CUSP for VAP: EVAP
NHSN VAE Surveillance Definition Review
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Pass code: 4757941
© The Johns Hopkins University and The Johns
Hopkins Health System Corporation, 2011
CUSP for VAP: EVAP
NHSN VAE Surveillance Definition Review
Presented by:
Kathleen Speck, MPH
September 13, 2012
Armstrong Institute for Patient Safety and Quality
© The Johns Hopkins University and The Johns
Hopkins Health System Corporation, 2011
Our Collaborators
– Karol G. Wicker, MHS
Senior Director, Quality Policy & Advocacy
Maryland Hospital Association
kwicker@mhaonline.org
– Mary Catanzaro RN BSMT CIC
Project Manager HAIs
Hospital and Healthsystem Association of
Pennsylvania
mcatanzaro@haponline.org
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Learning Objectives
• To discuss the NHSN VAE definition.
• To discuss the linelist generator developed by
Dr. Michael Klompas
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NHSN Surveillance 2012-2013
• Assessment must take place for all VAE tiers
– VAC - Ventilator-associated Condition
– IVAC - Infectious Ventilator-associated
Condition
– Possible Ventilator-associated Pneumonia
– Probable Ventilator-associated Pneumonia
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VAC Definition Criteria8
• Patient intubated for > 2 calendar days
• Baseline stability
– Baseline:
• 2 calendar days immediately preceding the first
day of increased daily minimum PEEP or FiO2
requirements
– Stability:
• ≥ 2 calendar days of stable or decreasing daily
minimum FiO2 or PEEP requirements
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Threshold change for VAC
• Threshold rise in daily minimum:
– PEEP by ≥3 cm H2O or
– FiO2 by ≥20 points
– sustained ≥2 days
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Example - VAC
Stable
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Example – no VAC
Unstable
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Example – no VAC
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Subsequent VAEs
• VAEs are defined as 14 days
– Starts on day 1 of worsening oxygenation
– New VAE cannot be reported until 14 day
period has elapsed
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VAE Outcomes
• VAE = VAC, IVAC, Possible VAP and Probable
VAP
• VAC = Significant respiratory deterioration after 2
or more days of stability
• IVAC = VAC + abnormal temp or WBC + ≥ 4 days
of new antibiotics
• Possible VAP = IVAC + purulent sputum or
positive sputum/BAL culture
• Probable VAP = IVAC + purulent sputum AND
positive sputum/BAL culture
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Setting Up a Linelist
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Linelist Definitions
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Steps to generate linelist for VAE
• Begin with “Daily Linelist”
• Enter daily minimum PEEP and FiO2 for
every ventilated patient for every calendar
day the patient spends any time on a
ventilator
• Worksheet will automatically flag events that
fulfill criteria for VAC
• If a patient is not identified as having VAC,
don’t collect any further information for that
patient.
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Step 1 – VAC
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Determination of IVAC
• Patients where VAC has already been
determined
• Enter:
– Tmin and Tmax
– WBCmin and WBCmax
– QAD – Qualifying antibiotic day
• IVAC requires 4 contiguous days of a new
antibiotic starting within the 5 days starting 2
days before the onset
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Step 2 - IVAC
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New Antimicrobial Agent
Qualifying Antimicrobial Day (QAD)
• Any agent listed in the Appendix of the Device
Associated Events: VAE (pages 10-19 through
10-21) that:
– Is initiated on or after the third day of mechanical
ventilation
AND
– is started in the 5 day period defined by
• 2 days before
• the day of the event
• the 2 days after
AND
– Was not given to the patient on either of the two
days preceding the current event
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Qualifying Antibiotic Days - Timing
(VAC has already been established)
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Example Antibiotic Worksheet
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Determination of Possible VAP or
Probable VAP
• Patients where IVAC has been determined
• From Sputum of BAL gram stain
– Enter
• Polys – polys, neutrophils or WBC
(semiquantitative scale)
• Epis – epithelial cells or squamous cells
(semiquantitative scale)
• Culture – result
• Quantity - threshold (10^5 for endotracheal
aspirate, 10^4 for BAL, 10^3 for protected
specimen brush). Semi-quantitative equivalent
also acceptable. Answer Yes or No.
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Step 3 – Possible VAP or Probable
VAP
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• Questions?
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