Determinants of Ventilator-Associated Pneumonia among Neonates-Gaza Governorates: (Cross-Sectional Study)
عبد الله رفيق اسماعيل مهدي, يوسف عوض
جامعة القدس · فلسطين
Ventilator-Associated Pneumonia VAPthatoccurs in a patient connected tomechanical ventilation whichdevelops 48 hoursor more after initiating mechanicalventilation. Themost common determinants of VAP in neonatal intensive care unit NICU are leukocytosis or Leukopenia, metabolic acidosis, Endotracheal IntubationETT, re-intubation, and contaminatedintensive care unitICU environment with lack of infection control measures, administration of blood products,enteral feeding, , prematurity, invasive devicesand low birth weight. Thisstudyisa cross sectional studycontainstwodirect observation checklists designed by the researcher.The first observation consistedof 102 neonates(known by the first observation checklist made by the researcher)that admitted to NICUdistributed in four hospitals (AL-shifa Hospital "47",AL-TahreerHospital"25", Al-Naser pediatric Hospital"21", and finally European Gaza HospitalEUG"9") during100 days (period of data collection) and diagnosed with VAP. Thestudy was conducted in the period from the first of May 2016 to the 10thof August 2016. The result of VAPdeveloped in 43 of 102ventilated neonates (42.2% VAP incidence)shows that significant common determinates for positive VAP were: longtime of intubation (X2= 21.020; P-Value= 0.000);ETT change times (X2= 6.847; P-Value= 0.033); Ryle tube(X2= 10.551; P-Value= 0.001);urinary catheters(X2= 23.287; P-Value= 0.000);umbilical line catheterULV (X2= 49.251; P-Value= 0.+000); chest tube (X2= 29.551; P-Value= 0.000); Administrationofblood products such as plasma and packedred blood cellsRBS(39.5%), plasma & human albumin &packed RBS (11.6%) then packed RBS (11.6), and finally plasma (4.7%) (X2= 14.989; P-Value= 0.000).Blood culture resultsshow thatAcinetobacter (48.8%),Klebsilla(30.2 %),Pseudomonas (11.6%), and Candida (7.0%) Coagulase-negative staphylococci (2.3%) (X2= 54.830; P-Value= 0.000).Mode of deliveryresultsshows thatcesarean sectionCSandnormal spontaneous vaginal deliveryNSVD (X2= 0.220; P-Value= 0.008). The second observation was designedto observefour hospitals (AL-shifa Hospital"12", AL-TahreerHospital"5",Al-Naser pediatric Hospital"10",and finally EUG "3"). For hand washing, the results show that (F = 24,807; P-Value= 0.000); disinfectanttools of ETT (F = 28.539; P-Value= 0.000); infection control procedures for the Suction process (F = 10,851; P-Value= 0.000); infectioncontrol Polices (F = 5,774; P-Value= 0.004); andinfection control Kits (F = 1.717; P-Value= 0.188).In conclusion, the mostimportant determinants of VAPare: prolongedperiod of intubation, placementULV,chest tube,insertingRyle feeding, electiveCS delivery, transfusion anycomponent of blood transfusionand re-intubation ETT. Ifthesedeterminants are avoided or decreased, thiswill help in reducing the morbidity and mortality inneonates withVAP inGazagovernorates(GG).Moreover,Blood cultures have value in microbiological diagnosis of VAP among neonatesbutit was foundthat there were not the same microorganismsisolated fromBronchoalveolar LavageBAL culture.