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Efficacy of an infection control program in reducing ventilator-associated pneumonia in a Chinese neonatal intensive care unit

Published:September 16, 2013DOI:https://doi.org/10.1016/j.ajic.2013.06.007

      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

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      References

        • Canadian Clinical Care Trials Group
        A randomized trial of diagnostic techniques for ventilator-associated pneumonia.
        N Engl J Med. 2006; 355: 2619-2630
        • Marik P.E.
        An evidence-based approach to the diagnosis of ventilator-associated pneumonia.
        Respir Care. 2009; 54: 1446-1448
        • Stoll B.J.
        • Hansen N.I.
        • Adams-Chapman I.
        • Fanaroff A.A.
        • Hintz S.R.
        • Vohr B.
        • et al.
        Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection.
        JAMA. 2004; 292: 2357-2365
        • van der Zwet W.C.
        • Kaiser A.M.
        • van Elburg R.M.
        • Berkhof J.
        • Fetter W.P.
        • Parlevliet G.A.
        • et al.
        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
        • Gaynes R.P.
        • Edwards J.R.
        • Jarvis W.R.
        • Culver D.H.
        • Tolson J.S.
        • Martone W.J.
        Nosocomial infections among neonates in high-risk nurseries in the United States. National Nosocomial Infections Surveillance System.
        Pediatrics. 1996; 98: 357-361
        • Hughes A.J.
        • Ariffin N.
        • Huat T.L.
        • Abdul M.H.
        • Hashim S.
        • Sarijo J.
        • et al.
        Prevalence of nosocomial infection and antibiotic use at a university medical center in Malaysia.
        Infect Control Hosp Epidemiol. 2005; 26: 100-104
        • Al-Tawfiq J.A.
        • Abed M.S.
        Decreasing ventilator-associated pneumonia in adult intensive care units using the Institute for Healthcare Improvement bundle.
        Am J Infect Control. 2010; 38: 552-556
        • Blamoun J.
        • Alfakir M.
        • Rella M.E.
        • Wojcik J.M.
        • Solis R.A.
        • Anees K.M.
        • et al.
        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
        • Cai X.D.
        • Cao Y.
        • Chen C.
        A survey on nosocomial infection in neonatal intensive care unit.
        Zhongguo Dang Dai Er Ke Za Zhi. 2010; 12: 81-84
      1. Performance standards for antimicrobial susceptibility testing, 16th informational supplement. Clinical and Laboratory Standards Institute, Wayne [PA]2006
        • Horan T.C.
        • Andrus M.
        • Dudeck M.A.
        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
        • Apisarnthanarak A.
        • Holzmann-Pazgal G.
        • Hamvas A.
        • Olsen M.A.
        • Fraser V.J.
        Ventilator-associated pneumonia in extremely preterm neonates in a neonatal intensive care unit: characteristics, risk factors, and outcomes.
        Pediatrics. 2003; 112: 1283-1289
        • System C.N.
        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
        • Lee S.K.
        • Aziz K.
        • Singhal N.
        • Cronin C.M.
        • James A.
        • Lee D.S.
        • et al.
        Improving the quality of care for infants: a cluster randomized controlled trial.
        Can Med Assoc J. 2009; 181: 469-476
        • Venkatram S.
        • Rachmale S.
        • Kanna B.
        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
        • Lachman P.
        • Yuen S.
        Using care bundles to prevent infection in neonatal and paediatric ICUs.
        Curr Opin Infect Dis. 2009; 22: 224-228
        • Garland J.S.
        Strategies to prevent ventilator-associated pneumonia in neonates.
        Clin Perinatol. 2010; 37: 629-643
        • Muscedere J.
        • Dodek P.
        • Keenan S.
        • Fowler R.
        • Cook D.
        • Heyland D.
        Comprehensive evidence-based clinical practice guidelines for ventilator-associated pneumonia: diagnosis and treatment.
        J Crit Care. 2008; 23: 138-147
        • Dudeck M.A.
        • Horan T.C.
        • Peterson K.D.
        • Allen-Bridson K.
        • Morrell G.
        • Pollock D.A.
        • et al.
        National Healthcare Safety Network (NHSN) Report, data summary for 2010, device-associated module.
        Am J Infect Control. 2011; 39: 798-816
        • Rosenthal V.D.
        • Bijie H.
        • Maki D.G.
        • Mehta Y.
        • Apisarnthanarak A.
        • Medeiros E.A.
        • et al.
        International Nosocomial Infection Control Consortium (INICC) report, data summary of 36 countries, for 2004-2009.
        Am J Infect Control. 2011;
        • Meyer E.
        • Sohr D.
        • Gastmeier P.
        • Geffers C.
        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
        • Rosenthal V.D.
        • Maki D.G.
        • Salomao R.
        • Moreno C.A.
        • Mehta Y.
        • Higuera F.
        • et al.
        Device-associated nosocomial infections in 55 intensive care units of 8 developing countries.
        Ann Intern Med. 2006; 145: 582-591
        • Petdachai W.
        Ventilator-associated pneumonia in a newborn intensive care unit.
        Southeast Asian J Trop Med Public Health. 2004; 35: 724-729
        • Chawla R.
        Epidemiology, etiology, and diagnosis of hospital-acquired pneumonia and ventilator-associated pneumonia in Asian countries.
        Am J Infect Control. 2008; 36: S93-100
        • Goldmann D.A.
        • Freeman J.
        • Durbin W.J.
        Nosocomial infection and death in a neonatal intensive care unit.
        J Infect Dis. 1983; 147: 635-641
        • Bischoff W.E.
        • Reynolds T.M.
        • Sessler C.N.
        • Edmond M.B.
        • Wenzel R.P.
        Handwashing compliance by health care workers: the impact of introducing an accessible, alcohol-based hand antiseptic.
        Arch Intern Med. 2000; 160: 1017-1021
        • Lankford M.G.
        • Zembower T.R.
        • Trick W.E.
        • Hacek D.M.
        • Noskin G.A.
        • Peterson L.R.
        Influence of role models and hospital design on hand hygiene of healthcare workers.
        Emerg Infect Dis. 2003; 9: 217-223
        • Bonello R.S.
        • Fletcher C.E.
        • Becker W.K.
        • Clutter K.L.
        • Arjes S.L.
        • Cook J.J.
        • et al.
        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
        • McCarney R.
        • Warner J.
        • Iliffe S.
        • van Haselen R.
        • Griffin M.
        • Fisher P.
        The Hawthorne effect: a randomised, controlled trial.
        BMC Med Res Methodol. 2007; 7: 30
        • Yuan T.M.
        • Chen L.H.
        • Yu H.M.
        Risk factors and outcomes for ventilator-associated pneumonia in neonatal intensive care unit patients.
        J Perinat Med. 2007; 35: 334-338
        • Xie D.S.
        • Xiong W.
        • Lai R.P.
        • Liu L.
        • Gan X.M.
        • Wang X.H.
        • et al.
        Ventilator-associated pneumonia in intensive care units in Hubei Province, China: a multicentre prospective cohort survey.
        J Hosp Infect. 2011; 78: 284-288
        • Raymond J.
        • Aujard Y.
        Nosocomial infections in pediatric patients: a European, multicenter prospective study. European Study Group.
        Infect Control Hosp Epidemiol. 2000; 21: 260-263
        • Leroy O.
        • Soubrier S.
        Hospital-acquired pneumonia: risk factors, clinical features, management, and antibiotic resistance.
        Curr Opin Pulm Med. 2004; 10: 171-175