Effectiveness of a multidimensional approach for prevention of ventilator-associated pneumonia in 21 adult intensive-care units from 10 cities in India: findings of the International Nosocomial Infection Control Consortium (INICC)

Abstract

We report on the effect of the International Nosocomial Infection Control Consortium's (INICC) multidimensional approach for the reduction of ventilator-associated pneumonia (VAP) in adult patients hospitalized in 21 intensive-care units (ICUs), from 14 hospitals in 10 Indian cities. A quasi-experimental study was conducted, which was divided into baseline and intervention periods. During baseline, prospective surveillance of VAP was performed applying the Centers for Disease Control and Prevention/National Healthcare Safety Network definitions and INICC methods. During intervention, our approach in each ICU included a bundle of interventions, education, outcome and process surveillance, and feedback of VAP rates and performance. Crude stratified rates were calculated, and by using random-effects Poisson regression to allow for clustering by ICU, the incidence rate ratio for each time period compared with the 3-month baseline was determined. The VAP rate was 17.43/1000 mechanical ventilator days during baseline, and 10.81 for intervention, showing a 38% VAP rate reduction (relative risk 0.62, 95% confidence interval 0.5-0.78, P = 0.0001).

Incidence and attributable costs of ventilator-associated pneumonia (VAP) in a tertiary-level intensive care unit (ICU) in northern India

“…The INICC data regarding VAP infections in 44 adult intensive care units from 14 developing countries revealed that the implementation of a multidimensional approach that includes a set infection control interventions, education outcome surveillance, process surveillance, feedback regarding ventilator-associated pneumonia rates and performance feedback regarding infection-control practices resulted in a 55.83% decrease in the rate of ventilator-associated pneumonia from 22.0 per 1000 mechanical ventilator days to 17.2 per 1000 mechanical ventilator days [32]. More specifically, data from 21 ICUs across 10 Indian cities revealed a 38% decrease in the VAP rates from 17.43/1000 mechanical ventilator days to 10.81/1000 mechanical ventilator days (relative risk 0.62, 95% confidence interval 0.5-0.78, P = 0.0001) during the same study period based on the same interventional measures [33].…”

Ventilator-associated pneumonia: A persistent healthcare problem in Indian Intensive Care Units!

“…[15] More specifically, the data from 21 ICUs across ten Indian cities demonstrated a 38% decrease in the VAP rates, from 17.43/1000 MV days to 10.81/1000 MV days (relative risk 0.62, 95% confidence interval: 0.5–0.78, P = 0.0001) during the same study period, and using the same interventional measures. [16]…”

Boas práticas na prevenção de pneumonia associada à ventilação mecânica

“…They have been extremely effective in improving the quality of care, when carried out continuously and collectively by health professionals. (8) The development of good practices, together with the training of the multiprofessional team is a determining factor for the reduction of the in-fection's incidence rates, ICU length of stay and its consequences, besides promoting a safe patient care. (9,10) Given this scenario, this study aimed to evaluate the compliance of health professionals with a set of good practices for the prevention of VAP, compliance index for each recommended measure and to associate clinical characteristics of patients and compliance with good practices with the development of pneumonia.…”