Zap the VAP

Purpose:
In the Pediatric Intensive Care Unit the rate of ventilator associated pneumonias (VAP) per 1000 ventilator days was 6.8 in 2010. A PI team was chartered and using standardized DMAIC methodology implemented rapid cycle interventions to develop a reliable process involving a VAP bundle.

Significance:
Ventilator associated pneumonia is the second most common hospital acquired infection in pediatric intensive care units. By improving our guidelines and standards related to VAP prevention measures strive to deliver the highest quality of care, improve mortality and reduce hospital cost.

Strategy and Implementation:
Fishbone diagrams were used to capture perceived root causes. The DMAIC process with sequential PDCA cycles was used to guide improvement. In general, the implementation plan was to: Assess how well the team performed VAP prevention activities already selected by the PICU Incorporate Chlorhexidine gluconate into the oral care routine for ventilated PICU patients twice a day and validate that routine oral care was performed and documented every four hours Improve real time analysis of VAP and VAP prevention strategies Break down silos and improve communication, raise awareness and accountability Throughout the VAP prevention journey all key players identified remained engaged. This was obtained through excellent communication and problem identification sharing. Frequent emails, messages, and posters were available for all to keep track of our challenges and progress. Celebrations occurred upon achieving 90 days without a VAP as noted on poster board that counted days of no VAP.

Evaluation:
Compliance with providing oral care every 4 hours and using chlorhexidine BID was assessed until reached greater than 90%. The VAP rate decreased to 0.92 per 1000 days with evidence of statistical process control.Time between Events shows 342 days without a ventilator associated pneumonia.

Implications for Practice:
The VAP bundle and hardwiring a culture committed to zapping a VAP has resulted in a significant decrese in VAPs. The results attained highlight the importance of the bundle, which includes the use of chlorhexidine twice a day and oral care every 4 hours. The PICU continues to adhere to the bundle.