RESUMEN
BACKGROUND: Ventilator associated pneumonia (VAP) occurring in the intensive care unit (ICU) are common, costly, and potentially lethal. METHODS: We 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, 4-15â¯month, 16-27â¯month, and 28-39â¯month periods. RESULTS: 174,987 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 (RRâ¯=â¯0.61; 95% CIâ¯=â¯0.58-0.65; Pâ¯<â¯0.001); 13.97 at the 3rd month (RRâ¯=â¯0.49; 95% CIâ¯=â¯0.46-0.52; Pâ¯<â¯0.001); 14.44 at the 4-15â¯month (RRâ¯=â¯0.51; 95% CIâ¯=â¯0.48-0.53; Pâ¯<â¯0.001); 11.40 at the 16-27â¯month (RRâ¯=â¯0.41; 95% CIâ¯=â¯0.38-0.42; Pâ¯<â¯0.001), and to 9.68 at the 28-39â¯month (RRâ¯=â¯0.34; 95% CIâ¯=â¯0.32-0.36; Pâ¯<â¯0.001). The multilevel Poisson regression model showed a continuous significant decrease in incidence rate ratios, reaching 0.39 (pâ¯<â¯0.0001) during the 28th to 39th months after implementation of the intervention. CONCLUSIONS: This intervention resulted in a significant VAP rate reduction by 66% that was maintained throughout the 39-month period.