Infection Control Department (VDR), International Nosocomial Infection Control Consortium, Buenos Aires, Argentina.
Crit Care Med. 2012 Dec;40(12):3121-8. doi: 10.1097/CCM.0b013e3182657916.
The aim of this study was to analyze the effect of the International Nosocomial Infection Control Consortium's multidimensional approach on the reduction of ventilator-associated pneumonia in patients hospitalized in intensive care units.
A prospective active surveillance before-after study. The study was divided into two phases. During phase 1, the infection control team at each intensive care unit conducted active prospective surveillance of ventilator-associated pneumonia by applying the definitions of the Centers for Disease Control and Prevention National Health Safety Network, and the methodology of International Nosocomial Infection Control Consortium. During phase 2, the multidimensional approach for ventilator-associated pneumonia was implemented at each intensive care unit, in addition to the active surveillance.
Forty-four adult intensive care units in 38 hospitals, members of the International Nosocomial Infection Control Consortium, from 31 cities of the following 14 developing countries: Argentina, Brazil, China, Colombia, Costa Rica, Cuba, India, Lebanon, Macedonia, Mexico, Morocco, Panama, Peru, and Turkey.
A total of 55,507 adult patients admitted to 44 intensive care units in 38 hospitals.
The International Nosocomial Infection Control Consortium ventilator-associated pneumonia multidimensional approach included the following measures: 1) bundle of infection-control interventions; 2) education; 3) outcome surveillance; 4) process surveillance; 5) feedback of ventilator-associated pneumonia rates; and 6) performance feedback of infection-control practices.
The ventilator-associated pneumonia rates obtained in phase 1 were compared with the rates obtained in phase 2. We performed a time-series analysis to analyze the impact of our intervention.
During phase 1, we recorded 10,292 mechanical ventilator days, and during phase 2, with the implementation of the multidimensional approach, we recorded 127,374 mechanical ventilator days. The rate of ventilator-associated pneumonia was 22.0 per 1,000 mechanical ventilator days during phase 1, and 17.2 per 1,000 mechanical ventilator days during phase 2.The adjusted model of linear trend shows a 55.83% reduction in the rate of ventilator-associated pneumonia at the end of the study period; that is, the ventilator-associated pneumonia rate was 55.83% lower than it was at the beginning of the study.
The implementation the International Nosocomial Infection Control Consortium multidimensional approach for ventilator-associated pneumonia was associated with a significant reduction in the ventilator-associated pneumonia rate in the adult intensive care units setting of developing countries.
本研究旨在分析国际医院感染控制联合会多维方法对降低重症监护病房患者呼吸机相关性肺炎的影响。
前瞻性主动监测前后研究。该研究分为两个阶段。在第 1 阶段，每个重症监护病房的感染控制团队通过应用疾病控制与预防中心国家卫生安全网络的定义和国际医院感染控制联合会的方法，对呼吸机相关性肺炎进行主动前瞻性监测。在第 2 阶段，除了主动监测外，每个重症监护病房还实施了呼吸机相关性肺炎的多维方法。
来自 14 个发展中国家的 31 个城市的 38 家医院、国际医院感染控制联合会成员的 44 个成人重症监护病房。
共纳入 44 家医院的 44 个重症监护病房的 55507 名成年患者。
国际医院感染控制联合会呼吸机相关性肺炎多维方法包括以下措施：1）感染控制干预措施包；2）教育；3）结果监测；4）过程监测；5）呼吸机相关性肺炎率反馈；和 6）感染控制实践绩效反馈。
第 1 阶段获得的呼吸机相关性肺炎率与第 2 阶段获得的率进行比较。我们进行了时间序列分析，以分析我们干预的影响。
在第 1 阶段，我们记录了 10292 个机械通气日，在第 2 阶段，通过实施多维方法，我们记录了 127374 个机械通气日。第 1 阶段呼吸机相关性肺炎发生率为每 1000 个机械通气日 22.0 例，第 2 阶段为每 1000 个机械通气日 17.2 例。线性趋势调整模型显示，研究期末呼吸机相关性肺炎发生率降低 55.83%；也就是说，呼吸机相关性肺炎发生率比研究开始时降低了 55.83%。
在发展中国家的成人重症监护病房中实施国际医院感染控制联合会多维方法与呼吸机相关性肺炎发生率的显著降低有关。
