Reducing Ventilator Associated Pneumonia in the NICU through oral care education: A quality improvement project

Abstract

BackgroundInadequate oral care in the Neonatal Intensive Care Unit (NICU) can lead to Ventilator Associated Pneumonia (VAP). VAP rate was reported at 2.52 per 1000 ventilator days for the 12 months prior to intervention. A root cause analysis of VAPs during this period revealed only 70% compliance with oral care. VAP contributes to higher costs for the hospital, patient pain and suffering, morbidity and mortality, length of time on mechanical ventilation and increased hospital length of stay. This Quality Project aims to reduce VAP in the NICU through multidisciplinary re-education on the importance of oral care, and fostering an interdisciplinary oral care team of Respiratory Therapists and Registered Nurses. MethodAn IRB approved interventional pre and post intervention review of VAP rate was conducted on intubated neonatal patients from June 1, 2015–May 31, 2017. Intervention consisted of education perform as an interdisciplinary oral care team. Education was coordinated between Respiratory (RT) and Nursing (RN) educators, Lactation, and unit leaders to ensure standardized education to all staff. An oral care poster was created and presented to both RT and NICU RN staff at department meetings. An oral care PowerPoint was created and sent to all NICU RN's and was required as annual mandatory education for all RT's. Encouragement was provided through random chart audits from June 2016–May 2017, praising staff that coordinated care, and reminding staff who did not through friendly face to face interaction and email of the importance of routine, coordinated oral care. ResultsNICU VAP rates dropped during June, and came back up in July 2016 and dropped again in March 2017. Chart review revealed insufficient oral care (72% and 78%) in the two days prior to VAP events. Oral Care poster and education were re-introduced in August 2016 and April 2017. NICU VAP rates post intervention, June 2016–May 2017, was reported as 0.78 per 1000 ventilator days. ConclusionsIdentifying the primary factor through VAP root cause analysis made us aware of a VAP bundle component that was not being routinely followed. Having identified oral care as a problem in our unit enabled us to form an educational intervention with a standardized oral care technique that was effective in increasing the frequency and efficacy of oral care. Utilizing a multidisciplinary team for oral care fosters a sense of importance and responsibility to the staff and improved collaboration in care.