every 4 hours; elevate head of bed; and drain ventilator circuit before moving patient. A VAP checklist was used to measure compliance with implementation of the bundle. The checklist was developed and monitored by frontline respiratory therapists and bedside nurses.
RESULTS: Mean baseline VAP rate was 6.6 infections per 1000 ventilator days. Post bundle implementation, mean VAP rate was 0.5/ 1000 vent days (p < 0.05) and days between VAP infections was 228. Pre-bundle there were 39 infections in 1076 ventilated patients (3.6%) compared to 1 infection in 409 patients (2.4%) post-bundle. Measured adherence with implementation of each bundle element was 100%. PICU mortality rates, LOS, and average duration of mechanical ventilation were not different pre and post VAP bundle.
CONCLUSION: Reliable implementation of a pediatric specific VAP prevention bundle eliminated VAP for 7.5 consecutive months and significantly reduced the VAP rate in our multidisciplinary PICU. Involving frontline staff in development and implementation strategies was deemed crucial for our success.
CLINICAL IMPLICATIONS: While reducing or eliminating VAP should remain an important goal, the rarity of the event in pediatric ICUs makes it difficult to demonstrate any change in aggregate long-term patient morbidity.
DISCLOSURE: Richard Brilli, None.