Assessing the impact of an educational intervention on ventilator-associated pneumonia in a pediatric critical care unit

• Published in: American journal of infection control 2014-02, Vol.42 (2), p.111-115
• Main Authors: Gupta, Ayush, MD, Kapil, Arti, MD, Kabra, Sushil Kumar, MD, Lodha, Rakesh, MD, Sood, Seema, MD, Dhawan, Benu, MD, Das, Bimal K., MD, Sreenivas, Vishnubhathla, PhD
• Format: Article
• Language: English
• Subjects: Active surveillance; Adolescent; Attitude of Health Personnel; Behavior Therapy - methods; Biological and medical sciences; Child; Child, Preschool; Cohort Studies; Developing; Developing Countries; Device utilization; Education; Education, Medical - methods; Epidemiology. Vaccinations; Female; General aspects; Human infectious diseases. Experimental studies and models; Humans; Incidence; Infant; Infection Control; Infectious Disease; Infectious diseases; Intensive Care Units; Male; Medical personnel; Medical sciences; Morbidity; Mortality; Pediatrics; Pneumology; Pneumonia; Pneumonia, Ventilator-Associated - epidemiology; Pneumonia, Ventilator-Associated - mortality; Pneumonia, Ventilator-Associated - prevention & control; Prospective Studies; Respiratory system : syndromes and miscellaneous diseases; Survival Analysis; Ventilators
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/j.ajic.2013.09.026

Background Ongoing educational programs targeting health care professionals have shown positive outcomes by reducing the morbidity and mortality associated with health care–associated infections (HAIs). We undertook this study to measure the impact of such a program in a pediatric critical care unit of a developing country. Methods This prospective study was conducted in 2 time periods of 6 months each, with an educational intervention for resident doctors and nurses in between. The rates of ventilator-associated pneumonia (VAP) during the preintervention and postintervention periods were estimated by active surveillance. Results The incidence density of VAP was reduced by 28% (20.2 vs 14.6 per 1,000 ventilator-days; P  = .21, Z test) despite a significant increase in the ventilator utilization ratio during the postintervention period (0.64 vs 0.88; P < .0001, Pearson’s χ² test). There was a statistically significant reduction in mortality among patients who received mechanical ventilation for ≥48 hours in the postintervention period (49.3% vs 31.4%; P  = .029, Pearson’s χ² test). Conclusions Educational programs have a positive impact on reducing the morbidity and mortality associated with HAIs. Incidence rates based on device-days should be compared by keeping the variations in device utilization ratio in mind.