Reducing Ventilator- Associated Pneumonia in Intensive Care Unit at King Faisal Hospital, Kigali, 2020-2022

Abstract

The most frequent complication for patients in intensive care units (ICUs) is ventilator-associated pneumonia (VAP), which has a significant morbidity. VAP is a lung infection that develops during or after intubation and mechanical ventilation. It is characterized by signs of infection (fever, altered white blood cells counts..), purulent tracheal discharge, along with radiological evidence of pneumonia (new or progressive infiltrate). VAP occurs within 48-72 hours and imposes a significant burden by contributing to more than the half of all hospital-acquired pneumonia. After identification of high VAP rate 36% in ICU KFH following Infection Prevention and Control report with confirmation of baseline data. The main objective of this pre and post interventional study is the reduction of VAP rate from 36 to 13%.With two process indicators increase knowledge of ICU clinical staff by trainings and increasing compliance rate of Evidence Based Guideline (EBG) of VAP preventive measures. This pre and post intervention study analyzed data of two different periods: The first period was considered as pre intervention period (October, November and December 2019) and Post intervention period (October, November and December 2021). Among 150 patients admitted only patients were chosen in study and they were intubated more than 48 hours. After finding the real root cause;Low compliance level of Evidence Based Guideline on VAP prevention‖ 55.8% due to lack of clinical staff training on VAP preventive measures. Several training conducted from August to September 2021 and some techniques demonstration of VAP preventions measures. This pre post interventions study was very successful and the main objective was achieved. The results shows VAP rate of 36 % in 2019 before all ICU staff training on EBG for VAP preventive measure compare to, 10% in 2021 which confirm the success of the intervention. This study had also 3 major outcomes; increasing staff knowledge on VAP preventive measures by staff training, from 12.5% to 96%, increase compliance rate of EBG’s from 55.8% to 86.2% and finally VAP rate reduction from 36% 10%. This means all outcomes were achieved.

Conclusion: clinical staff training lead to increase compliance rate of EBG’s and finally to VAP rate reduction. There is strong relationship (CI: 95%) between training and VAP incidence rate.

Key Words: Ventilator -Associated Pneumonia, Evidence Based Guidelines and clinical staff training on VAP preventive measures