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Ventilator-Associated Pneumonia as a Quality Indicator for Patient Safety?

Uç kay, Ilker ; Ahmed, Qanta A. ; Sax, Hugo ; Pittet, Didier

In: Clinical Infectious Diseases, 2008, vol. 46, no. 4, p. 557-563

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    Title
    • Ventilator-Associated Pneumonia as a Quality Indicator for Patient Safety?
    Author
    • Uç kay, Ilker. Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
    • Ahmed, Qanta A.. Division of Pulmonary and Critical Care Medicine, Allergy and Clinical Immunology, Medical University of South Carolina, Charleston
    • Sax, Hugo. Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
    • Pittet, Didier. Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
    Document Type
    • Postprint
    Language
    • English
    Published in
    • Clinical Infectious Diseases, 2008, vol. 46, no. 4, p. 557-563. The University of Chicago Press
    Other Version
    Classification
    • Health
    OAI-PMH Identifier
    • oai:doc.rero.ch:301292
    Summary
    The economic and clinical burden of ventilator-associated pneumonia (VAP) is uncontested. In many hospitals, VAP surveillance is conducted to identify outbreaks and to monitor infection rates. Here, we discuss the concept of benchmarking in health care as modeled on industry, and we contribute personal arguments against considering the VAP rate as a potential candidate for benchmarking or for monitoring the quality of patient care. Accurate benchmarking of VAP rates currently seems to be unfeasible, because the patient case mix is often too diverse and complicated to be adjusted for, and diagnostic criteria and surveillance protocols vary. Thus, the risk of drawing inaccurate comparisons is high. In contrast, some risk factors for VAP are modifiable and can be monitored and used as quality indicators. Process-oriented surveillance permits bypass of case-mix and diagnostic constraints. A well-defined interhospital surveillance system is necessary to prove that interventions on procedures do really lead to a reduction of VAP rates