Prevention of Ventilator associated Pneumonia

To ensure the appropriate prevention of ventilator associated pneumonia in hospitals and reduce the risk of VAP, specific indicators should be monitored regularly. These are some indicators which can provide measurable data to assess compliance, identify areas for improvement, and guide interventions. Here are some key indicators that can be included in hospital guidelines for prevention of VAP.

a)  Process Measures:

•        Process-measure definitions and measurement strategies vary widely.

•        For organizations that collect and report process measures:

o   Clearly define measures including data sources, inclusion and exclusion criteria, frequency of monitoring, and numerator and denominator criteria.

o   Develop a formal system to document compliance.

o   Compliance can be measured via direct observations or via audits of patient charts, bedside checklists, and/or electronic medical records. Periodically validate the accuracy of paper and/or electronic documentation.

-   Perform assessments regularly.

   i.    The optimal frequency of assessments (eg, once daily, twice daily, or weekly) is not known but can likely be adjusted based on compliance rates and unit size.

 ii.   An analysis of a large collaborative quality improvement effort suggests that the following approach can be used to determine the frequency of process measure assessments.

•   Start by measuring processes daily. If compliance is consistently high for a given process, then decrease the frequency of measures (ie, once every 2–3 days or once per week, and if compliance continues to be high, then decrease to once per month). If compliance is low or variable, then continue with daily measurements.

•   For units with at least 30 ventilator days per month, measuring compliance on 7 consecutive days per month provides accurate performance estimates

•  For units with <30 ventilator days per month, daily data collection is required to achieve accurate performance estimates.

•   There is no consensus on how best to define adherence to different process measures and definitions for measuring adherence vary widely.

1. Compliance with Prevention Bundles

Compliance can be reported for each process measure individually and/or as ‘all or none’ compliance with a bundle of process measures. For ‘all or none’ compliance, credit is given only if all components have been accomplished and documented; if any components were not performed and/or were not documented, no credit is given.

Calculate compliance of adherence to recommendation

●      Numerator: compliance of each certain recommendation (i.e. Number of documented daily assessments for the necessity of continuing MV access

●      Denominator: total number of MV connections

●      Standardization factor: 100 (i.e., multiply by 100 so that measure is expressed as a percentage)

b)   Outcome Measures:

1.     Rates of VAP (Number of VAP using CDC/NHSN per 1000 MV-days)

Measurement of rates allows an individual facility to gauge the longitudinal impact of implementation of prevention strategies:

●      Numerator: number of VAPs in each location monitored

●      Denominator: total number of MV-days for all patients that have a MV in each location monitored

●      Standardization factor: Multiply by 1000 so that the measure is expressed as cases per 1000 MV-days.

2.     Device Utilization Ratio (DUR) can be monitored longitudinally to identify any variations, allowing for comparisons at both hospital and unit levels, and serving as a surrogate for assessing patient exposure risk.

The catheter utilization ratio is the number of MV-days per number of patient-days in a given period. This is a measure of the total patient-days in which a MV was used and can be used as a marker for risk of infection.

●      Numerator: Number of MV Days for a location

●      Denominator: Number of Patient Days for a location

According to the approved CDC criteria,

*Device days are the total number of days of exposure to urinary catheter for all the patients during the selected time period.

*Patient days are the total number of days patients are in the ICU during the selected time period