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Smaller hospitals have higher rates of VAP


Small hospitals have a higher rate of ventilator-associated pneumonia than their larger counterparts, despite less frequent use of ventilators, according to a regional study.

The findings — published in the July issue of Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America — suggest ventilator care and outcomes are different in small community hospitals and that these hospitals may need additional resources to care for these critically ill patients.

“Although it is unclear why small community hospitals experience more cases of ventilator-associated pneumonia, it may be related to limited familiarity with ventilator use and fewer specialty healthcare workers such as respiratory therapists,” Deverick Anderson, MD, MPH, an author of the study, assistant professor of medicine at Duke University and co-director of the Duke Infection Control Outreach Network, said in a news release.

With most research on VAP focusing on large academic medical centers such as teaching hospitals, the researchers conducted this prospective study using surveillance data to help understand the epidemiology of VAP in community hospitals. They designated small hospitals as those with fewer than 30,000 patient days per year.

The researchers reviewed VAP cases observed in 31 community hospitals in the southeastern United States between 2007 and 2011. VAP accounted for an average of 1.4 infections per 1,000 ventilator days. The median length of stay for 247 patients with VAP was 26 days, and 35% died (among the 214 patients for whom outcomes were available).

Although the proportion of patients on ventilators was less in the smaller hospitals, those hospitals had a higher rate of VAP: 2.1 per 1,000 patient days, compared with 0.85 at medium hospitals (30,000 to 60,000 patient days per year) and 0.69 at large hospitals (more than 60,000 patient days per year).

“Our research may also suggest that staff at community hospitals are inexperienced with evidence-based protocols to prevent pneumonia in these under-resourced settings,” Anderson said.

Read the study abstract:


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