COMBAT VAT: Preventing Pediatric Ventilator-Associated Tracheitis

Seattle Children’s Hospital (Seattle, Washington)

CSI Summary

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Project Topic:

Decreasing ventilator-associated tracheitis (VAT) in the Pediatric Cardiac Intensive Care Unit through implementation of a VAT prevention bundle

Hospital Unit:

Cardiac Intensive Care Unit (CICU)

CSI Participants:

  • Krista Finley, BSN, RN
  • Jessica Olsen, BSN, RN, CCRN
  • Caitlyn Romoser, MSN, RN

Video Presentation

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Project Goals/Objectives:

  1. Achieve a 15% reduction in VAT rate in the CICU by March 2022
  2. Achieve VAT prevention bundle compliance of >90% in all measured elements

Project Outcomes:

  1. Decreased VAT rate 37%
  2. Reduced central-line associated bloodstream infection (CLABSI) rate 14%

Project Overview:

Ventilator-associated pneumonia (VAP) and ventilator-associated tracheitis (VAT) are common complications of mechanical ventilation, but VAT prevention is often overlooked to focus on VAP. Our CSI project focused on VAT prevention due to the low VAP rate yet high VAT rate in the cardiac intensive care unit (CICU).

From August 2020 to January 2021, the CICU VAT rate was 13 VATs per1,000 ventilator days. In 2020, 53% of patients diagnosed with a CLABSI in the CICU had a VAT with the same organism prior to their CLABSI. This statistic indicates that VATs may play a larger role in hospital-acquired infections than we previously thought and may warrant more focused prevention efforts.

Our CSI team created an evidence-based VAT prevention bundle using the mnemonic COMBAT VAT ― Change equipment, Oral care, Maintain closed circuit, Bed elevation And Thorough hand hygiene. We created an education module describing the unit’s VAT data and introducing the prevention bundle, which we shared with all CICU nurses, critical care float pool nurses, respiratory therapists and CICU providers.

The education module was also incorporated into the unit’s standard onboarding materials for nurses. We then performed regular audits on the unit to measure bundle compliance success and posted the results in a central location on the unit.

Six months post-implementation of the COMBAT VAT bundle, the CICU had achieved a 37% decrease in VATs and a 14% decrease in CLABSIs.

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