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15 February 2008

Volume 46, Number 4
Clinical Infectious Diseases 2008;46:557–563
© 2008 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2008/4604-0012$15.00
DOI: 10.1086/526534
VIEWPOINTS

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

Ilker Uçkay,1

Qanta A. Ahmed,2

Hugo Sax,1 and

Didier Pittet1

1Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; and 2Division of Pulmonary and Critical Care Medicine, Allergy and Clinical Immunology, Medical University of South Carolina, Charleston

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.

Received 19 June 2007; accepted 13 October 2007; electronically published 16 January 2008.

Reprints or correspondence: Prof. Didier Pittet, Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, 24 rue Micheli‐du‐Crest, 1211 Geneva 14, Switzerland ().

Cited by

Thiago Lisboa, Donald E. Craven, Jordi Rello. (2009) Safety in Critical Care and Pulmonary Medicine. Clinical Pulmonary Medicine 16:1, 28-32
Online publication date: 1-Feb-2009.
CrossRef
Didier Pittet, Benedetta Allegranzi. (2008) A unified approach to infection control: hand hygiene as the entrance door. Healthcare Infection 13:2, 25
Online publication date: 1-Feb-2008.
CrossRef
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