Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-14T04:27:30.422Z Has data issue: false hasContentIssue false
  • English
  • Français

Findings of the International Nosocomial Infection Control Consortium (INICC), Part II: Impact of a Multidimensional Strategy to Reduce Ventilator-Associated Pneumonia in Neonatal Intensive Care Units in 10 Developing Countries

Published online by Cambridge University Press:  02 January 2015

Victor D. Rosenthal ,
Maria E. Rodríguez-Calderón ,
Marena Rodríguez-Ferrer ,
Tanu Singhal ,
Mandakini Pawar ,
Martha Sobreyra-Oropeza ,
Amina Barkat ,
Teodora Atencio-Espinoza ,
Regina Berba  and
J. A. Navoa-Ng
...Show all authors
Victor D. Rosenthal*
Affiliation:
International Nosocomial Infection Control Consortium, Buenos Aires, Argentina
Maria E. Rodríguez-Calderón
Affiliation:
Hospital La Victoria, Bogota, Colombia
Marena Rodríguez-Ferrer
Affiliation:
Universidad Simón Bolívar, Barranquilla, Colombia
Tanu Singhal
Affiliation:
Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
Mandakini Pawar
Affiliation:
Pushpanjali Crosslay Hospital, Ghaziabad, India
Martha Sobreyra-Oropeza
Affiliation:
Hospital de la Mujer, Mexico City, Mexico
Amina Barkat
Affiliation:
Children Hospital of Rabat, Rabat, Morocco
Teodora Atencio-Espinoza
Affiliation:
Hospital Regional de Pucallpa, Pucallpa, Peru
Regina Berba
Affiliation:
Philippine General Hospital, Manila, Philippines
J. A. Navoa-Ng
Affiliation:
St. Luke's Medical Center, Quezon City, Philippines
Lourdes Dueñas
Affiliation:
Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador
Nejla Ben-Jaballah
Affiliation:
Hospital d'Enfants, Tunis, Tunisia
Davut Ozdemir
Affiliation:
Duzce University Medical School Infectious Diseases and Clinical Microbiology, Duzce, Turkey
Gulden Ersoz
Affiliation:
Mersin University, Faculty of Medicine, Mersin, Turkey
Canan Aygun
Affiliation:
Ondokuz Mayis University Medical School, Samsun, Turkey
*
Avenue Corrientes 4580, Piso 12, “D”, Buenos Aires (C1195AAR), Argentina (victor_rosenthal@inicc.org)
Get access Rights & Permissions [Opens in a new window]

Abstract

Design.

Before-after prospective surveillance study to assess the efficacy of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control program to reduce the rate of occurrence of ventilator-associated pneumonia (VAP).

Setting.

Neonatal intensive care units (NICUs) of INICC member hospitals from 15 cities in the following 10 developing countries: Argentina, Colombia, El Salvador, India, Mexico, Morocco, Peru, Philippines, Tunisia, and Turkey.

Patients.

NICU inpatients.

Methods.

VAP rates were determined during a first period of active surveillance without the implementation of the multidimensional approach (phase 1) to be then compared with VAP rates after implementation of the INICC multidimensional infection control program (phase 2), which included the following practices: a bundle of infection control interventions, education, outcome surveillance, process surveillance, feedback on VAP rates, and performance feedback on infection control practices. This study was conducted by infection control professionals who applied National Health Safety Network (NHSN) definitions for healthcare-associated infections and INICC surveillance methodology.

Results.

During phase 1, we recorded 3,153 mechanical ventilation (MV)–days, and during phase 2, after the implementation of the bundle of interventions, we recorded 15,981 MV-days. The VAP rate was 17.8 cases per 1,000 MV-days during phase 1 and 12.0 cases per 1,000 MV-days during phase 2 (relative risk, 0.67 [95% confidence interval, 0.50–0.91]; P = .001 ), indicating a 33% reduction in VAP rate.

Conclusions.

Our results demonstrate that an implementation of the INICC multidimensional infection control program was associated with a significant reduction in VAP rate in NICUs in developing countries.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 7 , July 2012 , pp. 704 - 710
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. van der Zwet, WC, Kaiser, AM, van Elburg, RM, et al. Nosocomial infections in a Dutch neonatal intensive care unit: surveillance study with definitions for infection specifically adapted for neonates. J Hosp Infect 2005;61(4):300–311.CrossRefGoogle Scholar
2. Richards, MJ, Edwards, JR, Culver, DH, Gaynes, RR Nosocomial infections in combined medical-surgical intensive care units in the United States. Infect Control Hosp Epidemiol 2000;21(8): 510–515.CrossRefGoogle ScholarPubMed
3. Garland, JS. Strategies to prevent ventilator-associated pneumonia in neonates. Clin Perinatal 2010;37(3):629–643.CrossRefGoogle ScholarPubMed
4. Rosenthal, VD. Health-care-associated infections in developing countries. Lancet 2011;377(9761): 186–188.CrossRefGoogle ScholarPubMed
5. Youngquist, P, Carroll, M, Färber, M, et al. Implementing a ventilator bundle in a community hospital, ft Comm f Qual Patient Sfl 2007;33(4):219–225.Google Scholar
6. Coffin, SE, Klompas, M, Classen, D, et al. Strategies to prevent ventilator-associated pneumonia in acute care hospitals. Infect Control Hosp Epidemiol 2008;29(suppl 1):S31–S40.CrossRefGoogle ScholarPubMed
7. Murila, F, Francis, JV, Bland, A, Kumbla, S, Doherty, R, Sehgal, A. Interpreting positive cultures of endotracheal aspirates: factors associated with treatment decisions in ventilated neonates. J Paediatr Child Health 2011;47:728–733.CrossRefGoogle ScholarPubMed
8. Aly, H, Badawy, M, El-Kholy, A, Nabil, R, Mohamed, A. Randomized, controlled trial on tracheal colonization of ventilated infants: can gravity prevent ventilator-associated pneumonia? Pediatrics 2008;122(4):770–774.CrossRefGoogle ScholarPubMed
9. Nakwan, N, Wannaro, J, Thongmak, T, Pornladnum, P, Saksawad, R, Chokephaibulkit, K. Safety in treatment of ventilator-associated pneumonia due to extensive drug-resistant Acinetobacter baumannii with aerosolized Colistin in neonates: a preliminary report. Pediatr Pulmonol 2011;46(1):60–66.CrossRefGoogle ScholarPubMed
10. Rosenthal, VD, Ramachandran, B, Dueñas, L, et al. Findings of the International Nosocomial Infection Control Consortium (INICC), part I: effectiveness of a multidimensional infection control approach on catheter-associated urinary tract infection rates in pediatric intensive care units of 6 developing countries. Infect Control Hosp Epidemiol 2012;33(7):696–703(in this issue).CrossRefGoogle ScholarPubMed
11. Tablan, OC, Anderson, LJ, Besser, R, Bridges, C, Hajjeh, R. Guidelines for preventing health-care-associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep 2004; 53(RR-3):1–36.Google ScholarPubMed
12. Boyce, JM, Pittet, D. Guideline for hand hygiene in health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HIPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Am J Infect Control 2002;30: S1–S46.CrossRefGoogle ScholarPubMed
13. Burns, KE, Adhikari, NK, Meade, MO. Noninvasive positive pressure ventilation as a weaning strategy for intubated adults with respiratory failure. Cochrane Database Syst Rev 2003(4): CD004127x.CrossRefGoogle Scholar
14. Tantipong, H, Morkchareonpong, C, Jaiyindee, S, Thamlikitkul, V. Randomized controlled trial and meta-analysis of oral decontamination with 2% Chlorhexidine solution for the prevention of ventilator-associated pneumonia. Infect Control Hosp Epidemiol 2008;29(2):131–136.CrossRefGoogle ScholarPubMed
15. Salord, F, Gaussorgues, P, Marti-Flich, J, et al. Nosocomial maxillary sinusitis during mechanical ventilation: a prospective comparison of orotracheal versus the nasotracheal route for intubation. Intensive Care Med 1990;16(6):390–393.CrossRefGoogle ScholarPubMed
16. Stamm, AM. Ventilator-associated pneumonia and frequency of circuit changes. Am J Infect Control 1998;26(1):71–73.CrossRefGoogle ScholarPubMed
17. Heyland, DK, Drover, JW, MacDonald, S, Novak, F, Lam, M. Effect of postpyloric feeding on gastroesophageal regurgitation and pulmonary microaspiration: results of a randomized controlled trial. Crit Care Med 2001;29(8):1495–1501.CrossRefGoogle ScholarPubMed
18. Cook, DJ, Reeve, BK, Guyatt, GH, et al. Stress ulcer prophylaxis in critically ill patients: resolving discordant meta-analyses. JAMA 1996;275(4):308–314.CrossRefGoogle ScholarPubMed
19. Rosenthal, VD, Maki, DG, Graves, N. The International Nosocomial Infection Control Consortium (INICC): goals and objectives, description of surveillance methods, and operational activities. Am J Infect Control 2008;36(9):e1–e12.CrossRefGoogle ScholarPubMed
20. Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36(5):309–332.CrossRefGoogle ScholarPubMed
21. World Bank. World Bank clasification of economies. 2007. http://web.worldbank.org/WBSITE/EXTERNAL/DATASTATISTICS/0contentMDK:20421402pagePK:64133150piPK:64133175theSitePK:239419,00.html. Accessed October 5, 2008.Google Scholar
22. Rosenthal, VD, Lynch, P, Jarvis, WR, et al. Socioeconomic impact on device-associated infections in limited-resource neonatal intensive care units: findings of the INICC. Infection 2011;39: 439–450.CrossRefGoogle ScholarPubMed
23. Rosenthal, VD. Device-associated nosocomial infections in limited-resources countries: findings of the International Nosocomial Infection Control Consortium (INICC). Am J Infect Control 2008;36(10):S171.e7–e12.CrossRefGoogle ScholarPubMed
24. Rosenthal, VD, Maki, DG, Tamulitrat, S, et al. International Nosocomial Infection Control Consortium (INICC) report, data summary for 2003-2008, issued June 2009. Am J Infect Control 2010;38(2):95–104.e2.CrossRefGoogle ScholarPubMed
25. Garland, JS. Strategies to prevent ventilator-associated pneumonia in neonates. Clin Perinatol 2010;37(3):629–643.CrossRefGoogle ScholarPubMed
26. Kelleghan, SI, Salemi, C, Padilla, S, et al. An effective continuous quality improvement approach to the prevention of ventilator-associated pneumonia. Am J Infect Control 1993;21(6):322–330.CrossRefGoogle Scholar
27. Rosenthal, VD, Maki, DG, Rodrigues, C, et al. Impact of International Nosocomial Infection Control Consortium (INICC) strategy on central line-associated bloodstream infection rates in the intensive care units of 15 developing countries. Infect Control Hosp Epidemiol 2010;31(12):1264–1272.CrossRefGoogle ScholarPubMed
28. Cuellar, L, Rosenthal, VD, Fernández-Maldonado, E, Castañeda-Sabogal, A, Antencio-Espinoza, T. Extra Mortality of Nosocomial Infections at 4 Hospitals of Peru: Findings of the International Nosocomial Infection Control Consortium (INICC). Paper presented at: 16th annual scientific meeting of the Society for Healthcare Epidemiology of America, March 19, 2006; Chicago.Google Scholar
29. Rosenthal, VD, Guzman, S, Safdar, N. Reduction in nosocomial infection with improved hand hygiene in intensive care units of a tertiary care hospital in Argentina. Am J Infect Control 2005; 33(7):392–397.CrossRefGoogle ScholarPubMed
30. Higuera, F, Rosenthal, VD, Duarte, P, Ruiz, J, Franco, G, Safdar, N. The effect of process control on the incidence of central venous catheter-associated bloodstream infections and mortality in intensive care units in Mexico. Crit Care Med 2005;33(9): 2022–2027.CrossRefGoogle ScholarPubMed
31. Rosenthal, VD, Guzman, S, Safdar, N. Effect of education and performance feedback on rates of catheter-associated urinary tract infection in intensive care units in Argentina. Infect Control Hosp Epidemiol 2004;25(1):47–50.CrossRefGoogle ScholarPubMed
32. Rosenthal, VD, McCormick, RD, Guzman, S, Villamayor, C, Ore-llano, PW. Effect of education and performance feedback on handwashing: the benefit of administrative support in Argentinean hospitals. Am J Infect Control 2003;31(2):85–92.CrossRefGoogle ScholarPubMed