Impact of the Quantity of Ventilator-Associated Pneumonia Bundle Audits on VAP Occurrence and Prevention Bundle Adherence

Background: Ventilator-associated pneumonia (VAP) is a costly and avoidable hospital-acquired condition. As recommended by the Solutions for Patient Safety (SPS), prevention bundles aim to reduce the occurrence of VAP, and support healthcare providers in providing care aligned with best practices to reduce the risk of VAP occurrence. Auditing bundle adherence ensures best practices are being followed, aims to identify barriers, and increases awareness of the importance of the VAP prevention bundles in action. However, mixed data for optimal quantity and frequency of auditing is available. Our pediatric hospital (260-bed, Level 1 Trauma, Level IV NICU) utilizes a VAP bundle and VAP pre-swarm process while caring for ventilator patients. The VAP pre-swarm identifies patients at high risk for VAP and facilitates a bedside multi-disciplinary chart review to assess barriers to bundle adherence. We aim to evaluate the impact of the frequency of VAP bundle audits and pre-swarms on VAP occurrence and audit success rate in our pediatric hospital. Methods: In an IRB-exempt retrospective review, VAP bundle audit and occurrence data was analyzed from 8/1/2023-5/31/2024. Data was exported from RedCap (bundle audits), QlikSense (VAP Rate), and the Infection Prevention database (Pre-Swarms). In April 2024 previous voluntary VAP bundle audits were mandated for the RT leadership team. VAP occurrence rate, pre-swarm occurrence, and audit success were compared to VAP bundle audit frequency, separating months with greater than and less than or equal to 5% of audits per ventilator days. Results: The percentage of audits compared to ventilator days ranged from 4-16% (Figure 1). Five months (50%) in the study period had 5% or fewer audits completed compared to ventilator days, and the remaining five months (50%) had 6% or greater completed audits. There was no correlation between the number of audits and the occurrence of VAP. However, the audit failure rate increased from 25.2% to 28.5%, and the audit success rate decreased from 74.7% to 71.5% when the percentage of audits increased. VAP pre-swarms doubled in the months with greater than 5% of audit occurrences, which correlates with an increased number of ventilator days in these months. Conclusions: Increased audit frequency resulted in increased failure rates; however, no relationship was found between quantity of VAP audits and VAP occurrence. Further studies must be done to develop guidelines for auditing frequency and appropriate volume.Figure 1: Details the VAP Prevention Bundle audits and VAP data for the study period.