Value and price of ventilator-associated pneumonia surveillance as a quality indicator

Awareness of the importance of quality assurance in the ICU is growing but the methodology is still under development and subject to debate [1-3]. Ventilatorassociated pneumonia (VAP) seemed to come close to being an important, valid, reliable, responsive, interpretable and feasible outcome parameter [3]. We therefore decided to measure VAP incidence on a regular basis. A prospective study was carried out with yearly assessment of the incidence of VAP during a 3-month period. Defi nition of VAP was based on the recommendations of the Centers for Disease Control and Prevention [4]. Overall, out of 550 patients ventilated for >48 hours, only two cases of defi nite VAP were observed [5]. Because no further improvement could be achieved in this fi eld, we turned our attention to other outcome parameters. A perceived rise in incidence of VAP led us to repeat our evaluation, despite growing concern about the importance, validity and reliability of VAP as a quality indicator [2].