A glass half-full: defining ventilator-associated pneumonia in the neonatal intensive care unit

Avoidance of hospital-acquired infections (HAIs) may be one of the most dramatic successes of recent quality improvement efforts in health care. In neonatal intensive care units (NICUs), as in medicine in general, this success story has shifted an old view of HAIs being unavoidable to a view that HAIs are preventable. This may be best exemplified by the experience with central line-associated bloodstream infections (CLABSIs), with significant reductions in NICU CLABSI rates reported locally and nationally and numerous NICUs reporting sustained CLABSI rates of zero.^1,2

Unfortunately, the experience with ventilator-associated pneumonia (VAP) in the NICUs has not followed a similar path, and widespread reductions in neonatal VAP rates have not been documented.³ What explains the different experiences with CLABSI and VAP, particularly in neonatal intensive care? One major contributing factor is eloquently described by Dr. Ergenekon and Dr. Cataltepe in this journal: the lack of a clear definition and diagnostic test for VAP in newborns.⁴ Unlike VAP, CLABSI has had relatively clear definitions and diagnostic criteria for many years. The most commonly used CLABSI definitions are from the National Healthcare Safety Network (NHSN) of the Centers for Disease Control and Prevention (CDC); while not perfect, these definitions have contributed to the reduction in CLABSI by allowing effective benchmarking, supporting the identification of risk factors, and enabling assessment of the impact of improvement efforts.⁵

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