Adding a bundle of low-cost interventions to surveillance significantly reduces rates of ventilator-associated pneumonia (VAP) in adult intensive care units (AICUs) in developing countries, shows an international study.
"This study is among the first few that have reported a substantial reduction in VAP rates in the AICU setting, proving the success of this kind of infection-control approach," say Victor Rosenthal (International Nosocomial Infection Control Consortium [INICC], Buenos Aires, Argentina) and colleagues.
The authors used data from 55,507 AICU patients in hospitals involved in the INICC surveillance program in 14 developing countries (Argentina, Brazil, China, Colombia, Costa Rica, Cuba, India, Lebanon, Macedonia, Mexico, Morocco, Panama, Peru, and Turkey).
During the baseline phase, centers began the surveillance program for 3 months. In the second phase, which lasted a mean of 35.2 months, additional measures were introduced, such as hand hygiene protocol, minimizing duration of ventilation, and antiseptic oral care, combined with performance feedback.
The authors found that between baseline and the end of the intervention period, the rate of VAP significantly decreased from 22.0 infections per 1000 mechanoventilated‑days to 17.2 infections per 1000 mechanoventilated‑days.
Adjusted analyses showed that between the start and end of the second phase, the VAP rate decreased by 55.8%.
Furthermore, during the intervention period, the average length of stay significantly decreased to 6.4 days compared with 6.9 days in the baseline period. Use of antibiotics also declined, being needed by 59.1% of patients in the intervention period compared with 63.8% in the baseline period. Rosenthal and colleagues say that both observations are likely due to the reduction in VAP rates.
They conclude that their results show that a multidimensional approach is required to optimize infection prevention.
"VAP control may not be sufficient or feasible if a single measure is implemented, but it requires a culture change involving the entire ICU team," they write in Critical Care Medicine.
"Similarly, a reduction in VAP rates cannot be expected to derive from surveillance itself, unless the collection of data is used for the improvement of patient-care practices, such as performance feedback."
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