Hostname: page-component-745bb68f8f-s22k5 Total loading time: 0 Render date: 2025-01-10T22:26:34.391Z Has data issue: false hasContentIssue false
  • English
  • Français

Trends in Ventilator-Associated Pneumonia Rates Within the German Nosocomial Infection Surveillance System (KISS)

Published online by Cambridge University Press:  02 January 2015

I. Zuschneid ,
F. Schwab ,
P. Gastmeier ,
C. Geffers ,
M. Behnke  and
H. Rüden
I. Zuschneid
Affiliation:
Institute of Hygiene and Environmental Medicine, Charité-University Medicine Berlin, Berlin National Reference Center for Surveillance of Nosocomial Infections, Berlin
F. Schwab
Affiliation:
Institute of Hygiene and Environmental Medicine, Charité-University Medicine Berlin, Berlin National Reference Center for Surveillance of Nosocomial Infections, Berlin
P. Gastmeier*
Affiliation:
National Reference Center for Surveillance of Nosocomial Infections, Berlin Division of Hospital Epidemiology and Infection Control, Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
C. Geffers
Affiliation:
Institute of Hygiene and Environmental Medicine, Charité-University Medicine Berlin, Berlin National Reference Center for Surveillance of Nosocomial Infections, Berlin
M. Behnke
Affiliation:
Institute of Hygiene and Environmental Medicine, Charité-University Medicine Berlin, Berlin National Reference Center for Surveillance of Nosocomial Infections, Berlin
H. Rüden
Affiliation:
Institute of Hygiene and Environmental Medicine, Charité-University Medicine Berlin, Berlin National Reference Center for Surveillance of Nosocomial Infections, Berlin
*
Institute of Medical Microbiology and Hospital Epidemiology, Hannover School of Medicine, Hannover, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To investigate trends in ventilator-associated pneumonia (VAP) rates during participation in the German nosocomial infection surveillance system (Krankenhaus-Infektions-Surveillance-System [KISS]).

Methods.

A total of 71 ICUs that began participating in KISS in 1999 or later and continued participation for at least 36 months were selected. Beginning with the first month of participation, the pooled mean rate of VAP in the ICUs was calculated for each year of participation. The incidence densities for the 3 years of participation were compared using the Pearson x2 test. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated. VAP rates were calculated for each ICU and year of participation, and rates for years 1 and 3 were compared using the Wilcoxon test for paired samples.

Results.

Twenty-nine medical-surgical, 18 medical, 20 surgical, 2 neurosurgical, and 2 pediatric ICUs met the selection criteria. Surveillance data were available on 181,275 patients, for whom there were 613,098 patient-days and 224,138 ventilator-days. A total of 2,043 cases of VAP were reported. The ICUs had a pooled VAP rate of 10.5 cases per 1,000 ventilator-days during year 1 of KISS surveillance. In year 2, the rate decreased by 19%, to 8.7 cases per 1,000 ventilator-days (RR, 0.81 [95% CI, 0.73-0.90]). In year 3, the rate decreased by 24% from year 1, to 8.0 cases per 1,000 ventilator-days (RR, 0.76; 95% CI, 0.68-0.85). Both results were significant (P < .001 by the Pearson x2 test). Comparison of the VAP rates of the ICUs did not show a significant difference between years 1 and 3 of KISS participation.

Conclusion.

Surveillance was associated with a significant reduction in the pooled rate of VAP during years 1-3 of KISS participation.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 3 , March 2007 , pp. 314 - 318
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Emori, TG, Culver, DH, Horan, TC, et al. National nosocomial infections surveillance system (NNIS): description of surveillance methods. Am J Infect Control 1991;19:19–35.CrossRefGoogle ScholarPubMed
2.Gastmeier, P, Sohr, D, Just, HM, Nassauer, A, Daschner, F, Ruden, H. How to survey nosocomial infections. Infect Control Hosp Epidemiol 2000;21:366–370.Google Scholar
3.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.CrossRefGoogle ScholarPubMed
4.Vincent, JL, Bihari, DJ, Suter, PM, et al. The prevalence of nosocomial infection in intensive care units in Europe: results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA 1995;274:639–644.Google Scholar
5.Ruden, H, Gastmeier, P, Daschner, FD, Schumacher, M. Nosocomial and community-acquired infections in Germany: summary of the results of the First National Prevalence Study (NIDEP). Infection 1997;25:199–202.Google Scholar
6.Rello, J, Ollendorf, DA, Oster, G, et al. Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest 2002;122:2115–2121.CrossRefGoogle Scholar
7.Papazian, L, Bregeon, F, Thirion, X, et al. Effect of ventilator-associated pneumonia on mortality and morbidity. Am J Respir Crit Care Med 1996;154:91–97.CrossRefGoogle ScholarPubMed
8.Markowicz, P, Wolff, M, Djedaini, K, et al. Multicenter prospective study of ventilator-associated pneumonia during acute respiratory distress syndrome: incidence, prognosis, and risk factors. ARDS Study Group. Am J Respir Cut Care Med 2000;161:1942–1948.CrossRefGoogle ScholarPubMed
9.Heyland, DK, Cook, DJ, Griffith, L, Keenan, SP, Brun-Buisson, C. The attributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient. The Canadian Critical Trials Group. Am J Respir Crit Care Med 1999;159:1249–1256.Google Scholar
10.Leu, HS, Kaiser, DL, Mori, M, Woolson, RF, Wenzel, RP. Hospital-acquired pneumonia: attributable mortality and morbidity. Am J Epidemiol 1989;129:1258–1267.Google Scholar
11.Alp, E, Guven, M, Yildiz, O, Aygen, B, Voss, A, Doganay, M. Incidence, risk factors and mortality of nosocomial pneumonia in intensive care units: a prospective study. Ann Clin Microbiol Antimicrob 2004;3:17.Google Scholar
12.Kollef, MH. Ventilator-associated pneumonia: a multivariate analysis. JAMA 1993;270:1965–1970.Google Scholar
13.Haley, RW, Culver, DH, White, JW, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 1985;121:182–205.Google Scholar
14.Kelleghan, SI, Salemi, C, Padilla, S, et al. An effective continuous quality improvement approach to the prevention of ventilator-associated pneumonia. Am J Infect Control 1993;21:322–330.Google Scholar
15.Berg, DE, Hershow, RC, Ramirez, CA, Weinstein, RA. Control of nosocomial infections in an intensive care unit in Guatemala City. Clin Infect Dis 1995;21:588–593.CrossRefGoogle Scholar
16.Joiner, GA, Salisbury, D, Bollin, GE. Utilizing quality assurance as a tool for reducing the risk of nosocomial ventilator-associated pneumonia. Am J Med Qual 1996;11:100–103.Google Scholar
17.Cohran, J, Larson, E, Roach, H, Blane, C, Pierce, P. Effect of intravascular surveillance and education program on rates of nosocomial bloodstream infections. Heart Lung 1996;25:161–164.Google Scholar
18.Kaye, J, Ashline, V, Erickson, D, et al. Critical care bug team: a multidis-ciplinary team approach to reducing ventilator-associated pneumonia. Am J Infect Control 2000;28:197–201.Google Scholar
19.Eggimann, P, Harbarth, S, Constantin, MN, Touveneau, S, Chevrolet, JC, Pittet, D. Impact of a prevention strategy targeted at vascular-access care on incidence of infections acquired in intensive care. Lancet 2000;355:1864–1868.Google Scholar
20.Zack, JE, Garrison, T, Trovillion, E, et al. Effect of an education program aimed at reducing the occurrence of ventilator-associated pneumonia. Crit Care Med 2002;30:2407–2412.CrossRefGoogle ScholarPubMed
21.Vandenberghe, A, Laterre, P, Goenen, M, et al. Surveillance of hospital-acquired infections in an intensive care department—the benefit of the full-time presence of an infection control nurse. J Hosp Infect 2002;52:56–59.Google Scholar
22.Lai, KK, Baker, SP, Fontecchio, SA. Impact of a program of intensive surveillance and interventions targeting ventilated patients in the reduction of ventilator-associated pneumonia and its cost-effectiveness. Infect Control Hosp Epidemiol 2003;24:859–863.Google Scholar
23.Zuschneid, I, Schwab, F, Geffers, C, Ruden, H, Gastmeier, P. Reducing central venous catheter-associated primary bloodstream infections in intensive care units is possible: data from the German nosocomial infection surveillance system. Infect Control Hosp Epidemiol 2003;24:501–505.Google Scholar
24.Babcock, HM, Zack, IE, Garrison, T, et al. An educational intervention to reduce ventilator-associated pneumonia in an integrated health system: a comparison of effects. Chest 2004;125:2224–2231.CrossRefGoogle Scholar
25.Misset, B, Timsit, JF, Dumay, MF, et al. A continuous quality-improvement program reduces nosocomial infection rates in the ICU. Intensive Care Med 2004;30:395–400.Google Scholar
26.Zuschneid, I, Geffers, C, Sohr, D, et al. Validation of the surveillance in the intensive care unit component of the German nosocomial infection surveillances system KISS. Infect Control Hosp Epidemiol. In press.Google Scholar
27.Dietrich, ES, Demmler, M, Schulgen, G, et al. Nosocomial pneumonia: a cost-of-illness analysis. Infection 2002;30:61–67.CrossRefGoogle ScholarPubMed
28.Warren, DK, Shukla, SJ, Olsen, MA, et al. Outcome and attributable cost of ventilator-associated pneumonia among intensive care unit patients in a suburban medical center. Crit Care Med 2003;31:1312–1317.CrossRefGoogle Scholar