Effectiveness of a multidimensional approach for prevention of ventilator-associated pneumonia in 11 adult intensive care units from 10 cities of Turkey: findings of the International Nosocomial Infection Control Consortium (INICC).
OBJECTIVE
To evaluate the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional approach on the reduction of ventilator-associated pneumonia (VAP) in adult patients hospitalized in 11 intensive care units (ICUs), from 10 hospitals, members of the INICC, in 10 cities of Turkey.


METHODS
A prospective active before-after surveillance study was conducted to determine the effect of the INICC multidimensional approach in the VAP rate. The study was divided into two phases. In phase 1, active prospective surveillance of VAP was conducted using the definitions of the Centers for Disease Control and Prevention National Health Safety Network, and the INICC methods. In phase 2, we implemented the multidimensional approach for VAP. The INICC multidimensional approach included the following measures: (1) bundle of infection control interventions, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback of VAP rates, and (6) performance feedback of infection control practices. We compared the rates of VAP obtained in each phase. A time series analysis was performed to assess the impact of our approach.


RESULTS
In phase 1, we recorded 2,376 mechanical ventilator (MV)-days, and in phase 2, after implementing the multidimensional approach, we recorded 28,181 MV-days. The rate of VAP was 31.14 per 1,000 MV-days during phase 1, and 16.82 per 1,000 MV-days during phase 2, amounting to a 46 % VAP rate reduction (RR, 0.54; 95 % CI, 0.42-0.7; P value, 0.0001.)


CONCLUSIONS
The INICC multidimensional approach was associated with a significant reduction in the VAP rate in these adult ICUs of Turkey.
Ondokuz Mayis University Medical School, Samsun, Turkey.
H
H
Leblebicioglu
A N
AN
Yalcin
V D
VD
Rosenthal
I
I
Koksal
F
F
Sirmatel
S
S
Unal
H
H
Turgut
D
D
Ozdemir
G
G
Ersoz
C
C
Uzun
S
S
Ulusoy
S
S
Esen
F
F
Ulger
A
A
Dilek
H
H
Yilmaz
O
O
Turhan
N
N
Gunay
E
E
Gumus
O
O
Dursun
G
G
Yýlmaz
S
S
Kaya
H
H
Ulusoy
M
M
Cengiz
L
L
Yilmaz
G
G
Yildirim
A
A
Topeli
S
S
Sacar
H
H
Sungurtekin
D
D
Uğurcan
M F
MF
Geyik
A
A
Şahin
S
S
Erdogan
A
A
Kaya
N
N
Kuyucu
B
B
Arda
F
F
Bacakoglu
D000328:Adult; D000368:Aged; D002947:Cities; D003140:Communicable Disease Control / Q000379:methods*; D003428:Cross Infection / Q000517:prevention & control*; D005260:Female; D019983:Guideline Adherence; D006282:Health Personnel / Q000193:education; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*; D015397:Program Evaluation / Q000379:methods*; D011446:Prospective Studies; D014421:Turkey