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Updated: May 17, 2026
Murine Oropharyngeal Aspiration Model of Ventilator-associated and Hospital-acquired Bacterial Pneumonia
Published on: June 28, 2018
Efficacy of a Chlorhexidine-Based Oral Prevention Protocol in Reducing Ventilator-Associated Pneumonia in Pediatrics:
Ivonne Portaccio1,2, Orazio Genovese1, Federico De Leonardis1
1Pediatric Intensive Care Unit and Trauma Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.
Insights
A new prevention bundle significantly reduced ventilator-associated pneumonia (VAP) in pediatric intensive care. This strategy, including chlorhexidine oral care, lowered VAP incidence by 69.5% in mechanically ventilated children.
Area of Science:
- Pediatric Critical Care Medicine
- Infectious Disease Prevention
- Hospital-Acquired Infections
Background:
- Ventilator-associated pneumonia (VAP) is a common nosocomial infection in pediatric intensive care units (PICUs).
- Limited evidence-based prevention strategies exist specifically for pediatric patients.
- VAP poses a significant threat to critically ill children requiring mechanical ventilation.
Purpose of the Study:
- To assess the effectiveness of a multimodal VAP prevention bundle in reducing VAP incidence.
- To evaluate the role of 0.12% chlorhexidine oral care within the bundle for pediatric patients.
- To determine the impact of the VAP bundle on VAP-related outcomes in a PICU setting.
Main Methods:
- A controlled before-and-after study conducted in a PICU from January 2016 to May 2019.
- Inclusion criteria: pediatric patients (<18 years) requiring mechanical ventilation for ≥48 hours.
- The intervention bundle included age-stratified oral hygiene (0.12% chlorhexidine or saline), head-of-bed elevation, microbiological surveillance, and daily weaning assessment.
Main Results:
- VAP incidence decreased by 69.5% (from 20% to 6.1%) following bundle implementation.
- VAP rate reduced from 3.3 to 1.0 VAP per 100 ventilator-days (P=.01).
- The bundle significantly reduced VAP risk (adjusted OR 0.23; P=.022) and VAP-associated mortality (0% vs 3.8%).
Conclusions:
- Structured implementation of an evidence-based VAP prevention bundle can significantly decrease VAP in pediatric intensive care.
- The multimodal approach, incorporating chlorhexidine oral care, shows promising results in reducing VAP incidence and associated mortality.
- Larger multicenter studies are needed to validate these findings due to the modest sample size.
Abstract:
BackgroundVentilator-associated pneumonia (VAP) remains the second most common nosocomial infection in pediatric intensive care units, yet evidence-based prevention strategies specific to children remain limited.ObjectiveTo evaluate the efficacy of a multimodal VAP prevention bundle incorporating 0.12% chlorhexidine oral care in reducing VAP incidence among mechanically ventilated pediatric patients.MethodsControlled before-after study in the Gemelli PICU (January 2016-May 2019) including 162 patients aged <18 years requiring mechanical ventilation ≥48 h: 80 historical controls (2016-2017) and 82 in the intervention group (2018-2019). The bundle comprised age-stratified oral hygiene (0.12% chlorhexidine for age >2 years, saline for younger children), head-of-bed elevation 30°-40°, biweekly microbiological surveillance, and daily weaning assessment. Primary outcome was VAP incidence using CDC/NHSN criteria.ResultsBundle implementation was associated with a 69.5% reduction in VAP incidence (20% to 6.1%, P = .01), decreasing from 3.3 to 1.0 VAP/100 ventilator-days. The number needed to treat was 7.2 patients. Protocol implementation reduced VAP risk (adjusted OR 0.23; 95% CI 0.07-0.81; P = .022). VAP-associated mortality was lower in the intervention group (0% vs 3.8% in controls). Duration of mechanical ventilation remained the strongest risk factor (OR 1.18 per day; 95% CI 1.08-1.29; P < .001). Pseudomonas aeruginosa was identified in 57.1% of VAP cases, with polymicrobial infections in 52.4%. All isolates remained antibiotic-susceptible.ConclusionsStructured implementation of an evidence-based VAP bundle may contribute to significant reductions in preventable VAP in pediatric intensive care. While findings are promising, the modest sample size necessitates cautious interpretation and validation through larger multicenter studies.
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