Ventilator Associated Pneumonia

Best Practices

Updated on December 16, 2015

“Insanity is doing things the way we’ve always done them and expecting different results”
Albert Einstein

Evidence-informed best practices are based on quality evidence and should be implemented into practice to optimize outcomes.8 Listed below you will find best practices graded according to the type of evidence. To view a description of the types of evidence, click here.

To help you move from best evidence to best practice, click on the + button next to each best practice to find details on how to implement, as well as change ideas to test using a PDSA approach. 

Change ideas are specific and practical changes by experience and research that focus on improving specific aspects of a system, process or behaviour. To learn more about change ideas see the QI: Getting Started tab.

  1. Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients' care.

    Lancet. 2003 Oct 11;362(9391):1225-30.
    Available from: http://www.ncbi.nlm.nih.gov/pubmed/14568747


Updated on December 16, 2015

“Some is not a number, soon is not a time.”
Don Berwick, former CEO and President of IHI, December 2004, at launch of the 100,000 Lives Campaign

How will we know if a change is an improvement? Measurement is one of the critical steps in a quality improvement (QI) initiative that assesses the impact of your tests of change. There are three types of quality indicators used to measure your QI efforts: outcome (indicators that capture clinical outcomes and or system performance), process (indicators that track the processes that measure whether the system is working as planned), and balancing indicators (indicators that ensure that changing one part of the system does not cause new problems in other parts of the system).

Quality indicators are used to measure how well something is performing. Just as a physician might measure a person's cholesterol to find out how healthy he or she is, quality indicators are used to determine how well the Ontario health system and long-term care homes are meeting the needs of their residents.8 Health Quality Ontario (HQO) publicly reports on some long-term care indicators which allow comparisons between long-term care homes and comparisons over time. Quality indicators can also be used by homes to assess whether the changes they are implementing have led to improvements.

Quality Indicators for Measuring Ventilator-Associated Pneumonia and The Impact of Strategies to Improve Ventilator-Associated Pneumonia:

Type of Indicator Indicator of Quality Improvement How to Calculate:


Targets/ Benchmarks How is This Indicator Used?
Outcome Ventilator-associated pneumonia rate per 1,000 ventilator days Total number of newly diagnosed VAP cases in the Intensive Care Unit (ICU) after at least 48 hours of mechanical ventilation during the reporting period X 1,000
Number of ventilator days in that reporting period
Targets: Theoretical best is 0

Provincial benchmarks:
not available
Quality improvement

QIP indicator

Publicly reported by HQO

Run Charts

Collected measures can be presented graphically by plugging the monthly results into a run chart.

  1. Safer Healthcare Now! Prevent Ventilator Associated Pneumonia Getting Started Kit. [Internet]

    2012 June. p. 39. SaferHealthCareNow!; [cited 2013 Jan 10].
    Available from: http://www.patientsafetyinstitute.ca/en/toolsResources/Documents/Interventions/Ventilator-Associated%20Pneumonia/VAP%20Getting%20Started%20Kit.pdf

Tools & Resources

Updated on December 16, 2015


Ventilator-Associated Pneumonia Tools
QI Tools

For a more comprehensive list of tools and resources, visit the following links on our HQO website:


Ventilator-Associated Pneumonia Resources
QI Resources


Updated on December 16, 2015


Ventilator-associated pneumonia (VAP) is defined as pneumonia occurring more than 48 hours after patients have been intubated and received assisted breathing through the use of a machine called a ventilator (mechanical ventilation).1 Patients requiring assisted breathing from ventilators are at risk of dying not only from their critical illness, but from nosocomial pneumonias associated with mechanical ventilation.1,2 VAP is associated with morbidity and mortality in critically-ill patients, increased duration of mechanical ventilation and length of hospital stay, as well as increased health care costs.3 In Canada, VAP increases the length of intensive care unit (ICU) stays by 4.3 days and costs the health care system an estimated $46 million per year.2

Call to Action

With simple processes in place, VAP and other hospital-acquired infections can be prevented and avoided. Hospitals have worked hard to decrease infection rates and with aggressive targets and dedicated resources VAP rates can be decreased. The VAP rate in Ontario had been on a decline throughout 2014 when examining the number of cases per 1,000 ventilator days. However, there has been an increase in 2015 (Figure 1).3 The provincial goal is to reduce the VAP rate to zero and eliminate these infections entirely.

  1. Waters B, Musceder J. A 2015 update on ventilator-associated pneumonia: new insights on its prevention, diagnosis, and treatment.

    Curr Infect Dis Rep 2015;17(8):496.
    Available from: http://www.ncbi.nlm.nih.gov/pubmed/26115700

  2. SaferHealthCareNow! Prevent Ventilator Associated Pneumonia Getting Started Kit.

    SaferHealthCareNow!; 2012 Jun, p. 39.
    Available from: http://www.patientsafetyinstitute.ca/en/toolsResources/Documents/Interventions/Ventilator-Associated%20Pneumonia/VAP%20Getting%20Started%20Kit.pdf

  3. Health Quality Ontario. Public Reporting. Ventilator-Associated Pneumonia.

    Provincial Average for July 01-September 30, 2015.
    Available from: http://www.hqontario.ca/Public-Reporting/Patient-Safety