Ventilator Associated Pneumonia (VAP) is a very common hospital acquired infection, especially in pediatric intensive care units, ranking as the second most common (Foglia, Meier, & Elward, 2007). It is defined as pneumonia that develops 48 hours or more after mechanical ventilation begins. A VAP is diagnosed when new or increase infiltrate shows on chest radiograph and two or more of the following, a fever of >38.3C, leukocytosis of >12x10 9 /mL, and purulent tracheobronchial secretions (Koenig & Truwit, 2006). VAP occurs when the lower respiratory tract that is sterile is introduced microorganisms are introduced to the lower respiratory tract and parenchyma of the lung by aspiration of secretions, migration of aerodigestive tract, or by contaminated equipment or medications (Amanullah & Posner, 2013). VAP occurs in approximately 22.7% of patients who are receiving mechanical ventilation in PICUs (Tablan, Anderson, Besser, Bridges, & Hajjeh, 2004). The outcomes of VAP are not beneficial for the patient or healthcare organization. VAP adds to increase healthcare cost per episode of between $30,000 and $40,000 (Foglia et al., 2007) (Craven & Hjalmarson, 2010). This infection is also associated with increase length of stay, morbidity and high crude mortality rates of 20-50% (Foglia et al., 2007)(Craven & Hjalmarson, 2010). Currently, the PICU has implemented all of the parts of the VARI bundle except the daily discussion of readiness to extubate. The VARI bundle currently includes, head of the bed greater then or equal to 30 degrees, use oral antiseptic (chlorhexidine) each morning, mouth care every 2 hours, etc. In the PICU at children’s, the rates for VAP have decreased since the implementation of safety rounds in which management goes to each room that is at risk for CLABSI, CAUTI, PU and VAP and makes sure the bundles are being followed. When nurses are asked if the patient is at high risk for VAP, most nurses are not sure. Also, after a patient is diagnosed with VAP, most are surprised and did not previously see this patient at high risk. Literature shows that there is strong evidence in improvement of decreasing VAP when clinicians are educated about their role in prevention. (Burns, 2014).
Some risk factors as shown in literature are increased intubation time, enteral feeding, aspiration, use of paralytic agents and sedation, immune-suppressed, and the young and old extremes of age (Burns, 2014).
Overview of Key Points
VAP is a preventable illness in which
Purpose of Document
The purpose of this document is to first describe the importance of decreasing the rates of VAP and the impact on health care costs and patient outcome. The literature will be reviewed to determine patients who are at a higher risk for developing VAP. Current literature will also be reviewed on the parts of the VARI bundle that the PICU doesn’t currently use and the VAP prevention and mitigation plan will be slightly updated. The...