VAP Getting Started Kit - Safer Healthcare Now!

Safer Healthcare Now! Prevent Ventilator Associated Pneumonia Getting Started Kit
Frequently Asked Questions: VAP
How do I Diagnose VAP?
There is currently much controversy on the accuracy and relevance of current criteria for
diagnosing VAP. The major difficulty in establishing universally accepted diagnostic criteria for
VAP is that there is no reference standard for VAP. In addition, as none of the available
diagnostic tests when performed alone provide an accurate diagnosis of VAP, a diagnostic
strategy incorporating a combination of several clinical criteria is required, which then describes
a clinical syndrome called “VAP”. Unfortunately, this strategy is burdensome and may lead to
variability in ascertaining VAP. 171 The considerable inter-observer subjectivity, inter-institutional
heterogeneity in surveillance/assessment and patient case mix may lead to gaming of the
surveillance process if benchmarking and public reporting add undue pressures to hospital
reputation and compensation instead of being used for internal quality improvement.
In order to address these issues the Center for Disease Control and Prevention Division of
Healthcare Quality Promotion is currently piloting various diagnostic strategies in order to
achieve a revised definition for VAP that will be objective, streamlined, reliable and potentially
automatable. This will not be a clinical definition but one that will be clinically credible and will
hopefully predict patient outcomes. The reader will be kept abreast of these events through
available CPSI/SHN communication resources (e.g. VAP Community of Practice, Canadian ICU
Collaborative Listserv discussion group).
Can I implement most of the VAP bundle, but exclude some items?
While this is possible, it is not recommended. In fact, the goal of bundling therapies together
aims to create a linkage between practices that makes the overall process more effective.
Certainly, in terms of monitoring compliance with the VAP bundle, “picking and choosing” items
would be unwise however we recognize that Teams starting their journey may implement
components of the bundle in a staged process. Compliance with specific components of the
bundle can in the early stages assist teams in targeting areas for improvement. Hence reporting
compliance with components of the bundle for Teams beginning their process improvement is
acceptable remembering that the ultimate goal however is to implement all elements as early as
possible.
How can you compare VAP rates between institutions?
The practice of comparing rates of disease entities or patterns of therapy across institutions is
commonly known as “benchmarking.” Benchmarking may not be a valid method to compare
performance between facilities because of differences in patient population, resource
availability, or severity of illness. Fortunately, none of the work required to improve the care of
ventilated patients requires a comparison of rates between institutions. As long as you establish
methods in your institution to determine the patterns and methods of your regular data
collection, your results will be consistent over time with respect to your own performance and
your own improvement, which is our primary interest. Presumably, any improvements you make
would be reflected in any benchmarking work that you do for other organizations.
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