title: Ventilator-associated pneumonia in the pediatric intensive care unit: characterizing the problem and implementing a sustainable solution.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Pediatrics, Division of Critical Care Medicine and Pediatric Intensive Care Unit, Cincinnati Children's Hospital, Cincinnati, OH, USA.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Bigham
authors.forename: Rick
authors.initials: R
authors.lastname: Amato
authors.forename: Pattie
authors.initials: P
authors.lastname: Bondurrant
authors.forename: Jon
authors.initials: J
authors.lastname: Fridriksson
authors.forename: Catherine D
authors.initials: CD
authors.lastname: Krawczeski
authors.forename: Jenni
authors.initials: J
authors.lastname: Raake
authors.forename: Sue
authors.initials: S
authors.lastname: Ryckman
authors.forename: Steve
authors.initials: S
authors.lastname: Schwartz
authors.forename: Julie
authors.initials: J
authors.lastname: Shaw
authors.forename: Dan
authors.initials: D
authors.lastname: Wells
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Brilli
mesh_terms: D002648:Child; D002675:Child, Preschool; D019091:Critical Pathways; D005260:Female; D006284:Health Plan Implementation; D006801:Humans; D007223:Infant; D017053:Infection Control; D015278:Intensive Care Units, Pediatric; D015146:Midwestern United States; D010043:Outcome and Process Assessment, Health Care; D053717:Pneumonia, Ventilator-Associated / Q000382:microbiology / Q000517:prevention & control*; D012307:Risk Factors