Infection control education: Impact on ventilator-associated pneumonia rates in a public sector intensive care unit in Pakistan

Abstract

We describe efforts towards introducing infection control (IC) practices and establishment of antimicrobial resistance (AMR) surveillance in a public sector hospital in Pakistan. The study was conducted in an eight-bed intensive care unit. IC principles, introduced through interactive sessions, were used as an intervention and their impact was observed by conducting surveillance for ventilator-associated pneumonia (VAP) before and after the intervention. Respiratory isolates of VAP patients in the period after intervention were screened for AMR, and empiric antibiotic at the time of admission was compared with the antimicrobial sensitivity pattern reported. VAP rates were high in general and declined in the period after intervention, although the difference was not significant. Of 37 VAP patients in the period after intervention, 68% had more than one clinically significant organism isolated from the respiratory specimen. Acinetobacter spp. were isolated from 76% of patients and Pseudomonas aeruginosa from 43%. All Acinetobacter spp. and 72% P. aeruginosa were multidrug resistant. The mean stay of the nosocomially infected patients was significantly higher than for the uninfected group (6.5 vs. 2.1 days, P<0.001). Our study suggests IC education needs to be supplemented by a hospital system that facilitates IC practices and development of surveillance programmes.

Effectiveness of educational programmes in preventing ventilator-associated pneumonia: a systematic review

“…19e22,24,25 By contrast, Khan et al reported no statistically significant reduction in the overall VAP rates. 23 The mean duration of hospital stay decreased significantly in Apisarnthanarak et al's study (P < 0.001), in line with that of Khan et al, who found that the mean length of stay of nosocomially infected patients was significantly higher than that of uninfected patients (P < 0.001). 20,23 Monthly antibiotic and hospitalization costs were reduced significantly (P < 0.001) in Apisarnthanarak et al's study.…”

“…23 The mean duration of hospital stay decreased significantly in Apisarnthanarak et al's study (P < 0.001), in line with that of Khan et al, who found that the mean length of stay of nosocomially infected patients was significantly higher than that of uninfected patients (P < 0.001). 20,23 Monthly antibiotic and hospitalization costs were reduced significantly (P < 0.001) in Apisarnthanarak et al's study. 20 However, no statistically significant changes in the length of ICU and hospital stays were found by Kulvatunyou et al 21 No statistically significant changes in the mortality rates were found by Apisarnthanarak et al and Kulvatunyou et al, by contrast with Danchaivijitr et al, who found that mortality decreased significantly from 12.3% to 8.7% (P < 0.001).…”

Impact of four sequential measures on the prevention of ventilator-associated pneumonia in cardiac surgery patients

“…Many groups and scientific societies have provided prevention guidelines in the last 10 years [19-22]. Several guidelines recommend different measures to decrease the incidence of VAP, including training, which quickly reduces the incidence of VAP rates, although its long-term efficacy is limited [23,24]. …”

Education on invasive mechanical ventilation involving intensive care nurses: a systematic review

“…Four studies targeted only ICU nurses (Al‐Faouri et al, ; Danchaivijitr et al, ; Kulvatunyou et al, ; Raurell‐Torreda, ), while the remainder were mixed participants. Three targeted nurses and RTs (Apisarnthanarak et al, ; Babcock et al, ; Zack et al, ); four included nurses and medical officers (Bloos et al, ; Salahuddin et al, ;Wolthuis et al, ; Wolthuis et al, ); and one study included nurses, medical officers and allied health professionals (Khan et al, ).…”