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J Pediatr ; 154(4): 582-587.e2, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19054530

RESUMO

OBJECTIVES: To characterize ventilator-associated pneumonia (VAP) in our pediatric intensive care unit (PICU), implement an evidence-based pediatric VAP prevention bundle, and reduce VAP rates. STUDY DESIGN: The setting is a 25-bed PICU in a 475-bed free-standing pediatric academic medical center. VAP was diagnosed according to Centers for Disease Control and National Nosocomial Infections Surveillance System definitions. A pediatric VAP prevention bundle was established and implemented. Baseline VAP rates were compared with implementation and post-bundle-implementation periods. RESULTS: VAP is significantly associated with increased PICU length of stay, mechanical ventilator days, and mortality rates (length of stay VAP 19.5+/-15.0 vs non-VAP 7.5+/-9.2, P< .001; ventilator days VAP 16.3+/-14.7 vs non-VAP 5.3+/-8.4, P< .001; mortality VAP 19.1% vs non-VAP 7.2%, P= .01). The VAP rate was reduced from 5.6 (baseline) to 0.3 infections per 1000 ventilator days after bundle implementation; P< .0001. Subglottic/tracheal stenosis, trauma, and tracheostomy are significantly associated with VAP. CONCLUSIONS: PICU VAP is associated with increased morbidity and mortality rates. A multidisciplinary improvement team can implement a sustainable pediatric-specific VAP prevention bundle, resulting in VAP rate reduction.


Assuntos
Procedimentos Clínicos , Controle de Infecções , Avaliação de Processos e Resultados em Cuidados de Saúde , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Criança , Pré-Escolar , Feminino , Implementação de Plano de Saúde , Humanos , Lactente , Unidades de Terapia Intensiva Pediátrica , Meio-Oeste dos Estados Unidos , Pneumonia Associada à Ventilação Mecânica/microbiologia , Fatores de Risco
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