Effect of an Education Program on the Prevention of Ventilator-Associated Pneumonia: A Multicenter Study
Somwang Danchaivijitr MD*, Susan Assanasen MD*, Anucha Apisarnthanarak MD**, Tepnimitr Judaeng MSc***, Varaporn Pumsuwan MSc***
Affiliation : *Division of Infectious Diseases, Department of Medicine Siriraj Hospital, Mahidol University, Bangkok **Division of Infectious Diseases, Faculty of Medicine, Thammasart University Hospital, Pathum Thani ***Center for Nosocomial Infection Control, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
Objective : To evaluate the effect of an educational program targeted on modifiable risk factors on ventilator-
associated pneumonia (VAP) rates.
Materials and Methods : After a preliminary study on VAP risk factors was conducted at one teaching hospital,
a pre- and post-interventional study was then performed on 12 hospitals in Thailand from January 1, 2002 to
June 30, 2003. Each hospital randomly selected 20 patients, who were on mechanical ventilation to be
enrolled. The study was divided into two phases; 1) pre-intervention, 2) post-intervention. Data collected
included patients’ demography and risk factors for VAP. During pre-interventional phase, data on risk factors
for VAP was analyzed and fedback to healthcare providers in the wards by an infection control nurse (ICN) of
the individual hospital. An educational programme on the prevention of VAP was introduced by the ICN.
Ventilator-associated pneumonia rates and their risk factors were continuously monitored during the post-
interventionl phase.
Results : Two hundred and forty four patients in the pre-interventional phase and 254 patients in the post-
interventional phase were included. There was no significant difference in the demography between these
two patient populations. After the intervetion, there was a significant improvement in hand-hygiene practices
(p<0.001) among healthcare providers and increased use of sucralfate (p=0.05) for stress ulcer prophylaxis.
Ventilation-associated pneumonia rate (40.5% vs. 24%; p<0.001) and crude mortality rate associated with
VAP (12.3% vs. 8.7%; p<0.001) were also reduced.
Conclusion : The educational programme targeted on modifiable risk factors for prevention of VAP was
effective and should be considered as an intervention to reduce VAP rates in developing countries.
Keywords : Education, Ventilator-associated pneumonia, Risk factors, Multicenter, Intervention
