Cases of Ventilator-Associated Pneumonia
Rate of Ventilator-Associated Pneumonia (VAP) per 1,000 Ventilator Days
Ventilator-associated pneumonia (VAP) is the leading cause of morbidity in adult ICUs and the second most common hospital-acquired infection in pediatric ICUs nationally. Published literature documents that VAP occurs in about 5 percent of mechanically ventilated children, and of those children who acquire VAP in the hospital almost 20 percent die.
The VAP initiative at Cincinnati Children's Hospital Medical Center was a collaborative improvement effort among our pediatric, cardiac and newborn ICUs, comprising 99 beds. The collaborative approach accelerated learning and quickly spread best practices among the three ICUs. The improvement team included doctors, nurses and respiratory therapists, as well as infection control and quality improvement staff.
The team's goal was to reduce VAPs by 50 percent in each of the ICUs and sustain these performance levels for at least two consecutive quarters. The results far exceeded the goal.
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March 2008 |
Ventilator Associated Pneumonia (VAP) Combined: How often do patients acquire pneumonia as a result of being on a ventilator?
(Rate of pneumonia detected per 1,000 ventilator days in the Regional Center for Newborn Intensive Care (RCNIC), Cardiac Intensive Care Unit (CICU), and the Pediatric Intensive Care Unit (PICU))How often do patients acquire pneumonia as a result of being on a ventilator?
(Rate of pneumonia detected per 1,000 ventilator days in the Regional Center for Newborn Intensive Care (RCNIC), Cardiac Intensive Care Unit (CICU), and the Pediatric Intensive Care Unit (PICU))
View our performance over time. (.pdf, 26k) |
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Cincinnati Children's Develops Pediatric Techniques to Reduce Ventilator-Associated Pneumonia
To achieve this outcome, the improvement team implemented a pediatric bundle of care practices and a strategy to achieve near perfect adherence to process changes. Steps included:
- Placement of the head of the bed at a 30 degree angle, unless medically contraindicated.
- Respiratory therapists identified, tested and purchased new ventilator tubing with heated wire circuits. This equipment reduced condensation in the ventilator tubing. (Moist warm air is a breeding ground for the bacteria that result in pneumonia.)
- Staff found a vendor who produced a mouth-care kit that placed all needed materials in one, convenient package.
- Staff redesigned the workspace around the bedside to improve convenience for care providers and availability of needed supplies.
- Staff developed a care checklist. Respiratory therapists and nurses began working in partnership to review the checklist every four hours.
- There was real time Infection Control reporting of suspected cases and analysis of each confirmed VAP. Access to immediate information relevant to clinical decision-making helped the staff quickly generate improvement ideas to test and to incorporate recommended changes in practice.
- Progress charts indicating "days since last infection" were posted in all ICUs, and updated weekly to maintain a high level of awareness and motivation.
The combination of equipment and process changes along with education and awareness activities succeeded in dramatically improving the quality and consistency of care.
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Last updated May 2008.
