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Implementation of a Ventilator-Associated Pneumonia Prevention Bundle in a Single PICU
Analía De Cristofano1, Verónica Peuchot, Andrea Canepari
11Pediatrics Department, Infection Control Committee, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. 2Pediatric Intensive Care Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. 3Respiratory Care Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. 4Nursing Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Insights
Implementing a ventilator-associated pneumonia prevention bundle in a pediatric intensive care unit significantly reduced infection rates. This quality improvement initiative achieved a 25% decrease every six months, ultimately reaching a zero rate in the final semester.
Area of Science:
- Critical Care Medicine
- Infectious Disease Prevention
- Healthcare Quality Improvement
Background:
- Ventilator-associated pneumonia (VAP) is a common and costly infection in pediatric intensive care units (PICUs).
- Effective prevention strategies are crucial for reducing patient morbidity and healthcare expenses.
Purpose of the Study:
- To implement and evaluate an evidence-based VAP prevention bundle in a PICU.
- To achieve a 25% reduction in VAP rates every six months over a two-year period.
Main Methods:
- A quasi-experimental, uninterrupted time series design was employed.
- An adapted VAP prevention bundle, including head-of-bed elevation, oral care with chlorhexidine, ventilator circuit maintenance, and daily sedation interruption, was implemented.
- The Plan-Do-Study-Act (PDSA) cycle was used for quality improvement.
Main Results:
- The baseline VAP rate was 6.3 episodes per 1,000 mechanical ventilation days.
- VAP rates decreased progressively: 5.7, 3.2, 1.8, and 0.0 episodes per 1,000 mechanical ventilation days across the four six-month periods.
- Statistical analysis indicated a significant reduction in VAP rates following bundle implementation.
Conclusions:
- The VAP prevention bundle, adapted and implemented using quality improvement tools, effectively reduced VAP rates in the PICU.
- Sustained application of the bundle led to a significant and progressive decline in VAP incidence.
- The study demonstrates the success of a targeted quality improvement initiative in combating VAP in critically ill children.
Objective:
Ventilator-associated pneumonia is considered the second most frequent infection in pediatric intensive care, and there is agreement on its association with higher morbidity and increased healthcare costs. The goal of this study was to apply a bundle for ventilator-associated pneumonia prevention as a process for quality improvement in the PICU of Hospital Italiano de Buenos Aires, Argentina, aiming to decrease baseline ventilator-associated pneumonia rate by 25% every 6 months over a period of 2 years.
Design:
Quasi-experimental uninterrupted time series.
Setting:
PICU of Hospital Italiano de Buenos Aires, Argentina.
Patients:
All mechanical ventilated patients admitted to the unit.
Intervention:
It consisted of the implementation of an evidence-based ventilator-associated pneumonia prevention bundle adapted to our unit and using the plan-do-study-act cycle as a strategy for quality improvement. The bundle consisted of four main components: head of the bed raised more than 30°, oral hygiene with chlorhexidine, a clean and dry ventilator circuit, and daily interruption of sedation.
Measurements And Main Results:
Ventilator-associated pneumonia prevention team meetings started in March 2012, and the ventilator-associated pneumonia bundle was implemented in November 2012 after it had been developed and made operational. Baseline ventilator-associated pneumonia rate for the 2 years before intervention was 6.3 episodes every 1,000 mechanical ventilation days. ventilator-associated pneumonia rate evolution by semester and during the 2 years was, respectively, 5.7, 3.2, 1.8, and 0.0 episodes every 1,000 mechanical ventilation days. Monthly ventilator-associated pneumonia rate time series summarized in a 51-point control chart showed the presence of special cause variability after intervention was implemented.
Conclusions:
The implementation over 2 years of a ventilator-associated pneumonia prevention bundle specifically adapted to our unit using quality improvement tools was associated with a reduction in ventilator-associated pneumonia rate of 25% every 6 months and a nil rate in the last semester.
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