Ventilator Associated

Event
(VAE) Surveillance
Adapted from CDC
Aisa Jensen Lee

Objectives
Define Ventilator Associated Event
Identify background of previous
evidence based critical care practice
guidelines
Identify and apply most recent
evidence based guidelines for
critical care practice
Be able to identify areas in which
critical care practice may be
impacted by most recent guidelines

Introduction
VAP is the 2nd most common nosocomial
infection = 15% of all hospital acquired
infections
Incidence = 9% to 70% of patients on
ventilators
Increased ICU stay by several days
Increased avg. hospital stay 1 to 3 weeks
Mortality = 13% to 55%
Added costs of $40,000 - $50,000 per
stay
Centers for Disease Control and Prevention, 2003.
Rumbak, M. J. (2000). Strategies for prevention and treatment. Journal of
Respiratory Disease, 21 (5), p. 321;

Probable
Causes of VAP

Old Definition of VAP

VAP is a Nosocomial Pneumonia
= Hospital acquired
Diagnosis is imprecise and
usually based on a Combination
of:
Clinical factors - fever or hypothermia;
change in secretions; cough;
apnea/bradycardia; tachypnea

Microbiological factors

- positive
cultures of blood/sputum/tracheal
American Thoracic Society, Infectious Diseases Society of America:Guidelines
fluids
for theaspirate/pleural
management of adults
with hospital-acquired, ventilatorassociated, and healthcare-associated pneumonia. Am J Respir Crit Care
- new or changing infiltrates
Med2005,171:388-416.

CXR factors

Ventilator Associated Event

Background :
Formerly known as VAP (Ventilator
Associated Pneumonia); last
updated in 2002
VAEs reported to National
Healthcare Safety Network (NHSN);
the CDC s Healthcare Associated
Infection (HAI) surveillance system;
newly updated in 2011
Previous reports too subjective and
variable across institutions based on
resources and lack of
standardization

Ventilator Associated Events in

Adults
New Algorithm for Surveillance :
Patients >/= 18 years of age
Patients who have been
intubated/mechanically ventilated for
at least 3 calendar days

New Algorithim vs Old Algorithm:

Whats Different? :
Xray:
No radiographic reporting is required due
to inconsistency in ordering practices and
variability in resources/techinique. Do
not adequately identify patients with VAP

Will detect ventilator associated

conditions and complications
Focuses on readily available, objective
clinical data
Requires a minimum period of time on
the ventilator

Define Ventilator
Ventilator a device to assist or
control respiration continuously,
inclusive of the weaning period,
through a tracheostomy or by
endotracheal intubation

Define Ventilators
Intermittent positive-pressure
breathing (IPPB), nasal positive endexpiratory pressure (nasal PEEP) and
continuous nasal positive airway
pressure (CPAP, hypoCAP) are NOT
ventilators unless delivered via
tracheostomy or ET

Temperatur
e, WBC
And New
Antimicrobi
al agent

Purulent
secretions
and/or other
positive lab
evidence

Possible or Probable Ventilator

Associated Pneumonia (VAP):
Definition:
On or after calendar day 3 of mechanical
ventilation within 2 calendar days of onset of
worsening oxygenation, ONE of the following
criteria is met:
Purulent respiratory secretions (>25
neutrophils and <10 squamous epithelial cells
per lpf) or be above quantitative thresholds
Positive culture of sputum, BAL, lung tissue,
histopathology, + pleural fluid

Break Down:
IVAC: Temp, signs of infection, lab data of
infection, new antimicrobial agent >4 days
Possible / Probable VAP : The above with
the addition of positive cultures from
lungs, lung tissue, purulent secretions
More objective data
VAP no longer used as the event; it is the
result of the event
Reference: 2011. Improving surveillance for ventilator-associated events in adults.
Centers for Disease Control and Prevention

Nurse with your

heart.

Thank you for

listening!