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Multidisciplinary Quality Improvement Initiative to Reduce Ventilator-Associated Tracheobronchitis in the PICU*

Muszynski, Jennifer A. MD1,2; Sartori, James RN, BSN3; Steele, Lisa RN, BSN2; Frost, Randall BS4; Wang, Wei MS, MAS5; Khan, Nadeem MD1; Lee, Anthony MD1; Lin, Ada MD1; Hall, Mark W. MD1,2; Ayad, Onsy MD1

Pediatric Critical Care Medicine:
doi: 10.1097/PCC.0b013e31828a897f
Quality and Safety
Abstract

Objective: To test the hypothesis that successful implementation of a care bundle designed to prevent nosocomial airway infection will be associated with decreased incidence of ventilator-associated tracheobronchitis.

Design: Prospective pre- and postinterventional.

Setting: PICU at an academic medical center

Patients: All patients admitted to the PICU who received invasive mechanical ventilation for greater than or equal to 48 hours between March 1, 2009, and December 31, 2011.

Intervention: Multidisciplinary, unitwide implementation of an evidence-based care bundle to prevent ventilator-associated airway infection.

Measurements and Main Results: There were 725 patients included in the analysis (338 patients preintervention and 387 patients postintervention). Baseline ventilator-associated tracheobronchitis rate in the preintervention period was 3.9 cases per 1,000 ventilator days compared with 1.8 cases per 1,000 ventilator days postintervention (p = 0.04, Fisher exact test). Compared with patients without ventilator-associated tracheobronchitis or ventilator-associated pneumonia, patients with ventilator-associated tracheobronchitis had fewer ventilator-free days in 28 days (4.9 vs 22; p < 0.0001, Mann-Whitney U test) and fewer ICU-free days in 28 days (0.5 vs 19; p < 0.0001, Mann-Whitney U test). These relationships remained significant after adjusting for covariates by multivariable linear regression.

Conclusions: Successful implementation of a care bundle to prevent ventilator-associated infection was associated with decreased incidence of ventilator-associated tracheobronchitis. Development of ventilator-associated tracheobronchitis was independently associated with adverse outcomes in our cohort of pediatric ICU patients.

Author Information

1Pediatric Critical Care Medicine, Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH.

2The Research Institute at Nationwide Children’s Hospital, Columbus, OH.

3Epidemiology, Nationwide Children’s Hospital, Columbus, OH.

4Quality Improvement Services, Nationwide Children’s Hospital, Columbus, OH.

5Biostatistics Core, The Research Institute at Nationwide Children’s Hospital, Columbus, OH.

*See also p. 553.

Supported, in part, by The Research Institute at Nationwide Children’s Hospital.

The authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: jennifer.muszynski@nationwidechildrens.org

©2013The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies