Traditional predictors of VAP incidence in tertiary care hospitals, such as ventilator utilization ratio (VUR), may not be predictive in community hospitals with few ventilated patients, according to new research in the July issue of Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America.

The study found that VAP incidence was inversely associated with size of hospital, with small community hospitals (less than 30,000 patient-days/year) experiencing more cases of the healthcare-associated infection.

The increased rates of VAP “may be related to limited familiarity with ventilator use and fewer specialty healthcare workers such as respiratory therapists,” said Deverick Anderson, MD, MPH, an author of the study and assistant professor of medicine at Duke University and co-director of the Duke Infection Control Outreach Network.

In the review, researchers discovered that 247 VAP cases in the community hospitals over the four-year study period accounted for 192,143 ventilator-days, 504,900 ICU days and 6,763,829 patient-days.

While VAP infections were relatively uncommon in the study hospitals, the numbers were a higher incidence than reported nationally in 2009 by the Centers for Disease Control and Prevention’s National Healthcare Safety Network for medical/surgical nonteaching hospitals.

“Our research may also suggest that staff at community hospitals are inexperienced with evidence-based protocols to prevent pneumonia in these under-resourced settings,” said Anderson. The authors believe these findings suggest these hospitals may need additional resources to care for these critically ill patients.