Original Paper

European Journal of Pediatrics

, Volume 171, Issue 2, pp 323-330

Reducing VAP by instituting a care bundle using improvement methodology in a UK Paediatric Intensive Care Unit

  • Joe BrierleyAffiliated withPaediatric and Neonatal Intensive Care Unit, Great Ormond Street Hospital for Children NHS Trust Email author 
  • , Lorraine HigheAffiliated withPaediatric and Neonatal Intensive Care Unit, Great Ormond Street Hospital for Children NHS Trust
  • , Sarah HinesAffiliated withPaediatric and Neonatal Intensive Care Unit, Great Ormond Street Hospital for Children NHS Trust
  • , Garth DixonAffiliated withDepartment of Microbiology, Great Ormond Street Hospital for Children NHS Trust

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Abstract

Preventing ventilator-associated pneumonia (VAP) is one of the Department of Health Saving Lives initiatives. We describe the institution of a purpose-designed bundle of care in a tertiary paediatric ICU based on the available literature as part of our hospital’s transformation project into reducing health-care-associated infection. A nurse-led VAP surveillance programme is in place, and we used this to compare VAP incidence before and after commencing a series of care measures aimed at reducing VAP as part of an overall drive for patient safety. The diagnostic criteria, surveillance methods and rates of VAP (5.6 per 1,000 ventilator days) have been previously reported. Nurse educators were added to the original core group, as a key feature is buy in from nursing staff. All nursing staff had multiple training opportunities, and VAP project education became a routine part of staff induction. The major features of the bundle of care were (1) elevation of bed to maximum (target, 45°; however, no beds currently permit this so achieved 20–30°), (2) mouth care using chlorhexidine or tooth brushing, (3) clean suctioning practice, (4) all patients not on full feeds commenced on ranitidine and (5) 4-hourly documentation. Compliance with these aspects was monitored. After the institution of the bundle, no paediatric case of VAP was recorded over a 12-month period, according to a priori definitions. One adult patient had a confirmed VAP over the same time interval. A paediatric VAP bundle was associated with reduced VAP on a UK PICU.

Keywords

Paediatric intensive care Health-care-associated infection Ventilator-associated pneumonia Improvement methodology