title: Efficacy of an infection control program in reducing ventilator-associated pneumonia in a Chinese neonatal intensive care unit.
abstract: BACKGROUND
  Measures employed in preventing ventilator-associated pneumonia (VAP) in developing countries are rarely reported. This study evaluates the efficacy of an infection control program in reducing VAP in a neonatal intensive care unit (NICU) in China.
  
  
  METHODS
  All neonates who received mechanical ventilation for at least 48 hours and were hospitalized in the NICU for ≥5 days during 3 epochs were included. The hospital relocated to a new site during phase 2 and a bundle of comprehensive preventive measures against VAP were gradually implemented using the evidence-based practice for improving quality method. Research physicians recorded associated information of patients diagnosed with VAP.
  
  
  RESULTS
  Of 491 patients receiving mechanical ventilation, 92 (18.7%) developed VAP corresponding to 27.33 per 1,000 ventilator-days. The rate decreased from 48.84 per 1,000 ventilator-days in phase 1 to 25.73 per 1,000 ventilator-days in phase 2 and further diminished to 18.50 per 1,000 ventilator-days in phase 3 (P < .001). Overall mortality rate of admitted neonates significantly decreased from 14.0% in phase 1 to 2.9% in phase 2 and 2.7% in phase 3 (P = .000). Gram-negative bacteria (95.5%) were the predominant organisms in VAP and Acinetobacter baumannii (65.2%) was the most frequently isolated microorganism.
  
  
  CONCLUSIONS
  Implementing a multifaceted infection control program resulted in a significant reduction in VAP rate with long-term effects. Such interventions could be extended to other low-income countries.
authors.affiliation: Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Zhou
authors.forename: Shoo K
authors.initials: SK
authors.lastname: Lee
authors.forename: Si-yuan
authors.initials: SY
authors.lastname: Jiang
authors.forename: Chao
authors.initials: C
authors.lastname: Chen
authors.forename: Majeeda
authors.initials: M
authors.lastname: Kamaluddeen
authors.forename: Xiao-jing
authors.initials: XJ
authors.lastname: Hu
authors.forename: Chuan-qing
authors.initials: CQ
authors.lastname: Wang
authors.forename: Yun
authors.initials: Y
authors.lastname: Cao
mesh_terms: D001424:Bacterial Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods*; D007363:Intensive Care Units, Neonatal; D008297:Male; D009181:Mycoses / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control*; D015995:Prevalence; D016019:Survival Analysis
keywords: Health care-associated infections; Infant