The Epidemiology of VAP in Community Hospitals
The Epidemiology of VAP in Community Hospitals
Objective. To describe the epidemiology of ventilator-associated pneumonia (VAP) in community hospitals.
Design and Setting. Prospective study in 31 community hospitals from 2007 to 2011.
Methods. VAP surveillance was performed by infection preventionists using the National Healthcare Safety Network protocol. VAP incidence was reported as number of events per 1,000 ventilator-days. We categorized hospitals into small (<30,000 patient-days/year), medium (30,000–60,000 patient-days/year), and large (>60,000 patient-days/year) groups and compared VAP incidence by hospital size.
Results. The median VAP incidence was 1.4 (interquartile range, 0.4–2.4), and ventilator utilization ratio (VUR) was 0.33 (0.25–0.47). VAP incidence was higher in small hospitals (2.1) than medium (0.85) or large (0.69) hospitals (P = .03) despite a lower VUR in small hospitals (0.29 vs 0.31 vs 0.44, respectively; P = .01). The median age of 247 VAP cases was 64 (53–73); 136 (55.1%) were female; 142 (57.5%) were Caucasian; 170 (68.8%) were admitted from home. The length of stay and duration of ventilation were 26 (14–42) and 12 (4–21) days, respectively. The pre- and postinfection hospital stays were 8 (3–13) days and 14 (8–30) days, respectively. Data on outcomes were available in 214 cases (86.6%), and 75 (35.0%) cases died during hospitalization. The top 3 pathogens were methicillin-resistant Staphylococcus aureus (MRSA; n = 70, 27.9%), Pseudomonas species (n = 40, 16.3%), and Klebsiella species (n = 34, 13.3%).
Conclusions. VAP incidence was inversely associated with size of hospital. VAP in community hospitals was frequently caused by MRSA. Importantly, predictors of VAP incidence in tertiary care hospitals such as VUR may not be predictive in community hospitals with few ventilated patients.
Prevention of healthcare-associated infections (HAIs) is a vital component of improving patient safety. Ventilator-associated pneumonia (VAP) is the most frequent intensive care unit (ICU)–acquired infection. VAP affects 4.8%–7.5% of patients intubated for longer than 24 hours and is associated with significant morbidity and mortality.
Monitoring the incidence of VAP and the pathogens responsible for VAP is an essential component of infection prevention and control activities. The VAP rate reported by the Centers for Disease Control and Prevention (CDC) has been decreasing. Between 2002 and 2009, the mean VAP rate among medical ICUs reporting to CDC dropped from 4.9 to 1.4 events per 1,000 ventilator-days and from 9.3 to 3.8 per 1,000 ventilator-days in surgical ICUs. In contrast, little data are currently available describing VAP specifically in community hospitals. To our knowledge, only one study has examined the epidemiology and outcome of VAP in community hospitals. We performed this study to determine the epidemiology and characteristics of patients with VAP hospitalized in our network of nonteaching community hospitals.
Abstract and Introduction
Abstract
Objective. To describe the epidemiology of ventilator-associated pneumonia (VAP) in community hospitals.
Design and Setting. Prospective study in 31 community hospitals from 2007 to 2011.
Methods. VAP surveillance was performed by infection preventionists using the National Healthcare Safety Network protocol. VAP incidence was reported as number of events per 1,000 ventilator-days. We categorized hospitals into small (<30,000 patient-days/year), medium (30,000–60,000 patient-days/year), and large (>60,000 patient-days/year) groups and compared VAP incidence by hospital size.
Results. The median VAP incidence was 1.4 (interquartile range, 0.4–2.4), and ventilator utilization ratio (VUR) was 0.33 (0.25–0.47). VAP incidence was higher in small hospitals (2.1) than medium (0.85) or large (0.69) hospitals (P = .03) despite a lower VUR in small hospitals (0.29 vs 0.31 vs 0.44, respectively; P = .01). The median age of 247 VAP cases was 64 (53–73); 136 (55.1%) were female; 142 (57.5%) were Caucasian; 170 (68.8%) were admitted from home. The length of stay and duration of ventilation were 26 (14–42) and 12 (4–21) days, respectively. The pre- and postinfection hospital stays were 8 (3–13) days and 14 (8–30) days, respectively. Data on outcomes were available in 214 cases (86.6%), and 75 (35.0%) cases died during hospitalization. The top 3 pathogens were methicillin-resistant Staphylococcus aureus (MRSA; n = 70, 27.9%), Pseudomonas species (n = 40, 16.3%), and Klebsiella species (n = 34, 13.3%).
Conclusions. VAP incidence was inversely associated with size of hospital. VAP in community hospitals was frequently caused by MRSA. Importantly, predictors of VAP incidence in tertiary care hospitals such as VUR may not be predictive in community hospitals with few ventilated patients.
Introduction
Prevention of healthcare-associated infections (HAIs) is a vital component of improving patient safety. Ventilator-associated pneumonia (VAP) is the most frequent intensive care unit (ICU)–acquired infection. VAP affects 4.8%–7.5% of patients intubated for longer than 24 hours and is associated with significant morbidity and mortality.
Monitoring the incidence of VAP and the pathogens responsible for VAP is an essential component of infection prevention and control activities. The VAP rate reported by the Centers for Disease Control and Prevention (CDC) has been decreasing. Between 2002 and 2009, the mean VAP rate among medical ICUs reporting to CDC dropped from 4.9 to 1.4 events per 1,000 ventilator-days and from 9.3 to 3.8 per 1,000 ventilator-days in surgical ICUs. In contrast, little data are currently available describing VAP specifically in community hospitals. To our knowledge, only one study has examined the epidemiology and outcome of VAP in community hospitals. We performed this study to determine the epidemiology and characteristics of patients with VAP hospitalized in our network of nonteaching community hospitals.
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