G222 Does the implementation of a ventilator associated pneumonia (vap) care bundle reduce incidence of vap in picu?

Abstract

Ventilator associated pneumonia (VAP) is pneumonia that develops 48 h after intubation. VAP is the second most common nosocomial infection in PICU patients and is associated with increased duration of ventilation, ICU stay, hospital stay, and cost. VAP is a preventable healthcare acquired infection and a Department of Health (1999) Saving Lives initiative. This poster aims to discover whether the introduction of a VAP care bundle (VCB) is effective at reducing VAP rates in PICU. A search of various databases was undertaken, including MedLine, Pubmed, CINHAL, EBSCO, using relevant PICO key words. 3 paediatric research studies were found and 4 published presentations of data. Due to the limited amount of paediatric data the search was extended to include adult studies, producing 12 valid studies. Results conclusively showed a decrease in VAP following the introduction of a VAP care bundle. Paediatric studies showed a reduction ranged from 76%–100% (91% average), with 210 days – 3 years VAP free with associated decreases in length of stay and cost. Adult studies found a 62% average decrease in VAP, with higher reduction in VAP associated with increased compliance. Due to limitations of the observational designs used, various implementation strategies, and lack of consistency in VCB elements, it is difficult to determine what is responsible for the measured outcomes. However the weight of evidence showing VAP reduction with VCB use suggests a strong relationship. And although the evidence is not at the highest experimental level, it is at the highest ethically acceptable level. It should also be taking into consideration that each individual bundle component is supported by its own breadth of high level experimental evidence. Routine use of VCB is widespread in adult ICUs, and the adult and paediatric literature agree that care bundles are an effective method for reducing the incidence of ventilator associated pneumonia. Therefore in absence of any contradictory data, care bundles should be adopted in paediatric intensive care practice. Further research is required to examine individual elements of the paediatric VCB; but with a synchronised team approach, VCB can result in continued reductions in VAP, length of stay, and costs.