Density incidence and outcome of VAP in home mechanical ventilated patients in Brazil

Abstract

Introduction: Ventilator-associated pneumonia (VAP) is a significant nosocomial complication among intensive care unit (ICU) patients. Home health care has been growing in size and complexity in Brazil, leading to an increasing number of health professionals working at patients homes, use of invasive devices and, potentially, health care-associated infections (HAIs) as VAP. Monitoring the incidence of home VAP is a tool to assess the quality of care provided. Objectives: To identify the density incidence (DI) of VAP and the mechanical ventilation (VM) use rate in patients from a private Brazilian home care company and to compare it with the incidence in patients from Brazilian ICUs. Methods: This study used the surveillance of infections recommended by APIC1, NHSN-CDC2 and ANVISA3 to measure DI of VAP in the home care setting from January 2018 to December 2018 and to compare it with DI of VAP from Brazilian ICUs in 2016 as reported by ANVISA4. Results: The global DI of HAIs was 3.8 per 1000 patients-day. The most common HAI was respiratory tract infection (49.3%) and VAP represented 12.4% of these cases (54 cases), with a density of 1.06 cases per 1000 patients-day (ANVISA 50th percentile: 12 cases/1000 patients-day). The rate of VM use was 17.9% (ANVISA 50th percentile: 30.2%). Of the 54 cases of home acquired VAP, 79% underwent home-based treatment and 12 patients required hospitalization (21%), with an average time of hospitalization of 12 days. One death occurred in a hospital environment (1.75%). Conclusion: Home treatment results in reduced incidence of VAP when compared to the hospital setting, supporting the urge to discharge a patient as early as possible and then provide care at home.