title: Implementation of a Sustainable Ventilator-Associated Pneumonia Prevention Protocol in a Pediatric Intensive Care Unit in Managua, Nicaragua.
abstract: BACKGROUND
  Ventilator-associated pneumonia (VAP) is a common nosocomial infection in pediatric intensive care units (ICUs). Ventilator-associated pneumonia protocols decrease the incidence of VAP; however, many components of these protocols are not feasible in all settings. This study was done in a large pediatric hospital in Nicaragua.
  
  
  OBJECTIVE
  The aim of this study is to implement a sustainable evidence-based VAP protocol, in a different culture, for the purpose of decreasing VAP rates.
  
  
  METHODS
  This quality improvement study used a bidirectional cohort design with the retrospective group as the control and the prospective group as the experimental population. A daily checklist monitored compliance to the implemented protocol in the prospective group. A 2-sided Fisher exact test compared the differences in VAP rates between the 2 populations.
  
  
  RESULTS
  During the 90-day implementation period, 123 ventilated patients in 3 separate ICU wings were evaluated, with 99 included in the final analysis. These data for 2014 were compared with the VAP rates recorded for the same time period in 2013. The highest adherence to the protocol was demonstrated by ICU wing 1, with a 90% decrease in VAP rates. No statistical difference in VAP rates was demonstrated by ICU 2, and ICU 3 demonstrated an increase in both patient acuity and VAP rates.
  
  
  CONCLUSIONS
  Implementation of a sustainable VAP protocol in a pediatric ICU in Nicaragua can reduce the incidence of VAP. Multiple barriers and challenges associated with implementation in a resource-constrained environment are discussed.
authors.affiliation: Kelsey Chinnadurai, DNP, is from the Vanderbilt Department of Anesthesiology in Nashville, Tennessee. Lindy Fenlason, MD, MPH, is from the Vanderbilt Department of Pediatrics in Nashville, Tennessee. Brian Bridges, MD, is from the Vanderbilt Department of Pediatrics in Nashville, Tennessee. Mana Espahbodi, BS, is from the Vanderbilt School of Medicine in Nashville, Tennessee. Sivakumar Chinnadurai, MD, MPH, is from the Vanderbilt Department of Otolaryngology in Nashville, Tennessee. Jane Blood-Siegfried, DNSc, PNP, is from the Duke University School of Nursing in Durham, North Carolina.
authors.forename: Kelsey
authors.initials: K
authors.lastname: Chinnadurai
authors.forename: Lindy
authors.initials: L
authors.lastname: Fenlason
authors.forename: Brian
authors.initials: B
authors.lastname: Bridges
authors.forename: Mana
authors.initials: M
authors.lastname: Espahbodi
authors.forename: Sivakumar
authors.initials: S
authors.lastname: Chinnadurai
authors.forename: Jane
authors.initials: J
authors.lastname: Blood-Siegfried
mesh_terms: D002648:Child; D003428:Cross Infection; D006801:Humans; D007362:Intensive Care Units; D015278:Intensive Care Units, Pediatric; D009527:Nicaragua; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*; D011446:Prospective Studies; D012189:Retrospective Studies