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● Infection Tracking

VAE surveillance helps clinicians


n January of this year, the National Healthcare Safety Network (NHSN) within the Centers for Disease Control and Prevention (CDC) rolled out new, more objective standards and defi nitions to track and report

ventilator-associated events (VAE), including ventilator- associated pneumonia (VAP). Although pneumonia has been found to be the most frequently fatal healthcare-associated infection (HAI), VAP can be diffi cult for infection-control departments to address. As of 2012, some 900 facilities were reporting VAP rates on the NHSN, either voluntarily or via state mandates. T e Centers for Medicare & Med- icaid Services (CMS) does not require this reporting, but consis- tent with healthcare reform’s move toward a pay-for-performance framework, this could easily change. In fact, one of the stated goals of the new VAE algo- rithm was to enable VAE to be included in the CMS pay- for-performance framework at some point in the future. Prior to the January 2013 introduction of the new VAE

From an infection- control perspective, the power of automation is that, with analytical tools, it is possible to not only collect, track and report, but ultimately gain insight into the differences among a hospital’s ventilated patients.

surveillance algorithm, the NHSN’s VAP defi nitions were based on subjective criteria, such as the interpretation of a chest X-ray. T e CDC determined that the subjectivity of the defi nition made it diffi cult to assess progress against

16 August 2013

improve outcomes What the CDC’s new ventilator- associated event protocol means. By Carlos Nunez, M.D.

Carlos Nunez, M.D., is chief medical officer, CareFusion. For more on CareFusion: www.

benchmarks and identify where additional eff orts were needed – both on the facility level and in terms of the goal of eliminating HAIs nationally. Based on the new surveillance algorithm, three types of

reportable events are possible: 1. A ventilator-associated condition (VAC); 2. An infection-related ventilator associated complication (IVAC); and

3. Possible or probable VAP. T e new algorithm is much more objective, more sensi-

tive and more specifi c, which also brings the added benefi t of making it easier to automate surveillance and report- ing. Automated surveillance helps give clinicians visibility regarding patients’ conditions relative to the new VAE algorithm, and it enables them to focus on the most at-risk patients for a reportable VAC. But to fully leverage automated surveillance and report-

ing, a ventilator must fi rst communicate with the hospital information system (HIS), so that the raw data can be collected and maintained in a way that is conducive to performing analytics. T is means that a hospital’s ventila- tors must have interoperability with the hospital network and other health IT systems. Case in point: T e prevailing data points for the algo-

rithm are two days of stability of daily minimum levels of positive end-expiratory pressure (PEEP) and fraction of inspired oxygen (FiO2), followed by a period of worsening oxygenation. T is data is readily available objective criteria coming straight from the ventilator, making automated collection possible (provided the ventilator is connected to the hospital IT infrastructure). However, from an infection-control perspective, the power of automation is that, with analytical tools, it is


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