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VAE: CDC Timing and Case Requirements Kathleen Speck, MPH September 27, 2012 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 2 VAC – Example 1 3 VAC – Example 1 4 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) 5 VAC – Example 2 6 VAC – Example 2 7 CDC: VAC Rules #3, Example 3 1. If 4th day is the event day, 3rd day is included as day -1. 8 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. 9 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 10 VAC – Example 4 11 VAC – Example 4 12 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) 13 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 14 IVAC – Example #1 Yes – 1 and Yes – 2 are 2 different Abx 15 IVAC – Example 2 16 IVAC – Example 2 17 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 18 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 19 Abx Worksheet – Example 1 20 IVAC Example 1 Explanation 1. 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. 21 Abx Worksheet – Example 2 22 IVAC Example 2 Explanation 1. Both Abx are new. Abx 2 fulfills QAD criteria. 23 Abx Worksheet – Example 3 24 IVAC Example 3 Explanation 1. If an Ab is given every other day, the days between are counted as QADs 25 Abx Worksheet – Example 4 26 IVAC Example 1 Explanation 1. QAD criteria met by Abx 2 and Abx 3 2. Abx 1 and 4 are not new. 27 Abx Worksheet – Example 5 28 IVAC Example 5 Explanation 1. 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. 29 Questions? 30 Next Steps • Look over the education • Develop questions • Face to face Pennsylvania – October 2nd Maryland – October 12th 31 Face to Face Registration • 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 [email protected] – Mary Catanzaro RN BSMT CIC Project Manager HAIs Hospital and Healthsystem Association of Pennsylvania [email protected] 32