Background
Measures employed in preventing ventilator-associated pneumonia (VAP) in developing
countries are rarely reported. This study evaluates the efficacy of an infection control
program in reducing VAP in a neonatal intensive care unit (NICU) in China.
Methods
All neonates who received mechanical ventilation for at least 48 hours and were hospitalized
in the NICU for ≥5 days during 3 epochs were included. The hospital relocated to a
new site during phase 2 and a bundle of comprehensive preventive measures against
VAP were gradually implemented using the evidence-based practice for improving quality
method. Research physicians recorded associated information of patients diagnosed
with VAP.
Results
Of 491 patients receiving mechanical ventilation, 92 (18.7%) developed VAP corresponding
to 27.33 per 1,000 ventilator-days. The rate decreased from 48.84 per 1,000 ventilator-days
in phase 1 to 25.73 per 1,000 ventilator-days in phase 2 and further diminished to
18.50 per 1,000 ventilator-days in phase 3 (P < .001). Overall mortality rate of admitted neonates significantly decreased from
14.0% in phase 1 to 2.9% in phase 2 and 2.7% in phase 3 (P = .000). Gram-negative bacteria (95.5%) were the predominant organisms in VAP and
Acinetobacter baumannii (65.2%) was the most frequently isolated microorganism.
Conclusions
Implementing a multifaceted infection control program resulted in a significant reduction
in VAP rate with long-term effects. Such interventions could be extended to other
low-income countries.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Infection ControlAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- A randomized trial of diagnostic techniques for ventilator-associated pneumonia.N Engl J Med. 2006; 355: 2619-2630
- An evidence-based approach to the diagnosis of ventilator-associated pneumonia.Respir Care. 2009; 54: 1446-1448
- Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection.JAMA. 2004; 292: 2357-2365
- Nosocomial infections in a Dutch neonatal intensive care unit: surveillance study with definitions for infection specifically adapted for neonates.J Hosp Infect. 2005; 61: 300-311
- Nosocomial infections among neonates in high-risk nurseries in the United States. National Nosocomial Infections Surveillance System.Pediatrics. 1996; 98: 357-361
- Prevalence of nosocomial infection and antibiotic use at a university medical center in Malaysia.Infect Control Hosp Epidemiol. 2005; 26: 100-104
- Decreasing ventilator-associated pneumonia in adult intensive care units using the Institute for Healthcare Improvement bundle.Am J Infect Control. 2010; 38: 552-556
- Efficacy of an expanded ventilator bundle for the reduction of ventilator-associated pneumonia in the medical intensive care unit.Am J Infect Control. 2009; 37: 172-175
- A survey on nosocomial infection in neonatal intensive care unit.Zhongguo Dang Dai Er Ke Za Zhi. 2010; 12: 81-84
- Performance standards for antimicrobial susceptibility testing, 16th informational supplement. Clinical and Laboratory Standards Institute, Wayne [PA]2006
- CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting.Am J Infect Control. 2008; 36: 309-332
- Ventilator-associated pneumonia in extremely preterm neonates in a neonatal intensive care unit: characteristics, risk factors, and outcomes.Pediatrics. 2003; 112: 1283-1289
- National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004.Am J Infect Control. 2004; 32: 470-485
- Improving the quality of care for infants: a cluster randomized controlled trial.Can Med Assoc J. 2009; 181: 469-476
- Study of device use adjusted rates in health care-associated infections after implementation of “bundles”in a closed-model medical intensive care unit.J Crit Care. 2010; 25: 111-174
- Using care bundles to prevent infection in neonatal and paediatric ICUs.Curr Opin Infect Dis. 2009; 22: 224-228
- Strategies to prevent ventilator-associated pneumonia in neonates.Clin Perinatol. 2010; 37: 629-643
- Comprehensive evidence-based clinical practice guidelines for ventilator-associated pneumonia: diagnosis and treatment.J Crit Care. 2008; 23: 138-147
- National Healthcare Safety Network (NHSN) Report, data summary for 2010, device-associated module.Am J Infect Control. 2011; 39: 798-816
- International Nosocomial Infection Control Consortium (INICC) report, data summary of 36 countries, for 2004-2009.Am J Infect Control. 2011;
- New identification of outliers and ventilator-associated pneumonia rates from 2005 to 2007 within the German Nosocomial Infection Surveillance System.J Hosp Infect. 2009; 73: 246-252
- Device-associated nosocomial infections in 55 intensive care units of 8 developing countries.Ann Intern Med. 2006; 145: 582-591
- Ventilator-associated pneumonia in a newborn intensive care unit.Southeast Asian J Trop Med Public Health. 2004; 35: 724-729
- Epidemiology, etiology, and diagnosis of hospital-acquired pneumonia and ventilator-associated pneumonia in Asian countries.Am J Infect Control. 2008; 36: S93-100
- Nosocomial infection and death in a neonatal intensive care unit.J Infect Dis. 1983; 147: 635-641
- Handwashing compliance by health care workers: the impact of introducing an accessible, alcohol-based hand antiseptic.Arch Intern Med. 2000; 160: 1017-1021
- Influence of role models and hospital design on hand hygiene of healthcare workers.Emerg Infect Dis. 2003; 9: 217-223
- An intensive care unit quality improvement collaborative in nine Department of Veterans Affairs hospitals: reducing ventilator-associated pneumonia and catheter-related bloodstream infection rates.Jt Comm J Qual Patient Saf. 2008; 34: 639-645
- The Hawthorne effect: a randomised, controlled trial.BMC Med Res Methodol. 2007; 7: 30
- Risk factors and outcomes for ventilator-associated pneumonia in neonatal intensive care unit patients.J Perinat Med. 2007; 35: 334-338
- Ventilator-associated pneumonia in intensive care units in Hubei Province, China: a multicentre prospective cohort survey.J Hosp Infect. 2011; 78: 284-288
- Nosocomial infections in pediatric patients: a European, multicenter prospective study. European Study Group.Infect Control Hosp Epidemiol. 2000; 21: 260-263
- Hospital-acquired pneumonia: risk factors, clinical features, management, and antibiotic resistance.Curr Opin Pulm Med. 2004; 10: 171-175
Article info
Publication history
Published online: September 16, 2013
Footnotes
Conflicts of interest: None to report.
Identification
Copyright
© 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
