Reducing VAP by instituting a care bundle using improvement methodology in a UK paediatric intensive care unit

Area of Science:

• Critical Care Medicine
• Infectious Disease Prevention
• Pediatric Nursing

Background:

• Ventilator-associated pneumonia (VAP) is a significant healthcare-associated infection, prompting initiatives to reduce its incidence.
• A tertiary pediatric intensive care unit (PICU) aimed to decrease VAP rates as part of a broader patient safety and hospital transformation project.

Purpose of the Study:

• To implement and evaluate a purpose-designed care bundle to reduce VAP incidence in a pediatric ICU.
• To assess the impact of a nurse-led VAP surveillance program and a new care bundle on VAP rates.

Main Methods:

• A VAP care bundle was developed based on literature, including head elevation, oral care with chlorhexidine, clean suctioning, ranitidine for non-fed patients, and regular documentation.
• Nurse educators facilitated staff training and buy-in, integrating VAP prevention education into routine induction.
• A nurse-led surveillance program monitored VAP incidence before and after the bundle's implementation.

Main Results:

• Following the implementation of the care bundle, no pediatric cases of VAP were recorded over a 12-month period.
• One adult patient developed VAP during the same 12-month interval.
• The VAP incidence rate prior to the intervention was 5.6 per 1,000 ventilator days.

Conclusions:

• A pediatric VAP bundle was associated with a significant reduction in VAP incidence in a UK PICU.
• The findings support the effectiveness of bundled interventions and nurse-led initiatives in preventing VAP.
• Sustained vigilance and adherence to evidence-based practices are crucial for controlling healthcare-associated infections in pediatric critical care settings.