1. 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

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

3. 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

4. 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  

5. 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

6. Possible Ventilator-Associated Pneumonia
VAE Definition Tiers
Possible Ventilator-Associated Pneumonia
(PVAP)
Reference:
CDC NHSN Device-associated Module Ventilator-Associated Event (VAE)

7. 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

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

9. 5-Day VAE Window Period MV Day Min PEEP Min FiO2 1 8 100 2 7 70 3 6 504 5 60 9 80 10

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

11. 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

12. 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

13. 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

14. 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

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

16. 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

17. 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.

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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]

24. 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]

25. 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

26. 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

27. 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

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

29. 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

30. 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

31. 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

32. 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

33. 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

34. 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

35. 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

36. 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

37. 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

38. 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

39. 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

40. 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

41. 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

42. 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

43. 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

44. 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

45. 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.

46. 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

47. 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

48. 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

49. 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

50. Example Patient: Non-APRV Readings

51. Case: APRV/BiLevel/PCV Readings

53. 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

54. 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

55. 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

56. 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

57. 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

58. 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

59. 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

60. 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

61. 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

62. 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

63. 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

64. 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!

65. 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)

66. CDC VAE Calculator

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

68. 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

69. 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

70. 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.

71. If You Already Perform VAE Surveillance
Collect an interesting and/or complicated case for discussion
to with the subject line VAE Surveillance Case

72. 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

73. 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

74. 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

75. 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

76. 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.

77. Mark Your Calendar: Upcoming Content Webinars
For current schedule of upcoming project webinars, visit

78. CUSP 4 MVP – VAP Website
Visit:

79. 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