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Changing a subscription often results in a proration: a charge adjustment.So you can prepare your customer for any additional expense that comes with a plan change, we provide a method of previewing a proration.What we can say for sure is that clinicians continue to start antibiotics for the possibility of VAP at a relatively high rate.

The worry then is that surveyors intent on demonstrating lower VAP rates may subconsciously err on the side of judging these subjective criteria more strictly and thus think there are fewer VAP cases than there might be.

In addition, there are some other prevention strategies that probably are quite helpful but are not necessarily included in all VAP prevention bundles such as early mobility, delirium screening, conservative fluid management, low tidal volume ventilation, and conservative blood transfusion thresholds. The leading cause of VAP is invasive mechanical ventilation.

Anything we can do to avoid intubation or speed extubation to minimize the amount of time patients spend on a ventilator will help prevent VAP.

The lack of clinical certainty carries over into surveillance where the classical VAP surveillance definitions allow lots of room for subjective judgments.

This means that two very thoughtful, very knowledgeable people looking at the same patient may well come to very different conclusions about whether or not VAP is present.

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