Is it possible to reduce the incidence of ventilator-associated pneumonia (VAP) to zero?

Hasegawa Ryuichi, Shime Nobuaki

doi:10.3918/jsicm.21.9

Ventilator-associated pneumonia (VAP) is a type of nosocomial pneumonia that occurs in patients undergoing mechanical ventilation. Is a “zero” incidence of VAP possible? Several recent studies on VAP prophylaxis have shown the efficacy of the “VAP bundle”, which is a combination of several patient care processes. One of the most famous VAP bundles is “the Ventilator Bundle” of the Institute for Healthcare Improvement (IHI). This bundle consists of 5 components, elevation of the head of the bed, daily “sedation vacations” and assessments of the readiness for extubation, peptic ulcer disease prophylaxis, deep venous thrombosis prophylaxis, and daily oral care with chlorhexidine. The Japanese Society of Intensive Care Medicine also presented a new VAP bundle (JSICM-VAP bundle) in 2010. Surveillance is indispensable for the evaluation of such bundles, and the Japan Nosocomial Infections Surveillance (JANIS) data for VAP is available in Japan for the years 2000 and onwards. However, the criteria for the diagnosis of VAP differ between surveillance and clinical diagnosis. Therefore, the Centers for Disease Control and Prevention (CDC) have proposed new surveillance criteria for “ventilator-associated events (VAEs)” that do not limit such events to VAP. A VAP incidence of zero is difficult, however, because the spread of VAP bundles depends on a team approach centered on paramedical staff, making it possible for patient prognosis to be improved with improvements in VAP prophylaxis.

Is it possible to reduce the incidence of ventilator-associated pneumonia (VAP) to zero?

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