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Effectiveness of a multidimensional approach for prevention of ventilator-associated pneumonia in adult intensive care units from 14 developing countries of four continents

Findings of the International Nosocomial Infection Control Consortium*

Rosenthal, Victor D. MD; Rodrigues, Camilla MD; álvarez-Moreno, Carlos MD; Madani, Naoufel MD; Mitrev, Zan MD; Ye, Guxiang MD; Salomao, Reinaldo MD; Ulger, Fatma MD; Guanche-Garcell, Humberto MD; Kanj, Souha S. MD; Cuéllar, Luis E. MD; Higuera, Francisco MD; Mapp, Trudell RN; Fernández-Hidalgo, Rosalía MSc INICC members

doi: 10.1097/CCM.0b013e3182657916
Feature Articles

Objectives: The aim of this study was to analyze the effect of the International Nosocomial Infection Control Consortium’s multidimensional approach on the reduction of ventilator-associated pneumonia in patients hospitalized in intensive care units.

Design: A prospective active surveillance before–after study. The study was divided into two phases. During phase 1, the infection control team at each intensive care unit conducted active prospective surveillance of ventilator-associated pneumonia by applying the definitions of the Centers for Disease Control and Prevention National Health Safety Network, and the methodology of International Nosocomial Infection Control Consortium. During phase 2, the multidimensional approach for ventilator-associated pneumonia was implemented at each intensive care unit, in addition to the active surveillance.

Setting: Forty-four adult intensive care units in 38 hospitals, members of the International Nosocomial Infection Control Consortium, from 31 cities of the following 14 developing countries: Argentina, Brazil, China, Colombia, Costa Rica, Cuba, India, Lebanon, Macedonia, Mexico, Morocco, Panama, Peru, and Turkey.

Patients: A total of 55,507 adult patients admitted to 44 intensive care units in 38 hospitals.

Interventions: The International Nosocomial Infection Control Consortium ventilator-associated pneumonia multidimensional approach included the following measures: 1) bundle of infection-control interventions; 2) education; 3) outcome surveillance; 4) process surveillance; 5) feedback of ventilator-associated pneumonia rates; and 6) performance feedback of infection-control practices.

Measurements: The ventilator-associated pneumonia rates obtained in phase 1 were compared with the rates obtained in phase 2. We performed a time-series analysis to analyze the impact of our intervention.

Main Result: During phase 1, we recorded 10,292 mechanical ventilator days, and during phase 2, with the implementation of the multidimensional approach, we recorded 127,374 mechanical ventilator days. The rate of ventilator-associated pneumonia was 22.0 per 1,000 mechanical ventilator days during phase 1, and 17.2 per 1,000 mechanical ventilator days during phase 2.The adjusted model of linear trend shows a 55.83% reduction in the rate of ventilator-associated pneumonia at the end of the study period; that is, the ventilator-associated pneumonia rate was 55.83% lower than it was at the beginning of the study.

Conclusion: The implementation the International Nosocomial Infection Control Consortium multidimensional approach for ventilator-associated pneumonia was associated with a significant reduction in the ventilator-associated pneumonia rate in the adult intensive care units setting of developing countries.

From the Infection Control Department (VDR), International Nosocomial Infection Control Consortium, Buenos Aires, Argentina; Infection Control Department (CR), PD Hinduja National Hospital & Medical Research Centre, Mumbai, India; Infection Control Department (CAM), Hospital Universitario San Ignacio, Universidad Pontificia Javeriana, Bogotá, Colombia; Infection Control Department (NM), Ibn Sina- Medical ICU, Rabat, Morocco; Infection Control Department (ZM), Filip II Special Hospital for Surgery, Skopje, Macedonia; Infection Control Department (GY), Yangpu Hospital, Shanghai, China; Infection Control Department (RS), Hospital Santa Marcelina, São Paulo, Brazil; Infection Control Department (FU), Ondokuz Mayis University Medical School, Samsun, Turkey; Infection Control Department (HGG), Hospital Docente Clínico Quirúrgico “Joaquín Albarrán Domínguez”, Havana, Cuba; Infection Control Department (SSK), American University of Beirut Medical Center, Beirut, Lebanon; Infection Control Department (LEC), Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Perú; Infection Control Department (FH), Hospital General de México, Mexico City, Mexico; Infection Control Department (TM), Clínica Hospital San Fernando, Panama City, Panama; Infection Control Department (RFH), Hospital Clínica Bíblica, San José, Costa Rica.

The remaining INICC members can be found in the Appendix.

*See also p. 3303.

The authors have not disclosed any potential conflicts of interest.

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© 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins