American Journal of Infectious Diseases and Microbiology
ISSN (Print): 2328-4056 ISSN (Online): 2328-4064 Website: https://www.sciepub.com/journal/ajidm Editor-in-chief: Maysaa El Sayed Zaki
Open Access
Journal Browser
Go
American Journal of Infectious Diseases and Microbiology. 2021, 9(1), 25-31
DOI: 10.12691/ajidm-9-1-6
Open AccessArticle

Rates of Ventilator Associated Pneumonia in Saudi Ministry of Health Hospitals; A Two-year Multi-Center Study

Tabish Humayun1, , Nasser Alshanbari1, Adel Alanazi1, Yvonne S. Aldecoa1, Khalid H. Alanazi1, Ghada Bin Saleh1, Mohammed Alqahtani1 and Aiman El-Saed2

1Surveillance Department, General Directorate of Infection Prevention and Control (GDIPC), Ministry of Health (MOH), PO Box: 11176, Riyadh, Kingdom of Saudi Arabia

2Surveillance Department, King Saud bin Abdul-Aziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia

Pub. Date: February 28, 2021

Cite this paper:
Tabish Humayun, Nasser Alshanbari, Adel Alanazi, Yvonne S. Aldecoa, Khalid H. Alanazi, Ghada Bin Saleh, Mohammed Alqahtani and Aiman El-Saed. Rates of Ventilator Associated Pneumonia in Saudi Ministry of Health Hospitals; A Two-year Multi-Center Study. American Journal of Infectious Diseases and Microbiology. 2021; 9(1):25-31. doi: 10.12691/ajidm-9-1-6

Abstract

BACKGROUND: Although the rates of ventilator associated pneumonia (VAP) have been estimated in Saudi Arabia, however national surveillance data for VAP has never been reported earlier. OBJECTIVES: To estimate VAP rates and ventilator utilization ratios in 105 Ministry of health (MOH) hospitals and to benchmark them with International Standards. METHODS: It was a prospective surveillance study in 15 different types of intensive care units (ICUs) between January 2018 and December 2019. The data were entered into the health electronic surveillance network (HESN) program. The methods of US National Healthcare Safety Network (NHSN) and the Gulf Cooperation Council (GCC) center for infection control were used. RESULTS: During two years of surveillance covering 1,469,658 patient-days and 569,961 ventilator-days, a total 1,694 VAP events were identified. The overall MOH VAP rate was 2.97 (95% confidence 2.83-3.11) per 1000 ventilator-days and the overall ventilator utilization ratio was 0.39 (95% confidence 0.387- 0.389). VAP rates were highest in adult medical (4.40), pediatric cardiothoracic (3.64), and adult medical surgical ICUs (3.61). VAP standardized infection ratio across all types of ICUs in MOH hospitals were 29% lower than GCC hospitals, 78% lower than International Nosocomial Infection Control Consortium (INICC) hospitals, and 191% higher than NHSN hospitals. Ventilator standardized utilization ratio in all types of ICUs in MOH hospitals were 19% lower than GCC hospitals, 32% higher than INICC hospitals, and 50% higher than NHSN hospitals. CONCLUSIONS: Using huge standardized data, the current report can serve as a unique national VAP benchmark, fostering a culture of competitiveness between the hospitals and regions.

Keywords:
ventilator associated pneumonia ventilator healthcare infection control benchmarking surveillance

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]  Alshamrani MM, El-Saed A, Alsaedi A, El Gammal A, Al Nasser W, Nazeer S, Balkhy HH: Burden of healthcare-associated infections at six tertiary-care hospitals in Saudi Arabia: A point prevalence survey. Infection Control and Hospital Epidemiology. 2019, 40 (3): 355-357.
 
[2]  Papazian L, Klompas M, Luyt C-E: Ventilator-associated pneumonia in adults: a narrative review. Intensive Care Medicine. 2020, 46 (5): 888-906.
 
[3]  World Health Organization: Report on the Burden of Endemic Health Care-Associated Infection Worldwide. A systematic review of the literature. URL:
 
[4]  http://whqlibdoc.who.int/publications/2011/9789241501507_eng.pdf (Last accesed January 1, 2021). 2011.
 
[5]  Nguile-Makao M, Zahar JR, Francais A, Tabah A, Garrouste-Orgeas M, Allaouchiche B, Goldgran-Toledano D, Azoulay E, Adrie C, Jamali S et al: Attributable mortality of ventilator-associated pneumonia: respective impact of main characteristics at ICU admission and VAP onset using conditional logistic regression and multi-state models. Intensive Care Med. 2010, 36 (5): 781-789.
 
[6]  Rosenthal VD, Maki DG, Mehta Y, Leblebicioglu H, Memish ZA, Al-Mousa HH, Balkhy H, Hu B, Alvarez-Moreno C, Medeiros EA et al: International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module. American Journal of Infection Control. 2014, 42 (9): 942-956.
 
[7]  Kollef MH, Hamilton CW, Ernst FR: Economic impact of ventilator-associated pneumonia in a large matched cohort. Infect Control Hosp Epidemiol. 2012, 33 (3): 250-256.
 
[8]  Umscheid CA, Mitchell MD, Doshi JA, Agarwal R, Williams K, Brennan PJ: Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol. 2011, 32 (2): 101-114.
 
[9]  Ladbrook E, Khaw D, Bouchoucha S, Hutchinson A: A systematic scoping review of the cost-impact of ventilator-associated pneumonia (VAP) intervention bundles in intensive care. Am J Infect Control. 2020.
 
[10]  Van Mourik MSM, Perencevich EN, Gastmeier P, Bonten MJM: Designing Surveillance of Healthcare-Associated Infections in the Era of Automation and Reporting Mandates. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America. 2018, 66 (6): 970-976.
 
[11]  BĂ©net T, Allaouchiche B, Argaud L, Vanhems P: Impact of surveillance of hospital-acquired infections on the incidence of ventilator-associated pneumonia in intensive care units: a quasi-experimental study. Crit Care. 2012, 16 (4): R161.
 
[12]  Al-Abdely HM, Khidir Mohammed Y, Rosenthal VD, Orellano PW, M AL, Kaid E, Al-Attas A, Hawsawi G, Kelany A, Hussein B et al: Impact of the International Nosocomial Infection Control Consortium (INICC)'s multidimensional approach on rates of ventilator-associated pneumonia in intensive care units in 22 hospitals of 14 cities of the Kingdom of Saudi Arabia. J Infect Public Health. 2018, 11 (5): 677-684.
 
[13]  Shorr AF, Chan CM, Zilberberg MD: Diagnostics and epidemiology in ventilator-associated pneumonia. Ther Adv Respir Dis. 2011, 5 (2):121-130.
 
[14]  Gaid E, Assiri A, McNabb S, Banjar W: Device-associated nosocomial infection in general hospitals, Kingdom of Saudi Arabia, 2013-2016. J Epidemiol Glob Health. 2018, 7 Suppl 1: S35-S40.
 
[15]  Banjar A, Felemban M, Dhafar K, Gazzaz Z, Al Harthi B, Baig M, Al Khatib K, Zakaria J, Hawsawi K, Isahac L et al: Surveillance of preventive measures for ventilator associated pneumonia (VAP) and its rate in Makkah Region hospitals, Saudi Arabia. Turk J Med Sci. 2017, 47 (1):211-216.
 
[16]  El-Saed A, Al-Jardani A, Althaqafi A, Alansari H, Alsalman J, Al Maskari Z, El Gammal A, Al Nasser W, Al-Abri SS, Balkhy HH: Ventilator-associated pneumonia rates in critical care units in 3 Arabian Gulf countries: A 6-year surveillance study. Am J Infect Control. 2016, 44 (7): 794-798.
 
[17]  Saudi Ministry of Health (MOH): Statistical Yearbook 1439H (2018 G). URL:
 
[18]  https://www.moh.gov.sa/en/Ministry/Statistics/book/Documents/book-Statistics.pdf (Last accessed January 1, 2021). 2019.
 
[19]  National Healthcare Safety Network (NHSN): NHSN Patient Safety Component Manual. Januray 2018. URL:
 
[20]  http://www.cdc.gov/nhsn/PDFs/pscManual/pcsManual_current.pdf (Last accesed January 1, 2021). 2018.
 
[21]  GCC Centre for Infection Control and Ministry of National Guard Health Affairs: Healthcare-associated Infections surveillance manual, 3rd edition. URL:
 
[22]  http://ngha.med.sa/English/MedicalCities/AlRiyadh/MedicalServices/Documents/3rd_edition_Surveillance_Manual.pdf (Last accessed January 1, 2021). 2018.
 
[23]  Saudi Ministry of Health (MOH): Health Electronic Surveillance Network. URL: https://hesn.moh.gov.sa/webportal/ (Last accessed January 1, 2021). 2020.
 
[24]  Dudeck MA, Edwards JR, Allen-Bridson K, Gross C, Malpiedi PJ, Peterson KD, Pollock DA, Weiner LM, Sievert DM: National Healthcare Safety Network report, data summary for 2013, Device-associated Module. Am J Infect Control. 2015, 43 (3): 206-221.
 
[25]  Dudeck MA, Weiner LM, Allen-Bridson K, Malpiedi PJ, Peterson KD, Pollock DA, Sievert DM, Edwards JR: National Healthcare Safety Network (NHSN) report, data summary for 2012, Device-associated module. Am J Infect Control. 2013, 41 (12): 1148-1166.
 
[26]  Klompas M: Eight initiatives that misleadingly lower ventilator-associated pneumonia rates. Am J Infect Control. 2012, 40 (5): 408-410.
 
[27]  Morris AC, Kefala K, Simpson AJ, Wilkinson TS, Everingham K, Kerslake D, Raby S, Laurenson IF, Swann DG, Walsh TS: Evaluation of the effect of diagnostic methodology on the reported incidence of ventilator-associated pneumonia. Thorax. 2009, 64 (6): 516-522.
 
[28]  El-Saed A, Balkhy HH, Weber DJ: Benchmarking local healthcare-associated infections: available benchmarks and interpretation challenges. J Infect Public Health. 2013, 6 (5): 323-330.