Abstract
To evaluate the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional approach on the reduction of ventilator-associated pneumonia (VAP) in adult patients hospitalized in 11 intensive care units (ICUs), from 10 hospitals, members of the INICC, in 10 cities of Turkey. A prospective active before-after surveillance study was conducted to determine the effect of the INICC multidimensional approach in the VAP rate. The study was divided into two phases. In phase 1, active prospective surveillance of VAP was conducted using the definitions of the Centers for Disease Control and Prevention National Health Safety Network, and the INICC methods. In phase 2, we implemented the multidimensional approach for VAP. The INICC multidimensional approach included the following measures: (1) bundle of infection control interventions, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback of VAP rates, and (6) performance feedback of infection control practices. We compared the rates of VAP obtained in each phase. A time series analysis was performed to assess the impact of our approach. In phase 1, we recorded 2,376 mechanical ventilator (MV)-days, and in phase 2, after implementing the multidimensional approach, we recorded 28,181 MV-days. The rate of VAP was 31.14 per 1,000 MV-days during phase 1, and 16.82 per 1,000 MV-days during phase 2, amounting to a 46 % VAP rate reduction (RR, 0.54; 95 % CI, 0.42-0.7; P value, 0.0001.) The INICC multidimensional approach was associated with a significant reduction in the VAP rate in these adult ICUs of Turkey.
Highlights
Ventilator-associated pneumonia (VAP) was reported as the primary cause of morbidity and mortality for deviceassociated infections (DAI) in the adult intensive care unit (AICU) setting, and has, been considered the most serious healthcare-associated infection (HAI) for critically ill patients [1, 2]
Purpose To evaluate the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional approach on the reduction of ventilator-associated pneumonia (VAP) in adult patients hospitalized in 11 intensive care units (ICUs), from 10 hospitals, members of the INICC, in 10 cities of Turkey
This study is among the first scarce studies that have reported a substantial reduction in VAP rates in the AICU setting, proving this kind of infection control approach successful [1]
Summary
Ventilator-associated pneumonia (VAP) was reported as the primary cause of morbidity and mortality for deviceassociated infections (DAI) in the adult intensive care unit (AICU) setting, and has, been considered the most serious healthcare-associated infection (HAI) for critically ill patients [1, 2]. The importance of surveillance for measuring AICU patient infection risks, outcomes and processes in limited-resource countries is many times under-recognized, in spite of the fact that surveillance has long been reported a most effective tool for the reduction of VAP in the developed world [1, 4]. Since 2002, with the aim of contributing to address this public health problem in developing countries, the International Nosocomial Infection Control Consortium (INICC) has been implementing an outcome and process surveillance program for ICUs in limited-resource settings [5]. The results of the INICC program showed that the rates of VAP differed considerably between ICUs from developing and developed countries. The rates in limitedresource ICUs were from 3 to 5 times higher [6,7,8,9,10,11,12,13,14,15]
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