Multidisciplinary quality improvement initiative to reduce ventilator-associated tracheobronchitis in the PICU.

Lower airway infection is among the leading causes of hospital-acquired infection in the PICU (1). Pediatric ventilator-associated pneumonia (VAP) is associated with increased ventilation days, ICU and hospital lengths of stay, and mortality (2, 3). In addition to VAP, the Centers for Disease Control and Prevention (CDC) (4, 5) have defined criteria for ventilator-associated airway infection without radiographic evidence of new pneumonia. This has been termed as “ventilator-associated tracheobronchitis” (VAT). VAT may be more prevalent than VAP in children and may be an important source of PICU morbidity (6, 7). Although quality improvement measures have been successfully employed to reduce the incidence of VAP, it is unknown whether quality-improvement measures designed to prevent VAP will also reduce the incidence of VAT. In 2009, as a means to capture a more complete spectrum of nosocomial airway infection, our hospital began tracking VAT rates in addition to VAP rates in our PICU. By early 2010, VAT rates far exceeded VAP rates in our unit (3.9 cases per 1,000 ventilator days vs 0.3 cases per 1,000 ventilator days). In March of 2010, a multidisciplinary team was convened and tasked with creating and implementing a care bundle intended to reduce the incidence of ventilator-associated airway infection. The aim of this prospective quality improvement effort was to test the hypothesis that successful implementation of a care bundle to prevent ventilator-associated infection would reduce the incidence of VAT in PICU patients.