Reduction of Ventilator Associated Pneumonia in the Pediatric Intensive Care Unit

Ventilator Associated Pneumonia is the most common hospital acquired infection among patients requiring mechanical ventilation.  It increases the chance of death, prolongs the amount of time spent in the hospital, and increases costs for medical care.  There are several strategies that can reduce the chance that a patient will acquire VAP.  When these strategies are grouped and implemented together, it is referred to as a ‘Care Bundle’. Care bundles are encouraged by most national organizations including the Institute for Healthcare Improvement (IHI) and the Centers for Disease Control and Prevention (CDC).   When clinicians follow the Care Bundle guidelines for every patient it has been proven that this can reduce or eliminate VAP. 

It is not uncommon for patients in the Pediatric Intensive Care Unit (PICU) to be placed on ventilators to help them breathe while they are very ill. It used to be thought that being on a ventilator would inevitably lead to some patients developing ventilator associated pneumonia. The doctors and nurses in the PICU at Kapiolani worked to customize a VAP Reduction Care Bundle which aimed to eliminate VAP for these patients.  They decided to look first at historic data.  It is very tricky to diagnose VAP for patients already discharged from the hospital, but the team concluded that while it was not possible to retrospectively determine the exact number of VAP cases, there had been between 4 and 9 VAP cases per year in the PICU.
 
In March 2005, the VAP Reduction Care Bundle was integrated into the daily routine of care for all patients.  The changes greatly impacted outcomes for PICU patients.  There were zero cases of VAP in 2005, one case in 2006, and as of September 2007 there were zero cases for 2007.  The team was recognized by its peers for this outstanding project when it received an award of excellence in 2007 at a statewide conference on quality and patient safety.