• Victor Daniel Rosenthal, Zhilin Jin, Ruijie Yin, Suneeta Sahu, Prasad Rajhans, Mohit Kharbanda, Pravin K Nair, Shakti Bedanta Mishra, Rajesh Chawla, Rajalakshmi Arjun, Kavita Sandhu, Camilla Rodrigues, Reshma Dongol, Sheila Nainan Myatra, Mat Nor Mohd-Basri, Tai Chian-Wern, Arpita Bhakta, Ider Bat-Erdene, Subhash P Acharya, Gustavo Andres Alvarez, Lina Alejandra Aguilar Moreno, Katherine Gomez, Luisa Fernanda da Jimenez-Alvarez, Claudia Milena Henao-Rodas, Sandra Liliana Valderrama-Beltran, Maria Adelia Zuniga-Chavarria, Guadalupe Aguirre-Avalos, Blanca Estela Hernandez-Chena, Alejandro Sassoe-Gonzalez, Mary Cruz Aleman-Bocanegra, Maria Isabel Villegas-Mota, Daisy Aguilar De Moros, Alex Castaneda-Sabogal, CarreazoNilton YhuriNYUniversidad Peruana de Ciencias Aplicadas, Hospital de Emergencias Pediatricas, Lima, Peru., Safaa Alkhawaja, Hala Mounir Agha, Amani El-Kholy, Mohammad Abdellatif-Daboor, Oguz Dursun, Emel Okulu, Merve Havan, Dincer Yildizdas, Suna Secil Ozturk Deniz, Ertugrul Guclu, Sona Hlinkova, Aamer Ikram, Lili Tao, Abeer Aly Omar, Naheed Elahi, Ziad A Memish, Michael M Petrov, Lul Raka, Jarosław Janc, George Horhat-Florin, Eduardo Alexandrino Medeiros, Estuardo Salgado, Lourdes Dueñas, Monica Coloma, Valentina Perez, and Eric Christopher Brown.
• Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; INICC Foundation, International Nosocomial Infection Control Consortium, Miami, USA. Electronic address: vdr21@miami.edu.
• J Crit Care. 2024 Apr 1; 80: 154500154500.

BackgroundVentilator associated pneumonia (VAP) occurring in the intensive care unit (ICU) are common, costly, and potentially lethal.MethodsWe implemented a multidimensional approach and an 8-component bundle in 374 ICUs across 35 low and middle-income countries (LMICs) from Latin-America, Asia, Eastern-Europe, and the Middle-East, to reduce VAP rates in ICUs. The VAP rate per 1000 mechanical ventilator (MV)-days was measured at baseline and during intervention at the 2nd month, 3rd month, 4-15 month, 16-27 month, and 28-39 month periods.Results174,987 patients, during 1,201,592 patient-days, used 463,592 MV-days. VAP per 1000 MV-days rates decreased from 28.46 at baseline to 17.58 at the 2nd month (RR = 0.61; 95% CI = 0.58-0.65; P < 0.001); 13.97 at the 3rd month (RR = 0.49; 95% CI = 0.46-0.52; P < 0.001); 14.44 at the 4-15 month (RR = 0.51; 95% CI = 0.48-0.53; P < 0.001); 11.40 at the 16-27 month (RR = 0.41; 95% CI = 0.38-0.42; P < 0.001), and to 9.68 at the 28-39 month (RR = 0.34; 95% CI = 0.32-0.36; P < 0.001). The multilevel Poisson regression model showed a continuous significant decrease in incidence rate ratios, reaching 0.39 (p < 0.0001) during the 28th to 39th months after implementation of the intervention.ConclusionsThis intervention resulted in a significant VAP rate reduction by 66% that was maintained throughout the 39-month period.Copyright © 2023. Published by Elsevier Inc.

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