Improving management of ventilator associated tracheitis in a level IV NICU

Ellen C. Ingolfsland; Juan David Gonzalez-Villamizar; Jeanne Moore; Janet Kubly; Hawa M. Ali; Ann Kvant; Betsy Smith; Laura E Norton

doi:10.1038/s41372-022-01399-1

Improving management of ventilator associated tracheitis in a level IV NICU

Ellen C. Ingolfsland, Juan David Gonzalez-Villamizar, Jeanne Moore, Janet Kubly, Hawa M. Ali, Ann Kvant, Betsy Smith, Laura E Norton

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Abstract

Background: There are no published guidelines regarding the diagnosis and treatment of ventilator-associated tracheitis (VAT) in the neonatal intensive care unit (NICU). VAT is likely over-diagnosed and over-treated, increasing antibiotic burden and cost. Local problem: Diagnosis and treatment of VAT were entirely NICU provider dependent. Methods: Retrospective pre- and post-intervention chart reviews were performed. Interventions: A VAT diagnosis and treatment algorithm was created for use in the care of intubated patients without tracheostomies. 3 plan-do-study-act (PDSA) cycles were used to implement change. Results: Intubated patients treated for VAT with <25 PMNs on Gram stain decreased from 79% to 35% following the quality improvement (QI) initiative. Treatment of VAT with >7 days of antibiotic therapy decreased from 42% to 10%. Conclusion: Implementing a QI initiative to improve the diagnosis and treatment of VAT in the NICU decreased the percent of patients treated inappropriately for VAT.

Original language	English (US)
Pages (from-to)	1260-1265
Number of pages	6
Journal	Journal of Perinatology
Volume	42
Issue number	9
DOIs	https://doi.org/10.1038/s41372-022-01399-1
State	Published - Sep 2022

Bibliographical note

Funding Information:
We would like to thank Ali Anderson, RN for her contribution to improvement ideas, implementation of the QI interventions, and data collection. We would also like to thank our entire multidisciplinary NICU staff for participation in this QI initiative.

Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer Nature America, Inc.

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title = "Improving management of ventilator associated tracheitis in a level IV NICU",

abstract = "Background: There are no published guidelines regarding the diagnosis and treatment of ventilator-associated tracheitis (VAT) in the neonatal intensive care unit (NICU). VAT is likely over-diagnosed and over-treated, increasing antibiotic burden and cost. Local problem: Diagnosis and treatment of VAT were entirely NICU provider dependent. Methods: Retrospective pre- and post-intervention chart reviews were performed. Interventions: A VAT diagnosis and treatment algorithm was created for use in the care of intubated patients without tracheostomies. 3 plan-do-study-act (PDSA) cycles were used to implement change. Results: Intubated patients treated for VAT with <25 PMNs on Gram stain decreased from 79% to 35% following the quality improvement (QI) initiative. Treatment of VAT with >7 days of antibiotic therapy decreased from 42% to 10%. Conclusion: Implementing a QI initiative to improve the diagnosis and treatment of VAT in the NICU decreased the percent of patients treated inappropriately for VAT.",

author = "Ingolfsland, {Ellen C.} and Gonzalez-Villamizar, {Juan David} and Jeanne Moore and Janet Kubly and Ali, {Hawa M.} and Ann Kvant and Betsy Smith and Norton, {Laura E}",

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AU - Moore, Jeanne

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AU - Ali, Hawa M.

AU - Kvant, Ann

AU - Smith, Betsy

AU - Norton, Laura E

N1 - Funding Information: We would like to thank Ali Anderson, RN for her contribution to improvement ideas, implementation of the QI interventions, and data collection. We would also like to thank our entire multidisciplinary NICU staff for participation in this QI initiative. Publisher Copyright: © 2022, The Author(s), under exclusive licence to Springer Nature America, Inc.

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N2 - Background: There are no published guidelines regarding the diagnosis and treatment of ventilator-associated tracheitis (VAT) in the neonatal intensive care unit (NICU). VAT is likely over-diagnosed and over-treated, increasing antibiotic burden and cost. Local problem: Diagnosis and treatment of VAT were entirely NICU provider dependent. Methods: Retrospective pre- and post-intervention chart reviews were performed. Interventions: A VAT diagnosis and treatment algorithm was created for use in the care of intubated patients without tracheostomies. 3 plan-do-study-act (PDSA) cycles were used to implement change. Results: Intubated patients treated for VAT with <25 PMNs on Gram stain decreased from 79% to 35% following the quality improvement (QI) initiative. Treatment of VAT with >7 days of antibiotic therapy decreased from 42% to 10%. Conclusion: Implementing a QI initiative to improve the diagnosis and treatment of VAT in the NICU decreased the percent of patients treated inappropriately for VAT.

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Improving management of ventilator associated tracheitis in a level IV NICU

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