Interprofessional Approach to the Sustained Reduction in Ventilator-Associated Pneumonia in a Pediatric Intensive Care Unit

McBeth, Cheryl Lynne; Montes, Rosa Solis; Powne, Amy; North, Sopon Elizabeth; Natale, JoAnne E.

doi:10.4037/ccn2018121

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Feature| December 01 2018

Interprofessional Approach to the Sustained Reduction in Ventilator-Associated Pneumonia in a Pediatric Intensive Care Unit

Cheryl Lynne McBeth, MS, BSN, RN, CCRN;

Cheryl Lynne McBeth, MS, BSN, RN, CCRN

Cheryl Lynne McBeth is a nurse manager for the pediatric intensive care unit (PICU), pediatric cardiac intensive care unit (PCICU), and Critical Care Transport Team, University of California, Davis, Children’s Hospital, Sacramento, California. Rosa Solis Montes is clinical nurse III, University of California, Davis, Children’s Hospital. She has been the cochair or chair of the No VAP committee since 2010. Amy Powne is Fetal Care and Treatment Center registered nurse coordinator at University of California, Davis, Children’s Hospital. Sopon Elizabeth North is clinical nurse III, University of California, Davis, Children’s Hospital. She currently is chair of the PICU/PCICU Hospital-Acquired Infection Committee. JoAnne E. Natale is professor of clinical pediatrics, Pediatric Critical Care, Children’s Hospital Quality & Safety, and director of quality and safety, University of California, Davis, Medical Center.

Corresponding author: Cheryl Lynne McBeth, MS, BSN, RN, CCRN, University of California, Davis, Children’s Hospital, 2315 Stockton Blvd., Sacramento, CA 95677 (email: [email protected]).

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Rosa Solis Montes, BSN, RN;

Rosa Solis Montes, BSN, RN

Cheryl Lynne McBeth is a nurse manager for the pediatric intensive care unit (PICU), pediatric cardiac intensive care unit (PCICU), and Critical Care Transport Team, University of California, Davis, Children’s Hospital, Sacramento, California. Rosa Solis Montes is clinical nurse III, University of California, Davis, Children’s Hospital. She has been the cochair or chair of the No VAP committee since 2010. Amy Powne is Fetal Care and Treatment Center registered nurse coordinator at University of California, Davis, Children’s Hospital. Sopon Elizabeth North is clinical nurse III, University of California, Davis, Children’s Hospital. She currently is chair of the PICU/PCICU Hospital-Acquired Infection Committee. JoAnne E. Natale is professor of clinical pediatrics, Pediatric Critical Care, Children’s Hospital Quality & Safety, and director of quality and safety, University of California, Davis, Medical Center.

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Amy Powne, MSN, RN, PCNS-BC;

Amy Powne, MSN, RN, PCNS-BC

Cheryl Lynne McBeth is a nurse manager for the pediatric intensive care unit (PICU), pediatric cardiac intensive care unit (PCICU), and Critical Care Transport Team, University of California, Davis, Children’s Hospital, Sacramento, California. Rosa Solis Montes is clinical nurse III, University of California, Davis, Children’s Hospital. She has been the cochair or chair of the No VAP committee since 2010. Amy Powne is Fetal Care and Treatment Center registered nurse coordinator at University of California, Davis, Children’s Hospital. Sopon Elizabeth North is clinical nurse III, University of California, Davis, Children’s Hospital. She currently is chair of the PICU/PCICU Hospital-Acquired Infection Committee. JoAnne E. Natale is professor of clinical pediatrics, Pediatric Critical Care, Children’s Hospital Quality & Safety, and director of quality and safety, University of California, Davis, Medical Center.

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Sopon Elizabeth North, BSN, RN, CCRN;

Sopon Elizabeth North, BSN, RN, CCRN

Cheryl Lynne McBeth is a nurse manager for the pediatric intensive care unit (PICU), pediatric cardiac intensive care unit (PCICU), and Critical Care Transport Team, University of California, Davis, Children’s Hospital, Sacramento, California. Rosa Solis Montes is clinical nurse III, University of California, Davis, Children’s Hospital. She has been the cochair or chair of the No VAP committee since 2010. Amy Powne is Fetal Care and Treatment Center registered nurse coordinator at University of California, Davis, Children’s Hospital. Sopon Elizabeth North is clinical nurse III, University of California, Davis, Children’s Hospital. She currently is chair of the PICU/PCICU Hospital-Acquired Infection Committee. JoAnne E. Natale is professor of clinical pediatrics, Pediatric Critical Care, Children’s Hospital Quality & Safety, and director of quality and safety, University of California, Davis, Medical Center.

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JoAnne E. Natale, MD, PhD

Cheryl Lynne McBeth is a nurse manager for the pediatric intensive care unit (PICU), pediatric cardiac intensive care unit (PCICU), and Critical Care Transport Team, University of California, Davis, Children’s Hospital, Sacramento, California. Rosa Solis Montes is clinical nurse III, University of California, Davis, Children’s Hospital. She has been the cochair or chair of the No VAP committee since 2010. Amy Powne is Fetal Care and Treatment Center registered nurse coordinator at University of California, Davis, Children’s Hospital. Sopon Elizabeth North is clinical nurse III, University of California, Davis, Children’s Hospital. She currently is chair of the PICU/PCICU Hospital-Acquired Infection Committee. JoAnne E. Natale is professor of clinical pediatrics, Pediatric Critical Care, Children’s Hospital Quality & Safety, and director of quality and safety, University of California, Davis, Medical Center.

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Crit Care Nurse (2018) 38 (6): 36–45.

https://doi.org/10.4037/ccn2018121

BACKGROUND

Ventilator-associated pneumonia (VAP) increases morbidity, mortality, and health care costs.

OBJECTIVE

To reduce the VAP rate in the pediatric/cardiac intensive care unit to fewer than 2 events per 1000 ventilator days within 2 years and to sustain a rate near 0 for the next 5 years.

METHODS

An evidence-based VAP prevention bundle was developed and implemented by an interprofessional team using the Six Sigma Define, Measure, Analyze, Improve, Control methodology. The mixed unit’s 5-element VAP prevention bundle consisted of age-appropriate oral care, proper airway suction technique, maintenance of safe endotracheal-tube cuff pressures, aspiration precautions, and head-of-bed elevation. Knowledge and practice were reinforced through multidisciplinary education and one-on-one teaching. Practice compliance was monitored through regular, unannounced bedside audits linked to just-in-time teaching.

RESULTS

Within 2 years, the annual VAP rate fell from 7.86 to 1.16 events per 1000 ventilator days; VAP bundle-element compliance ranged from 86% to 99%. There were no VAP events during a 10-quarter period in 2012 through 2014.

CONCLUSIONS

Development, implementation, and revision of a VAP prevention strategy using the Define, Measure, Analyze, Improve, Control methodology was associated with marked, sustained reduction in VAP rates, notably during the unit’s expansion from 16 to 24 beds, the opening of a pediatric cardiothoracic unit, and the hiring of more than 80 new nurses. After 7 years, the VAP rate continues to be low at 0.86 for 2016 and 0 through June 2017.

2018

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Interprofessional Approach to the Sustained Reduction in Ventilator-Associated Pneumonia in a Pediatric Intensive Care Unit

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