Effectiveness of Educational Intervention in Preventing Ventilator Associated Pneumonia in Neonatal Intensive Care Unit: A Cohort Study

Prevention of ventilator associated pneumonia

Abstract

Background: Despite improvement in overall survival, neonatal period is not free of complications. Ventilator associated Pneumonia (VAP) is a serious complication and account for 6.8 - 32.2 % of healthcare associated infections among neonates.

Objective: The objective of the study was to document the effectiveness of an educational programme for neonatal intensive care (NICU) service provider in preventing occurrence of ventilator associated pneumonia in NICU.

Methods: It was a prospective cohort study compared with historical control taken from the hospital records. All neonates admitted to the NICU during 12 months period from May 2019 to April 2020 were enrolled. Prospective enrollment of ventilated baby after educational interventions was subjected to the VAP educational care bundle. Eligible neonates who spent more than 48 h on MV were followed up and monitored closely for the development of VAP. Detail history, thorough clinical examination, relevant investigation including chest radiography were carried out on all enrolled infants.

Results: A total of 54 neonates ventilated newborn, 41 met the inclusion criteria and were enrolled in the current study; 22 cases in pre-intervention phase and 19 cases in the post- intervention phase. Among enrolled mechanically ventilated newborn, 18 patients (18/41, 44%) developed at least single episode of VAP during the ventilated period. Baseline characteristics were comparable in both the groups. The primary indication of mechanical ventilation was sepsis related complications during both the phases (9/22, 41% and 8/19, 42.1%). Next to sepsis, perinatal asphyxia (5/22, 22.7%) was the indication of MV in pre-intervention period whereas respiratory distress syndrome (7/19, 36.8%) was the second leading causes of MV during post-intervention period. Significant reduction in VAP incidence rate was observed after implementation of VAP interventions, as 13/22, 59 % episodes of VAP were diagnosed in pre-intervention period compared to 5/19, 26.3% were diagnosed during implementation period. (p = 0.035). Non-significant reduction in mean duration of MV days was observed in the post-intervention period when compared to pre-intervention counterpart (7.23±4.48 days versus 5.16±2.77 days, p = 0.089). There was no significant reduction in NICU length of stay (13.05±8.16 versus 11.58±7.75 days in pre and post intervention period respectively, p = 0.56). The difference in overall mortality rates between the two phases were 15/22, 68.18% and 10/19, 52.63% respectively and found to be non- significant. Gram negative bacteria were the most commonly isolated micro-organisms, Acinetobacter was the leading causative pathogen.

Conclusion: It demonstrates that an educational program including bundle of infection control practice can reduce the occurrence of VAP during ventilation period. These educational programs for NICU care providers can be expanded to other NICU s of the country to prevent ventilator associated pneumonia.

Bangladesh Med Res Counc Bull 2021; 47(2): 143-150