168 - Reducing Ventilator-Associated Pneumonia Through a Multicomponent Bundle: A Multicampus NICU Quality Improvement Project in China

Publication Number: 3162.168

Juan He, Guangzhou Women and children’s Hospital,Guangzhou medical university, guangzhou, Guangdong, China (People's Republic); Sirui Wang, Xiamen Children's Hospital (Xiamen Hospital affiliated with Fudan University), Xiamen, Fujian, China (People's Republic); Run Dang, Children's Hospital & Medical Center, Guangzhou, Guangdong, China (People's Republic); Zhiqiang Guo, Jiangxi Provincial Children's Hospital, Nanchang, Jiangxi, China (People's Republic); Kuimiao Deng, Women and Children's Medical Center Affiliated to Guangzhou Medical University, Guangzhou, Guangdong, China (People's Republic); Qing Wang, Guangzhou children and women's Medical Center, Guangzhou, Guangdong, China (People's Republic); Shufeng Tian, Shenzhen Children's Hospital, Shenzhen, Guangdong, China (People's Republic); Xialing Pang, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region,Guangxi Clinical Research Center for Pediatric Diseases, Nanning, Guangxi, China (People's Republic); Song Zhang, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China (People's Republic); Shufeng Yu, Guangzhou women and children's medical center, Guangzhou, Guangdong, China (People's Republic); Yi Sun, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China (People's Republic); Cuizhen Gao, Guangzhou Women and Children's Medical Center,Guangzhou Medical University, Guangzhou, Guangdong, China (People's Republic); Kuiyan Yang, Women and Children's Medical Center Affiliated to Guangzhou Medical University, GuangZhou, Guangdong, China (People's Republic); John Chuo, University of Pennsylvania Perelman School of Medicine, doylestown, PA, United States; Huayan Zhang, Children's Hospital of Philadelphia-University of Pennsylvania, Philadelphia, PA, United States

Background: Ventilator-associated pneumonia (VAP) is a common healthcare-associated infection. Although VAP prevention bundles are widely implemented, maintaining high compliance remains challenging in busy Chinese NICUs. Guangzhou Women and Children's Medical Center, a tertiary network with over 200 NICU beds across three campuses, provided an opportunity to pilot and scale a standardized bundle within an integrated system where staff rotate across sites.

Objective: The purpose of this project was to increase the VAP-free interval by ≥20% within six months.

Design/Methods: This project was first piloted in the NICU of Zhujiang campus in May, 2025 and expanded to NICUs in the other two campuses. Infants receiving invasive ventilation ≥48 hours, except those on ECMO or diagnosed with immunodeficiency were included. VAP was defined based on the 2022 CDC definition. A multidisciplinary QI team，comprising neonatologists, nurses, respiratory and infectious disease specialists，identified key drivers and implemented interventions through PDSA cycles: (1) establishing a unified policy for VAP prevention ; (2) providing nurse and physician training on diagnosis and bundle implementation; (3) conducting monthly multicampus audit and feedback sessions; (4) optimizing workflow through standardized ventilator weaning. The primary outcome was the VAP-free interval. Process measures included compliance with hand hygiene, oral care, suction care etc. Balancing measures included nursing satisfaction and unplanned extubation. Staff knowledge was evaluated after education sessions.

Results: Hand hygiene compliance and completion rates improved from 89.1% and 49.0% at baseline to 96.9% and 84.5%. There was also significant increase in the compliance with head-of-bed elevation (43.8% to 67.7%), oral care (71.9% to 93.6%), suction care (83.0% to 95.9%), and ventilator circuit positioning management (47.7% to 63.3%). At the pilot campus, the VAP-free interval increased from 7.2 to 14.1 days within four months after bundle implementation with no increase in unplanned extubation. The protocol was then adapted and introduced to the other two campuses through structured staff training and shared data reviews.

Conclusion(s): This multicampus QI project successfully increased the VAP-free interval. Starting with a pilot at the main campus and expanding across sites, the initiative demonstrated that a standardized, evidence-based prevention bundle can be feasibly scaled within an integrated neonatal system. This approach offers a replicable model for regional or multicampus NICU networks worldwide, particularly in developing healthcare settings.

Key drivers diagram of the study
Key drivers diagram of the study included aims,key drivers,second drivers and interventions.

Change in Ventilator-Associated Pneumonia Occurrence Interval and unplanned extubation rate at zhujiang Campus.
At Zhujiang Campus, the VAP-free interval increased from 7.2 to 14.1 days after bundle implementation,without an increase in extubation rate.

Change in Ventilator-Associated Pneumonia Occurrence Interval at zengcheng and children Campus
VAP-free interval trends at Zengcheng and Children's campuses are in progress, with ongoing implementation of bundle interventions.