Errors in administrative-reported ventilator-associated pneumonia rates: are never events really so?

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Surgical Critical Care

Background:

• Ventilator-associated pneumonia (VAP) is a significant complication in intensive care units (ICUs).
• Accurate VAP incidence data is crucial for effective patient management and quality improvement.
• Current surveillance methods may not fully capture the true burden of VAP.

Purpose of the Study:

• To compare the incidence of VAP diagnosed by surgical intensivists (SIS-VAP) versus the hospital Infection Control Service (ICS-VAP).
• To evaluate the diagnostic accuracy of SIS-VAP and ICS-VAP against bronchoalveolar lavage (BAL) VAP criteria.
• To assess the reliability of administrative VAP reporting in surgical ICU populations.

Main Methods:

• Prospective evaluation of trauma and surgical ICU patients over 5 months.
• VAP assessment using Centers for Disease Control and Prevention (CDC) criteria by both surgical intensivists and the ICS.
• Comparison of clinician and administrative VAP diagnoses with BAL findings for suspected cases.

Main Results:

• SIS-VAP was diagnosed in 28.5% of patients, significantly higher than ICS-VAP at 8.3% (P < 0.001).
• Bronchoalveolar lavage (BAL) confirmed VAP in 23.3% of evaluated patients.
• SIS-VAP demonstrated higher sensitivity (61.3%) compared to ICS-VAP (29%) when validated against BAL criteria.

Conclusions:

• Physician-based VAP assessments in surgical ICUs are more sensitive and accurate than those reported by hospital administrative sources.
• Administrative VAP rates significantly underestimate the actual incidence, challenging the 'never event' concept for critically ill surgical and trauma patients.
• Improved surveillance strategies incorporating clinical judgment are needed for accurate VAP burden assessment.