Reducing Ventilator-Associated Pneumonia in the NICU
Reducing Ventilator-Associated Pneumonia in the NICU
Throughout the study period, 6,829 patients hospitalized for a total of 90,433 days in 15 NICUs were enrolled for a total of 19,134 MV-days. The participating hospitals were summarized and classified according to the number of NICUs, the number of patients per hospital NICU, type of hospital, and country (Table 1).
Patient characteristics, such as sex and weight, are shown in Table 2. We found that although MV use ratio was higher during the intervention period, MV duration was similar in both periods (Table 2).
The multifaceted infection control program showed its effectiveness in relation to correlated improvements in compliance rates. More specifically, during phase 2, we found a statistically significant increase in hand hygiene compliance, which improved from 62% to 81% (P < .01;Table 2).
In phase 1, there were 3,153 documented MV-days, and 56 VAPs were recorded, for an overall baseline rate of 17.8 VAPs per 1000 MV-days. In phase 2, after the implementation of the multifaceted infection control program, there were 15,981 MV-days. There were 191 VAPs, for an incidence density of 12.0 VAPs per 1,000 MV-days.
These results showed a 33% reduction in VAP rate from baseline (from 17.8 to 12.0 cases of VAP per 1,000 MV-days; RR, 0.67 [95% CI, 0.50–0.91];P = .0009; Table 2).
Among the isolated microorganisms associated with VAP, the most common was Pseudomonas species (which accounted for 45% of isolates during the baseline period and 50% of isolates during the intervention period; see Table 3 for a full bacterial profile).
Rates of VAP decreased immediately after the first 3 months of participation in the INICC, but rates remained at this reduced level with no further clear decrease with increased time in the INICC. During the intervention period (excluding the baseline surveillance), VAP rates decreased by 7% for every 3 months of follow-up (Table 4).
Results
Throughout the study period, 6,829 patients hospitalized for a total of 90,433 days in 15 NICUs were enrolled for a total of 19,134 MV-days. The participating hospitals were summarized and classified according to the number of NICUs, the number of patients per hospital NICU, type of hospital, and country (Table 1).
Patient characteristics, such as sex and weight, are shown in Table 2. We found that although MV use ratio was higher during the intervention period, MV duration was similar in both periods (Table 2).
The multifaceted infection control program showed its effectiveness in relation to correlated improvements in compliance rates. More specifically, during phase 2, we found a statistically significant increase in hand hygiene compliance, which improved from 62% to 81% (P < .01;Table 2).
In phase 1, there were 3,153 documented MV-days, and 56 VAPs were recorded, for an overall baseline rate of 17.8 VAPs per 1000 MV-days. In phase 2, after the implementation of the multifaceted infection control program, there were 15,981 MV-days. There were 191 VAPs, for an incidence density of 12.0 VAPs per 1,000 MV-days.
These results showed a 33% reduction in VAP rate from baseline (from 17.8 to 12.0 cases of VAP per 1,000 MV-days; RR, 0.67 [95% CI, 0.50–0.91];P = .0009; Table 2).
Among the isolated microorganisms associated with VAP, the most common was Pseudomonas species (which accounted for 45% of isolates during the baseline period and 50% of isolates during the intervention period; see Table 3 for a full bacterial profile).
Rates of VAP decreased immediately after the first 3 months of participation in the INICC, but rates remained at this reduced level with no further clear decrease with increased time in the INICC. During the intervention period (excluding the baseline surveillance), VAP rates decreased by 7% for every 3 months of follow-up (Table 4).
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