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Ventilator-associated pneumonia: depends on your definition

Timothy J Novosel1, Laura A Hodge, Leonard J Weireter

  • 1Department of Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA. tnovosel@hotmail.com

The American Surgeon
|August 4, 2012
PubMed

Insights

Different diagnostic criteria for ventilator-associated pneumonia (VAP) significantly impact reported infection rates. Trauma services identified 36 VAPs, while infection control reported only two, highlighting discrepancies in patient safety metrics.

Area of Science:

  • Medical research
  • Infectious disease epidemiology
  • Patient safety

Background:

  • Hospital-acquired infections are a key patient safety concern.
  • Discrepancies exist in ventilator-associated pneumonia (VAP) rates reported by Infection Control Committees (ICC) and clinical services.

Purpose of the Study:

  • To investigate the reasons for discordance in VAP rates between the ICC and the Trauma Service.
  • To analyze the impact of differing diagnostic criteria on VAP surveillance.

Main Methods:

  • Retrospective evaluation of VAP cases diagnosed by the Trauma Service.
  • Comparison of VAP diagnoses with ICC data from January 2010 to June 2011.
  • Analysis of diagnostic criteria, including the National Nosocomial Infection Survey (NNIS) algorithm and quantitative microbiology.

Main Results:

  • The Trauma Service identified 36 VAPs, while the ICC identified only two among 136 potential patients.
  • Differences in diagnostic criteria, particularly the use of chest radiographs in the NNIS algorithm, led to under-identification of VAP by the ICC.
  • 35 of 36 VAPs identified by the Trauma Service were missed by the NNIS algorithm.

Conclusions:

  • Varying definitions of VAP lead to significantly different reported infection rates.
  • These discrepancies have substantial implications for quality metrics and patient safety reporting.
  • Standardizing VAP diagnostic criteria is crucial for accurate surveillance and performance evaluation.

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