Developing a New, National Approach to Surveillance for Ventilator-Associated Events: Executive Summary
Clinical Infectious Diseases ,
Dec 2013
Shelley S. Magill , Michael Klompas , Robert Balk , Suzanne M. Burns , Clifford S. Deutschman , Daniel Diekema , Scott Fridkin , Linda Greene , Alice Guh , David Gutterman , et al.
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Developing a New, National Approach to Surveillance for Ventilator-Associated Events: Executive Summary
Shelley S. Magill
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Michael Klompas
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Robert Balk
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Suzanne M. Burns
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Clifford S. Deutschman
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Daniel Diekema
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Scott Fridkin
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Linda Greene
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Alice Guh
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David Gutterman
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Beth Hammer
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David Henderson
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Dean Hess
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Nicholas S. Hill
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Teresa Horan
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Marin Kollef
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Mitchell Levy
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Edward Septimus
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Carole VanAntwerpen
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Don Wright
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Pamela Lipsett
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Clinical Infectious Diseases 2013;57(12):1742-6 The Author 2013. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions
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motion, Centers for Disease Control and Prevention
,
1600 Clifton Road, MS A-24, Atlanta, GA 30329
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In September 2011, the Centers for Disease Control and Prevention (CDC) convened a Ventilator-Associated Pneumonia (VAP) Surveillance De
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rithm, which is referred to as the ventilator-associated
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The Working Group's surveillance de
patients (Table 1). The charges to the Working Group were to: 1. Critically review a draft, streamlined VAP surveillance definition developed for use in adult patients; 2. Suggest modifications to enhance the reliability and credibility of the surveillance definition within the critical care and infection prevention communities; 3. Propose a final adult surveillance definition algorithm, to be implemented in the CDC's National Healthcare Safety Network (NHSN), taking into consideration the potential future use of the definition algorithm in public reporting, interfacility comparisons, and pay-forreporting and pay-for-performance programs.
Table 1. Ventilator-Associated Pneumonia Surveillance Definition
Working Group Organizations, Representatives, and Federal
Participants
American Association of Critical
Care Nurses
American Association for
Respiratory Care
American College of Chest
Physicians
American Thoracic Society
Association of Professionals in
Infection Control and
Epidemiology
Council of State and Territorial
Epidemiologists
Healthcare Infection Control
Practices Advisory Committee
Surveillance Working Group
Infectious Diseases Society of
America
Society for Healthcare
Epidemiology of America
Society of Critical Care Medicine
U.S. Department of Health and
Human Services, Office of
Disease Prevention and Health
Promotion
National Institutes of Health
Centers for Disease Control and
Prevention, Division of
Healthcare Quality Promotion Representative(s) Suzanne Burns and Beth Hammer
Dean Hess
Gutterman
Linda Greene
Carole VanAntwerpen
Daniel Diekema
Edward Septimus
Michael Klompas
Clifford Deutschman, Marin
Kollef, and Pamela Lipsett
Don Wright
David Henderson
Scott Fridkin, Alice Guh, Shelley
Magill, Teresa Horan, others
events or VAE surveillance definition algorithm, represents a
purposeful departure from VAP toward more general, objective
measures of conditions and complications occurring in patients
on mechanical ventilation (Figure 1; VAE surveillance protocol
available at: http://www.cdc.gov/nhsn/acute-care-hospital/vae/
index.html). The VAE surveillance definition algorithm uses a
tiered approach, moving from measures of ventilator-associated
conditions (VAC), to infection-related ventilator-associated
complications (IVAC), to possible and probable VAP.
The first tier of VAE surveillance, VAC, seeks to identify
episodes of sustained respiratory deterioration, and will capture
both infectious and non-infectious conditions and
complications occurring in mechanically ventilated patients. VAC is
defined by a sustained period of worsening oxygenation that
immediately follows a baseline period of stability or
improvement on the ventilator. To meet the VAC definition, a
mechanically ventilated patient must have at least 2 calendar days of
stable or decreasing daily minimum positive end-expiratory
pressure (PEEP) or fraction of inspired oxygen FIO2 , followed
by at least 2 days of increased daily minimum PEEP or FIO2 ,
where the increase in the daily minimum PEEP is 3 cm H2O
greater than the daily minimum PEEP during the baseline
period, or where the increase in the daily minimum FIO2 is
0.20 (or 20 percentage points in oxygen concentration)
greater than the daily minimum FIO2 during the baseline
period. For example, if a patients daily minimum FIO2
requirement on days 4 and 5 of mechanical ventilation is 0.40, then
the patients daily minimum FIO2 requirement would need to
be at least 0.60 on days 6 and 7 of mechanical ventilation for
the VAC definition to be met. The Working Groups decisions
to set specific thresholds of 3 cm H2O and 0.20 (20 points) for
the increases in PEEP and FIO2 , respectively, and to define a
sustained increase as an increase persisting for at least 2
calendar days, were based on expert opinion of what criteria
would likely identify clinically important events, while
minimizing inadvertent incl (...truncated)
This is a preview of a remote PDF: https://cid.oxfordjournals.org/content/57/12/1742.full.pdf
Shelley S. Magill, Michael Klompas, Robert Balk, Suzanne M. Burns, Clifford S. Deutschman, Daniel Diekema, Scott Fridkin, Linda Greene, Alice Guh, David Gutterman, Beth Hammer, David Henderson, Dean Hess, Nicholas S. Hill, Teresa Horan, Marin Kollef, Mitchell Levy, Edward Septimus, Carole VanAntwerpen, Don Wright, Pamela Lipsett.
Developing a New, National Approach to Surveillance for Ventilator-Associated Events: Executive Summary ,
Clinical Infectious Diseases,
2013, pp. 1742-1746, 57/12, DOI: 10.1093/cid/cit577