In the Netherlands, three ICU levels are discerned, ranging from I (relatively low complex care) to III (high complex care). The participating hospitals had ICU level I (1), II (3) and III (3) (see Table B in S1 File for hospital‐specific results). Median ventilation duration differed significantly between hospitals (p<0.0001), ranging from four to eight days. Four of the five hospitals that participated for two years or more demonstrated a reduction in VAP (Fig 2), of which two significantly so. Ventilation periods The surveillance included 940 first ventilation periods of 940 ICU‐admissions, all in mixed medical/surgical ICUs, comprising 7872 ventilation days, including all calendar days. The median ventilation duration for all admissions was 6 days (interquartile range (IQR) 4–10 days) (Table B in S1 File); for patients without VAP, 6 days (4–11); and for those that developed VAP, 5 days (3–7) until VAP. During follow‐up, the number of patients that were still on the ventilator each day declined exponentially (Figure A in S1 File). Of the 940 admissions, 81 developed a VAP during follow‐up (8.6%) and 23 were still on the Figure 2: Average yearly incidence density, per 1000 ventilation days, of ventilator‐associated pneumonia, per hospital. Hospitals with significant reduction are indicated with an * . ventilator on day 28. The average VAP incidence density was 10.3/1000 ventilation days (range between hospitals 0.0 to 20.1). Admission characteristics Our study population included more men (59.3%, median age 68 [IQR 59‐76] and APACHE II score 20 [15‐26.5]) than women (median age 70 [59‐78] and APACHE II score 22 [17‐28]), and men developed VAP more often (10.1%; 95% confidence interval (CI) (8.2‐12.0%) versus 6.5% (4.9‐8.1%)). The median age was 69 (IQR 59–77) years for all 66 Chapter 4
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