A comparison of ventilator-associated pneumonia rates as identified according to the National Healthcare Safety Network and American College of Chest Physicians criteria*

Abstract

There is poor agreement between clinical and administrative surveillance methods for the diagnosis of ventilator-associated pneumonia. Although there may be some benefit to using more stringent criteria for surveillance of ventilator-associated pneumonia, use of the administratively applied National Healthcare Safety Network criteria may significantly underestimate the scope of the clinical problem.

The Vexing Problem of Ventilator-Associated Pneumonia: Observations on Pathophysiology, Public Policy, and Clinical Science

“…However, VAP rates determined by CDC/NHSN criteria are systematically lower compared with those based upon ATS/IDSA criteria (1.2 vs 8.5 cases/1,000 ventilator days). 26 These discrepancies are not surprising as surveillance definitions were not designed for clinical care. An additional problem is that inter-rater reliability bedevils the capability to accurately track the incidence of VAP.…”

“…11 Recently, the Centers for Medicare and Medicaid Services (CMS) considered designating VAP as a non-reimbursable event, whereas The Joint Commission considered incorporating VAP into both the rating and accreditation of hospitals. 26,28,33,34 This would have a profoundly negative impact on the reputation of hospitals with significant economic consequences.…”

“…35 The response to these trends in the medical literature has been one of pervasive skepticism. 26,27,33,[36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51] In fact, VAP experts have pointedly criticized the growing misperception that administrative surveillance methods reflect the true incidence of ventilatorassociated tracheobronchitis/VAP. 29 This skepticism is buttressed by observations that validation studies examining surveillance techniques have found that infection-control surveyors miss almost one third of VAP cases.…”

“…In particular, there is considerable tension between clinical criteria (used prospectively to guide therapy) developed by the 2005 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) guidelines 25 and administrative methods (used retrospectively for surveillance) based on criteria developed by the Centers for Disease Control and Prevention/National Healthcare Safety Network (CDC/NHSN) ( Table 1). [26][27][28][29] Both methods rely upon subjective components in the diagnostic criteria. However, VAP rates determined by CDC/NHSN criteria are systematically lower compared with those based upon ATS/IDSA criteria (1.2 vs 8.5 cases/1,000 ventilator days).…”

Ventilator Associated Pneumonia in the ICU: Microbiological Profile

“…4,5 The mortality with VAP is considerably high, varying from 24 to 50% and can reach as high as 76% in some specific settings. 6 The etiologic agents widely differ according to the population of patients in an intensive care unit, duration of hospital stay, prior antimicrobial therapy and co-morbid conditions. Despite the advancements in antimicrobial regimes, VAP continues to be an important cause of morbidity and mortality.…”