title: Reducing ventilator-associated pneumonia in neonatal intensive care unit using "VAP prevention Bundle": a cohort study.
abstract: BACKGROUND
  Ventilator-associated pneumonia (VAP) is a serious health care-associated infection, resulting in high morbidity and mortality. It also prolongs hospital stay and drives up hospital costs. Measures employed in preventing ventilator-associated pneumonia in developing countries are rarely reported. In this study we tried to assess the efficacy of our designed "VAP prevention bundle" in reducing VAP rate in our neonatal intensive care unit (NICU).
  
  
  METHODS
  This prospective before-and-after study was conducted at university hospital NICU, all neonates who had mechanical ventilation for ≥ 48 h were eligible. VAP rates were evaluated before (phase-I) and after (phase-II) full implementation of comprehensive preventive measures specifically designed by our infection control team.
  
  
  RESULTS
  Of 143 mechanically ventilated neonates, 73 patients developed VAP (51%) throughout the study period (2500 mechanical ventilation days). The rate of VAP was significantly reduced from 67.8% (42/62) corresponding to 36.4 VAP episodes/1000 mechanical ventilation days (MV days) in phase-I to 38.2% (31/81) corresponding to 23 VAP/1000 MV days (RR 0.565, 95% confidence interval 0.408-0.782, p = 0.0006) after VAP prevention bundle implementation (phase-II). Parallel significant reduction in MV days/case were documented in post-intervention period (21.50 ± 7.6 days in phase-I versus 10.36 ± 5.2 days in phase-II, p = 0.000). There were a trend toward reduction in NICU length of stay (23.9 ± 10.3 versus 22.8 ± 9.6 days, p = 0.56) and overall mortality (25% versus 17.3%, p = 0.215) between the two phases but didn't reach statistical significance. The commonest micro-organisms isolated throughout the study were gram-negative bacteria (63/66, 95.5%) particularly Klebsilla pneumonia (55/66, 83.4%).
  
  
  CONCLUSIONS
  Implementation of multifaceted infection control bundle resulted in reduction of VAP rate, length of stay in our NICU.
authors.affiliation: Faculty of Medicine, Zagazig University, 18 Omar Bin Elkhattab St, Al Qawmia, Zagazig City, Al Sharqia Governorate, Egypt. Seham_Azab@yahoo.com.
authors.forename: Seham F A
authors.initials: SF
authors.lastname: Azab
authors.affiliation: Faculty of Medicine, Zagazig University, 18 Omar Bin Elkhattab St, Al Qawmia, Zagazig City, Al Sharqia Governorate, Egypt. h_sherbiny@zu.edu.eg.
authors.forename: Hanan S
authors.initials: HS
authors.lastname: Sherbiny
authors.affiliation: Faculty of Medicine, Zagazig University, 18 Omar Bin Elkhattab St, Al Qawmia, Zagazig City, Al Sharqia Governorate, Egypt. safaahamdy11@yahoo.com.
authors.forename: Safaa H
authors.initials: SH
authors.lastname: Saleh
authors.affiliation: Faculty of Medicine, Zagazig University, 18 Omar Bin Elkhattab St, Al Qawmia, Zagazig City, Al Sharqia Governorate, Egypt. dr.wafaaelsaeed@live.com.
authors.forename: Wafaa F
authors.initials: WF
authors.lastname: Elsaeed
authors.affiliation: Faculty of Medicine, Zagazig University, 18 Omar Bin Elkhattab St, Al Qawmia, Zagazig City, Al Sharqia Governorate, Egypt. mona1234455@hotmail.com.
authors.forename: Mona M
authors.initials: MM
authors.lastname: Elshafiey
authors.affiliation: Faculty of Medicine, Zagazig University, 18 Omar Bin Elkhattab St, Al Qawmia, Zagazig City, Al Sharqia Governorate, Egypt. agsiam@hotmail.com.
authors.forename: Ahmed G
authors.initials: AG
authors.lastname: Siam
authors.affiliation: Faculty of Medicine, Zagazig University, 18 Omar Bin Elkhattab St, Al Qawmia, Zagazig City, Al Sharqia Governorate, Egypt. Moharafaped@gmail.com.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Arafa
authors.affiliation: Faculty of Medicine, Zagazig University, 18 Omar Bin Elkhattab St, Al Qawmia, Zagazig City, Al Sharqia Governorate, Egypt. ashgan_1000@gmail.com.
authors.forename: Ashgan A
authors.initials: AA
authors.lastname: Alghobashy
authors.affiliation: Faculty of Medicine, Zagazig University, 18 Omar Bin Elkhattab St, Al Qawmia, Zagazig City, Al Sharqia Governorate, Egypt. em_ben2010@yahoo.com.
authors.forename: Eman A
authors.initials: EA
authors.lastname: Bendary
authors.affiliation: Faculty of Medicine, Zagazig University, 18 Omar Bin Elkhattab St, Al Qawmia, Zagazig City, Al Sharqia Governorate, Egypt. maha.aly@gmail.com.
authors.forename: Maha A A
authors.initials: MA
authors.lastname: Basset
authors.affiliation: Faculty of Medicine, Zagazig University, 18 Omar Bin Elkhattab St, Al Qawmia, Zagazig City, Al Sharqia Governorate, Egypt. mohammed.sanaa61@gmail.com.
authors.forename: Sanaa M
authors.initials: SM
authors.lastname: Ismail
authors.affiliation: Faculty of Medicine, Zagazig University, 18 Omar Bin Elkhattab St, Al Qawmia, Zagazig City, Al Sharqia Governorate, Egypt. dr.akeel@hotmail.com.
authors.forename: Nagwa E
authors.initials: NE
authors.lastname: Akeel
authors.affiliation: Faculty of Medicine, Zagazig University, 18 Omar Bin Elkhattab St, Al Qawmia, Zagazig City, Al Sharqia Governorate, Egypt. dr.nasamad@hotmail.com.
authors.forename: Nahla A
authors.initials: NA
authors.lastname: Elsamad
authors.affiliation: Faculty of Medicine, Zagazig University, 18 Omar Bin Elkhattab St, Al Qawmia, Zagazig City, Al Sharqia Governorate, Egypt. dr_wesammokhtar@yahoo.com.
authors.forename: Wesam A
authors.initials: WA
authors.lastname: Mokhtar
authors.affiliation: Faculty of Medicine, Zagazig University, 18 Omar Bin Elkhattab St, Al Qawmia, Zagazig City, Al Sharqia Governorate, Egypt. tarek_gheith@yahoo.com.
authors.forename: Tarek
authors.initials: T
authors.lastname: Gheith
mesh_terms: D002648:Child; D015331:Cohort Studies; D003428:Cross Infection / Q000517:prevention & control; D003906:Developing Countries; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology / Q000628:therapy; D017053:Infection Control / Q000379:methods*; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000517:prevention & control*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects