Preventative strategies of VAP: Lessons from a one year retrospective study

Abstract

Introduction: Ventilator-associated pneumonia (VAP) is a largely preventable complication of mechanical ventilation. Little is known about the current status of the VAP preventive strategies in a paediatric setting. Objective: To describe VAP preventative strategies implemented and documented by nurses in a paediatric intensive care unit (PICU). Methods: A retrospective review of electronic records was undertaken on all admissions attending a metropolitan PICU in Brisbane, Australia in 2015. The review was restricted to admissions that were intubated and mechanically ventilated greater than or equal to 48 hours. Nurses' hand hygiene compliance data was obtained from the Patient Safety and Quality Service, Children’s Health Queensland. Results: In total, 1713 mechanical ventilation days from 262 episodes of mechanical ventilation in 234 children were evaluated. The average frequency of oral hygiene performed in a 24 hour period was 4.9 times (SD=1.0); less than the 6 times per day expected based on unit protocol. While the performance of endotracheal suctioning was above the minimum expected frequency (8.6 times versus 4.0 times/day SD=2.6). Despite the median frequency of 1.8 times/day for cuff pressure checks being close to the expected value of twice daily, wide practice variation was identified with a range of 0 -12 times daily. Substantial variation also existed in the documentation of cuff pressure with the majority of staff ticking that the task was completed rather than documenting the precise value. Cuff pressure checks had a significant relationship with VAP occurrence (p=0.001). The median frequency of performing head of bed elevation, the average of ventilator circuit checks and hand hygiene compliance among PICU nurses was 22,17 (SD=6.6) times/day and 86.4% respectively. Conclusion(s): Although the documented practices of VAP preventative strategies were close to unit standards there was substantial variation in practice ranges. This may be addressed by education, and ongoing compliance auditing.