Interventional Program in Nosocomial Pneumonia Associated to Depressed Consciousness in a Chilean Teaching Hospital, 7-Year Follow-Up

ISSUE: Pneumonia associated to depressed consciousness (NADC) is an important problem in large hospitals. In our hospital it accounts for 21% of the reported pneumonia with a crude mortality of 26.7%, 18.1 extra days stay (observed mainly at internal medicine and neurosurgery departments). The objective of this work is to evaluate the impact of an interventional program in decreasing the rate of NADC. PROJECT: In the period 1996–2002 an interventional program in NADC was instituted. It was based in two strategies: 1) inform regularly to internal medicine and neurosurgery department staff the rates of NADC, and 2) an educational program and evaluation of CDC/HICPAC–recommended practices (position patient upright at 300-450, aspiration of secretions, and verified placement of enteral feeding tube), and feedback of results. Surveillance was done by infection control nurses according to local definitions, and rates were calculated by patient day. RESULTS: In neurosurgery, the rate of NADC during 1996–1999 was 2.0 cases/1000 patients days. This was reduced in the period 2000–2002 to 1.3 (OR 0.65, IC 0.45–0.93, P=0.016). In internal medicine, the rate during 1996–1999 was 0.37 cases/1000 patients days. This was reduced during 2000–2002 to 0.07 (OR 0.19, IC 0.07–0.55, P=0.0012) LESSONS LEARNED: With an evidence-based interventional program, it is possible to reduce NADC rates, prevent deaths, and decrease costs.