Preventing Ventilator-Associated Pneumonia in the Middle East and North Africa: A Systematic Review of Effective Strategies

Background: Ventilator-associated pneumonia (VAP) is the most common ICU-acquired pneumonia among patients who are invasively intubated for mechanical ventilation. Our aim was to comprehensively analyze the effectiveness of various VAP prevention strategies, which is crucial for improving patient outcomes. Methods: A comprehensive literature search was conducted across multiple databases, including PubMed, Scopus, and CINAHL, with a 20-year (2004-2024) date restriction, focusing on articles published in the Middle East and North Africa (MENA) region. Duplicates were removed using EndNote, and preliminary screening was performed on the Rayyan platform. Data extraction was performed using a standardized form, and both internal and external validity was assessed using the risk of bias tool developed by Hoy et al. Results: We identified 1,756 records, of which 88 were selected for full-text review. Following methodological examination and quality assessment, 37 studies were included in the data synthesis highlighting various VAP prevention strategies implemented in the MENA region. Oral care protocols using chlorhexidine mouthwash significantly reduced VAP rates, with one study reporting a decrease from 5.8% to 0% over 2 years. Comparisons between chlorhexidine and miswak, a traditional Middle Eastern oral care tool, were also evaluated. Elevating the head of the bed to 30-45 degrees proved effective, with a clinical trial showing lower VAP incidence at 45 degrees compared to 30 degrees. Ventilator care bundles, including oral care, hand hygiene, and regular suctioning, were associated with substantial VAP reductions; one study reported a decrease from 33.8% to 8.8% with comprehensive training and adherence. A daily sedation interruption protocol also showed effectiveness, with lower VAP rates in the intervention group. Additional strategies, such as subglottic secretion drainage and continual oral hygiene, further supported VAP prevention efforts. Conclusions: The findings indicate that comprehensive, multifaceted VAP prevention strategies significantly reduce VAP occurrence in the MENA region. Effective strategies include oral care protocols, head-of-bed elevation, ventilator care bundles, and daily sedation interruption. This review underscores the need for standardized protocols and continuous education for healthcare providers to enhance VAP prevention and improve patient outcomes.PRISMA Flowchart