VAE: CDC Timing and Case RequirementsKathleen Speck, MPHSeptember 27, 2012

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CDC: VAC Rules #1

1. 2 days of stable or decreasing PEEP and/or FiO2

2. On 3rd day (event day), increase in PEEP of ≥3 cm H2O or increase in FiO2 of ≥0.20 over stable period

3. Change must be maintained at least for day 4

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VAC – Example 1

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VAC – Example 1

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CDC: VAC Rules #2

1. 3rd ventilated day is the 1st day that can be a VAE.

2. 1st and 2nd ventilated day can be used to determine 2 day stability requirement

1. 1st day cannot be used as event day -2 (Review later)

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VAC – Example 2

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VAC – Example 2

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CDC: VAC Rules #3,Example 3

1. If 4th day is the event day, 3rd day is included as day -1.

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CDC: VAC Rules #4

1. ‘Days’ used in definition are calendar days

1. If patient is on MV at any time in a calendar day, he/she is considered to be on MV for that entire day.

2. Any break in MV for ≥1 calendar day is a new MV period.

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CDC: IVAC Rules #1

1. Establish VAC and VAC date

2. Check min and max temp and WBC for 2 days before VAC and 2 days after

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VAC – Example 4

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VAC – Example 4

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CDC: VAC Example 4 – Explanation

1. 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.

2. HAP after MV can only be considered VAP for the 1st calendar day following extubation (as opposed to the current 48 hour rule)

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CDC: IVAC Rules #1

1. Establish VAC and VAC date

2. Check min and max temp and WBC for 5 day window, 2 days before and after VAC and the event day

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IVAC – Example #1

Yes – 1 and Yes – 2 are 2 different Abx

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IVAC – Example 2

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IVAC – Example 2

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CDC: IVAC Rules #2

1. Check for all Abx starting within the 5 days (-2, -1, 1, 2, 3)

2. Need 4 consecutive days of Abx 1. Can be a combination of Abx

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CDC: IVAC Rules #3

1. Any Abx starting outside the window (day -3 or day 4) doesn’t count in the 4 consecutive days

2. Check to see if Abx are new. (not given within the 2 days prior to the 5 day event window

3. Every other day counts as consecutive

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Abx Worksheet – Example 1

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IVAC Example 1Explanation1. 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.

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Abx Worksheet – Example 2

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IVAC Example 2Explanation1. Both Abx are new. Abx 2 fulfills QAD

criteria.

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Abx Worksheet – Example 3

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IVAC Example 3Explanation1. If an Ab is given every other day, the

days between are counted as QADs

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Abx Worksheet – Example 4

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IVAC Example 1Explanation1. QAD criteria met by Abx 2 and Abx 3

2. Abx 1 and 4 are not new.

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Abx Worksheet – Example 5

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IVAC Example 5Explanation1. 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.

2. 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.

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Questions?

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Next Steps

• Look over the education• Develop questions• Face to face

Pennsylvania – October 2nd

Maryland – October 12th

Face to FaceRegistration

• Please contact your state’s hospital association to register for the face to face!

– Karol G. Wicker, MHSSenior Director, Quality Policy & AdvocacyMaryland Hospital Associationkwicker@mhaonline.org

– Mary Catanzaro RN BSMT CIC Project Manager HAIs Hospital and Healthsystem Association of Pennsylvaniamcatanzaro@haponline.org

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