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Surveillance of Ventilator Associated Pneumonia (VAP) by the New National Health Safety Network (NHSN) Guidelines FREE TO VIEW

Abhash Joshi; James Walsh
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Guthrie Health Care/Robert Packer Hospital, Sayre, PA

Chest. 2014;146(4_MeetingAbstracts):524A. doi:10.1378/chest.1992261
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SESSION TITLE: Quality & Clinical Improvement (Poster Discussion)

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: The purpose of the study was to compare the inconsistencies in the diagnosis of Ventilator Associated Pneumonia using the old clinical guidelines as compared to the new standardized NHSN surveillance guidelines for public reporting. Quality Improvement Project to improve awareness on prevention and the new surveillance guidelines for VAP.

METHODS: Chart review was done retrospectively on the already confirmed cases of VAP according to the old clinical guidelines from January 2010 to May 2012. We had 11 new cases of VAP diagnosed during this period according to the clinical guidelines. The VAP calculator provided by the NHSN along with our own calculator developed in Microsoft Excel was used to help diagnose and classify the various Ventilator Associated Events (VAE).

RESULTS: Out of 11 confirmed cases of VAP from January 2010 to May 2012, 4 cases turned out to have No Ventilator Associated Condition( VAC), 2 cases met the criteria for Ventilator Associated Condition(VAC), 2 were Infection Related Ventilator Associated condition(IVAC), 1 of possible Ventilator Associated Pneumonia(VAP) and 2 were probable Ventilator Associated Pneumonia(VAP).

CONCLUSIONS: This is a comparison study of the various old clinical guidelines that incorporated chest X- Ray and clinical symptoms with the new NHSN surveillance guidelines for VAP. It shows that some of the cases that might have been classified as VAP according to the previous clinical guidelines did not meet criteria for any VAE according to the NHSN guidelines. There was lot of variability in the diagnosis and public reporting of VAE/VAP events with the older guidelines. The older clinical guidelines which was used to help with diagnosis as well as public reporting was failing on its consistency in purposes of public reporting, inter-facility comparisons, and pay-for-reporting and pay-for-performance programs according to NHSN.

CLINICAL IMPLICATIONS: The NHSN surveillance guidelines for VAE will add consistency to the definition of various VAE and will be more reliable in public reporting. This ultimately will give us a better picture of the success or failure of various strategies in use for VAP prevention. The newer algorithmic guidelines can also be easily incorporated into electronic health record system to prompt event detection, and identify events that are clinically important such as ICU and hospital length of stay and mortality.

DISCLOSURE: The following authors have nothing to disclose: Abhash Joshi, James Walsh

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