Hospitals in pursuit of excellence

VAP Reduction in the NICU

In 2005, the neonatal intensive care unit at Women and Children's Hospital of West Virginia experienced a ventilator-associated pneumonia incidence rate of 18 percent for infants weighing less than 1,500 grams. The incidence rate was 50 percent higher than the baseline standard of the Vermont Oxford Network, a worldwide consortium of 800 NICUs.

The Solution

That year, Women and Children's Hospital adopted a VAP prevention bundle developed by the Vermont Oxford Network. The bundle includes steps for proper hand washing, gloving, gowning, masking and educating staff and NICU visitors on those techniques. NICU clinicians began giving patients a regular oral antibiotic treatment every four hours as a preventive measure.

The NICU also implemented strategies to reduce the time patients are exposed to ventilators, thus reducing their potential exposure to pneumonia. As an alternative to ventilator use for newborns, clinicians began using devices to facilitate nasal continuous positive airway pressure, or nasal CPAP. Clinicians also reduced the pressure of the ventilators on infants' lungs, which are susceptible to lifelong damage from too much pressure. Additionally, housekeeping incorporated a checklist to ensure that the NICU was properly cleaned each time.