Preventing Ventilator-Associated Pneumonia in Children: An Evidence-Based Protocol

Abstract

A s a hospital-acquired infection (HAI), ventilator-associated pneumonia (VAP) is associated with additional complications for patients in the pediatric intensive care unit (PICU). Despite the volume of published information on VAP in adults, the amount of research on VAP in children is limited. Health care providers need to be aware of the risk for VAP in infants and children and should have preventive programs in place. Evidence-based protocols that outline preventive and therapeutic treatments for specific situations for adults treated with mechanical ventilation have been developed, but little has been offered for the care of children receiving mechanical ventilation. Ventilator-associated pneumonia, the second most common hospital-acquired infection in pediatric intensive care units, is linked to increased morbidity, mortality, and lengths of stay in the hospital and intensive care unit, adding tremendously to health care costs. Prevention is the most appropriate intervention, but little research has been done in children to identify necessary skills and strategies. Critical care nurses play an important role in identification of risk factors and prevention of ventilator-associated pneumonia. A care bundle based on factors, including evidence regarding the pathophysiology and etiology of pneumonia, mechanical ventilation, duration of ventilation, and age of the child, can offer prompts and consistent prevention strategies for providers caring for children in the pediatric intensive care unit. Following the recommendations of the Centers for Disease Control and Prevention and adapting an adult model also can support this endeavor. Ultimately, the bedside nurse directs care, using best evidence to prevent this important health care problem. (Critical Care Nurse. 2013;33[3]:21-30) by AACN on May 12, 2018 http://ccn.aacnjournals.org/ Downloaded from

Oral care in prevention of ventilator-associated pneumonia in neonatal and pediatric intensive care unit: protocol proposal

“…24,32,35 The use of distilled or sterile water showed no undesired effect and was indicated for being an effective method in assisting the removal of residues that may be in the oral cavity, in a safely manner since they occur in their neutral form and free from impurities. 5,14,15,34,35,37 In adults, we observed that the main substance used and recommended was the 0.12% chlorhexidine digluconate due to its bactericidal and bacteriostatic effects for up to 12 hours, and with wide range of bacterial reduction both aerobic and anaerobic, Gram-positive and Gram-negative. 1,2,[4][5][6]18,23 The 0.12% chlorhexidine digluconate was recommended at different concentrations by 14 authors; however, the majority indicated its use only in PICU.…”

“…Among the most recommended substances for toothless newborns and babies, we have: bicarbonate water at 3%, 24,34 enzymatic solution based on lactoperoxidase, 24,32 hydrogen peroxide, 24,35 distilled or sterile water 14,15,34,35,37 and saline solution. 14,29 It is crucial to be careful on the guidance on adjuvant solutions to the mechanical methods used in the cleaning of the oral cavity due to risk of damage to the oral mucosa.…”

“…6 Wehbe et al 17 performed a study that identified the major risk factors for the VAP in Pediatrics, as: prematurity (<28 weeks of gestation); immunological immaturity; colonization of mucosae by external agents; prolonged period of invasive MV; non-sanitation of hands before and after handling the patient; lack of hygiene of oral cavity; unnecessary handling of patient; non-elevated decubitus; and non-performance of suctioning of oral cavity. 12,15,16,18 Dal-Bó et al 11 published that the incidence rates of hospital infection reported in Brazilian NICU are 45.8%, with general mortality of 12.1%, and mortality from nosocomial infection in 33.8%.…”

“…[1][2][3][4][5][6] There are few studies about NICU and PICU, and there is still no consensus on what would be the best technique to be performed in them, as well as the best substance for use, the frequency and of how to perform the removal of dental biofilm. 9,[14][15][16][17] Given this, we observed the need to define an effective oral care protocol in this type of ICU, so that it can be applied with the aim of VAP prevention, providing oral comfort and improvement of the quality of life.…”

What are the effects of care bundles on the incidence of ventilator‐associated pneumonia in paediatric and neonatal intensive care units? A systematic review

“…Many researchers implemented a modified paediatric ventilator bundles which were adapted from adult VAP bundles (Weber, ). Ventilator bundles that include head of the bed elevation, clean endotracheal suctioning practices, minimal ventilator circuit changes, peptic ulcer prophylaxis and oral care are recommended in paediatrics (Cooper & Haut, ). However, there are variations in the ventilator bundle interventions implemented to prevent VAP in paediatric populations.…”