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Prevention of ventilator-associated pneumonia in intensive care units: an international online survey

Marie-Laurence Lambert1*, Mercedes Palomar23, Antonella Agodi4, Michael Hiesmayr5, Alain Lepape6, Anne Ingenbleek1, Eduardo Palencia Herrejon7, Stijn Blot8 and Uwe Frank9

Author Affiliations

1 Healthcare associated infections unit, Scientific Institute of Public Health, Rue Juliette Wytsmanstraat 14, Brussels, 1050, Belgium

2 Intensive care department, Hospital Vall d’Hebron, Barcelona, Spain

3 Universitat Autonoma de Barcelona, Barcelona, Spain

4 Department GF Ingrassia, University of Catania, Catania, Italy

5 Department Anaesthesia, General Intensive Care and Pain Control, Medical University of Vienna, Vienna, Austria

6 Department Anaesthesia, General Intensive Care, University hospital, Lyon, France

7 Intensive Care department, Hospital Universitario “Infanta Leonor”, Madrid, Spain

8 Department of Internal Medicine, Ghent University, De Pintelaan 185, Ghent, 9000, Belgium

9 Infectious diseases department, University hospital, Heidelberg, Germany

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Antimicrobial Resistance and Infection Control 2013, 2:9  doi:10.1186/2047-2994-2-9

Published: 26 March 2013



On average 7% of patients admitted to intensive-care units (ICUs) suffer from a potentially preventable ventilator-associated pneumonia (VAP). Our objective was to survey attitudes and practices of ICUs doctors in the field of VAP prevention.


A questionnaire was made available online in 6 languages from April, 1st to September 1st, 2012 and disseminated through international and national ICU societies. We investigated reported practices as regards (1) established clinical guidelines for VAP prevention, and (2) measurement of process and outcomes, under the assumption “if you cannot measure it, you cannot improve it”; as well as attitudes towards the implementation of a measurement system. Weighted estimations for Europe were computed based on countries for which at least 10 completed replies were available, using total country population as a weight. Data from other countries were pooled together. Detailed country-specific results are presented in an online additional file.


A total of 1730 replies were received from 77 countries; 1281 from 16 countries were used to compute weighted European estimates, as follows: care for intubated patients, combined with a measure of compliance to this guideline at least once a year, was reported by 57% of the respondents (95% CI: 54–60) for hand hygiene, 28% (95% CI: 24–33) for systematic daily interruption of sedation and weaning protocol, and 27% (95%: 23–30) for oral care with chlorhexidine. Only 20% (95% CI: 17–22) were able to provide an estimation of outcome data (VAP rate) in their ICU, still 93% (95% CI: 91–94) agreed that “Monitoring of VAP-related measures stimulates quality improvement”. Results for 449 respondents from 61 countries not included in the European estimates are broadly comparable.


This study shows a low compliance with VAP prevention practices, as reported by ICU doctors in Europe and elsewhere, and identifies priorities for improvement.

Healthcare associated infection; Ventilator-associated pneumonia; Patient safety; Preventive measures; Quality of care