Reducing Ventilator-Associated Pneumonia in Neonatal Intensive Care Unit Using "VAP Prevention Bundle"

ABSTRACT

Background and study aim: Ventilator-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 for preventing ventilator-associated pneumonia in developing countries are scarcely reported. The aim of the current work is to assess the efficacy of our designed "VAP prevention bundle" in reducing VAP rates in the neonatal intensive care unit (NICU). Patients and Methods: This prospective before-and-after study was conducted at Zagazig university hospital NICU; all neonates who had mechanical ventilation during the period from January 2013 to March 2014 for ≥48 hours were eligible after parental consent. VAP rates were evaluated before (phase-I) and after (phase-II) full implementation of the comprehensive preventive measures specifically designed by our infection control team. Results: Out of 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 the 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 trends 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 which 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%). Conclusion: The implementation of our multifaceted infection control bundle has resulted in a significant reduction of VAP rates, length of stay and hospital cost in our NICU. These rates are still far behind the internationally acknowledged ones