Incidence of ventilator-associated pneumonia in Australasian intensive care units: use of a consensus-developed clinical surveillance checklist in a multisite prospective audit

Abstract

ObjectivesWith disagreements on diagnostic criteria for ventilator-associated pneumonia (VAP) hampering efforts to monitor incidence and implement preventative strategies, the study objectives were to develop a checklist for clinical surveillance of VAP, and conduct an audit in Australian/New Zealand intensive care units (ICUs) using the checklist.SettingOnline survey software was used for checklist development. The prospective audit using the checklist was conducted in 10 ICUs in Australia and New Zealand.ParticipantsChecklist development was conducted with members of a bi-national professional society for critical care physicians using a modified Delphi technique and survey. A 30-day audit of adult patients mechanically ventilated for >72 h.Primary and secondary outcome measuresPresence of items on the screening checklist; physician diagnosis of VAP, clinical characteristics, investigations, treatments and patient outcome.ResultsA VAP checklist was developed with five items: decreasing gas exchange, sputum changes, chest X-ray infiltrates, inflammatory response, microbial growth. Of the 169 participants, 17% (n=29) demonstrated characteristics of VAP using the checklist. A similar proportion had an independent physician diagnosis (n=30), but in a different patient subset (only 17% of cases were identified by both methods). The VAP rate per 1000 mechanical ventilator days for the checklist and clinician diagnosis was 25.9 and 26.7, respectively. The item ‘inflammatory response’ was most associated with the first episode of physician-diagnosed VAP.ConclusionsVAP rates using the checklist and physician diagnosis were similar to ranges reported internationally and in Australia. Of note, different patients were identified with VAP by the checklist and physicians. While the checklist items may assist in identifying patients at risk of developing VAP, and demonstrates synergy with the recently developed Centers for Disease Control (CDC) guidelines, decision-making processes by physicians when diagnosing VAP requires further exploration.

Preventing ventilator-associated pneumonia—a mixed-method study to find behavioral leverage for better protocol adherence

“…1 VAP is defined as pneumonia occurring 48 h following endotracheal intubation with the ventilator being in place the date of event or the day before. 2 The incidence of VAP was reported to be as high as 42%, [3][4][5] but estimates vary substantially depending on different diagnostic scoring systems. 3,6 Also, VAP is associated with substantial morbidity, an increase in mortality, and excess costs.…”

Clinical, microbiological research of the effectiveness of inhalation use of quaternary ammonium antiseptic in the prevention and treatment of infectious respiratory complications in critically ill patients

“…Pneumonia is one of the most frequent (6-52%) and serious hospital-acquired infectious complications which occur in critically ill children, and which is treated in the intensive care unit (ICU) [1][2][3][4][5] . Pneumonia is diagnosed in 9-10 cases per 1000 of all hospitalized critically ill patients 1,6 . According to the data of North American and European researchers, the incidence of ventilatorassociated pneumonia (VAP) in patients of multidisciplinary ICU reaches 23.8-32.0% 5 .…”

“…According to the National Nosocomial Infection Surveillance (NNIS) system data, VAP can develop in 6 cases per 1000 patient ventilator days. Thus, the mortality rate in patients with VAP varies from 20-50%, and in some cases, when the etiological factor of this complication is multidrug-resistant agents, may exceed 70% 1,2,[5][6][7][8] . The microbial factor is crucial in causing VA and influences the recovery of patients with this pathology.…”

Incidence and characteristics of ventilator-associated pneumonia in a regional non-tertiary Australian intensive care unit: protocol for a retrospective clinical audit study

“… 5 This is due to the lack of clinically relevant diagnostic criteria. A recent study by Elliott et al 6 reported a list of diagnostic criteria to establish the VAP incidence in a cohort of 10 Australian ICUs. These criteria evolved through a modified Delphi study and were reviewed by the Quality and Safety Committee of the Australian and New Zealand Intensive Care Society.…”

“…These criteria evolved through a modified Delphi study and were reviewed by the Quality and Safety Committee of the Australian and New Zealand Intensive Care Society. 6 …”