A world without ventilator-associated pneumonia: time to abandon surveillance and deconstruct the bundle.

Much ink has been spilled and time spent over ventilator-associated pneumonia (VAP). The Centers for Disease Control and Prevention (CDC) and national patient safety and quality improvement organizations have led the charge to help intensive care units (ICUs) rid themselves of VAP. Now the Centers for Medicare and Medicaid Services is proposing to add VAP to the list of “never events” subject to punitive reimbursement policies (1). This commentary focuses on the key challenges confronting hospitals and ICUs as they address VAP surveillance, prevention, and reporting. VAP is important because of its high incidence, attributable mortality, and resource use (2, 3). However, there is considerable subjectivity surrounding its diagnosis and nagging questions regarding the efficacy, safety, and validity of current preventive and reporting strategies.