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VAE: CDC Timing and Case Requirements

VAE: CDC Timing and Case Requirements. Kathleen Speck, MPH. September 27, 2012. CDC: VAC Rules #1. 2 days of stable or decreasing PEEP and/or FiO2 On 3 rd day (event day), increase in PEEP of ≥3 cm H 2 O or increase in FiO2 of ≥0.20 over stable period

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VAE: CDC Timing and Case Requirements

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  1. VAE: CDC Timing and Case Requirements Kathleen Speck, MPH September 27, 2012

  2. CDC: VAC Rules #1 2 days of stable or decreasing PEEP and/or FiO2 On 3rd day (event day), increase in PEEP of ≥3 cm H2O or increase in FiO2 of ≥0.20 over stable period Change must be maintained at least for day 4

  3. VAC – Example 1

  4. VAC – Example 1

  5. CDC: VAC Rules #2 • 3rd ventilated day is the 1st day that can be a VAE. • 1st and 2nd ventilated day can be used to determine 2 day stability requirement • 1st day cannot be used as event day -2(Review later)

  6. VAC – Example 2

  7. VAC – Example 2

  8. CDC: VAC Rules #3,Example 3 If 4th day is the event day, 3rd day is included as day -1.

  9. CDC: VAC Rules #4 • ‘Days’ used in definition are calendar days • If patient is on MV at any time in a calendar day, he/she is considered to be on MV for that entire day. • Any break in MV for ≥1 calendar day is a new MV period.

  10. CDC: IVAC Rules #1 Establish VAC and VAC date Check min and max temp and WBC for 2 days before VAC and 2 days after

  11. VAC – Example 4

  12. VAC – Example 4

  13. CDC: VAC Example 4 – Explanation • 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. • HAP after MV can only be considered VAP for the 1st calendar day following extubation (as opposed to the current 48 hour rule)

  14. CDC: IVAC Rules #1 Establish VAC and VAC date Check min and max temp and WBC for 5 day window, 2 days before and after VAC and the event day

  15. IVAC – Example #1 Yes – 1 and Yes – 2 are 2 different Abx

  16. IVAC – Example 2

  17. IVAC – Example 2

  18. CDC: IVAC Rules #2 • Check for all Abxstarting within the 5 days (-2, -1, 1, 2, 3) • Need 4 consecutive days of Abx • Can be a combination of Abx

  19. CDC: IVAC Rules #3 Any Abx starting outside the window (day -3 or day 4) doesn’t count in the 4 consecutive days Check to see if Abx are new. (not given within the 2 days prior to the 5 day event window Every other day counts as consecutive

  20. Abx Worksheet – Example 1

  21. IVAC Example 1Explanation 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.

  22. Abx Worksheet – Example 2

  23. IVAC Example 2Explanation Both Abx are new. Abx 2 fulfills QAD criteria.

  24. Abx Worksheet – Example 3

  25. IVAC Example 3Explanation If an Ab is given every other day, the days between are counted as QADs

  26. Abx Worksheet – Example 4

  27. IVAC Example 1Explanation QAD criteria met by Abx 2 and Abx 3 Abx 1 and 4 are not new.

  28. Abx Worksheet – Example 5

  29. IVAC Example 5Explanation 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. 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.

  30. Questions?

  31. Next Steps • Look over the education • Develop questions • Face to face Pennsylvania – October 2nd Maryland – October 12th

  32. Face to FaceRegistration • 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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