CUSP 4 MVP – VAP Improving Care for Mechanically Ventilated Patients Infection Prevention 3 VAE Surveillance Training: Possible VAP (PVAP) APRV and other related vent modes March 25, 2015 ARMSTRONG INSTITUTE FOR PATIENT SAFETY AND QUALITY Johns Hopkins University

CUSP 4 MVP – VAP Comprehensive Unit-based Safety Program for Mechanically Ventilated Patients and Ventilator-Associated Pneumonia

CUSP 4 MVP – VAP Improving Care for Mechanically Ventilated Patients VAE Surveillance Training: Possible VAP (PVAP) APRV and other related vent modes Kathleen Speck, MPH CUSP 4 MVP – VAP Improving Care for Mechanically Ventilated Patients

Polling Question Who is on the call? IP – infection preventionist RN – registered nurse RT – respiratory therapist PT – physical therapist OT – occupational therapist MD – medical doctor Quality improvement professional Healthcare executive Educator National project team Other  

Objectives Review the definitions of VAE tiers Discuss case finding and determination of the third tier in VAE – PVAP Discuss PEEP and FiO2 case determination for APRV, BiLevel, A/C and PCV vent modes

Possible Ventilator-Associated Pneumonia VAE Definition Tiers Possible Ventilator-Associated Pneumonia (PVAP) Reference: CDC NHSN Device-associated Module Ventilator-Associated Event (VAE) http://www.cdc.gov/nhsn/pdfs/pscManual/10-VAE_FINAL.pdf

CUSP 4 MVP–VAP VAE Surveillance Assessment must take place for all VAE tiers VAC Ventilator-associated Condition IVAC Infectious Ventilator-associated Complication Possible VAP Possible Ventilator-associated Pneumonia

VAE Surveillance Training: Quick Review VAC and IVAC CUSP 4 MVP – VAP Improving Care for Mechanically Ventilated Patients

5-Day VAE Window Period MV Day Min PEEP Min FiO2 1 8 100 2 7 70 3 6 50 4 5 60 9 80 10

Why Is the Event Date Important? Defines the “VAE Window Period” Period during which criteria for other events must be met Defines beginning of 14-day Event Period Another VAE may not happen during the 14-day Event Period following the VAE in question

Tier 2: IVAC Criteria Patient meets criteria for VAC On or after calendar day 3 of mechanical ventilation or after the onset of worsening oxygenation, the patient meets BOTH of the following criteria: EITHER Temp > 38oC (100.4oF) or < 36oC (96.8oF), OR WBC ≥ 12,000 cells/mm3 or ≤ 4,000 cell/mm3 AND A new antimicrobial agent(s) is started, and is continued for ≥ 4 calendar days

3-day VAE Event Window: Not IVAC MV Day Min PEEP Min FiO2 Temp min Temp max WBC min WBC max Abx 1 5 50 36.9 37.6 2 36.5 39.2 12.1 13.6 3 8 37.5 37.9 14.0 14.9 4 37.8 11.6 12.8 7 60 11.1 11.9 6 70 11.2 80 9 10

Qualifying Antimicrobials Day (QAD) The day when a patient was administered a “new” antimicrobial agent within the VAE Window Period 4 consecutive QADs are needed to meet the IVAC antimicrobial criterion, starting within the VAE Window Period

3-day VAE Event Window: IVAC MV Day Min PEEP Min FiO2 Temp min Temp max WBC min WBC max Abx 1 5 50 36.9 37.6 2 38.1 39.2 12.1 13.6 3 8 38.4 38.9 12.5 14.5 No 4 36.5 37.8 12.6 16.8 7 60 11.1 15.9 Yes 6 70 11.2 80 9 10

QAD – Example 1 Consider Vanc VAE Day -3 -2 -1 1 2 3 4 5 Abx Levo Mero Vanc QAD √

CUSP 4 MVP – VAP Improving Care for Mechanically Ventilated Patients VAE Surveillance Training: Possible Ventilator-associated Pneumonia (PVAP) CUSP 4 MVP – VAP Improving Care for Mechanically Ventilated Patients

PVAP – Criteria On or after calendar day 3 of MV and within 2 days before or after the onset of worsening oxygenation, ONE of the following 3 criteria must be met.

PVAP – Criterion 1 Positive culture of one of the following specimens, meeting quantitative or semi-quantitative thresholds as outlined in protocol, without requirement for purulent respiratory secretions: Endotracheal aspirate, ≥105 CFU/ml or * Bronchoalveolar lavage, ≥104 CFU/ml or * Lung tissue, ≥104 CFU/ml or * Protected specimen brush, ≥103 CFU/ml or * *or corresponding semi-quantitative result

PVAP – Criterion 2 Purulent respiratory secretions plus a positive culture of one of the following specimens (qualitative culture or quantitative/semi-quantitative culture without sufficient growth to meet Criterion 1): Sputum Endotracheal aspirate Bronchoalveolar lavage Lung tissue Protected specimen brush

Excluded Organisms Organisms that indicate isolation of commensal flora of the oral cavity or upper respiratory tract Normal respiratory flora Normal oral flora Mixed respiratory flora Altered oral flora

More Excluded Organisms Organisms that can only be reported as PVAP pathogens if isolated from cultures of lung tissue of pleural fluid Candida species or yeast not otherwise specified Coagulase-negative Staphylococcus species Enterococcus species

2015 Additional Excluded Organisms Organisms that cause community-associated respiratory infections, that are rarely or are not known to be causes of healthcare-associated infections Blastomyces Histoplasma Coccidiodes Paracoccidiodes Cryptococcus Pneumocystis

Purulent Respiratory Secretions Definitions Secretions from the lungs, bronchi or trachea that contain ≥25 neutrophils and ≤10 squamous epithelial cells per low power field [lpf, x100]

Lab Report Issues: Neutrophils and Squamous Epithelial Cells WHAT IF MY LAB…? INSTRUCTION Reports WBCs, polymorphonuclear leukocytes, leukocytes? Assume equal to neutrophils unless your lab confirms this is not the case Reports semi-quantitative results (not quantitative) for numbers of neutrophils and squamous epithelial cells? Check with lab for how quantitative ranges correspond on the semi-quantitative reports Reports only the numbers for neutrophils? Use the specified quantitative and semi-quantitative thresholds for neutrophils alone Cannot provide additional info on how semi-quantitative reporting corresponds to quantitative ranges for neutrophils and squamous epithelial cells? Use the following direct examination results to meet the purulent secretions criteria: Heavy: 4+ or ≥25 neutrophils per low power field (lpf) [x100], AND Rare, occasional, few: 1+, 2+ or ≤10 squamous epithelial cells per lpf [x100]

Lab Report Issues: Neutrophils and Squamous Epithelial Cells WHAT IF MY LAB…? INSTRUCTION Uses different reporting thresholds for neutrophils and squamous epithelial cells (e.g., max report of ≥20 neutrophils per lpf [x100], or min report of ≤15 squamous epithelial cells per lpf? The purulent secretion criteria may be met using the lab’s specified max quantitative threshold for neutrophils, and/or min quantitative threshold for squamous epithelial cells Processes respiratory specimens such as BAL fluid using a centrifugation procedure (e.g., cytospin), and there is no quantitation or semi-quantitation of neutrophils or WBCs in the direct examination report? A report indicating the presence of WBCs, without quantitation, is sufficient to meet the purulent secretions criteria

PVAP - Criterion 3 One of the following positive tests: Pleural fluid culture obtained during thoracentesis or initial placement of chest tube Lung histopathology Abcess formation or foci of consolidation with intense neutrophil accumulation in bronchioles and alveoli Evidence of lung parenchyma invasion by fungi (hyphae, pseudohyphae, or yeast forms) Evidence of infection with the viral pathogens on the next slide Diagnostic test for Legionella species Diagnostic test on respiratory secretions for specific viruses

Respiratory Viruses and Detection Methods Influenza, RSV, parainfluenza viruses, human metapneumovirus, coronaviruses, rhinoviruses and adenovirus, identified by: By PCR or other viral nucleic acid detection or antigen detection methods Immunohistochemical assays cytology, microscopy or Serological assays demonstrating seroconversion or a significant rise in antibody titer

Denominator Ventilator Days per Month Numbers of patients managed with ventilation devices Collected at the same time daily Summed and entered as a total

Denominator – Episodes of Mechanical Ventilation (EMV) per Month Sum of the number of episodes of mechanical ventilation that occurred during the month Count all patients that are on mechanical ventilation on the first day of the month Add each additional new patient that is started on ventilation of every subsequent day of the month Include new episodes identified in previously ventilated patients New episode is defined when the patient has been extubated for at least one calendar day Summed and entered as a total

Poll – VAC, IVAC or PVAP? MV Day Min PEEP Min FiO2 Temp min Temp max WBC min WBC max Abx Speci-men Polys Epis Organism 1 5 100 No 2 70 3 6 50 12.1 Sputum >25/≤10 CNS 4 7 36.9 37.6 16.8 38.1 39.2 14.5 15.9 38.4 38.9 12.6 13.6 Yes 36.5 37.8 11.1 8 80 9 10

VAC, IVAC or PVAP? MV Day Min PEEP Min FiO2 Temp min Temp max WBC min WBC max Abx Speci-men Polys Epis Organism 1 5 100 No 2 70 3 6 50 12.1 Sputum >25/≤10 CNS 4 7 36.9 37.6 16.8 38.1 39.2 14.5 15.9 38.4 38.9 12.6 13.6 Yes 36.5 37.8 11.1 8 80 9 10

IVAC or PVAP? Sputum >25/≤10 CNS Criterion 1: Specimen is not from one of the required sites Endotracheal aspirate Bronchoalveolar lavage Lung tissue Protected specimen brush Criterion 2: Has purulent secretions, but the organism, CNS, is excluded Criterion 3: Does not have one of the listed positive tests Pleural fluid cx Lung histopathology Diagnostic test for Legionella species Respiratory virus detection method

IVAC! Purulent respiratory secretion criteria met for # 2 Specimen from sputum grew an excluded organism. Sputum not a viable site for #1, excluded organism for #2 MV Day Min PEEP Min FiO2 Temp min Temp max WBC min WBC max Abx Speci-men Polys Epis Organism 1 5 100 No 2 70 3 6 50 12.1 Sputum >25/≤10 CNS 4 7 36.9 37.6 16.8 38.1 39.2 14.5 15.9 38.4 38.9 12.6 13.6 Yes 36.5 37.8 11.1 8 80 9 10

Poll - VAC, IVAC, or PVAP? MV Day Min PEEP Min FiO2 Temp min Temp max WBC min WBC max Abx Speci-men Polys Epis Organism 1 5 100 38.0 39.1 4.5 5.0 No 2 70 37.8 38.2 5.5 3 6 50 37.5 6.0 4 7 38.6 39.0 7.0 7.5 37.9 8.0 10.0 9.0 14.0 Yes 37.1 37.4 12.0 8 80 8.5 BAL >25/≤10 > 105 S. aureus 9 6.5 10 37.6

IVAC, or PVAP? MV Day Min PEEP Min FiO2 Temp min Temp max WBC min WBC max Abx Speci-men Polys Epis Organism 1 5 100 38.0 39.1 4.5 5.0 No 2 70 37.8 38.2 5.5 3 6 50 37.5 6.0 4 7 38.6 39.0 7.0 7.5 37.9 8.0 10.0 9.0 14.0 Yes 37.1 37.4 12.0 8 80 8.5 BAL >25/≤10 > 105 S. aureus 9 6.5 10 37.6

IVAC or PVAP? Criterion 1: Specimen is from one of the required sites BAL >25/≤10 >105 S. aureus Criterion 1: Specimen is from one of the required sites Criterion 3: Does not have one of the listed positive tests Endotracheal aspirate Bronchoalveolar lavage Lung tissue Pleural fluid cx Protected specimen brush Lung histopathology Meets the growth criteria Diagnostic test for Legionella species No purulent secretions Respiratory virus detection method Criterion 2: Has purulent secretions Growth meets Criterion 1 requirements

PVAP! Criterion 1 No purulent secretions MV Day Min PEEP Min FiO2 Temp min Temp max WBC min WBC max Abx Speci-men Polys Epis Organism 1 5 100 38.0 39.1 4.5 5.0 No 2 70 37.8 38.2 5.5 3 6 50 37.5 6.0 4 7 38.6 39.0 7.0 7.5 37.9 8.0 10.0 9.0 14.0 Yes 37.1 37.4 12.0 8 80 8.5 BAL >25/≤10 > 104 S. aureus 9 6.5 10 37.6 No purulent secretions Specimen from BAL meets organism and growth criteria

Poll – No event, VAC, IVAC, PVAP? MV Day Min PEEP Min FiO2 Temp min Temp max WBC min WBC max Abx Speci-men Polys Epis Organism 1 5 100 39.5 40.0 10.0 10.5 BAL Moderate S. aureus 2 70 38.0 39.7 11.5 12.5 3 7 50 37.5 11.0 QAD 4 37.0 39.0 10 13.0 6 60 13.5 Sputum >25/≤10 Rare 8 Patient expired

No Event, VAC, IVAC or PVAP? MV Day Min PEEP Min FiO2 Temp min Temp max WBC min WBC max Abx Speci-men Polys Epis Organism 1 5 100 39.5 40.0 10.0 10.5 BAL Moderate S. aureus 2 70 38.0 39.7 11.5 12.5 3 7 50 37.5 11.0 QAD 4 37.0 39.0 10 13.0 6 60 13.5 Sputum >25/≤10 Rare 8 Patient expired

No Event, VAC, IVAC or PVAP? MV Day Min PEEP Min FiO2 Temp min Temp max WBC min WBC max Abx Speci-men Polys Epis Organism 1 5 100 39.5 40.0 10.0 10.5 BAL Moderate S. aureus 2 70 38.0 39.7 11.5 12.5 3 7 50 37.5 11.0 QAD 4 37.0 10 39.0 13.0 6 60 13.5 Sputum >25/≤10 Rare 8 Patient expired

IVAC or PVAP? Criterion 2: Criterion 1: Criterion 3: Sputum >25/≤10 Rare S. aureus Criterion 1: Specimen is not from one of the required sites – endotracheal aspirate, bronchoalveolar lavage, lung tissue, protected specimen Criterion 2: Has purulent secretions Growth does not meet Criterion 1 requirements Culture from included site Criterion 3: Does not have one of the listed positive tests – pleural fluid cx, lung histopathology, diagnostic test for Legionella species respiratory virus detection method

No Event, VAC, IVAC, PVAP? MV Day Min PEEP Min FiO2 Temp min Temp max WBC min WBC max Abx Speci-men Polys Epis Organism 1 5 100 39.5 40.0 10.0 10.5 BAL Few S. aureus 2 70 38.0 39.7 11.5 12.5 3 7 50 37.5 11.0 QAD 4 37.0 10 13.0 6 60 13.5 Sputum >25/≤10 8 Patient expired No event? - S. aureus was present in BAL on MV day – pre-existing pneumonia Pre-existing diagnosis has no bearing on this VAC – criteria are met with PEEP IVAC – criteria are met PVAP Criterion 2

Poll - VAC, IVAC, PVAP? MV Day Min PEEP Min FiO2 Temp min Temp max WBC min WBC max Abx Speci-men Polys Epis Organism 1 5 100 38.0 39.1 10.0 10.5 2 80 37.8 38.2 11.5 12.5 3 60 37.5 38.1 11.0 4 50 38.6 39.0 37.9 13.0 QAD Lung histopathology abscess Candida spps. 6 70 7 37.1 37.4 13.5 8

Lung histopathology - abscess VAC, IVAC, PVAP? MV Day Min PEEP Min FiO2 Temp min Temp max WBC min WBC max Abx Speci-men Polys Epis Organism 1 5 100 38.0 39.1 10.0 10.5 2 80 37.8 38.2 11.5 12.5 3 60 37.5 38.1 11.0 4 50 38.6 39.0 37.9 13.0 QAD Lung histopathology - abscess Candida spps. 6 70 7 37.1 37.4 13.5 8

Lung histopathology - abscess IVAC or PVAP? Lung histopathology - abscess Candida spps. Criterion 1: Specimen is from one of the required sites – endotracheal aspirate, bronchoalveolar lavage, lung tissue, protected specimen Pathogen is excluded for this criterion Criterion 2: Does not have purulent secretions Growth is unstated Criterion 3: Has positive lung histopathology for accepted organism.

Lung histopathology - abscess No Event, VAC, IVAC, PVAP? MV Day Min PEEP Min FiO2 Temp min Temp max WBC min WBC max Abx Speci-men Polys Epis Organism 1 5 100 38.0 39.1 10.0 10.5 2 80 37.8 38.2 11.5 12.5 3 60 37.5 38.1 11.0 4 50 38.6 39.0 37.9 13.0 QAD Lung histopathology - abscess Candida spps. 6 70 7 37.1 37.4 13.5 8 No VAE – the patient had a fever on MV day 1 Pre-existing diagnosis has no bearing on this VAC – Criteria met on day 6 IVAC – Meets IVAC criteria PrVAP – purulent secretions, Candida spps. organism exclusions don’t apply to lung tissue samples

CUSP 4 MVP-VAP Understanding PEEP and FiO2 with APRV, BiLevel, A/C and PCV Case donated by Cheryl Morrin BS, MT(ASCP), CIC – Cohort 1 November 10, 2018

Case 1 - History 59 yo female w/ COPD on home cannula From PCP wt/ S/S of fever, muscle pain and cxr w/ PNA “correlate clinically” Admitted w/CPAP, +Legionella (POA) MV started on HD1

Review Rules for PEEP and FiO2 Minimum PEEP = Minimum PEEP value that is maintained for ≥ 1 hour If PEEP or FiO2 aren’t recorded hourly, use lowest value If PEEP or FiO2 values aren’t stable for at least one hour, use the lowest value PEEP from 0-5 = 5 PEEP and APRV (and related modes) Partial day: Use PEEP from non-APRV mode Full day: Skip PEEP, baseline starts with non- APRV mode PEEP readings on next day

Example Patient: Non-APRV Readings

Case: APRV/BiLevel/PCV Readings

MV Day 1, 11/12 Patient on APRV/Bivent FiO2 for MV day 1 = 100, from 21:53 – 23:14 No PEEP   11/12 21:53 23:14 MV mode APRV/Bivent FIO2 100 PEEP

MV Day 2, 11/13 Patient on APRV/Bivent and BiLevel 02:00   2:25 3:17 4:01 5:00 7:55 8:25 MV Mode APRV/Bivent BiLevel FiO2 100 90 80 70 PEEP   11/13 9:12 10:07 10:53 11:01 12:55 14:57 18:13 MV mode BiLevel FIO2 70 100 80 PEEP 7   11/13  19:30 20:08 21:40 22:16 22:41 23:27 23:42 MV mode BiLevel FIO2 90 100 80 75 PEEP Patient on APRV/Bivent and BiLevel Use FiO2 for MV day 2 = 70, from 4:01-7:55 NO PEEP for MV day 2

MV Day 3, 11/14 Patient on BiLevel and A/C modes 2:20   2:34 4:53 7:56 12:40 MV Mode BiLevel FiO2 100 90 PEEP   11/14 15:50 17:23 18:53 19:59 23:43 MV mode BiLevel A/C FIO2 90 60 50 PEEP 14 Patient on BiLevel and A/C modes FiO2 for MV day 3 = 50, from 18:53-19:59 PEEP for MV day 3 = 14, from 17:23-23:43

MV Day 4, 11/15 Patient on AC and PCV modes FiO2 for MV day 4 = 50 00:25   00:35 00:51 2:56 4:01 4:35 4:49 MV Mode A/C FiO2 100 90 60 50 PEEP 12 11/15 5:06   8:51 10:00 10:10 14:18 15:26 15:27 MV Mode A/C PCV FiO2 50 100 75 PEEP 12  11/15 15:53   17:06 18:52 19:38 20:12 22:41 MV Mode PCV FiO2 50 100 60 PEEP 14 12 10 Patient on AC and PCV modes FiO2 for MV day 4 = 50 PEEP for MV day 4 = 12

MV Day 5, 11/16 MV Day 6, 11/17 Patient on A/C and PCV modes FiO2 for MV day 5 = 40, from 12:40-20:17 No PEEP MV Day 5, 11/16 11/16 05:44   8:01 11:43 12:40 15:53 20:17 MV Mode PCV A/C FiO2 50 40 PEEP 10 14 Patient on A/C and PCV modes FiO2 for MV day 6 = 40, from 00:00-06:47 PEEP for MV day 6 = 14, from 13:25-20:34 MV Day 6, 11/17 11/17 4:36   6:47 8:44 9:12 9:48 13:25 20:34 MV Mode PCV A/C FiO2 40 45 50 PEEP 14 16

MV Day 7, 11/18 MV Day 8, 11/19 Patient on A/C and PCV modes FiO2 for MV day 7 = 50, from 0:00-2:00 PEEP for MV day 7 = 14 MV Day 7, 11/18 11/18 00:24   2:00 5:52 7:37 10:40 15:35 21:46 MV Mode PCV A/C FiO2 50 60 PEEP 14 16 Patient on A/C mode FiO2 for MV day 8 = 40 PEEP for MV day 7 = 12 MV Day 8, 11/19 11/19 00:32   3:09 7:34 13:20 17:40 21:36 MV Mode A/C FiO2 55 50 40 PEEP 12

MV Day 9, 11/20 MV Day 10, 11/21 Patient on A/C mode FiO2 for MV day 9 = 40 PEEP for MV day 9 = 7 MV Day 9, 11/20 11/20 4:19   8:10 10:27 11:01 14:37 14:39 20:16 MV Mode A/C FiO2 40 PEEP 12 10 7 Patient on A/C mode FiO2 for MV day 10 = 40 PEEP for MV day 10 = 7 MV Day 10, 11/21 11/21 5:58   9:15 9:59 16:49 18:38 20:00 MV Mode A/C PCV FiO2 40 70 60 50 PEEP 7 5 10

MV Day 11, 11/22 Patient on PCV mode FiO2 for MV day 11 = 40 No PEEP 00:20   5:00 7:32 8:30 10:11 17:47 20:22 MV Mode PCV FiO2 50 40 PEEP 10 5 Patient on PCV mode FiO2 for MV day 11 = 40 No PEEP

MV Day 12, 11/23 Patient on PCV, SBT/PAV, A/C modes 00:11   4:42 5:30 5:32 5:34 5:48 7:44 MV Mode PCV FiO2 40 30 PEEP 5   15:51 20:10 21:49 23:36 MV Mode A/C FiO2 30 PEEP 5 7 Patient on PCV, SBT/PAV, A/C modes FiO2 for MV day 12 = 30 PEEP for MV day 12 = 5

MV Day 13, 11/24 MV Day 14, 11/25 Patient on PCV, SBT/PAV, A/C modes FiO2 for MV day 13 = 30 PEEP for MV day 13 = 5 MV Day 13, 11/24 11/24 04:38 4:47   4:48 8:20 16:34 22:35 MV Mode A/C SBT PCV FiO2 30 PEEP 5 Patient on A/C, SBT, and CPAP/pr sup modes FiO2 for MV day 14 = 30 PEEP for MV day 14 = 5 MV Day 14, 11/25 11/25 4:18   4:32 4:37 7:23 17:14 20:44 MV Mode A/C SBT CPAP/pr sup FiO2 30 PEEP 5

Patient on SBT/PAV, A/C FiO2 for MV day 17 = 30 PEEP for MV day 17 = 5 MV Day 15, 11/26 11/26 5:33   5:38 7:35 11:25 17:22 17:30 18:00 20:54 MV Mode SBT A/C FiO2 30 100 PEEP 5 MV Day 16 and 17, 11/27 and 11/28 11/27 5:10   9:19 14:26 21:00 MV Mode A/C FiO2 30 PEEP 5 11/28 5:59   8:03 MV Mode SBT FiO2 PEEP 5 Patient on PAV, A/C FiO2 for MV day 16 = 30 PEEP for MV day 16 = 5 Patient on SBT Extubated at 8:03

Longitudinal PEEP and FiO2 MV Day FiO2 PEEP 1 100 - 2 70 3 50 14 4 12 5 40 6 7 8 9 MV Day FiO2 PEEP 10 40 7 11 - 12 30 5 13 14 15 16 After digging and combing through all those data, There is no VAE!

Surveillance data can be complicated Determining which values to use for your PEEP and FiO2 minimums can be time consuming Before you use the calculator or make your final determination Set up your own tables Check the vent modes Check the duration of the settings (≥ 1 hour)

CDC VAE Calculator http://www.cdc.gov/nhsn/VAE-calculator/

CUSP 4 MVP – VAP Improving Care for Mechanically Ventilated Patients Next Steps CUSP 4 MVP – VAP Improving Care for Mechanically Ventilated Patients

Remember! Gather FiO2 and PEEP on all ventilated patients Determine VAC first! Then determine window period If VAC, collect Temp and WBC for the window period If Temp and WBC criteria for IVAC are met, then collect antibiotic information If all IVAC criteria are met, then collect culture information, but only for the window period

Next Steps If you ARE using the NHSN system for VAE reporting: Upload six (6) months baseline data Confer rights to your CE, if you haven’t already done so CEs can then download your data from NHSN and upload to the CECity platform

Next Steps If you ARE NOT using the NHSN surveillance system or you choose not to confer rights, enter this data into CECity system manually.

If You Already Perform VAE Surveillance Collect an interesting and/or complicated case for discussion Email to cusp4mvp@jhmi.edu with the subject line VAE Surveillance Case

Would Continuing VAE Calls Be Helpful? Establish a community to discuss Interesting cases Confusing cases Changes in VAE surveillance as they arise Invite guest speakers

Polling Question How often would you like to attend IP calls? Not interested in additional calls at this time Monthly calls Every other month calls Quarterly calls Only when VAE surveillance definitions change

Login Information Expect to receive information 10 days after you submit Letter of Commitment (LOC) Data Use Agreement (DUA) If the DUA is edited, this can be a longer process

Data Entry: Tablets Interface to data portal is the same as a computer Can enter manually as you walk unit Can use spreadsheet template to gather data and then upload to portal Can use our spreadsheet with dropdown menus and skip logic for both data collection and uploading

CUSP 4 MVP–VAP Categories Daily Care Processes Early Mobility Low Tidal Volume Ventilation CUSP can help engage / find value / make sure the front line know they are doing important work. This is why CUSP is at the center of our project.

Mark Your Calendar: Upcoming Content Webinars For current schedule of upcoming project webinars, visit https://armstrongresearch.hopkinsmedicine.org/cusp4mvp/schedules.aspx

CUSP 4 MVP – VAP Website Visit: https://armstrongresearch.hopkinsmedicine.org/cusp4mvp.aspx

What Can I Find on the CUSP 4 MVP – VAP Website? CUSP Tools and Guides HSOPS Resources Data Collection Tools Educational Materials Toolkits Literature Reviews Fast Fact Sheets Archive of webinars led by subject matter experts