1. A PRACTICAL GUIDE FAYE DEAL, RN CIC LISA BROWN, MT(ASCP) CIC VAE

2. Objectives Look at data collection process Examples of data collection tools Use of NHSN calculator

3. Criteria for Ventilator Associated Events *Specific Event: □ VAC□ IVAC□ PVAP *Specify Criteria Used: STEP 1: VAC (≥1 REQUIRED) □ Daily min FiO 2 increase ≥ 0.20 (20 points) for ≥ 2 days † OR □ Daily min PEEP increase ≥ 3 cm H 2 O for ≥ 2 days † †after 2+ days of stable or decreasing daily minimum values. STEP 2: IVAC □ Temperature > 38°C or < 36° OR □ White blood cell count ≥ 12,000 or ≤ 4,000 cells/mm 3 AND □ A new antimicrobial agent(s) is started, and is continued for ≥ 4 days STEP 3: PVAP □ Criterion #1: Positive culture of one of the following specimens, meeting quantitative or semi-quantitative thresholds as outlined in protocol, ‡ without requirement for purulent respiratory secretions: □ Endotracheal aspirate□ Lung tissue □ Bronchoalveolar lavage□ Protected specimen brush OR □ Criterion #2: Purulent respiratory secretions ‡ (defined in the protocol) plus a positive culture of one of the following specimens (qualitative culture, or quantitative/semi-quantitative culture without sufficient growth to meet criterion #1): ‡ □ Sputum□ Lung tissue □ Endotracheal aspirate□ Protected specimen brush □ Bronchoalveolar lavage OR □ Criterion #3: One of the following positive tests (as outlined in the protocol): ‡ □ Pleural fluid culture□ Diagnostic test for Legionella species □ Lung histopathology□ Diagnostic test for selected viral pathogens ‡ collected after 2 days of mechanical ventilation and within +/- 2 days of onset of increase in FiO 2 or PEEP.

4. Worksheet example

5. VAC requirements STEP 1: VAC (≥1 REQUIRED) □ Daily min FiO2 increase ≥ 0.20 (20 points) for ≥ 2 days† OR □ Daily min PEEP increase ≥ 3 cm H2O for ≥ 2 days† †after 2+ days of stable or decreasing daily minimum values.

6. Daily PEEP & FIO2 report

7. PEEP &FIO2 log Name: MR#: Date vented: Extubated: Dates on unit: Date:FiO2 PEEP Date:FiO2 PEEP Date:FiO2 PEEP Date:FiO2 PEEP Date:FiO2 PEEP Date:FiO2 PEEP 3/19/201525N/A3/19/20153053/21/20153N/A 3/21/201 56083/23/20155083/24/20156010 3/20/201535N/A3/20/20152553/22/2015100N/A 3/22/201 53563/24/20154083/25/2015405 3/21/20152153/23/2015100N/A 3/23/201 53063/25/20154583/26/2015405 3/22/2015255 3/24/201 53063/26/20154083/27/2015405 3/23/2015605 3/25/201 52563/27/20154083/28/2015VAC 4515 3/24/2015VAC 408 3/26/201 54053/28/20154053/29/2015458 3/25/2015408 3/27/201 53553/29/20154553/30/2015455 3/26/2015405 3/30/2015455 VAC ONLY DOESN'T MEET IVAC VAC ONLY

8. VAC VAE workup Patient: Sex: F Adm date: 3/1/15 Date to ICU: 3/15 Transferred Phys: Adm diag:see below VAC IVACor and PVAP MV Date:PEEP min FiO 2min Temp <96.8 Temp >100.4 WBC< =400 0 WBC >=1200 0 AbxSpecimenPoly/EpisOrganism VAE categoryMisc info: 3/3/15580 3/4/15550 3/5/15550 3/6/15540 3/7/15540 3/8/15530 3/9/15525 3/10/1554096.6 14.6none addednone 3/11/15540 13.3none addednone 3/12/151040 13.5none addednone VAC 3/13/1584096.3 21none addednone 3/14/1584096.4 none addednone 3/15/15840 3/16/15840 3/17/15540 Secondary BSI?NoMidas Died?Yes NHSN form Date of Dis:E-mail CDC calcx

9. IVAC criteria STEP 2: IVAC □ Temperature > 38°C or < 36° OR □ White blood cell count ≥ 12,000 or ≤ 4,000 cells/mm3 AND □ A new antimicrobial agent(s) is started, and is continued for ≥ 4 days

10. IVAC VAE workup Patient: Sex: F Adm date: 12/4/14 Date to ICU: 2/26/15 Transferred from: 4N Phys:Solh Adm diag:See below VAC IVAC PVAP MV Date:PEEP min FiO 2min Temp <96. 8 Temp >100.4 WBC< =40 00 WBC >=12 000 AbxSpecimen Poly/Ep is Organis m VAE category Misc info: 3/1/15540 3/2/15540 3/3/15540none 3/4/15540none 3/5/15850none 3.2 Micafunginnone IVAC 3/6/15835none 2.5 Micafunginnone 3/7/15835none 0.8 Micafunginnone 3/8/15850 Micafungin 3/9/15840 3/10/15835 3/11/15635 3/12/15530 3/13/15530 Secondary BSI? NoMidas Died?Yes NHSN form Date of Dis:E-mail CDC calcx

11. Criteria for Ventilator Associated Events STEP 3: PVAP □ Criterion #1: Positive culture of one of the following specimens, meeting quantitative or semi-quantitative thresholds as outlined in protocol,‡ without requirement for purulent respiratory secretions: □ Endotracheal aspirate□ Lung tissue □ Bronchoalveolar lavage□ Protected specimen brush OR □ Criterion #2: Purulent respiratory secretions‡ (defined in the protocol) plus a positive culture of one of the following specimens (qualitative culture, or quantitative/semi-quantitative culture without sufficient growth to meet criterion #1):‡ □ Sputum□ Lung tissue □ Endotracheal aspirate□ Protected specimen brush □ Bronchoalveolar lavage OR □ Criterion #3: One of the following positive tests (as outlined in the protocol):‡ □ Pleural fluid culture□ Diagnostic test for Legionella species □ Lung histopathology□ Diagnostic test for selected viral pathogens ‡collected after 2 days of mechanical ventilation and within +/- 2 days of onset of increase in FiO2 or PEEP.

12. PVAP

13. VAE calculator http://www.cdc.gov/nhsn/VAE- calculator/index.htmlwww.cdc.gov/nhsn/VAE- calculator/index.html