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Open Access Highly Accessed Research article

Impact of availability of guidelines and active surveillance in reducing the incidence of ventilator-associated pneumonia in Europe and worldwide

Klaus Kaier12*, Marie-Laurence Lambert3, Uwe K Frank24, Werner Vach1, Martin Wolkewitz1, Evelina Tacconelli5, Jordi Rello6, Ursula Theuretzbacher7 and Maria Martin28

Author Affiliations

1 Institute of Medical Biometry and Medical Informatics, University Medical Center, Freiburg, Germany

2 Department of Environmental Health Sciences, University Medical Center, Freiburg, Germany

3 Scientific Institute of Public Health, Brussels, Belgium

4 Division of Infection Control and Hospital Epidemiology, Department of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany

5 Infectious Diseases, Department of Internal Medicine I, University Hospital, Tübingen, Germany

6 Critical Care Department. Hospital Vall d’Hebron. Barcelona, Spain and CIBER de Epidemiología y Salud Pública (CIBERESP), Universidad Autónoma de Barcelona, Barcelona, Spain

7 Center for Anti-Infective Agents, Vienna, Austria

8 Institut für Infektionsprävention und Klinikhygiene, SLK Klinikum, Bad Friedrichshall, Germany

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BMC Infectious Diseases 2014, 14:199  doi:10.1186/1471-2334-14-199

Published: 12 April 2014



To analyse whether the availability of written standards for management of mechanically ventilated patients and/or the existence of a surveillance system for cases of ventilation-associated pneumonia (VAP) are positively associated with compliance with 6 well-established VAP prevention measures.


Ecological study based on responses to an online-questionnaire completed by 1730 critical care physicians. Replies were received from 77 different countries, of which the majority, i.e. 1351, came from 36 European countries.


On a cross-country level, compliance with VAP prevention measures is higher in countries with a large number of prevention standards and/or VAP surveillance systems in place at ICU level., Likewise, implementation of standards and VAP surveillance systems has a significant impact on self-reported total compliance with VAP prevention measures (both p < 0.001). Moreover, predictions of overall prevention measure compliance show the effect size of the availability of written standards and existence of surveillance system. For instance, a female physician with 10 years of experience in critical care working in a 15-bed ICU in France has a predicted baseline level of VAP prevention measure compliance of 63 per cent. This baseline level increases by 9.5 percentage points (p < 0.001) if a written clinical VAP prevention standard is available in the ICU, and by another 4 percentage points (p < 0.001) if complemented by a VAP surveillance system.


The existence of written standards for management of mechanically ventilated patients in an ICU and the availability of VAP surveillance systems have shown to be positively associated with compliance with VAP prevention measures and should be fostered on a policy level.

Ventilation-associated pneumonia; VAP; Bundle; Guideline; Surveillance