资料来源

国家卫生健康委医院管理研究所要求参与国家护理质量数据平台建设、数据采集工作的进修人员经过申请审批后，才具备匿名使用相关数据的资格。本研究选取2014年-2019年各季度均完整上报数据的三甲医院，共计305家，涉及全国29个省（自治区、直辖市）（未包含宁夏回族自治区和青海省）。所有数据均为匿名分析。纳入分析的变量包括医院分布地区、医院编制床位数、VAP发生率等。

结果

总体VAP发生率情况

从年度来看，2014年-2019年，我国三甲医院VAP发生率中位数呈持续下降趋势，从2014年的7.02%降低至2019年的3.40%。从季度来看，2014年—2016年，各年度第二季度VAP发生率中位数均为当年四个季度最高值。    

不同地区医院VAP发生率情况

纵向来看，2014年-2019年，东部地区和中部地区医院VAP发生率中位数逐年下降，西部地区医院VAP发生率中位数出现波动，但总体呈下降趋势。横向来看，除2014年外（中部地区医院最高），其余各年份VAP发生率中位数均为西部地区医院最高；除2014年（东部地区医院最低）和2015年（东部地区医院最低）外，其余各年份VAP发生率中位数均为中部地区医院最低。

不同规模医院VAP发生率情况

纵向来看，2014年-2019年，编制床位数为≤1 000张和＞2 000张医院VAP发生率中位数逐年下降，编制床位数为＞1 000张～≤2 000张医院VAP发生率中位数出现波动，但总体呈下降趋势。横向来看，除2014年外（编制床位数为≤1 000张医院最高），其余各年份VAP发生率中位数均为编制床位数为＞1 000张～≤2 000张医院最高。

VAP发生率与年份、医院分布地区、季度、编制床位数回归分析

控制年份因素后，2015年-2019年VAP发生风险分别是2014年的0.93倍、0.84倍、0.74倍、0.72倍、0.61倍；控制地区因素后，中部和西部地区医院VAP发生风险高于东部地区；控制季度因素后，第二季度VAP发生风险高于第一季度，第四季度VAP发生风险低于第一季度；控制医院编制床位数后，＞1 000张～≤2 000张床位医院VAP发生风险是≤1 000张床位医院的1.06倍。

建议

我国三甲医院VAP发生率逐年下降，但仍有改进空间。建议医疗机构应持续完善VAP感染监测与报告制度，加快信息化建设；同时应依据诊疗特点，完善VAP感染风险评估制度。三甲医院VAP发生率地区间的差异性说明，同质化建设仍是医疗质量管理的一项长期工作。

国家需进一步加强全国医疗机构协作，共享优质医疗资源，帮助经济较差地区加强感染防控管理理念建设等；同时成立专家组，共同讨论制定VAP防控国家标准，建立VAP医疗服务标准化体系。我国三甲医院VAP发生率因医院规模而不同，说明医院建设应把控好发展建设内涵。

此外，我国三甲医院VAP发生率呈现季节性变化，医院管理者可以将VAP预防作为春夏感染防控重点任务，提前部署，合理配置资源，主动制定干预措施。 

作者来源： 首都医科大学附属北京朝阳医院 胡晓科 等 全文拟发表于本刊2022年第6期

From an annual perspective, from 2014 to 2019, the median incidence of VAP in China's 3A hospitals continued to decline, from 7.02% in 2014 to 3.40% in 2019. From a quarterly perspective, from 2014 to 2016, the median incidence of VAP in the second quarter of each year was the highest in the four quarters of that year.

The occurrence of Ventilator Associate Pneumonia (VAP) increases the risk of death in critically ill patients, prolongs the period of hospital stay, and increases the financial burden on patients, directly affecting patient safety and quality of medical care. The use of quality control index data to carry out quality management is conducive to improving the scientific level of medical quality management.

This study uses the national nursing quality data platform to retrospectively analyze the incidence of VAP in China's 3A hospitals from 2014 to 2019, in order to provide reference for hospital infection control and nursing quality management.

Data Source

The Institute of Hospital Management of the National Health Commission requires trainees who participate in the construction of the national nursing quality data platform and data collection to be qualified to use relevant data anonymously after applying for approval. This study selected 305 3A hospitals that reported complete data in each quarter from 2014 to 2019, covering 29 provinces (autonomous regions and municipalities directly under the central government) (excluding NingxiaAutonomous Region and Qinghai Province). All data is analysed anonymously. Variables included in the analysis includes hospital distribution area, number of hospital beds, VAP incidence, etc.

Conclusion

Overall VAP incidence

From an annual perspective, from 2014 to 2019, the median incidence of VAP in China's 3A hospitals continued to decline, from 7.02% in 2014 to 3.40% in 2019. From a quarterly perspective, from 2014 to 2016, the median incidence of VAP in the second quarter of each year was the highest in the four quarters of that year.    

The incidence of VAP in hospitals in different regions

From 2014 to 2019, the median incidence of VAP in hospitals in the eastern and central regions decreased year by year, and the median incidence of VAP in hospitals in the western region fluctuated, but the overall trend was declining. Horizontally, except for 2014 (the highest in hospitals in the central region), the median incidence of VAP in all other years was the highest in hospitals in the western region. With the exception of 2014 (lowest in Eastern Regional hospitals) and 2015 (lowest in Eastern Regional hospitals), the median incidence of VAP was lowest in Central Regional hospitals in all remaining years.

VAP incidence in hospitals of different sizes

From 2014 to 2019, the median incidence of VAP in hospitals with ≤1 000 beds and > 2 000 beds decreased year by year, and the median incidence of VAP in hospitals with >1 000~≤2 000 beds fluctuated, but the overall trend was declining. Horizontally, except for 2014 (the highest number of beds in ≤ 1 000 hospitals), the median incidence of VAP in all other years was the highest in hospitals with > 1 000 beds ~ ≤ 2 000 beds.

Regression analysis of VAP incidence with year, hospital distribution, quarter, and number of beds

After controlling for the year factor, the risk of VAP from 2015 to 2019 was 0.93 times, 0.84 times, 0.74 times, 0.72 times and 0.61 times that of 2014, respectively. After controlling for regional factors, the risk of VAP in hospitals in central and western regions was higher than that in eastern regions. After controlling for quarterly factors, the risk of VAP occurrence in the second quarter is higher than that in the first quarter, and the risk of VAP occurrence in the fourth quarter is lower than that in the first quarter; After controlling the number of beds in hospitals, the risk of VAP in hospitals > 1,000~≤ 2,000 beds is 1.06 times that of ≤ 1,000-bed hospitals.

Suggestion

The incidence of VAP in China's 3A hospitals has decreased year by year, but there is still space for improvement. It is recommended that medical institutions should continue to improve the VAP infection monitoring and reporting system and accelerate the construction of informatization; At the same time, the VAP infection risk assessment system should be improved according to the characteristics of diagnosis and treatment. The regional differences in VAP incidence in 3A hospitals show that homogenization is still a long-term task of medical quality management.

The country needs to further strengthen the cooperation of medical institutions, share high-quality medical resources, and help economically disadvantaged areas strengthen the construction of infection prevention and control management concepts. At the same time, an expert group was established to discuss the formulation of national standards for VAP prevention and control and the establishment of a VAP medical service standardization system. The incidence of VAP in China's 3A hospitals varies according to the scale of hospitals, indicating that hospital construction should control the development and construction.

In addition, the incidence of VAP in China's 3A hospitals shows seasonal changes, and hospital management team can take VAP prevention as a key task for infection prevention and control in spring and summer, prepare in advance, rationally allocate resources, and actively formulate interventions. 

Source: Beijing Chaoyang Hospital Affiliated to Capital Medical University Xiaoke Hu etc. The full text is to be published in the 6th issue of this journal in 2022