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.
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.
Authors: Elizabeth Wastnedge; Donald Waters; Sarah R Murray; Brian McGowan; Effie Chipeta; Alinane Linda Nyondo-Mipando; Luis Gadama; Gladys Gadama; Martha Masamba; Monica Malata; Frank Taulo; Queen Dube; Kondwani Kawaza; Patricia Munthali Khomani; Sonia Whyte; Mia Crampin; Bridget Freyne; Jane E Norman; Rebecca M Reynolds Journal: J Glob Health Date: 2021-12-30 Impact factor: 4.413
Authors: Nabila Zaka; Emma C Alexander; Logan Manikam; Irena C F Norman; Melika Akhbari; Sarah Moxon; Pavani Kalluri Ram; Georgina Murphy; Mike English; Susan Niermeyer; Luwei Pearson Journal: Implement Sci Date: 2018-01-25 Impact factor: 7.327
Authors: Alexandra Molina García; James H Cross; Elizabeth J A Fitchett; Kondwani Kawaza; Uduak Okomo; Naomi E Spotswood; Msandeni Chiume; Veronica Chinyere Ezeaka; Grace Irimu; Nahya Salim; Elizabeth M Molyneux; Joy E Lawn Journal: EClinicalMedicine Date: 2022-01-10