| Description |
Background: Ventilator-associated pneumonia (VAP) is the second most common nosocomial infection in newborn intensive care units (NICUs), prolonging hospital stay and increasing healthcare costs (Raycheva et al., 2022). VAP prevention bundles are cost-effective interventions that have proven to reduce VAP in adult models when combined with caregiver education and bundle compliance (Mastrogianni et al., 2023). Local Problem: A level IV NICU is lacking a current evidence-based VAP prevention bundle, potentially contributing to increased length of stay, cost, exposure to antibiotics, and morbidity and mortality rates. This quality improvement project aims to revise, implement, and evaluate an evidence-based VAP prevention bundle to decrease the incidence of VAP in a level IV NICU and to determine the feasibility, useability, and clinician satisfaction of the bundle. Methods: Education regarding VAP and the bundle was disseminated to all NICU caregivers trained to provide care for mechanically ventilated patients. This included registered nurses (n=250), respiratory therapists (n=60), and advanced practice providers (n=65). A retrospective chart review was completed to assess VAP incidence pre- and post-implementation. A caregiver pre- and post-implementation survey was used to assess VAP knowledge, VAP prevention practices, and views of standardized care. Interventions: Key stakeholders contributed to the revision of the NICU-specific VAP prevention bundle. VAP education was disseminated by email and in person check-ins. The bundle was implemented into practice via a printed QR code, attached to every ventilator in use. Plan-Do-Study-Act (PDSA) cycles were used to evaluate and implement necessary changes. Retrospective chart reviews for NICU patients with positive tracheal aspirate cultures and artificial airways were identified for cases of VAP to assess pre- and post-implementation VAP rates. Pre- and post implementation caregiver surveys collected data regarding current ventilatory care practices, VAP knowledge, opinions regarding VAP prevention care, and demographics. Results: Eighty-seven positive tracheal aspirates were identified during the 9-month preimplementation timespan. Of those, 28 (32.2%) were treated for pneumonia and 25 (28.7%) met criteria for VAP. Over the four-month post-implementation timeframe, 28 positive tracheal aspirates were identified. Of those, 11 (39.3%) were treated for pneumonia and met criteria for VAP. Pre- and post-implementation survey data showed insignificant changes in caregiver VAP knowledge scores (mean score of 62.6%, SD ± 23.4 versus 62.4%, SD ± 27.6) and minor changes in caregiver agreement regarding standardized NICU VAP prevention practices (68.3% versus 73.9%). Qualitative analysis of feedback revealed several themes among survey respondents, including the need for more education and time for implementation. Conclusion: Despite 87% of survey participants rating the bundle as easy to use and 91% stating they would continue to use the bundle in future practice, time and resources were significant barriers to implementation. Similar projects have demonstrated poor success in decreasing VAP rates without sufficient implementation time causing low staff buy-in and compliance (Mastrogianni et al., 2023). Further education and dissemination of the bundle over a longer timeframe are required to enable change in caregiver practice and unit culture to ensure the project's success and sustainability. |
