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A Quality Improvement Initiative to Decrease Ventilator-Associated Pneumonia in the Neonatal Intensive Care Unit, 2012-2016

Jacobs Pepin, Breanna APRN, CNNP; Lesslie, Debra APRN, CNNP; Berg, Wendy BSN, RN, CIC; Spaulding, Alicen B. PhD, MPH; Pokora, Thomas MD

Section Editor(s): Harris-Haman, Pamela A. DNP, CRNP, NNP-BC; ; Zukowsky, Ksenia PhD, APRN, NNP-BC;

doi: 10.1097/ANC.0000000000000635
Clinical Issues in Neonatal Care

Background: 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.

Purpose: The objectives of this quality improvement project were to create and evaluate the effectiveness of a VAP prevention bundle (“ZAP-VAP”) in reducing VAP.

Methods: 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.

Results: 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).

Implications for Practice: 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.

Implications for Research: 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.

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).

Correspondence: Breanna Jacobs Pepin, APRN, CNNP, Neonatal Intensive Care Unit, Children's Minnesota, 345 North Smith Ave, St Paul, MN 55102 (

The authors report no conflicts of interest for this project.

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© 2019 by The National Association of Neonatal Nurses