Abstract
Background: Ventilator-associated pneumonia (VAP) can prolong ventilator days, increase mortality rate, and directly influence patient outcomes. VAP prevention bundles have proven effective in decreasing the VAP rate, however VAP remains one of the most common causes of nosocomial infections and death in the ICU. Current challenges in the management of VAP involve complexity of, the absence of effective preventative strategies, and the rise in antibiotic resistance.1 From 1/1/2016 to 12/21/2017, our VAP rate in the PICU ranged from 6.5-1.4 per 1,000 ventilator days. In 2018, we implemented VAP bundle elements and saw a decline in our VAP rate to 0/1,000 vent days in 2018. With an increase in our rate to 1.4 at the end of first quarter 2019, our PICU set out to address patients with a high-risk of developing a VAP to maintain our rate of zero.
Methods: An IRB approved retrospective study showed that our VAP rate of 0 in 2018 was ended by a patient who had many difficulties completing elements of our VAP bundle. The interdisciplinary VAP Prevention Team (RT, MD, IP, RN) implemented a pre-swarm process on patients determined to be high-risk for developing a VAP. VAP pre-swarm screening were respiratory-driven and performed on every mechanically ventilated patient upon arrival to the ICU and once every shift by the bedside PICU RT. Patients identified by the RT as high risk during the VAP pre-swarm initiated the VAP Prevention Team to meet, discuss the patient case, highlight their risk and identify mitigation strategies. VAP rate was analyzed again from Q2 2019 to Q2 2020 after the pre-swarm process was in place for one year.
Results: PICU 2018 rolling VAP rate was 0/1000 ventilator days with an increase to 1.4 after Q1 2019. After implementation of the RT-driven VAP pre-swarm identification process, the VAP rate in our PICU from 4/1/2019-4/1/2020 decreased to 0 and has been maintained in 2020 as of the time of publication. See Figure 1 for quarterly data.
Conclusions: A respiratory-driven pre-swarm identification process increased awareness and aided in a more proactive approach to decreasing VAP in our PICU. Further research must be done to evaluate ongoing effectiveness in conjunction with already-established prevention techniques.
Figure 1 displays the VAP rate per 1,000 ventilator days in our Pediatric Intensive Care Unit
Footnotes
Commercial Relationships: K. Burr- Patient Trainer, Hill-Rom.
- Copyright © 2020 by Daedalus Enterprises
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