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Ventilator-Associated Pneumonia Rates Might Not Have Dropped, After All

FARMINGTON, CT — Efforts to reduce the rates of ventilator-associated pneumonia (VAP) were not particularly successful, suggests a study looking at Medicare Patient Safety Monitoring System (MPSMS) trends from 2005 to 2013.

The research letter, published online by the Journal of the American Medical Association, reports that the VAP rates, studied among 1,856 patients, were stable over time with an observed rate of 10.8% during 2005-2006 and 9.7% during 2012-2013.

University of Connecticut School of Medicine researchers and colleagues say it remains unclear whether previously reported decreases in the rates of VAP were related to better care or stricter application of subjective surveillance criteria.

"Persistently high VAP rates bolster concerns that most interventions purported to reduce VAP are supported by limited evidence,” the study authors noted.

The MPSMS has independently measured VAP rates since 2005, using a stable definition of VAP, and the current analysis included MPSMS VAP rates during calendar years 2005-2013 among Medicare patients 65 years and older with principal diagnoses of heart attack, heart failure, pneumonia — including a primary diagnosis of sepsis or respiratory failure and a secondary diagnosis of pneumonia — and selected major surgical procedures.

For the study, the cohort was divided into four periods: 2005-2006, 2007-2009, 2010-2011, and 2012-2013.

"From 2005 through 2013, MPSMS VAP rates remained stable and substantial, affecting approximately 10% of ventilated patients. Persistently high VAP rates bolster concerns that most interventions purported to reduce VAP are supported by limited evidence," the authors wrote in the study supported by the Agency for Healthcare Research and Quality.

The difference between these results and past studies showing significant declines in VAP, such as reports by the National Healthcare Safety Network (NHSN), could be explained by difference definitions, hospitals or patient groups, changes in characteristics of hospitals reporting to the NHSN over time, or preferential declines in VAP rates among hospitals reporting to the NHSN, according to the research letter.

"Nonetheless, the dichotomy between VAP rates reported to the NHSN and measured in the MPSMS supports the concern that surveillance using traditional definitions may be unreliable," the authors wrote. "The ongoing risk to patient safety represented by VAP supports the NHSN’s decision to explore more objective surveillance targets."