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Care bundle may lower VAP rates in pediatric ICU


Implementation of a bundle for prevention of ventilator-associated pneumonia in critically ill infants and children may lead to lower rates of VAP in these patients, according to a study,

VAP, the second most common hospital-associated infection in PICUs, is linked to increased morbidity, mortality and lengths of stay in the hospital and ICU, adding substantially to healthcare costs, according to a news release from the American Association of Critical-Care Nurses about the study. Prevention is the most appropriate intervention, but no official guidelines have been published for VAP prevention in infants and children, and little research has been done in children to guide bedside care.

The article in the June issue of the journal Critical Care Nurse assembles evidence-based practice recommendations and integrates pediatric-specific interventions with a proven adult model to propose new strategies bedside nurses can implement to prevent VAP.

The bundled prevention protocol for support of infants and children receiving mechanical ventilation focuses on suctioning or airway clearance, ventilator circuit changes and oral hygiene.

Virginia Cooper, RN, MS, a nurse in the pediatric intensive and intermediate care units at the University of Maryland Medical Center in Baltimore, developed the program with Catherine Haut, CCRN, DNP, CPNP/AC, director of the acute care pediatric nurse practitioner program at the University of Maryland School of Nursing and a nurse practitioner in the PICU at Herman & Walter Samuelson Children’s Hospital at Sinai in Baltimore.

“Critical care nurses play an important role in identification of risk factors and prevention of ventilator-associated pneumonia,” Cooper said in the news release. “The care bundle we propose offers evidence-based alerts and consistent prevention strategies for providers caring for children in the pediatric intensive care unit.”

The researchers also called for additional research to document the effectiveness of bedside protocols to prevent VAP in infants and children. Maintaining data collection over time with the use of the VAP bundle will supply critical information on the effectiveness of these nursing and respiratory interventions in changing the incidence of VAP in a particular setting.

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