. 2013 Nov;41(11):2467-75.

doi: 10.1097/CCM.0b013e3182a262db.

Developing a new, national approach to surveillance for ventilator-associated events*

Affiliations

Affiliation

¹ 1Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA. 2Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. 3Infection Control Department, Brigham and Women's Hospital, Boston, MA. 4Society for Healthcare Epidemiology of America, Arlington, VA. 5Division of Pulmonary and Critical Care Medicine, Rush University School of Medicine, Chicago, IL. 6Critical Care Societies Collaborative-American Association of Critical-Care Nurses, American College of Chest Physicians, American Thoracic Society, Society of Critical Care Medicine. 7School of Nursing, Critical and Acute Care, University of Virginia, Charlottesville, VA. 8Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. 9Division of Infectious Diseases, University of Iowa Carver College of Medicine, Iowa City, IA. 10Healthcare Infection Control Practices Advisory Committee Surveillance Working Group, Atlanta, GA. 11Infection Prevention and Control Department, Rochester General Health System, Rochester, NY. 12Association for Professionals in Infection Control and Epidemiology, Washington, DC. 13Department of Medicine, Medical College of Wisconsin, Milwaukee, WI. 14Department of Cardiology, Zablocki VA Medical Center, Milwaukee, WI. 15Hospital Epidemiology and Quality Improvement, The Clinical Center, National Institutes of Health, Bethesda, MD. 16Department of Respiratory Care, Massachusetts General Hospital, Boston, MA. 17Department of Anesthesia, Harvard Medical School, Boston, MA. 18American Association for Respiratory Care, Irving, TX. 19Division of Pulmonary and Critical Care Medicine, Tufts Medical Center, Boston, MA. 20Division of Pulmonary and Critical Care Medicine, Washington University, St. Louis, MO. 21Division of Pulmonary, Critical Care, and Sleep, Warren Alpert Medical School at Brown University, Rhode Island Hospital, Providenc

PMID: 24162674
PMCID: PMC10847970
DOI: 10.1097/CCM.0b013e3182a262db

Developing a new, national approach to surveillance for ventilator-associated events*

Shelley S Magill et al. Crit Care Med. 2013 Nov.

. 2013 Nov;41(11):2467-75.

doi: 10.1097/CCM.0b013e3182a262db.

Affiliation

¹ 1Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA. 2Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. 3Infection Control Department, Brigham and Women's Hospital, Boston, MA. 4Society for Healthcare Epidemiology of America, Arlington, VA. 5Division of Pulmonary and Critical Care Medicine, Rush University School of Medicine, Chicago, IL. 6Critical Care Societies Collaborative-American Association of Critical-Care Nurses, American College of Chest Physicians, American Thoracic Society, Society of Critical Care Medicine. 7School of Nursing, Critical and Acute Care, University of Virginia, Charlottesville, VA. 8Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. 9Division of Infectious Diseases, University of Iowa Carver College of Medicine, Iowa City, IA. 10Healthcare Infection Control Practices Advisory Committee Surveillance Working Group, Atlanta, GA. 11Infection Prevention and Control Department, Rochester General Health System, Rochester, NY. 12Association for Professionals in Infection Control and Epidemiology, Washington, DC. 13Department of Medicine, Medical College of Wisconsin, Milwaukee, WI. 14Department of Cardiology, Zablocki VA Medical Center, Milwaukee, WI. 15Hospital Epidemiology and Quality Improvement, The Clinical Center, National Institutes of Health, Bethesda, MD. 16Department of Respiratory Care, Massachusetts General Hospital, Boston, MA. 17Department of Anesthesia, Harvard Medical School, Boston, MA. 18American Association for Respiratory Care, Irving, TX. 19Division of Pulmonary and Critical Care Medicine, Tufts Medical Center, Boston, MA. 20Division of Pulmonary and Critical Care Medicine, Washington University, St. Louis, MO. 21Division of Pulmonary, Critical Care, and Sleep, Warren Alpert Medical School at Brown University, Rhode Island Hospital, Providenc

PMID: 24162674
PMCID: PMC10847970
DOI: 10.1097/CCM.0b013e3182a262db

Abstract

Objective: To develop and implement an objective, reliable approach to surveillance for ventilator-associated events in adult patients.

Design: The Centers for Disease Control and Prevention (CDC) convened a Ventilator-Associated Pneumonia (VAP) Surveillance Definition Working Group in September 2011. Working Group members included representatives of stakeholder societies and organizations and federal partners.

Main results: The Working Group finalized a three-tier, adult surveillance definition algorithm for ventilator-associated events. The algorithm uses objective, readily available data elements and can identify a broad range of conditions and complications occurring in mechanically ventilated adult patients, including but not limited to VAP. The first tier definition, ventilator-associated condition (VAC), identifies patients with a period of sustained respiratory deterioration following a sustained period of stability or improvement on the ventilator, defined by changes in the daily minimum fraction of inspired oxygen or positive end-expiratory pressure. The second tier definition, infection-related ventilator-associated complication (IVAC), requires that patients with VAC also have an abnormal temperature or white blood cell count, and be started on a new antimicrobial agent. The third tier definitions, possible and probable VAP, require that patients with IVAC also have laboratory and/or microbiological evidence of respiratory infection.

Conclusions: Ventilator-associated events surveillance was implemented in January 2013 in the CDC's National Healthcare Safety Network. Modifications to improve surveillance may be made as additional data become available and users gain experience with the new definitions.

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Conflict of interest statement

The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

**Figure 1.**
Ventilator-associated events surveillance definition algorithm*. *Available at: http://www.cdc.gov/nhsn/acute-care-hospital/vae/index.html. CFU = colony-forming units, Fio₂ = fraction of inspired oxygen, PEEP = positive end-expiratory pressure, VAP = ventilator-associated pneumonia

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Comment in

Updated approach for the assessment of ventilator-associated pneumonia.
Macht M, Robinson JC, Graham BB. Macht M, et al. Crit Care Med. 2013 Nov;41(11):2641-2. doi: 10.1097/CCM.0b013e3182a84be1. Crit Care Med. 2013. PMID: 24162675 Free PMC article. No abstract available.
Developing a new, national approach to surveillance for ventilator-associated events: executive summary.
Magill SS, Klompas M, Balk R, Burns SM, Deutschman CS, Diekema D, Fridkin S, Greene L, Guh A, Gutterman D, Hammer B, Henderson D, Hess DR, Hill NS, Horan T, Kollef M, Levy M, Septimus E, VanAntwerpen C, Wright D, Lipsett P. Magill SS, et al. Chest. 2013 Nov;144(5):1448-1452. doi: 10.1378/chest.13-1640. Chest. 2013. PMID: 24189858 Free PMC article. No abstract available.

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Developing a new, national approach to surveillance for ventilator-associated events*

Affiliation

Developing a new, national approach to surveillance for ventilator-associated events*

Authors

Affiliation

Abstract

Conflict of interest statement

Figures

Comment in

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

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Medical