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  • Quality Improvement Article
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Improving management of ventilator associated tracheitis in a level IV NICU

Journal of Perinatology volume 42, pages 1260–1265 (2022)Cite this article

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A Correction to this article was published on 12 December 2022

This article has been updated

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.

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Fig. 1
Fig. 2
Fig. 3: Proportion of sampled patients treated inappropriately for VAT across all 4 time periods.
Fig. 4

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Acknowledgements

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.

Author information

Author notes

  1. These authors contributed equally: Ellen C Ingolfsland, Juan David Gonzalez-Villamizar.

Authors and Affiliations

  1. University of Minnesota Medical School, Minneapolis, MN, United States

    Ellen C. Ingolfsland & Hawa M. Ali

  2. Children’s Minnesota, Minneapolis, MN, United States

    Juan David Gonzalez-Villamizar

  3. M Health Fairview, Minneapolis, MN, United States

    Jeanne Moore, Janet Kubly, Ann Kvant & Betsy Smith

  4. Division of Pediatric Infectious Diseases, Medical School, University of Minnesota, Minneapolis, MN, United States

    Laura Norton

Authors
  1. Ellen C. Ingolfsland
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  2. Juan David Gonzalez-Villamizar
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  3. Jeanne Moore
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  4. Janet Kubly
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  5. Hawa M. Ali
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  6. Ann Kvant
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  7. Betsy Smith
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Contributions

ECI and JDG-V assisted with project design and improvement ideas, participated in the PDSA cycles, designed the data collection instruments, collected data, drafted the initial manuscript, and reviewed and revised the manuscript. JK assisted with project design and improvement ideas, collected data, and reviewed and revised the manuscript. JM and HMA assisted with project design and improvement ideas, collected data, carried out the initial analyses, and reviewed and revised the manuscript. AK and BS assisted with project design and improvement ideas, collected data, and reviewed and revised the manuscript. LN conceptualized and designed the study, supervised data collection, and critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Ellen C. Ingolfsland.

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The authors declare no competing interests.

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The original online version of this article was revised: Figure 1 has been corrected.

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Ingolfsland, E.C., Gonzalez-Villamizar, J.D., Moore, J. et al. Improving management of ventilator associated tracheitis in a level IV NICU. J Perinatol 42, 1260–1265 (2022). https://doi.org/10.1038/s41372-022-01399-1

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