216. Implementing a VAP Bundle in Conjunction with a Compliance Audit Program Reduces VAP Rates in the NICU
Session: Poster Abstract Session: Criticare, HAIs: Pneumonia and Chlorhexidine
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
  • VAP posterproposed final-4.pdf (1.5 MB)
  • Background:

    Ventilated Associated Pneumonia (VAP) is a cause of nosocomial infections in ventilated patients in the NICU.  To reduce VAP in our NICU, we instituted a VAP bundle using evidence-based best practice. Following a period of education, we created an audit program to measure compliance to the VAP bundle.


    The following parameters were included in our VAP bundle:  1) date and change resuscitation bag every 7 days; 2) oral care every 4-6 hours; 3) use of Biotene; 4) change ventilator circuits every 30 days, or if visibly soiled; 5) change in-line suction every 7 days; 6) change suction tubing every 24 hours; 7) change suction canisters every 7 days. Respiratory therapists were trained on the implementation of the bundle. Following this period of education, an audit program was created to measure compliance. The audit program encouraged a minimum of 3 audits monthly by RT staff and recognized individuals who completed the most in any given quarter. The auditor assessed bedside equipment and documentation in the EMR. Audits were tabulated and presented quarterly at RT staff meetings. Meetings provided opportunities to review VAP rates and bundle compliance and to reassess the VAP bundle. VAP rates were determined by hospital infection control in collaboration with an attending neonatologist.


    In a 24 month period there were an average of 30 audits and 250 ventilator days monthly. VAP rates decreased from a baseline of 1.9 to 0.5 per 1000 ventilator days (a 74% reduction). Compliance with the VAP bundle improved from 76% to 88% during the same time. The VAP bundle was implemented as a standard of care and adopted into our Policy and Procedures.  The auditing tool provided measures of compliance with each component of the bundle. Quality improvement efforts focused on areas deemed poorly compliant. Staff education and feedback at regularly scheduled meetings was key to the success of the program.


    Implementation of a VAP bundle in conjunction with a compliance audit program significantly decreased our incidence of VAP in the NICU.  This practice has proven to be effective at our facility and should be considered at other institutions.

    Mark Speziale, MD, PhD1, Ellen Knodel, RRT-NPS2 and Nikki Tarantino, RRT2, (1)Neonatology, Rady Children's Hospital San Diego, San Diego, CA, (2)Respiratory Care, Rady Children's Hospital San Diego, San Diego, CA


    M. Speziale, None

    E. Knodel, None

    N. Tarantino, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.