<b>EFFECTIVENESS OF CONTINUOUS SURVEILLANCE ON REDUCING VENTILATOR-ASSOCIATED PNEUMONIA RATES IN THE INTENSIVE CARE UNIT OF MEDICARE HOSPITAL MULTAN</b>

Background: Ventilator-associated pneumonia (VAP) is a leading cause of morbidity and mortality in intensive care units (ICUs) worldwide, with disproportionately high rates reported in low- and middle-income countries, including Pakistan. Continuous surveillance programs have demonstrated effectiveness in high-resource settings, but evidence from Pakistani tertiary care hospitals remains limited (Raza et al., 2024). Medicare Hospital Multan, a 300-bed tertiary care facility, reported baseline VAP rates of 15.8 per 1000 ventilator days in 2024, exceeding national benchmarks. Objective: To evaluate the effectiveness of implementing a continuous surveillance program on reducing VAP rates, improving ventilator care bundle compliance, and decreasing mechanical ventilation duration in the ICU of Medicare Hospital Multan over 12 months (January–December 2025). Methods: A prospective quasi-experimental before-after study was conducted in the 18-bed mixed medical-surgical ICU. The pre-intervention phase (mobefore-and-afternths 1-3, n=112 patients) utilized routine retrospective VAP surveillance without structured feedback. The intervention phase (months 4-12, n=230 patients) implemented a continuous surveillance program consisting of daily VAP monitoring using CDC/NHSN criteria (Centers for Disease Control and Prevention, 2024), real-time bedside feedback, weekly multidisciplinary infection control rounds, automated electronic alerts for ventilator bundle deviations, and structured VAP prevention education. VAP rates were calculated per 1000 mechanical ventilator days. Statistical analysis employed Poisson regression for incidence rate ratios (IRR) and chi-square tests for categorical variables, using SPSS version 28 (IBM Corp., 2025). Significance was set at p < 0.05. Results: Over 1,892 total ventilator days (baseline: 455 days; intervention: 1,437 days), 342 patients were enrolled (mean age 58.4 ± 14.2 years; 58% male). The VAP rate decreased significantly from 15.8 per 1000 ventilator days (95% CI: 12.4-19.2) in the pre-intervention phase to 8.5 per 1000 ventilator days (95% CI: 6.2-10.8) in the intervention phase, representing a 46.2% relative reduction (IRR = 0.54, 95% CI: 0.38-0.77, p = 0.001). Ventilator care bundle compliance improved from 62% to 84% (p < 0.001). Mean duration of mechanical ventilation for patients who developed VAP was significantly lower during the intervention period (9.8 ± 3.6 days vs. 12.4 ± 4.2 days, p = 0.03). The median time from intubation to VAP diagnosis increased from 5.2 days (IQR: 3.4-7.1) to 7.8 days (IQR: 5.1-10.2) post-intervention (p = 0.02), suggesting delayed onset. No significant differences were observed in ICU mortality between phases (32.1% vs. 28.7%, p = 0.52). Conclusion: Implementation of a continuous surveillance program in a Pakistani ICU achieved a clinically and statistically significant 46% reduction in VAP rates, accompanied by improved bundle compliance and delayed VAP onset. These findings support continuous surveillance as an effective, feasible infection control strategy in resource-limited healthcare settings, aligning with global VAP prevention guidelines (Torres et al., 2022). However, lack of mortality benefit highlights the need for comprehensive quality improvement approaches.