Establishing nurse-led ventilator-associated pneumonia surveillance in paediatric intensive care

Preventing ventilator-associated pneumonia (VAP) is one of the Department of Health 'Saving Lives' initiatives. Whereas morbidity and mortality from VAP is well-documented in adults, it is poorly studied in children. We describe the establishment of a nurse-led VAP surveillance programme as part of an overall drive for patient safety and healthcare-associated infection reduction. All children admitted to a tertiary referral paediatric intensive care unit over a four-month period were studied. VAP was defined as pneumonia occurring >48 h post intubation. Diagnostic criteria were: (i) radiological: new/progressive infiltrates, consolidation or cavitation on chest X-ray; (ii) clinical: > or = 3 of new onset purulent bronchial secretions, leucopaenia or leucocytosis, core temperature > or = 38.5 degrees C or < or = 36 degrees C without other cause, significant positive respiratory culture or culture from another relevant site of infection. A flow diagram and teaching programme was developed for bedside nurses to facilitate investigations of suspected VAP. The nurse in charge collected data daily at midnight until 24h post extubation, discharge or death. Suspected cases of VAP were referred to infection control for secondary verification. A total of 158 intubated children were admitted over four months with 58 excluded (ventilated <24 h). Full data were obtained on all 100 children. VAP incidence was 5.6 per 1000 ventilator-days. We report successful introduction of a nurse-led VAP surveillance programme. Data acquisition in this study was dependent on nursing workload, however, and placed a significant time burden on the study leads. Although a relatively low VAP rate was demonstrated, VAP bundles with automated surveillance are being introduced.