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Interprofessional Approach to the Sustained Reduction in Ventilator-Associated Pneumonia in a Pediatric Intensive
Cheryl Lynne McBeth1, Rosa Solis Montes2, Amy Powne2
1Cheryl Lynne McBeth is a nurse manager for the pediatric intensive care unit (PICU), pediatric cardiac intensive care unit (PCICU), and Critical Care Transport Team, University of California, Davis, Children's Hospital, Sacramento, California. Rosa Solis Montes is clinical nurse III, University of California, Davis, Children's Hospital. She has been the cochair or chair of the No VAP committee since 2010. Amy Powne is Fetal Care and Treatment Center registered nurse coordinator at University of California, Davis, Children's Hospital. Sopon Elizabeth North is clinical nurse III, University of California, Davis, Children's Hospital. She currently is chair of the PICU/PCICU Hospital-Acquired Infection Committee. JoAnne E. Natale is professor of clinical pediatrics, Pediatric Critical Care, Children's Hospital Quality & Safety, and director of quality and safety, University of California, Davis, Medical Center. clmcbeth@ucdavis.edu.
Insights
Implementing a ventilator-associated pneumonia (VAP) prevention bundle significantly reduced VAP rates in a pediatric intensive care unit. This evidence-based strategy achieved sustained low VAP events, improving patient outcomes.
Area of Science:
- Critical Care Medicine
- Infection Prevention
- Quality Improvement
Background:
- Ventilator-associated pneumonia (VAP) is a significant cause of increased patient morbidity, mortality, and healthcare expenses.
- Effective strategies are crucial to mitigate the impact of VAP in intensive care settings.
Purpose of the Study:
- To decrease the VAP rate in a pediatric/cardiac intensive care unit to below 2 events per 1000 ventilator days within two years.
- To maintain a VAP rate close to zero for five years post-implementation.
Main Methods:
- Developed and implemented an evidence-based VAP prevention bundle using the Six Sigma methodology (Define, Measure, Analyze, Improve, Control).
- The bundle included oral care, airway suctioning, endotracheal tube cuff pressure management, aspiration precautions, and head-of-bed elevation.
- Reinforced knowledge and practices through multidisciplinary education and bedside audits with just-in-time teaching.
Main Results:
- Achieved a reduction in the annual VAP rate from 7.86 to 1.16 events per 1000 ventilator days within two years.
- VAP bundle compliance ranged from 86% to 99%.
- Experienced a 10-quarter period with zero VAP events between 2012 and 2014.
Conclusions:
- The VAP prevention strategy, utilizing the Six Sigma methodology, led to a substantial and sustained decrease in VAP rates.
- This success was maintained despite unit expansion, the opening of a new unit, and significant staff turnover.
- VAP rates remained low, at 0.86 in 2016 and zero through June 2017, demonstrating long-term effectiveness.
Background:
Ventilator-associated pneumonia (VAP) increases morbidity, mortality, and health care costs.
Objective:
To reduce the VAP rate in the pediatric/cardiac intensive care unit to fewer than 2 events per 1000 ventilator days within 2 years and to sustain a rate near 0 for the next 5 years.
Methods:
An evidence-based VAP prevention bundle was developed and implemented by an interprofessional team using the Six Sigma Define, Measure, Analyze, Improve, Control methodology. The mixed unit's 5-element VAP prevention bundle consisted of age-appropriate oral care, proper airway suction technique, maintenance of safe endotracheal-tube cuff pressures, aspiration precautions, and head-of-bed elevation. Knowledge and practice were reinforced through multidisciplinary education and one-on-one teaching. Practice compliance was monitored through regular, unannounced bedside audits linked to just-in-time teaching.
Results:
Within 2 years, the annual VAP rate fell from 7.86 to 1.16 events per 1000 ventilator days; VAP bundle-element compliance ranged from 86% to 99%. There were no VAP events during a 10-quarter period in 2012 through 2014.
Conclusions:
Development, implementation, and revision of a VAP prevention strategy using the Define, Measure, Analyze, Improve, Control methodology was associated with marked, sustained reduction in VAP rates, notably during the unit's expansion from 16 to 24 beds, the opening of a pediatric cardiothoracic unit, and the hiring of more than 80 new nurses. After 7 years, the VAP rate continues to be low at 0.86 for 2016 and 0 through June 2017.
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