Ventilator-Associated Pneumonia in the Pediatric Intensive Care Unit: Characterizing the Problem and Implementing a Sustainable Solution

Objectives To characterize ventilator-associated pneumonia (VAP) in our pediatric intensive care unit (PICU), implement an evidence-based pediatric VAP prevention bundle, and reduce VAP rates. Study design The setting is a 25-bed PICU in a 475-bed free-standing pediatric academic medical center. VAP was diagnosed according to Centers for Disease Control and National Nosocomial Infections Surveillance System definitions. A pediatric VAP prevention bundle was established and implemented. Baseline VAP rates were compared with implementation and post-bundle-implementation periods. Results VAP is significantly associated With increased PICU length of stay, mechanical ventilator days, and mortality rates (length of stay VAP 19.5 +/- 15.0 vs non-VAP 7.5 +/- 9.2, P < .001; ventilator days VAP 16.3 +/- 14.7 vs non-VAP 5.3 +/- 8.4, P < .001; mortality VAP 19.1% vs non-VAP 7.2%, P = .01). The VAP rate was reduced from 5.6 (baseline) to 0.3 infections per 1000 ventilator days after bundle implementation; P < .0001. Subglottic/tracheal stenosis, trauma, and tracheostomy are significantly associated with VAP. Conclusions PICU VAP is associated with increased morbidity and mortality rates. A multidisciplinary improvement team can implement a sustainable pediatric-specific VAP prevention bundle, resulting in VAP rate reduction. (J Pediatr 2009;154:582-7)