Despite Targeted Measures, VAP in the ICU May Be Unpreventable

Acknowledging that ventilator-associated pneumonia (VAP) is the most common hospital-acquired infection in intensive care units (ICUs), Bouadma, et al. (2010) describe the long-term impact of a multifaceted program for decreasing VAP rates that markedly improved compliance with eight preventive measures; the researchers say that VAP rates remained substantial despite high compliance with these preventive measures, suggesting that eliminating VAP in the ICU may be an unrealistic goal. Their research was published in the November issue of Clinical Infectious Diseases.

The researchers report that they compared VAP rates during a 45-month baseline period and a 30-month intervention period in a cohort of patients who received mechanical ventilation for more than 48 hours. VAP was diagnosed on the basis of quantitative cultures of distal specimens. VAP incidence density rates were expressed as total VAP episodes over total mechanical ventilation duration and as first VAP episodes over mechanical ventilation duration at VAP or hospital discharge. The researchers used segmented regression analysis and a Cox proportional hazard model to assess the impact of the program on first VAP occurrence.

According to Bouadma, et al. (2010), baseline and intervention VAP rates were 22.6 and 13.1 total VAP episodes over total mechanical ventilation duration per 1,000 ventilation-days, respectively, and 26.1 and 14.9 first VAP episodes over mechanical ventilation duration at VAP or hospital discharge per 1,000 procedure-days, respectively. VAP rates decreased by 43 percent in both statistical analyses and remained significant after adjustment for confounders. Daily VAP hazard rates on ventilation days 5, 10, and 15 were 2.6 percent, 3.5 percent, and 3.4 percent, respectively, during the baseline period and 1.4 percent, 2.3 percent, and 2 percent, respectively, during the intervention period.

Reference: Bouadma L, Deslandes E, Lolom I, Le Corre B, Mourvillier B, Regnier B, Porcher R, Wolff M and Lucet JC. Long-Term Impact of a Multifaceted Prevention Program on VentilatorAssociated Pneumonia in a Medical Intensive Care Unit. Clinical Infectious Diseases 2010;51:1115-1122.