Surveillance for ventilator-associated pneumonia: the challenges and pitfalls

Abstract

The VICNISS Hospital Acquired Infection Surveillance System, operating from Victoria, Australia, was developed in 2002. VICNISS performs surveillance for hospital acquired infections (HAIs), including an intensive care unit (ICU) component. Surveillance is an essential component of an effective infection prevention programme. Surveillance for ventilator-associated pneumonia (VAP) is a key component of ICU surveillance for HAIs. VICNISS utilises the VAP surveillance definitions developed by the USA Centers for Disease Control and Prevention's (CDC) National Nosocomial Infections Surveillance (NNIS) system.

VAP surveillance commenced in November 2002; however, currently, only four hospitals of a possible 15 are continuing with VAP surveillance in Victoria. No neonatal intensive care units (NICUs) participate in VAP surveillance. The State aggregate VAP rate for ’Group A1’ ICUs was 5.0/1000 device days, which compared favourably with NNIS rates, while the VAP rate for ’Other’ ICUs was higher than NNIS rates, at 14.3/1000 device days. Hospitals that ceased performing VAP surveillance cited reasons including labour intensity of VAP surveillance, difficulty in applying and disagreement with the NNIS definitions, and lack of confidence that useful data were obtained.

VICNISS continues to aim at improving the acceptance of VAP surveillance by Victorian public hospitals. Nonetheless, VAP surveillance in Victoria has not been well accepted by participating hospitals, and is currently only performed by a minority of ICUs.