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Safety in Critical Care and Pulmonary Medicine: Should Ventilator-Associated Pneumonia Be a Quality Indicator for Patient Safety?

Lisboa, Thiago MD*; Craven, Donald E. MD†‡; Rello, Jordi MD, PhD*

doi: 10.1097/CPM.0b013e3181940508
Critical Care/Respiratory Care

Prevention of nosocomial infections constitutes a strategy to improve patient safety and quality of care in intensive care unit (ICU). Infection prevention measures, specifically targeting ventilator-associated pneumonia (VAP), have been purposed as quality of care indicators for ICU patients. We discuss some of the recent evidence on the prevention of nosocomial infections with a particular emphasis on VAP. Moreover, there are several pitfalls in considering VAP rate as a quality indicator that include difficulties with sensitivity, specificity of VAP diagnosis, variability in surveillance methods, differences in patient case-mix between hospitals, and the risk of underreporting or manipulating VAP rates. Because of these limitations, we recommend the use of specific process measures to reduce VAP as for interinstitutional benchmarking.

We discuss the risk of inaccurate comparisons when considering ventilator-associated pneumonia rate as a quality indicator in intensive care unit. Controversies include the difficulties on definition of ventilator-associated pneumonia diagnosis, the variability on surveillance strategies, different inter-hospital case-mix, and the risk of underreporting ventilator-associated pneumonia rate.

From the *Critical Care Department, Hospital Universitari Joan XXIII, Universidad Rovira and Virgili, Institut Pere Virgili, CIBER Enfermedades Respiratorias, Tarragona, Spain; †Lahey Clinic Medical Center, Burlington, Massachusetts; and ‡Tufts University School of Medicine, Boston, Massachusetts.

Supported in part by FIS 07/90960, FIS 06/0060, CIBER 06/06/0036 and FADO (Departament de Salut, Generalitat de Catalunya).

Address correspondence to: Thiago Lisboa, MD, Critical Care Department, Joan XXIII University Hospital, Carrer Dr. Mallafre Guasch 4. (43007) Tarragona, Spain. E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.