Ventilator-Associated Pneumonia: Depends on Your Definition

Abstract

Reduction of hospital-acquired infections is a patient safety goal and regularly monitored by Performance Improvement committees. There is discordance between the ventilator-associated pneumonia (VAP) rate reported by the Infection Control Committee (ICC) and that observed by our Trauma Service. To investigate this difference, a retrospective evaluation of cases of VAP diagnosed on a single service was undertaken. A prospectively collected database was queried for VAP in intensive care unit patients between January 2010 and June 2011. This was compared with the list of mechanically ventilated patients provided by the ICC. Comparison for criteria used to diagnose pneumonia, ventilator day of the diagnosis, was recorded. The ICC identified two VAPs from 136 potential patients compared with the Trauma Service identifying 36 VAPs. A difference in diagnostic criteria between the ICC and the Trauma Service focused on use of the National Nosocomial Infection Survey (NNIS) algorithm versus quantitative microbiology from bronchoalveolar lavage specimens. Thirty-five of 36 Trauma Service VAPs were not identified as VAPs by the NNIS algorithm as a result of the chest radiographs. Application of differing definitions of VAP results in markedly different VAP rates. The difference has significant implications as infection rates are increasingly reported as a quality metric.

Ventilator-associated Pneumonia caused by commensal oropharyngeal Flora: a retrospective Analysis of a prospectively collected Database

“…There are several limitations to the study. First, due to the lack of a globally accepted gold standard to diagnose VAP [ 7 , 8 , 11 ], VAP in clinically suspected patients was defined as BALF revealing ≥ 2 % ICOs and/or significant growth (≥ 10 4 cfu/ml [ 36 ]) of a potential pathogenic microorganism. Second, a limited number of clinical and microbiological data were irretrievable in a number of patients.…”

“…Mechanically ventilated patients are at risk for ventilator-associated pneumonia (VAP) [ 1 ], which is associated with an increased intensive care unit (ICU) length of stay (LOS), morbidity and mortality [ 2 – 5 ]. A globally accepted gold standard for the diagnosis of VAP is lacking [ 6 – 8 ], with the exception of the new surveillance ventilator-associated events definitions [ 9 ]. Generally recommended and accepted microbiological diagnostic modalities for VAP are quantitative specimen collection techniques as bronchoalveolar lavage (BAL) [ 10 , 11 ] and protected specimen brushing obtained bronchoscopically and nonbronchoscopically.…”

Discordance between Novel and Traditional Surveillance Definitions for Ventilator-Associated Pneumonia: Insights and Opportunities to Improve Patient Care

“…Multiple studies have documented substantial discordance between clinical and surveillance VAP rates. [10][11][12] All told, close evaluation of the data presented by Liu and colleagues reminds us of many of the limitations of traditional VAP definitions that helped spur the development of VAE criteria. These include subjectivity, lack of specificity, complexity, and limited concordance between surveillance versus clinical diagnoses.…”

Preventing Ventilator-Associated Pneumonia: Educating Emergency Room Nurses

“…Systemic inflammatory response syndrome (SIRS) is a method used by some intensive care units to identify VAP (Novosel et al, 2012). Criteria for systemic inflammatory response syndrome includes temperature greater than 38 degrees or less than 36 degrees, heart rate greater than 90 beats per minute, respiratory rate greater than 20 breaths per minute, PaCO2 less than 32mmHg, and white blood cell count greater than 12,000 cells/mm or less than 4,000 cells/mm.…”

“…A retrospective evaluation using a database of mechanically ventilated patients was performed at a level 1 trauma center in Virginia between January 2010 and June 2011 (Novosel et al, 2012). The purpose of the study was to assess the different criteria to diagnosis VAP used by the trauma service and the infection control committee.…”