Assessing the impact of an educational intervention on ventilator-associated pneumonia in a pediatric critical care unit.
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.
Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
Ayush
A
Gupta
Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India. Electronic address: akapilmicro@gmail.com.
Arti
A
Kapil
Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
Sushil Kumar
SK
Kabra
Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
Rakesh
R
Lodha
Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
Seema
S
Sood
Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
Benu
B
Dhawan
Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
Bimal K
BK
Das
Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.
Vishnubhathla
V
Sreenivas
D000293:Adolescent; D001291:Attitude of Health Personnel; D001521:Behavior Therapy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003906:Developing Countries; D004501:Education, Medical / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007362:Intensive Care Units; D008297:Male; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control*; D011446:Prospective Studies; D016019:Survival Analysis
Active surveillance; Developing; Device utilization; Education; Infection control