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ORIGINAL ARTICLE
Year : 2017  |  Volume : 30  |  Issue : 2  |  Page : 74-83

Implementation of ventilator associated pneumonia prevention bundle in the neonatal intinsive care unit at Alexandria University Children’s Hospital, Egypt


1 Department of Pediatrics, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
2 Department of Medical Microbiology and Immunology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt

Correspondence Address:
Reem M.A Tayel
Department of Pediatric, Neonatology Division, Faculty of Medicine, Alexandria University, Alexandria, 21523
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AJOP.AJOP_19_17

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Introduction Ventilator-associated pneumonia (VAP) is a nosocomial lung infection that develops at or later than 48 h after mechanical ventilation (MV). It is the second most frequent hospital-acquired infection in neonatal intensive care units (NICUs). It results in high morbidity, mortality, prolonged NICU length of stay, and increased cost of hospitalization. Egypt and other developing countries report higher VAP rates compared with developed countries. Furthermore, studies monitoring VAP rates and success of intervention strategies in Egyptian NICUs are few. Aim The aim of the present study was to estimate the incidence of VAP during the implementation of the prevention bundle and also to identify the causative agents and significant risk factors in the NICU at Alexandria University Children’s Hospital. Patients and methods A nonrandomized clinical trial with historical control was conducted. All neonates admitted to the NICU in the period from July 2015 till March 2016, who spent more than 48 h on MV, were subjected to a VAP prevention bundle. Eligible neonates who spent more than 48 h on MV were monitored closely for VAP development. A thorough assessment of history, clinical examination, routine investigations, and chest radiography were carried out on all enrolled infants. Neonates who developed clinically suspected VAP were further subjected to nonbronchoscopic bronchoalveolar lavage for bacteriological confirmation of the clinical diagnosis. A review of records was performed to determine the incidence of VAP in the 9 months before intervention. Oral swabs were taken to study the pattern of oral colonization in ventilated neonates to trace its role in VAP development. Also, cultures of residual gastric volume and water traps inserted into the ventilator circuits were studied. Results A total of 108 episodes of VAP were diagnosed, with a cumulative incidence of clinically diagnosed VAP equal to 37.6% (34.2 VAP cases/1000 ventilation days). The incidence of bacteriological-confirmed VAP in this study was 19.97/1000 ventilation days. The most important risk factors for the occurrence of VAP were prematurity, low birth weight, prolonged duration of ventilation, re-intubations, and enteral feeding. Gram-negative bacteria were the predominating cause of VAP in the NICU and Klebsiella was the most common pathogen isolated from nonbronchoscopic bronchoalveolar lavage cultures. Conclusion VAP is a severe complication of MV as it significantly increases neonatal mortality. The VAP preventive bundle implemented in the present work was associated with a reduction in the VAP rate in the NICU.


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