Assessing the impact of an educational intervention on ventilator-associated pneumonia in a pediatric critical care unit

Abstract

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.

Keywords: Active surveillance; Developing; Device utilization; Education; Infection control.