Prevention of VAP in the Yale New Haven Children's Hospital PICU

Purpose:
To decrease the incidence of ventilator acquired pneumonia (VAP)in the Pediatric Intensive Care Unit (PICU)at Yale New Haven Hospital.VAP was chosen because utilizing interventions to decrease VAP we can decrease length of ICU stay with an end goal of decreasing total length of hospital stay.

Significance:
By decreasing the incidence of VAP we improve patient care, improve patient satisfaction and decrease patients length of stay (LOS) which would result in an overall cost savings.

Strategy and Implementation:
We implemented a VAP bundle and educated our staff with a video production.The VAP bundle included: Head of bed(HOB)elevation 30-45 degrees for children/adolescent, 15-30 degrees for infants,an oral care protocol, use of in-line suction or port, and a Yankauer suction in a clean plastic bag at the bedside when not in use.Our team includes nurses,respiratory therapists,M.D.s & PCAs.Respiratory therapists are responsible for: on admission placing either an in-line suction system or port through which to suction as well as changing the systems every 24 hours. Nurses are also responsible for ensuring the in-lines are available, the head of the bed is elevated to correct height and monitoring that mouth care is performed and doccumented 6 times in a 24 hour period (every 4 hours).PCAs are instrumental because they organize mouth care baggies for each ventilated patient to have at their bedside. They individualize the bags based on whether or not the child has teeth.

Evaluation:
We have showed marked improvement in the areas of: head of bed elevation, keeping mouth care baggies at each bedside, and frequency of mouth care. Audits are preformed daily with feedback presented to the staff on a routine basis.Re-education is ongoing.Our plan is to include LOS stats to our audit.

Implications for Practice:
By decreasing the incidence of VAP in the ICU we improve patient care, decrease length of ICU stay decrease overall LOS for ventilated patients, resulting in a decrease cost per patient stay.More importantly it is another way we strive to improve quality & safety of care for our patients.