Ventilator Associated Pneumonia in the Pediatric Patients: Barriers to Head of Bed Elevation (HOB)

Thursday, 15 July 2010: 1:45 PM

Marisa G. Mize, DNP, RN, BSN, MSN, CPNP, AC, PC, CCRN
Department of Pediatrics, Walter Reed Army Medical Center, Washington, DC

Learning Objective 1: 1. To recognize the impact of ventilator associated pneumonia in the pediatric patient.

Learning Objective 2: 2. To understand the importance of head of bed elevation in the prevention of ventilator associated pneumonia.

Objective– Head of bed (HOB) elevation compared to supine position in adults has been shown to decrease ventilator-associated pneumonia (VAP).  The effects of HOB elevation have not been studied in pediatric population. The objective of this project was to create an educational module that would help increase the frequency of HOB positioning in mechanically ventilated pediatric patients.  A survey was conducted to gather knowledge from among pediatric health care providers about VAP and determinants and barriers to HOB elevation.

Setting- The CICU and PICU at Children’s National Medical Center in Washington, DC.

Participants- Pediatric intensive care nurses and physicians.

Methods- Information about the insights about the benefits and barriers to HOB elevation were collected.  Information gained from the survey was used to create an educational module to encourage HOB use as a means of decreasing VAP.    
Results- Most nurses and physicians were familiar with HOB elevation as a VAP prevention strategy.  A majority of participants endorsed HOB elevation.  Clinicians perceived VAP prevention, patient hemodyanmics and diagnosis as determinants   of HOB elevation.  Participants identified barriers to HOB elevation related to administrative, unit culture,  and physical barriers.

  Education, chart audits, guidelines and policies were suggested as ways to improve HOB elevation in the mechanically ventilated child. A  ten-item questionnaire was created to incorporate the survey findings and make a more specific tool to improve HOB elevation in the pediatric ventilated patient. 

Conclusions- HOB elevation practice in the mechanically ventilated pediatric patient is inconsistently utilized due to a lack of awareness of its benefit and lack of agreement as to who should implement it.  The lack of organized strategies further reduces HOB elevation. Both the survey serves as the bridge to implementing adult interventions to the pediatric population.   An educational module is an important initial step in developing a consistent approach to reducing VAP through HOB elevation.