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. 2024 Apr:80:154500.
doi: 10.1016/j.jcrc.2023.154500. Epub 2023 Dec 20.

Assessing the impact of a multidimensional approach and an 8-component bundle in reducing incidences of ventilator-associated pneumonia across 35 countries in Latin America, Asia, the Middle East, and Eastern Europe

Victor Daniel Rosenthal  1 , Zhilin Jin  2 , Ruijie Yin  2 , Suneeta Sahu  3 , Prasad Rajhans  4 , Mohit Kharbanda  5 , Pravin K Nair  6 , Shakti Bedanta Mishra  7 , Rajesh Chawla  8 , Rajalakshmi Arjun  9 , Kavita Sandhu  10 , Camilla Rodrigues  11 , Reshma Dongol  12 , Sheila Nainan Myatra  13 , Mat Nor Mohd-Basri  14 , Tai Chian-Wern  15 , Arpita Bhakta  16 , Ider Bat-Erdene  17 , Subhash P Acharya  18 , Gustavo Andres Alvarez  19 , Lina Alejandra Aguilar Moreno  20 , Katherine Gomez  21 , Luisa Fernanda da Jimenez-Alvarez  22 , Claudia Milena Henao-Rodas  23 , Sandra Liliana Valderrama-Beltran  24 , Maria Adelia Zuniga-Chavarria  25 , Guadalupe Aguirre-Avalos  26 , Blanca Estela Hernandez-Chena  27 , Alejandro Sassoe-Gonzalez  28 , Mary Cruz Aleman-Bocanegra  29 , Maria Isabel Villegas-Mota  30 , Daisy Aguilar De Moros  31 , Alex Castaneda-Sabogal  32 , Nilton Yhuri Carreazo  33 , Safaa Alkhawaja  34 , Hala Mounir Agha  35 , Amani El-Kholy  36 , Mohammad Abdellatif-Daboor  37 , Oguz Dursun  38 , Emel Okulu  39 , Merve Havan  40 , Dincer Yildizdas  41 , Suna Secil Ozturk Deniz  42 , Ertugrul Guclu  43 , Sona Hlinkova  44 , Aamer Ikram  45 , Lili Tao  46 , Abeer Aly Omar  47 , Naheed Elahi  48 , Ziad A Memish  49 , Michael M Petrov  50 , Lul Raka  51 , Jarosław Janc  52 , George Horhat-Florin  53 , Eduardo Alexandrino Medeiros  54 , Estuardo Salgado  55 , Lourdes Dueñas  56 , Monica Coloma  2 , Valentina Perez  57 , Eric Christopher Brown  2
Affiliations

Assessing the impact of a multidimensional approach and an 8-component bundle in reducing incidences of ventilator-associated pneumonia across 35 countries in Latin America, Asia, the Middle East, and Eastern Europe

Victor Daniel Rosenthal et al. J Crit Care. 2024 Apr.

Abstract

Background: Ventilator associated pneumonia (VAP) occurring in the intensive care unit (ICU) are common, costly, and potentially lethal.

Methods: We implemented a multidimensional approach and an 8-component bundle in 374 ICUs across 35 low and middle-income countries (LMICs) from Latin-America, Asia, Eastern-Europe, and the Middle-East, to reduce VAP rates in ICUs. The VAP rate per 1000 mechanical ventilator (MV)-days was measured at baseline and during intervention at the 2nd month, 3rd month, 4-15 month, 16-27 month, and 28-39 month periods.

Results: 174,987 patients, during 1,201,592 patient-days, used 463,592 MV-days. VAP per 1000 MV-days rates decreased from 28.46 at baseline to 17.58 at the 2nd month (RR = 0.61; 95% CI = 0.58-0.65; P < 0.001); 13.97 at the 3rd month (RR = 0.49; 95% CI = 0.46-0.52; P < 0.001); 14.44 at the 4-15 month (RR = 0.51; 95% CI = 0.48-0.53; P < 0.001); 11.40 at the 16-27 month (RR = 0.41; 95% CI = 0.38-0.42; P < 0.001), and to 9.68 at the 28-39 month (RR = 0.34; 95% CI = 0.32-0.36; P < 0.001). The multilevel Poisson regression model showed a continuous significant decrease in incidence rate ratios, reaching 0.39 (p < 0.0001) during the 28th to 39th months after implementation of the intervention.

Conclusions: This intervention resulted in a significant VAP rate reduction by 66% that was maintained throughout the 39-month period.

Keywords: Developing countries; Device-associated infection; Healthcare-associated infection; Hospital infection; Limited resources countries; Low-income countries; Network; Nosocomial infection; Ventilator-associated pneumonia.

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Conflict of interest statement

Declaration of Competing Interest All authors declare that don't have any financial and personal relationships with other people or organizations that could inappropriately influence (bias) their work. All authors declare that don't have potential competing interests, such as employment, consultancies, stock ownership, honoraria, paid expert testimony, patent applications/registrations, and grants or other funding. Submission of this article implies that the work described has not been published previously, that it is not under consideration for publication elsewhere, that its publication is approved by all authors and tacitly or explicitly by the responsible authorities where the work was carried out, and that, if accepted, it will not be published elsewhere in the same form, in English or in any other language, including electronically without the written consent of the copyright-holder.

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