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Findings of the International Nosocomial Infection Control Consortium (INICC), Part II: Impact of a Multidimensional Strategy to Reduce Ventilator-Associated Pneumonia in Neonatal Intensive Care Units in 10 Developing Countries

Published online by Cambridge University Press:  02 January 2015

Victor D. Rosenthal*
International Nosocomial Infection Control Consortium, Buenos Aires, Argentina
Maria E. Rodríguez-Calderón
Hospital La Victoria, Bogota, Colombia
Marena Rodríguez-Ferrer
Universidad Simón Bolívar, Barranquilla, Colombia
Tanu Singhal
Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
Mandakini Pawar
Pushpanjali Crosslay Hospital, Ghaziabad, India
Martha Sobreyra-Oropeza
Hospital de la Mujer, Mexico City, Mexico
Amina Barkat
Children Hospital of Rabat, Rabat, Morocco
Teodora Atencio-Espinoza
Hospital Regional de Pucallpa, Pucallpa, Peru
Regina Berba
Philippine General Hospital, Manila, Philippines
J. A. Navoa-Ng
St. Luke's Medical Center, Quezon City, Philippines
Lourdes Dueñas
Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador
Nejla Ben-Jaballah
Hospital d'Enfants, Tunis, Tunisia
Davut Ozdemir
Duzce University Medical School Infectious Diseases and Clinical Microbiology, Duzce, Turkey
Gulden Ersoz
Mersin University, Faculty of Medicine, Mersin, Turkey
Canan Aygun
Ondokuz Mayis University Medical School, Samsun, Turkey
Avenue Corrientes 4580, Piso 12, “D”, Buenos Aires (C1195AAR), Argentina (



Before-after prospective surveillance study to assess the efficacy of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control program to reduce the rate of occurrence of ventilator-associated pneumonia (VAP).


Neonatal intensive care units (NICUs) of INICC member hospitals from 15 cities in the following 10 developing countries: Argentina, Colombia, El Salvador, India, Mexico, Morocco, Peru, Philippines, Tunisia, and Turkey.


NICU inpatients.


VAP rates were determined during a first period of active surveillance without the implementation of the multidimensional approach (phase 1) to be then compared with VAP rates after implementation of the INICC multidimensional infection control program (phase 2), which included the following practices: a bundle of infection control interventions, education, outcome surveillance, process surveillance, feedback on VAP rates, and performance feedback on infection control practices. This study was conducted by infection control professionals who applied National Health Safety Network (NHSN) definitions for healthcare-associated infections and INICC surveillance methodology.


During phase 1, we recorded 3,153 mechanical ventilation (MV)–days, and during phase 2, after the implementation of the bundle of interventions, we recorded 15,981 MV-days. The VAP rate was 17.8 cases per 1,000 MV-days during phase 1 and 12.0 cases per 1,000 MV-days during phase 2 (relative risk, 0.67 [95% confidence interval, 0.50–0.91]; P = .001 ), indicating a 33% reduction in VAP rate.


Our results demonstrate that an implementation of the INICC multidimensional infection control program was associated with a significant reduction in VAP rate in NICUs in developing countries.

Original Articles
Copyright © The Society for Healthcare Epidemiology of America 2012

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