Reducing ventilator-associated pneumonia in neonatal intensive care unit using “VAP prevention Bundle”: a cohort study

Abstract

BackgroundVentilator-associated pneumonia (VAP) is a serious health care- associated infection, resulting in high morbidity and mortality. It also prolongs hospital stay and drives up hospital costs. Measures employed in preventing ventilator- associated pneumonia in developing countries are rarely reported. In this study we tried to assess the efficacy of our designed “VAP prevention bundle” in reducing VAP rate in our neonatal intensive care unit (NICU).MethodThis prospective before-and-after study was conducted at university hospital NICU, all neonates who had mechanical ventilation for ≥ 48 h were eligible. VAP rates were evaluated before (phase-I) and after (phase-II) full implementation of comprehensive preventive measures specifically designed by our infection control team.ResultsOf 143 mechanically ventilated neonates, 73 patients developed VAP (51 %) throughout the study period (2500 mechanical ventilation days). The rate of VAP was significantly reduced from 67.8 % (42/62) corresponding to 36.4 VAP episodes/1000 mechanical ventilation days (MV days) in phase-I to 38.2 % (31/81) corresponding to 23 VAP/1000 MV days (RR 0.565, 95 % confidence interval 0.408-0.782, p = 0.0006) after VAP prevention bundle implementation (phase-II). Parallel significant reduction in MV days/case were documented in post-intervention period (21.50 ± 7.6 days in phase-I versus 10.36 ± 5.2 days in phase-II, p = 0.000). There were a trend toward reduction in NICU length of stay (23.9 ± 10.3 versus 22.8 ± 9.6 days, p = 0.56) and overall mortality (25 % versus 17.3 %, p = 0.215) between the two phases but didn’t reach statistical significance. The commonest micro-organisms isolated throughout the study were gram-negative bacteria (63/66, 95.5 %) particularly Klebsilla pneumonia (55/66, 83.4 %).ConclusionImplementation of multifaceted infection control bundle resulted in reduction of VAP rate, length of stay in our NICU.

Bundle Method In Reducing Pneumonia Associated With Mechanical Ventilation In Newborns And Children: Integrative Review

“…Most of the interventions related to the care of the ventilation circuits and system maintenance without water condensation and exchange only in case of visible dirt or malfunction [9][10][11][12][13]15], followed the recommendations of IHI [23]. However, there are differences in the level of evidence of these strategies when applied in neonates because the evidence is considered weak.…”

“…The practice of hand hygiene by the health professionals was described in most studies [8][9][10][11][12][13]15]. It is the most important and recognized measure for prevention and control of infections related to care.…”

“…Among the interventions for maintenance of permeable airways, tracheal aspiration aseptically was identified with system closed and hands off use [9,10,13,14,16]. The use of the closed suction system has had low evidence in reducing PAV over the other technique of vacuum, with the system off [4,30].…”

“…This generates a variety of interventions for oral hygiene in infants. In studies of the review, there was the use of saline 0.9%, sterile distilled water and breast milk [8,10,13].…”

“…The intervention of the headboard elevation was present in most of the bundles [10][11][12][13][14][15], which is considered a weak evidence [25]. According to the CDC´s recommendation, there are differences in the angle of inclination for newborns and pediatric patients [27].…”