The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts


David Heitz1, Stephanie Sparacino1, Charlene Cunningham3, Donna Peace5, Jana Stockwell2,4; 1Respiratory Care, Children’s Healthcare of Atlanta, Atlanta, GA; 2Department of Pediatrics, Emory University School of Medicine, Atlanta, GA; 3Pediatric Intensive Care Unit, Children’s Healthcare of Atlanta, Atlanta, GA; 4Critical Care Medicine, Children’s Healthcare of Atlanta, Atlanta, GA; 5Infection Control, Children’s Healthcare of Atlanta, Atlanta, GA

Introduction: Our organization consists of 525 total inpatient pediatric beds, 147 of which provide ICU level care (ventilator capable), spread among 7 units in 2 hospitals. In 2005, each ICU adopted and implemented the IHI VAP bundle recommendations for which supporting evidence focused on adult ventilated patients. The year following implementation our VAP rate (VAPs/1000 vent days) decreased but rose again in 2008 and 2009 (fig 1). In August 2009, a multidisciplinary group convened to both improve compliance with our current VAP bundle and to discuss additional VAP prevention practices to be implemented. We report the process of implementation and our VAP rates before and after. Method: Our team of RCPs, RNs, MDs, and representatives from infection control and clinical informatics, met monthly. Reviewing the literature a list of clinical practices was created. Twenty three practices were adopted and divided into 4 sections: Basic Hygiene (5); Management of the Artificial Airway (4); Ventilator Management (8); Secretion Aspiration Management (6). Each was ranked for the strength of its supporting evidence1 then scrutinized for age and clinical exclusions. During the first 8 months of 2010 we incrementally implemented 21 practices into the care routines of each ICU. To serve as a reminder and create an audit trail, a VAP section was added to the electronic medical record (EMR). A RCA (root cause analysis) tool was modified from the Pediatric Affinity Group2 and used to review the EMR documentation of each VAP patient. Results: Prior to implementation our VAP rates for 2007, 2008 and 2009 were 2.31, 1.42 and 0.72 respectively with zero VAPs for 39% of 36 months. Post implementation our VAP rates diminished to 0.06 and 0.17 for years 2010 and 2011 respectively with zero VAPs for 85% of 27 months. We measured general VAP documentation compliance of the EMR for 3 months in 77% (2010), 81% (2011) and 85% the first three months of 2012. Practices not implemented are related to artificial airway management which involves acquiring equipment and training additional disciplines outside of the ICUs. Use of our RCA tool to review the EMR of VAP patients has consistently implicated non-compliance with routine mouth care and HOB elevation. Conclusion: Implementing adult evidence-based VAP practices can also reduce VAP rates for pediatric ventilator patients. 1 US Preventive Services Task Force 2 How-to-Guide Pediatric Supplement Ventilator Associated Pneumonia Sponsored Research - None Figure 1 Combined monthly unit VAP rates for each hospital