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Effect of ventilator care bundle for pediatric nurses on occurrence of ventilator-associated pneumonia among children
Hanaa Diab Khalfallah1,2, Nahed Alquwez3, Marwa Abd Elkreem Ibrahim4,5
1Faculty of Nursing, Cairo University, Cairo, Egypt. Hanaadiab0@gmail.com.
Insights
Implementing a ventilator care bundle (VCB) significantly reduced ventilator-associated pneumonia (VAP) in pediatric intensive care units. This evidence-based approach improved nurse knowledge and practices, leading to better patient outcomes and fewer VAP occurrences.
Area of Science:
- Pediatric Intensive Care
- Infectious Disease Prevention
- Healthcare-Associated Infections
Background:
- Ventilator-associated pneumonia (VAP) is a common healthcare-associated infection in pediatric intensive care units (PICUs).
- VAP affects 10% of pediatric patients on mechanical ventilation (MV), increasing morbidity and mortality.
- Effective strategies are needed to reduce VAP incidence in critically ill children.
Purpose of the Study:
- To evaluate the impact of a comprehensive ventilator care bundle (VCB) on VAP occurrence in pediatric patients.
- To assess changes in nurses' knowledge and practices following VCB implementation.
- To compare VAP rates between children receiving standard care and those under the VCB protocol.
Main Methods:
- A quasi-experimental design was employed at Cairo University Specialized Pediatric Hospital.
- A ventilator care bundle (VCB) including head-of-bed elevation, hand hygiene, sterile suctioning, and daily extubation readiness assessment was implemented.
- Data were collected using questionnaires, checklists, and the Clinical Pulmonary Infection Scale (CPIS) for 60 ventilated children and 30 nurses.
Main Results:
- Nurses demonstrated a significant increase in knowledge and improvement in practices after VCB implementation.
- A statistically significant difference in Clinical Pulmonary Infection Scale (CPIS) scores was observed between the study and control groups.
- The VCB intervention was associated with a reduction in VAP occurrence.
Conclusions:
- The ventilator care bundle (VCB) is effective in reducing VAP in pediatric intensive care settings.
- Educational programs and consistent application of VCB components are crucial for preventing VAP.
- Improving ventilator care quality through VCB implementation enhances patient safety and outcomes.
Background:
In pediatric intensive care units (PICUs), ventilator-associated pneumonia (VAP) is one of the most prevalent infections linked to healthcare. VAP affects 10% of children on mechanical ventilation (MV) and is associated with severe morbidity and mortality. The study aimed to evaluate the effect of the ventilator care bundle (VCB) on the occurrence of VAP among pediatric patients.
Method:
A quasi-experimental design was conducted at Cairo University Specialized Pediatric Hospital (CUSPH), including all children who had mechanical ventilation within 24 h. VAP rates were evaluated before and after the implementation of a comprehensive VCB, which included head-of-bed elevation to 30-45°, hand hygiene reinforcement, sterile suctioning and handling of respiratory equipment, daily evaluation of extubation readiness, peptic ulcer prophylaxis, and deep venous thrombosis prophylaxis. A convenience sample of 30 nurses and a purposive sample of 60 ventilated children in the PICU participated in the study. Data collection was performed using (1) structured interview sheets, (2) the Nurses' Knowledge Assessment Questionnaire (pre/post-test), (3) the Ventilator Bundle Checklist, and (4) the Clinical Pulmonary Infection Scale (CPIS).
Results:
There was a significant increase in nurses' level of knowledge before and after the implementation of the VCB (X² = 21.46, p ≤ 0.01). There was a statistically significant difference between the total mean scores of nurses' practices in the first and second checklist readings (p < 0.01). Additionally, there were statistically significant differences between children in the study and control groups regarding the clinical pulmonary infection score (p < 0.01). The total mean score on the CPIS was significantly different between the study group and the control group (t = - 3.692, p = 0.001).
Conclusion:
The study concluded that children who were cared for by nurses receiving VCB sessions were less likely to experience VAP compared to those in the control group.
Recommendation:
Educational programs and in-service training courses for pediatric nurses to improve the quality of ventilator care for children and reduce the occurrence of VAP are essential.
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