Authors: (including presenting author): :
Wong KY (1), Ng CYA (1), Chow SYP (1)
Affiliation: :
(1) Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital
Keyword 1: :
Ventilator-Associated Pneumonia
Keyword 4: :
Infection Control
Introduction: :
In 2023 and 2024, VAP incidence at the QMH NICU was 20.98 and 15.34 per 1000 ventilator days respectively. This rate significantly exceeds the international benchmark of 1.4–7 per 1000 ventilator days established for developed countries. VAP is associated with higher mortality and morbidity, prolonged hospitalization, and increased healthcare costs. This persistent elevation in incidence revealed a critical service gap in infection control prevention practices, creating an urgent need for a systematic intervention to enhance patient safety and clinical outcomes for this vulnerable population.
Objectives: :
(1) To identify the root causes for the elevated VAP incidence (2) To implement targeted interventions to reduce VAP incidence by at least 20%
Methodology: :
A workgroup was formed to perform a root cause analysis through direct clinical observation and staff interviews. Four key, modifiable causes were identified: (1) Frequent omission of post-procedure suction tubing rinsing was noted which promotes significant bacterial colonization within the tubing. (2) Suction tubing tips were often left inside incubators via cable ports instead of being secured in wall-mounted holders, which promotes bacterial growth. Nurses reported the existing holders were inconveniently located, being too far from the incubators. (3) Inconsistent weekly suction canister changes by Patient Care Assistants, creating a risk for bacterial overgrowth. (4) The bi-weekly frequency for changing incubators was insufficient and likely promoted bacterial colonization in the patient's direct environment Corresponding improvement actions were implemented: (1) Introduce a standardized daily checklist for auditing tubing cleanliness and storage by ward in-charge (2) Installation of additional suction tube holders in convenient locations adjacent to each incubator. (3) Implementation of a color-coded weekly tape system on all suction canisters, providing clear, visual verification of the last change date to simplify monitoring for the ward in-charge. (4) Protocol revision to change incubators weekly.
Result & Outcome: :
Following the implementation of these enhanced infection control practices in the NICU, the VAP incidence was successfully reduced to 6.86 per 1000 ventilator days in 2025. This result represents a 55.3% reduction from the 2024 rate, surpassing the project's initial goal of a 20% reduction. The interventions effectively addressed the identified root causes, demonstrating that systematic quality improvement can bridge critical safety gaps in infection control practices and align clinical outcomes with international standards.
