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