ZAP-VAP

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

Breanna Jacobs Pepin, Debra Lesslie, Wendy Berg, Alicen B. Spaulding, Thomas Pokora, Pamela Harris-Haman, Ksenia Zukowsky

Research output: Contribution to journalReview article

Abstract

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.

Original languageEnglish (US)
Pages (from-to)253-261
Number of pages9
JournalAdvances in Neonatal Care
Volume19
Issue number4
DOIs
StatePublished - Aug 1 2019
Externally publishedYes

Fingerprint

Ventilator-Associated Pneumonia
Neonatal Intensive Care Units
Quality Improvement
Gestational Age
Pneumonia
Extremely Premature Infants
Outcome Assessment (Health Care)
Hospital Units
Electronic Health Records
Infant Mortality
Mechanical Ventilators

Keywords

  • intensive care
  • neonates
  • ventilator-Associated pneumonia

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

ZAP-VAP : A Quality Improvement Initiative to Decrease Ventilator-Associated Pneumonia in the Neonatal Intensive Care Unit, 2012-2016. / Pepin, Breanna Jacobs; Lesslie, Debra; Berg, Wendy; Spaulding, Alicen B.; Pokora, Thomas; Harris-Haman, Pamela; Zukowsky, Ksenia.

In: Advances in Neonatal Care, Vol. 19, No. 4, 01.08.2019, p. 253-261.

Research output: Contribution to journalReview article

Pepin, Breanna Jacobs ; Lesslie, Debra ; Berg, Wendy ; Spaulding, Alicen B. ; Pokora, Thomas ; Harris-Haman, Pamela ; Zukowsky, Ksenia. / ZAP-VAP : A Quality Improvement Initiative to Decrease Ventilator-Associated Pneumonia in the Neonatal Intensive Care Unit, 2012-2016. In: Advances in Neonatal Care. 2019 ; Vol. 19, No. 4. pp. 253-261.
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abstract = "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.",
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