A bundled prevention protocol for support of infants and children receiving mechanical ventilation that focuses on suctioning or airway clearance, ventilator circuit changes, and oral care may lead to lower rates of ventilator-associated pneumonia (VAP) in critically ill infants and children, according to a new research article.

VAP is the second most common hospital-associated infection in pediatric ICUs and is linked to increased morbidity, mortality and length of hospitalization, according to the authors. However, no official guidelines have been published for VAP prevention in infants and children, and little research has been done in children to guide bedside care.

Prevention is the most appropriate intervention, according to author Virginia Cooper, RN, MS, a pediatric nurse practitioner at the University of Maryland Medical Center in Baltimore. “The care bundle we propose offers evidence-based alerts and consistent prevention strategies for providers caring for children in the pediatric intensive care unit,” said Cooper.

The research article assembles evidence-based practice recommendations and integrates pediatric-specific interventions with a proven adult model to propose new strategies for preventing VAP. Authors recommend a care bundle based on factors that include evidence regarding the pathophysiology and etiology of pneumonia, mechanical ventilation, duration of ventilation, and age of the child.

The proposed bundle for prevention of ventilator-associated pneumonia in infants and children can be viewed here.

The authors also call for additional research to document the effectiveness of bedside protocols to prevent VAP in infants and children. Maintaining data collection over time with the use of the VAP bundle will supply critical information on the effectiveness of these nursing and respiratory interventions in changing the incidence of VAP in a particular setting, according to researchers.