Effectiveness Of Bundle For The Incidence Of Ventilator-associated Pneumonia

Objective To investigate the trends in VAP rates during the infection surveillance and to assess the impact of the interventions to improve respiratory infection control practices.Methods We conducted prospective surveillance from 9/2004 to 12/2009 of VAP in ICUs in Zhongshan Hospital. The trained infection control professionals collected the data regarding to pneumonia and related information at least twice per week. VAP was diagnosed using the criteria of Healthcare associated infection by the Ministry of Health published in 2001.We calculated the rates of VAP quarterly using Disease Control and Prevention (CDC)/US National Healthcare Safety Network (NHSN) methods.During the surveillance, different infection control interventions were implemented:Intensive education and training for health-care workers were initiated from 9/2004 to improve the consciousness for preventing VAP; oral care with chlorhexidine for all ventilation patients was initiated from 1/2005; strict hand hygiene was initiated from 1/2006 and alcohol-based hand rub (ABHR) were applied widely; head-of-bed elevated to 30°for all the ventilation patients without contraindication was initiated from 1/2008. The post-interventional incidence rates for each year were compared using the Pearson x2 test. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated. We calculated and compared the incidence rates of VAP in the first year to the the incidence rates in the last year during interventional period.Results We collected data from 28,533 patients hospitalized in ICUs for a total of 122,098 days. The ventilator utility was 0.32. The overall rate of ventilator-associated pneumonia (VAP) was 12.16 per 1000 ventilator-days, higher than NHSN benchmark rate (3.1 per 1000 ventilator-days) and lower than 13.6 per 1000 ventilator-days reported from INICC ICUs, much lower than 23.9 per 1000 ventilator-days reported from 70 hospitals in Shanghai. Acinetobacter baumannii was the most common pathogen (24.8%),followed by Pseudomonas aeruginosa (18.2%) and Staphylococcus aureus (17.9%).MRSA accounted for 82.5% among Staphylococcus aureus. Crude mortality with VAP was 8.32%,and ICU LOS increased 14.2d. The VAP rate in different ICU changed obviously. The VAP rate in surgical ICU was the highest,16.6/1000 ventilator-days. During the surveillance, the VAP rate was decreased greatly. In CCU,CICU and SICU,the VAP rate was 27.34 per 1000 ventilator-days in 2005 and decreased to 18.41 in 2006,9.58 in 2007,7.72 in 2008,5.69 in 2009. As the results of the interventions, the rate of VAP decreased from 24.57/1000 ventilator-days (10/2004～9/2005) to 5.34/1000 ventilator-days (1/2009～12/2009).Conclusions(1) The rate of VAP in our ICUs is lower than the rate in 70 hospitals in Shanghai, higher than the rate from American surveillance system; (2) The rate of VAP is associated with a significant decrease after interventions. This study indicates that education and training, oral care with Chlorhexidine, strict hand hygiene and head-of-bed elevated are effective in preventing VAP.