Preventing Ventilator Associated Pneumonia: Innovative Strategies Beyond the Bundle

Purpose:
In 2011, the critical care units began to realize an increase in VAP rates, following two successful years of reduction. The VAP committee reconvened to review evidence, ensure best practice, and develop creative and innovative strategies to utilize across all pediatric critical care units.

Significance:
Patients with mechanically-assisted ventilation have a high risk of developing healthcare-associated pneumonia. Strategies for sustainability are not well documented in literature, leading this organization to utilize innovative and creative thinking to develop ideas to sustain positive results.

Strategy and Implementation:
A multidisciplinary critical care group including critical care nurses, leaders, educators, respiratory therapists, physicians, and infection preventionists met monthly to discuss creative strategies that could be implemented across all three critical care units to emphasize importance of the VAP care bundle on the prevention of the HAI ventilator associated pneumonia and ensure the importance of this practice remained a focus to all critical care staff caring for the pediatric critical care patients. This group generated multiple ideas that included; development of a “real-time VAP audit”, quarterly VAP activities with all critical care staff, development of a “Days Since Last VAP” poster, development and tracking of patient and family education, and VAP bundle documentation in the electronic record.

Evaluation:
Initiative implementation began in October, 2011 through January, 2013. One VAP was confirmed on November 14, 2011. Critical care has not had a confirmed VAP for 444 days as of January 31, 2013 and demonstrated a reduction in VAP rate from 0.68 January YTD FY11 to .06 January YTD FY13.

Implications for Practice:
The innovative strategies implemented by our organization's multidisciplinary critical care VAP committee could be easily replicated and initiated in other organizations that provide care for ventilated patients.