Evaluation of a Multi-Disciplinary Intervention to Reduce Incidence of Ventilator-Associated Pneumonia in a Pediatric Intensive Care Unit

Background: Ventilator-associated pneumonia (VAP) is a major cause of hospital morbidity, mortality, and increased health care costs1. Since multiple factors contribute to the high risk of ventilator-associated pneumonia, a multi-strategy approach is required to prevent such infections2. VAP care bundle implementation with education prepared according to evidence-based guidelines has been shown to decrease VAP rates. The role of the Respiratory Therapist is integral to the success of any VAP prevention bundle. We aimed to evaluate a multidisciplinary intervention model to reduce our PICU VAP rate. Methods: We identified that VAP was a common problem in our 24-bed tertiary PICU. We then initiated a multifaceted approach to design a program to reduce VAP. Hospital management, infection prevention, respiratory therapy (RT), physicians, and nursing (RN) developed a core group to plan an approach to reduce VAP rates. A bundle of items that previously existed was edited and enhanced, and rigid audits were done to ensure compliance. We developed a twice-daily protocol-driven spontaneous breathing trial (SBT). The physician provided education and created an order set to use within the electronic medical record (EMR) to ensure all bundle elements were ordered. The RT group provided training and began the SBT process. EMR modifications ensured identification of VAP risks. A formal evaluation process was initiated for each VAP, including a multidisciplinary swarm of the event within 48 hours and distribution of findings. We also began a protocolized identification process by bedside RTs of high-risk patients and began having a pre-swarm" on these patients to highlight their risk and identify mitigation strategies. Results: Quarterly VAP rate per 1000 vent days decreased from 4.8 the quarter before the intervention to 0, 1.4, 0, 0, 0, 0 for the following quarters. The number of audits of bundle compliance increased as well as adherence. Conclusions: We instituted a multidisciplinary long-term bundled approach to reduce VAP in our PICU. Using this comprehensive program of interventions, education and ongoing evaluation, we were able to significantly reduce VAP and achieve a zero rate for the past year (2018). References: 1. Galal et al. VAP: incidence, risk factors and outcome in pediatric intensive care units. J Clin Diagn Res 2016;10(6):SC06-SC11. 2. Alsadat R et al. Use of VAP bundle and statistical process control chart to decrease VAP rate in Syria. Avicenna J Med 2012;2(4):79-83.