Reducing Ventilator-associated Pneumonia in Neonatal Intensive Care Unit Using "VAP Prevention Bundle": a Cohort Study

Overview

Journal BMC Infect Dis

Publisher Biomed Central

Specialty Infectious Diseases

Date 2015 Aug 7

PMID 26246314

Citations 23

Authors

Seham F A Azab

Hanan S Sherbiny

Safaa H Saleh

Wafaa F Elsaeed

Mona M Elshafiey

Ahmed G Siam

Mohamed A Arafa

Ashgan A Alghobashy

Eman A Bendary

Maha A A Basset

Sanaa M Ismail

Nagwa E Akeel

Nahla A Elsamad

Wesam A Mokhtar

Tarek Gheith

Affiliations

Soon will be listed here.

Abstract

Background: Ventilator-associated pneumonia (VAP) is a serious health care-associated infection, resulting in high morbidity and mortality. It also prolongs hospital stay and drives up hospital costs. Measures employed in preventing ventilator-associated pneumonia in developing countries are rarely reported. In this study we tried to assess the efficacy of our designed "VAP prevention bundle" in reducing VAP rate in our neonatal intensive care unit (NICU).

Method: This prospective before-and-after study was conducted at university hospital NICU, all neonates who had mechanical ventilation for ≥ 48 h were eligible. VAP rates were evaluated before (phase-I) and after (phase-II) full implementation of comprehensive preventive measures specifically designed by our infection control team.

Results: Of 143 mechanically ventilated neonates, 73 patients developed VAP (51%) throughout the study period (2500 mechanical ventilation days). The rate of VAP was significantly reduced from 67.8% (42/62) corresponding to 36.4 VAP episodes/1000 mechanical ventilation days (MV days) in phase-I to 38.2% (31/81) corresponding to 23 VAP/1000 MV days (RR 0.565, 95% confidence interval 0.408-0.782, p = 0.0006) after VAP prevention bundle implementation (phase-II). Parallel significant reduction in MV days/case were documented in post-intervention period (21.50 ± 7.6 days in phase-I versus 10.36 ± 5.2 days in phase-II, p = 0.000). There were a trend toward reduction in NICU length of stay (23.9 ± 10.3 versus 22.8 ± 9.6 days, p = 0.56) and overall mortality (25% versus 17.3%, p = 0.215) between the two phases but didn't reach statistical significance. The commonest micro-organisms isolated throughout the study were gram-negative bacteria (63/66, 95.5%) particularly Klebsilla pneumonia (55/66, 83.4%).

Conclusion: Implementation of multifaceted infection control bundle resulted in reduction of VAP rate, length of stay in our NICU.

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References

Koksal N, Hacimustafaoglul M, Celebi S, Ozakin C . Nonbronchoscopic bronchoalveolar lavage for diagnosing ventilator-associated pneumonia in newborns. Turk J Pediatr. 2006; 48(3):213-20. View

Apisarnthanarak A, Holzmann-Pazgal G, Hamvas A, Olsen M, Fraser V . Ventilator-associated pneumonia in extremely preterm neonates in a neonatal intensive care unit: characteristics, risk factors, and outcomes. Pediatrics. 2003; 112(6 Pt 1):1283-9. DOI: 10.1542/peds.112.6.1283. View

Craven D, Goularte T, Make B . Contaminated condensate in mechanical ventilator circuits. A risk factor for nosocomial pneumonia?. Am Rev Respir Dis. 1984; 129(4):625-8. View

Omrane R, Eid J, Perreault M, Yazbeck H, Berbiche D, Gursahaney A . Impact of a protocol for prevention of ventilator-associated pneumonia. Ann Pharmacother. 2007; 41(9):1390-6. DOI: 10.1345/aph.1H678. View

. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005; 171(4):388-416. DOI: 10.1164/rccm.200405-644ST. View

Xie D, Xiong W, Lai R, Liu L, Gan X, Wang X . Ventilator-associated pneumonia in intensive care units in Hubei Province, China: a multicentre prospective cohort survey. J Hosp Infect. 2011; 78(4):284-8. DOI: 10.1016/j.jhin.2011.03.009. View

Holleman-Duray D, Kaupie D, Weiss M . Heated humidified high-flow nasal cannula: use and a neonatal early extubation protocol. J Perinatol. 2007; 27(12):776-81. DOI: 10.1038/sj.jp.7211825. View

Drakulovic M, Torres A, Bauer T, Nicolas J, Nogue S, Ferrer M . Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet. 1999; 354(9193):1851-8. DOI: 10.1016/S0140-6736(98)12251-1. View

Kollef M . Prevention of hospital-associated pneumonia and ventilator-associated pneumonia. Crit Care Med. 2004; 32(6):1396-405. DOI: 10.1097/01.ccm.0000128569.09113.fb. View

10.

Al-Tawfiq J, Abed M . Decreasing ventilator-associated pneumonia in adult intensive care units using the Institute for Healthcare Improvement bundle. Am J Infect Control. 2010; 38(7):552-6. DOI: 10.1016/j.ajic.2010.01.008. View

11.

Foglia E, Meier M, Elward A . Ventilator-associated pneumonia in neonatal and pediatric intensive care unit patients. Clin Microbiol Rev. 2007; 20(3):409-25, table of contents. PMC: 1932752. DOI: 10.1128/CMR.00041-06. View

12.

Rosenthal V, Bijie H, Maki D, Mehta Y, Apisarnthanarak A, Medeiros E . International Nosocomial Infection Control Consortium (INICC) report, data summary of 36 countries, for 2004-2009. Am J Infect Control. 2011; 40(5):396-407. DOI: 10.1016/j.ajic.2011.05.020. View

13.

Gaynes R, Edwards J, Jarvis W, Culver D, Tolson J, Martone W . Nosocomial infections among neonates in high-risk nurseries in the United States. National Nosocomial Infections Surveillance System. Pediatrics. 1996; 98(3 Pt 1):357-61. View

14.

Blamoun J, Alfakir M, Rella M, Wojcik J, Solis R, Khan M . Efficacy of an expanded ventilator bundle for the reduction of ventilator-associated pneumonia in the medical intensive care unit. Am J Infect Control. 2008; 37(2):172-5. DOI: 10.1016/j.ajic.2008.05.010. View

15.

Tablan O, Anderson L, Besser R, Bridges C, Hajjeh R . Guidelines for preventing health-care--associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep. 2004; 53(RR-3):1-36. View

16.

Raymond J, Aujard Y . Nosocomial infections in pediatric patients: a European, multicenter prospective study. European Study Group. Infect Control Hosp Epidemiol. 2000; 21(4):260-3. DOI: 10.1086/501755. View

17.

Rosenthal V, Maki D, Salomao R, Alvarez Moreno C, Mehta Y, Higuera F . Device-associated nosocomial infections in 55 intensive care units of 8 developing countries. Ann Intern Med. 2006; 145(8):582-91. DOI: 10.7326/0003-4819-145-8-200610170-00007. View

18.

Leroy O, Soubrier S . Hospital-acquired pneumonia: risk factors, clinical features, management, and antibiotic resistance. Curr Opin Pulm Med. 2004; 10(3):171-5. DOI: 10.1097/00063198-200405000-00005. View

19.

Petdachai W . Ventilator-associated pneumonia in a newborn intensive care unit. Southeast Asian J Trop Med Public Health. 2005; 35(3):724-9. View

20.

van der Zwet W, Kaiser A, van Elburg R, Berkhof J, Fetter W, Parlevliet G . Nosocomial infections in a Dutch neonatal intensive care unit: surveillance study with definitions for infection specifically adapted for neonates. J Hosp Infect. 2005; 61(4):300-11. DOI: 10.1016/j.jhin.2005.03.014. View