Page 1 of 7 not for citation purposes Infection control: Impact and challenges Hasan Int J Infect Control 2011, v7:i3 doi: 10.3396/ijic.V7i3.018.11 Muhammad S Khan 1 , Saeeda Haider 2 , Safa Z Siddiqui 2 , Afa Zafar 1 , Faisal Malik 1 , Rumina Hasan 1 1 Department of Pathology and Microbiology, Aga Khan University, Karachi, Pakistan 2 Department of Anaesthesia, Dow University of Health Sciences, Karachi, Pakistan International Journal of Infection Control Impact and challenges of infection control in a public sector intensive care unit: Experience from a low resourced country ISSN 1996-9783 www.ijic.info DOI: 10.3396/ijic.V7i3.018.11 Corresponding author Rumina Hasan Department of Microbiology and Pathology, Aga Khan University Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan Telephone: +92 21 34861640, +92 21 34861641 Fax: +92 21 34934294, +92 21 34932095 Email: rumina.hasan@aku.edu ORIgINAl ARTIClE Abstract Impact of introducing infection control (IC) on Ventilator Associated Pneumonia (VAP) rates in a low resource public sector intensive care unit was investigated. The study was conducted in two parts; pre and post intervention periods. 285 patients admitted during the pre intervention period (July to December 2007) and 426 patients admitted during post intervention period (September 2008 to May 2009) were included. IC was implemented through educational sessions, introduction of a computerized surveillance program for recording data, and the establishment of a team responsible for monitoring and improving IC. VAP rate following the interventions was noted to be 3.5% (15/426), a signifcant decrease (p<0.0001) from the pre intervention rate of 13% (37/285). Case fatality reduced from 57% (21/37) to 53% (8/15) post intervention. 81% VAP causing organisms were multidrug resistant (resistant to ≥2 classes of antibiotics) in the post intervention period compared to 91% in the pre intervention period. Although stringent interventional measures were effective in reducing VAP rates, impact on antimicrobial resistance and on mortality was limited. Regular surveillance and team work were essential components that were required. Signifcant challenges encountered included the need of continuous education to modify behaviours and improve attitudes towards IC. Key words Nosocomial infections, hospital acquired infections, infection control, ventilator associated pneumonia, multidrug resistance.