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990 Incidence density of VAP and effects of HOB elevation in 70 hospitals in Shanghai

Sunday, March 21, 2010
Grand Hall (Hyatt Regency Atlanta)
Bijie Hu, MD, PHD , Zhongshan Hospital of Fudan University, Shanghai, China
Xiaodong Gao, BM , Zhongshan Hospital of Fudan University, Shanghai, China
Qing Zhou, MSc , Zhongshan Hospital of Fudan University, Shanghai, China
Linlin Yu, BM , Zhongshan Hospital of Fudan University, Shanghai, China
Lili Tao, BM , Zhongshan Hospital of Fudan University, Shanghai, China
Yiwen Zhang, BM , Zhongshan Hospital of Fudan University, Shanghai, China
Wenjuan Wang , Zhongshan Hospital of Fudan University, Shanghai, China
Jinlan Ren , Zhongshan Hospital of Fudan University, Shanghai, China
Yangwen Cui , Zhongshan Hospital of Fudan University, Shanghai, China
Yan Shen , Zhongshan Hospital of Fudan University, Shanghai, China
Background: Ventilator associated pneumonia (VAP) is the leading cause of healthcare-associated infection (HAI) in the ICU. A lot of surveillance showed that the incidence of VAP in China was much higher than that reported in U.S. and many European countries. The bundle for VAP was seldom introduced before 2006.

Objective: Active surveillance for the incidence density of VAP were performed in 70 hospitals of Shanghai Nosocominal Infection Surveillance Net (SNISN) and the effect of intervention, head of bed (HOB) elevation, were evaluated.

Methods: All ICUs from 70 hospitals of SNISN were required to join this surveillance. The trained infection control nurses collected the data regarding to pneumonia and related information at least 3 times per week. The diagnosis criteria for VAP were issued by MOH of China in 2001, similar to CDC of U.S. The surveillance began in Sep. 2004. We induced the intervention for VAP in 2008. All ICU patients were required to keep HOB at 30 degrees or greater unless medically contraindicated.

Results: From Sep. 2004 to Sep. 2009, a total of ICU-days we surveyed was 2 047 937 and endotracheal intubation days was 507 788. 12 114 cases were diagnosed as VAP. The incidence density was 23.9 per 1000 endotracheal intubation-day (ETD). After several times of education and monitoring, HOB elevation police was gradually accepted and performed in these 70 hospitals since first quarter of 2009. The compliance rate rose from less than 20% before 2008 to 80% or more in 2009. As the results of this intervention, the incidence density of VAP decrease from 21.3~30.0 (4th quarter 2004-4th 2007) to 14.9~20.0 (1st -3rd quarter 2009).

Tab. Incidence density of VAP in 70 hospitals of Shanghai (per 1000 endotracheal intubation-day)

2004

2005
2006
2007
2008
2009
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
30.0
25.3
26.1
28.8
22.3
21.3
23.9
26.8
28.7
25.4
22.8
23.5
22.0
26.2
23.5
23.4
26.1
20.6
17.7
14.9

Conclusions: The incidence of VAP was high in Shanghai. Our data suggests that patient positioning is the effective intervention in significantly reducing the VAP rate