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

• Published in: American journal of infection control Vol. 41; no. 11; pp. 1059 - 1064
• Main Authors: Zhou, Qi, MD, Lee, Shoo K., PhD, MBBS, FRCPC, Jiang, Si-yuan, MD, Chen, Chao, MD, PhD, Kamaluddeen, Majeeda, MD, Hu, Xiao-jing, MSN, RN, Wang, Chuan-qing, PhD, Cao, Yun, MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.11.2013; Elsevier; Mosby-Year Book, Inc
• Subjects: Bacteria; Bacterial Infections - epidemiology; Bacterial Infections - microbiology; Bacterial Infections - prevention & control; Biological and medical sciences; China - epidemiology; Developing countries; Disease control; Epidemiology. Vaccinations; Female; General aspects; Health care-associated infections; Human infectious diseases. Experimental studies and models; Humans; Infant; Infant, Newborn; Infection Control; Infection Control - methods; Infectious Disease; Infectious diseases; Intensive care; Intensive Care Units, Neonatal; LDCs; Male; Medical sciences; Mycoses - epidemiology; Mycoses - microbiology; Mycoses - prevention & control; Pneumology; Pneumonia; Pneumonia, Ventilator-Associated - epidemiology; Pneumonia, Ventilator-Associated - microbiology; Pneumonia, Ventilator-Associated - prevention & control; Prevalence; Respiratory system : syndromes and miscellaneous diseases; Survival Analysis; Asia; China; Infant; Health care-associated infections; Human; Prevention; Lung disease; Nosocomial infection; Pneumonia; Newborn; Respiratory disease; Check; Artificial ventilation; Intensive care unit
• ISSN: 0196-6553; 1527-3296
• DOI: 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.