Jacobs Pepin Breanna, Lesslie Debra, Berg Wendy, Spaulding Alicen B, Pokora Thomas
Neonatal Intensive Care Unit (Mss Pepin and Lesslie and Dr Pokora) and Infection Prevention and Control (Ms Berg), Children's Minnesota, St Paul; and Children's Minnesota Research Institute, Minneapolis (Dr Spaulding).
Adv Neonatal Care. 2019 Aug;19(4):253-261. doi: 10.1097/ANC.0000000000000635.
Ventilator-associated pneumonia (VAP) is the second most frequent hospital-acquired infection in neonatal intensive care units (NICUs) and significantly affects neonatal morbidity and mortality. The population most at risk for VAP are extremely preterm infants.
The objectives of this quality improvement project were to create and evaluate the effectiveness of a VAP prevention bundle ("ZAP-VAP") in reducing VAP.
The development of the ZAP-VAP bundle and creation of audit tools were documented. A targeted gestational age less than 29 weeks was selected for this study. Electronic medical record review was used to determine the preintervention baseline for patient outcomes. Patient medical record data were analyzed retrospectively to measure patient outcomes preimplementation. VAP rates (number of VAP cases per 1000 ventilator days) were calculated pre- and postintervention. After implementation, data were analyzed prospectively to measure patient outcomes between neonates who developed VAP and those who did not.
The VAP rate significantly decreased from 8.5 (2010-2011) to 2.5 (P= .0004) postintervention (2016). Median mechanical ventilation days decreased among VAP cases (47 vs 33 days) and slightly increased among non-VAP cases (19 vs 24 days) during the intervention period. Median length of stay decreased for VAP cases (136 vs 100 days) but remained unchanged for non-VAP cases (85 vs 84 days).
The intervention was implemented from 2012 to 2016. The protocol was readily accepted by our neonatal intensive care unit (NICU) team through education and practice changes. ZAP-VAP is an effective and straightforward protocol that improved VAP outcomes in our level IIIB NICU. An interdisciplinary team successfully implemented this intervention for mechanically ventilated infants of all gestational ages in our unit and has been a model for these practice changes in other units and other hospitals.
Future studies should focus on how to create sustainable interventions to decrease VAP in NICUs and to expand the approaches to other units in our hospital and other hospitals in our city among patients at risk for VAP.
呼吸机相关性肺炎（VAP）是新生儿重症监护病房（NICU）中第二常见的医院获得性感染，对新生儿的发病率和死亡率有显著影响。VAP风险最高的人群是极早产儿。
本质量改进项目的目标是创建并评估一种预防VAP的综合措施（“ZAP-VAP”）在降低VAP方面的有效性。
记录了ZAP-VAP综合措施的制定过程及审核工具的创建。本研究选择了目标胎龄小于29周的婴儿。通过电子病历回顾来确定干预前患者结局的基线。对患者病历数据进行回顾性分析以测量实施前的患者结局。计算干预前后的VAP发生率（每1000呼吸机日的VAP病例数）。实施后，对数据进行前瞻性分析以测量发生VAP的新生儿与未发生VAP的新生儿之间的患者结局。
干预后（2016年），VAP发生率从8.5（2010 - 2011年）显著降至2.5（P = .0004）。在干预期间，VAP病例的机械通气天数中位数减少（47天对33天），非VAP病例的机械通气天数中位数略有增加（19天对24天）。VAP病例的住院时间中位数减少（136天对100天），而非VAP病例的住院时间中位数保持不变（85天对84天）。
该干预措施于2012年至2016年实施。通过教育和实践变革，我们的新生儿重症监护病房（NICU）团队很容易接受了该方案。ZAP-VAP是一种有效且直接的方案，改善了我们三级B类NICU的VAP结局。一个跨学科团队成功地在我们科室对所有胎龄的机械通气婴儿实施了这一干预措施，并且已成为其他科室和其他医院这些实践变革的典范。
未来的研究应侧重于如何创建可持续的干预措施以降低NICU中的VAP，并将方法扩展到我们医院的其他科室以及我市其他医院中VAP风险患者。
