VAE: CDC Timing and
Case Requirements
Kathleen Speck, MPH
September 27, 2012
CDC: VAC Rules #1
1. 2 days of stable or decreasing PEEP
and/or FiO2
2. On 3rd day (event day), increase in
PEEP of ≥3 cm H2O or increase in
FiO2 of ≥0.20 over stable period
3. Change must be maintained at least
for day 4
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VAC – Example 1
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VAC – Example 1
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CDC: VAC Rules #2
1. 3rd ventilated day is the 1st day that can
be a VAE.
2. 1st and 2nd ventilated day can be used
to determine 2 day stability
requirement
1. 1st day cannot be used as event day -2
(Review later)
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VAC – Example 2
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VAC – Example 2
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CDC: VAC Rules #3,
Example 3
1. If 4th day is the event day, 3rd day is
included as day -1.
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CDC: VAC Rules #4
1. ‘Days’ used in definition are calendar
days
1. If patient is on MV at any time in a
calendar day, he/she is considered to be
on MV for that entire day.
2. Any break in MV for ≥1 calendar day is a
new MV period.
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CDC: IVAC Rules #1
1. Establish VAC and VAC date
2. Check min and max temp and WBC for
2 days before VAC and 2 days after
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VAC – Example 4
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VAC – Example 4
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CDC: VAC Example 4 –
Explanation
1. Definition requires 2 days of stable
PEEP and/or FiO2 prior to event. A
day without MV cannot be used for
either of those days because PEEP
and FiO2 are not collected without MV.
2. HAP after MV can only be considered
VAP for the 1st calendar day following
extubation (as opposed to the current
48 hour rule)
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CDC: IVAC Rules #1
1. Establish VAC and VAC date
2. Check min and max temp and WBC for
5 day window, 2 days before and after
VAC and the event day
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IVAC – Example #1
Yes – 1 and Yes – 2 are 2 different Abx
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IVAC – Example 2
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IVAC – Example 2
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CDC: IVAC Rules #2
1. Check for all Abx starting within the 5
days (-2, -1, 1, 2, 3)
2. Need 4 consecutive days of Abx
1. Can be a combination of Abx
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CDC: IVAC Rules #3
1. Any Abx starting outside the window
(day -3 or day 4) doesn’t count in the 4
consecutive days
2. Check to see if Abx are new. (not
given within the 2 days prior to the 5
day event window
3. Every other day counts as consecutive
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Abx Worksheet – Example 1
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IVAC Example 1
Explanation
1. While the Abx are started within the 5
day period, Abx 1 is not a new Abx. It
was given within the 2 days prior to the
5 day event period.
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Abx Worksheet – Example 2
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IVAC Example 2
Explanation
1. Both Abx are new. Abx 2 fulfills QAD
criteria.
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Abx Worksheet – Example 3
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IVAC Example 3
Explanation
1. If an Ab is given every other day, the
days between are counted as QADs
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Abx Worksheet – Example 4
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IVAC Example 1
Explanation
1. QAD criteria met by Abx 2 and Abx 3
2. Abx 1 and 4 are not new.
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Abx Worksheet – Example 5
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IVAC Example 5
Explanation
1. Day -1 does not count as a QAD. The
intervening day, day -1, doesn’t count
because the Abx on days -2 and 1 are
different.
2. While there are ≥ 4 days of Abx
starting within the 5 day period they
are not consecutive. Any Abx that can
qualify as a QAD must be started
within the 5 day period. Abx 3 doesn’t
qualify.
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Questions?
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Next Steps
• Look over the education
• Develop questions
• Face to face
Pennsylvania – October 2nd
Maryland – October 12th
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Face to Face
Registration
• Please contact your state’s hospital
association to register for the face to face!
– 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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