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Multimodal Implementations to Reduce Neonatal Ventilator-Associated Pneumonia and Colistin Use: An Interrupted Time

Gunlawadee Maneenil1, Anucha Thatrimontrichai1, Praew Chareesri1

  • 1Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand.

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Summary

Multimodal strategies, including environmental cleaning and specialized ventilation, significantly reduced neonatal ventilator-associated pneumonia (VAP) and antimicrobial use. Further interventions sustained these improvements over an 11-year study.

Keywords:
antimicrobial stewardshipdrug utilization reviewhealth care-associated infectionhigh-frequency ventilationintermittent positive-pressure ventilationneonatal intensive care unitnewbornnoninvasive ventilationpolymyxinquality of health care

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Area of Science:

  • Neonatal intensive care
  • Infectious disease prevention
  • Respiratory support

Background:

  • Neonatal ventilator-associated pneumonia (VAP) and antimicrobial resistance are critical challenges.
  • Multimodal strategies are needed to reduce VAP and antibiotic use in neonates.

Purpose of the Study:

  • To investigate the impact of phased multimodal interventions on VAP incidence and antimicrobial use in a neonatal intensive care unit (NICU).

Main Methods:

  • A quasi-experimental study design was employed over an 11-year period in a Thai NICU.
  • Interrupted time-series analysis with segmented regression analyzed trends in VAP and colistin use.
  • Interventions included environmental cleaning, HFOV, oral care, and nasal synchronized intermittent positive pressure ventilation.

Main Results:

  • Overall VAP incidence was 4.55 per 1000 ventilator days, with a significant yearly decrease from 2014.
  • Period 1 interventions (environmental decontamination, HFOV) significantly reduced VAP and colistin use.
  • Subsequent interventions in periods 2 and 3 maintained VAP reduction and limited colistin prescriptions.

Conclusions:

  • Phased multimodal strategies, starting with environmental and ventilator care, effectively reduced VAP and antimicrobial use.
  • Additive interventions like oral care and nasal synchronized intermittent positive pressure ventilation sustained these positive outcomes.
  • The study demonstrates a successful approach to VAP and antibiotic stewardship in the NICU setting.