A multidisciplinary approach to decrease ventilator-associated pneumonia in a pediatric intensive care unit

BACKGROUND: Ventilator-associated pneumonia (VAP) is a significant complication in critically ill, intubated pediatric patients. While there are data demonstrating effective interventions in decreasing the incidence of VAP in adults, there is little data regarding interventions to decrease VAP in the pediatric population. We describe a multidisciplinary approach to decrease VAP in a pediatric intensive care unit (PICU). METHODS: The PICU at St. Louis Childrenʹs Hospital is a 26-bed multidisciplinary unit. In September 2003, education regarding the pathophysiology and risk factors of VAP was given to PICU physicians, nurses, and respiratory therapists in the form of educational flyers, a self-study module, and lectures. VAP was defined according to CDC NNIS definitions, and the rate expressed as number of VAP episodes per 1000 ventilator (vent) days. In January 2004, a PICU team consisting of management, an intensivist, an infection control practitioner, an advanced practice nurse, staff nurses, and respiratory therapists was assembled to identify and implement strategies to decrease the incidence of VAP. Interventions known to affect the incidence of VAP in adults were targeted. These included: elevation of head of bed (HOB) 30 degrees, use of in-line suction (minimizing breaks into the system), wearing gloves while draining the ventilator condensate away from the patient, and emphasizing hand hygiene before and after handling the ventilator/ventilator circuit. VAP rates for the PICU were shared with physicians, nurses, and respiratory therapists on a monthly basis and posted in areas accessible to staff. Pre- and post-intervention VAP rates were compared using chi square. RESULTS: The baseline VAP rate in 2002, pre intervention, was 9.1 (41 VAP/4509 vent days). In 2003, the rate was 8.8 (33 VAP/3741 vent days). In 2004, the rate decreased to 3.3 (14 VAP/4202 vent days). This represents a decrease of 42% from 2003 (p=0.001). CONCLUSION: A multidisciplinary team approach with focused interventions, including educational programs, can decrease VAP in the PICU. Similar to findings in adult populations, elevating the HOB 30 degrees, avoiding interruption of the ventilator circuit, and wearing gloves when handling ventilator condensate can decrease the incidence of VAP. It is especially important to involve members of the patient care team in addition to infection control in order to implement and monitor interventions.