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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
Minerva Anestesiologica 2008 October;74(10):537-41
Improvement of the ventilator associated pneumonia rate with infection control practices in an Italian ICU
Prospero E. 1, Bacelli S. 1, Barbadoro P. 1, Nataloni S. 2, D’Errico M. M. 1, Pelaia P. 2, SICU Working Group *
1 Department of Infectious Disease and Public Health, Polytechnic University of Marche, Ancona, Italy;
2 Intensive Care Unit, Ancona Associated Hospital, Ancona, Italy
Background. To assess the impact of an intervention to improve respiratory infection control practices and reduce the ventilator associated pneumonia (VAP) rate in an intensive care unit, at the request of the ICU staff.
Methods. Design: prospective surveillance before-after study. Baseline VAP rates were determined over a 4-month period of active surveillance without an infection control program (period 1) and compared to VAP rates following implementation of an infection control program (period 2). The ICU staff requested the implementation of infection control practices. Setting: Intensive Care Unit (ICU) at a university teaching hospital in Italy. Patients: A total of 185 patients admitted to the ICU were included in the study.
Results. Patients assessed during period 1 were similar to patients assessed during period 2 with regard to age, sex, origin, type of admission and mortality. Patients who were admitted during period 2 had significantly lower simplified acute physiology scores (SAPS) II and acute physiology and chronic health evaluation (APACHE) II scores than patients admitted during period 1 (P<0.05). During period 1, there were 27 cases of VAP, and the incidence rate was 36.9/1000 MV-days. During period 2, the VAP rate decreased significantly (P=0.049): there were only 17 cases of VAP, and the incidence rate was 22.5/1 000 MV-days, with a rate-ratio of 0.61.
Conclusion. Despite our short study period, the results appear to be encouraging and show a measurable impact on the incidence of VAP.