title: Effectiveness of a multidimensional approach for prevention of ventilator-associated pneumonia in adult intensive care units from 14 developing countries of four continents: findings of the International Nosocomial Infection Control Consortium.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  A total of 55,507 adult patients admitted to 44 intensive care units in 38 hospitals.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Infection Control Department (VDR), International Nosocomial Infection Control Consortium, Buenos Aires, Argentina. victor_rosenthal@inicc.org
authors.forename: Victor D
authors.initials: VD
authors.lastname: Rosenthal
authors.forename: Camilla
authors.initials: C
authors.lastname: Rodrigues
authors.forename: Carlos
authors.initials: C
authors.lastname: Álvarez-Moreno
authors.forename: Naoufel
authors.initials: N
authors.lastname: Madani
authors.forename: Zan
authors.initials: Z
authors.lastname: Mitrev
authors.forename: Guxiang
authors.initials: G
authors.lastname: Ye
authors.forename: Reinaldo
authors.initials: R
authors.lastname: Salomao
authors.forename: Fatma
authors.initials: F
authors.lastname: Ulger
authors.forename: Humberto
authors.initials: H
authors.lastname: Guanche-Garcell
authors.forename: Souha S
authors.initials: SS
authors.lastname: Kanj
authors.forename: Luis E
authors.initials: LE
authors.lastname: Cuéllar
authors.forename: Francisco
authors.initials: F
authors.lastname: Higuera
authors.forename: Trudell
authors.initials: T
authors.lastname: Mapp
authors.forename: Rosalía
authors.initials: R
authors.lastname: Fernández-Hidalgo
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D003906:Developing Countries; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000517:prevention & control*; D011159:Population Surveillance; D015397:Program Evaluation; D011446:Prospective Studies