Contrary to CDC data, ventilator-associated pneumonia (VAP) rates in hospital ICUs have not declined significantly since 2005, according to a new study from the University of Connecticut School of Medicine, in Farmington (JAMA 2016 Nov 11. [Epub ahead of print]).
From 2005 to 2013, the study found that about 10% of critically ill patients placed on a ventilator develop VAP. Researchers reviewed data compiled by the Medicare Patient Safety Monitoring System from a representative sampling of 1,856 critically ill Medicare patients, aged 65 years and older, who needed two or more days of mechanical ventilation after a myocardial infarction, heart failure, pneumonia or major surgery.
Although the VAP rates were stable throughout that time, the rates did not correlate with the CDC’s National Healthcare Safety Network reported rates, which conveyed declining rates between 2006 and 2012 in medical and surgical ICUs. Between 2006 and 2012, the CDC reported the incidence of VAP decreased 79% in medical ICUs and decreased 62% in surgical ICUs. The rate of VAP is a patient safety and health care delivery quality metric that many hospitals are scored on nationally.
“VAP is not going away; it still affects approximately one in 10 ventilated patients,” said the study’s lead author Mark L. Metersky, MD, of the University of Connecticut Health’s Division of Pulmonary and Critical Care Medicine, in Farmington. “Our findings are in stark contrast to the CDC’s report of a marked decline in VAP rates that had some believing that it may no longer be an important problem.”
Patients in need of mechanical ventilation are often the most critically ill in the ICU. Research has shown that up to 15% of patients who develop pneumonia while on a ventilator may die.
“We have not beat this,” Dr. Metersky said. “Current hospital interventions that are used in an attempt to prevent VAP are not working. VAP is still a significant issue and needs more examination into how we survey its occurrence and report it, along with more research into how best to prevent this type of pneumonia in vulnerable patient populations.”
The potential effect of higher-than-expected VAP rates may be leading patients to experience complications or death from their lung infections, spend more time on a ventilator or in the ICU slowing recovery, and increased use of antibiotics leading to potential resistance, as well as increased health care costs due to longer hospital stays.
Dr. Metersky collaborated on the study with colleagues at Qualidigm, Harvard Medical School and Harvard School of Public Health. It was supported by the Agency for Healthcare Research and Quality of the Department of Health and Human Services.