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Ventilator acquired pneumonia (VAP) has been one of the preventable diseases targeted for eradication in first the 100,000 and then the 5 Million Lives Campaigns.  There has been much research performed on the adult population with resultant recommendations from both the Centers for Disease Control (CDC) and The Institutes for Healthcare Improvement (IHI).  A review of the literature shows that since these recommendations in 2003, only a small amount of research has been done in our most vulnerable of populations—the neonate in our intensive care nurseries; and most of that research is just confirming that our population is at risk, especially the very low birth weight infants (VLBW).            In early 2007, the Manager of the Neonatal Intensive Care Unit (NICU) met with infection control to review data.  While the NICU’s overall infection rate was low it was identified that there was definitely room for improvement in VAPs.  Infection Control was questioning if there had been any recent changes in practices or the environment that could account for the increase in incidence.  The investigative process began.  Our goal was to decrease our VAPs, but first we needed to figure out who, what, why, and how.   

What initially started as simple “Googling” of “VAP” and discovering the right words to use snowballed into benchmarking and an extensive literature review to discover just what research had been done. The management team began to look at and think differently about their processes and how to make changes in practices.  Bundling used to mean how they wrapped a baby, but now it took on a whole new meaning.  At first the usual trial and error methods of common sense practices were used.  Staff was incorporated into the development of the new practices to increase their awareness of the problem, enlist their support of the changes and to offer feedback based on the outcomes they were seeing.  Staff was encouraged to share ideas and learning’s from conferences they had attended and literature they had reviewed.  The management team then did additional research to find the evidence behind the proposed changes in practices.   

The team collaboratively developed the process. It was to be a multidisciplinary team effort with specific roles for each team member.  There were checklists developed, products trialed, and specific interventions to be used.  There was always a communication loop for feedback--what worked well, what wasn’t working and how things could be improved still.  Joining the adult VAP committee enlightened the team on the use of inline suction catheters and sterilizing laryngoscope blades. The staff became more involved and more excited as they saw positive outcomes from their efforts.  VAPs significantly reduced and this achievement has been maintained.  We now have VAP champions to keep the excitement going and the process ever improving. 

What are our next steps?  We are currently working on our blood stream infections (BSI) and interventions and in developing a research study that can contribute to the evidence behind the practices we developed for our bundles.