Uçkay Ilker, Ahmed Qanta A, Sax Hugo, Pittet Didier
Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
Clin Infect Dis. 2008 Feb 15;46(4):557-63. doi: 10.1086/526534.
The economic and clinical burden of ventilator-associated pneumonia (VAP) is uncontested. In many hospitals, VAP surveillance is conducted to identify outbreaks and to monitor infection rates. Here, we discuss the concept of benchmarking in health care as modeled on industry, and we contribute personal arguments against considering the VAP rate as a potential candidate for benchmarking or for monitoring the quality of patient care. Accurate benchmarking of VAP rates currently seems to be unfeasible, because the patient case mix is often too diverse and complicated to be adjusted for, and diagnostic criteria and surveillance protocols vary. Thus, the risk of drawing inaccurate comparisons is high. In contrast, some risk factors for VAP are modifiable and can be monitored and used as quality indicators. Process-oriented surveillance permits bypass of case-mix and diagnostic constraints. A well-defined interhospital surveillance system is necessary to prove that interventions on procedures do really lead to a reduction of VAP rates.
呼吸机相关性肺炎（VAP）的经济和临床负担是无可争议的。在许多医院，都会开展VAP监测以识别疫情爆发并监测感染率。在此，我们讨论以行业为蓝本的医疗保健领域基准化的概念，并提出个人观点，反对将VAP发生率视为基准化或监测患者护理质量的潜在候选指标。目前，对VAP发生率进行准确的基准化似乎不可行，因为患者病例组合往往过于多样和复杂，难以进行调整，而且诊断标准和监测方案也各不相同。因此，进行不准确比较的风险很高。相比之下，VAP的一些风险因素是可改变的，可以进行监测并用作质量指标。以流程为导向的监测可以绕过病例组合和诊断方面的限制。需要一个定义明确的医院间监测系统来证明对操作的干预确实能降低VAP发生率。
