Candida Species Gram Stain

Ventilatorassociated Events Training

gt;gt; So you're in thehome stretch. You're getting there. This is the next couplehours are going to be on something new and different. Many of you may have heardof the coming changes to ventilator associatedpneumonia surveillance. And I'm glad to be ableto share with you some of the details of that today.

So what I'm going to go throughis really the who, what, when, why, and how of VAE, orventilator associated events, but not necessarilyin that order. So we'll start firstwith some of the why. Why we made this change,what's the background, what's the rational forVAE surveillance instead of for VAP surveillance. Then we'll talk about who'seligible for VAE surveillance

and when it's actuallygoing to be available in the NHSN application. We'll go into what is VAEwith a rather detailed review of the surveillance definitions. And then we're going tospend some time talking about how you should prepare forand conduct the VAE surveillance and some of the key termsthat you'll need to know. In that process, we'll talkabout some of the pearls

and pitfalls that weknow about at this point. We'll go through denominatorsand VAE rate calculations. I'll mention some of the toolswe hope to make available to you soon and finally gothrough some takehome points. So what we'll do, I'll gothrough the presentation. I think we'll have plenty oftime at the end for questions. So might be best tohold off till that point to ask your questions.

So why VAE? So just to put this in context, I'm going to summarize theproblem a little bit for you. This is probablyobvious to many of you, but VAP is obviously animportant complication of mechanical ventilation, butit's not the only bad thing that happens to patients whoare on mechanical ventilators. There are lots of other events,acute respiratory syndrome,

atelectasis, pulmonaryedema, pulmonary embolism. There are lots of other thingsthat can happen in the course of mechanical ventilation. Current, there's no validreliable definition for VAP. Whether it's definitionsor diagnostics we use at the bed side, in alresearch, or in public health. So we really do need moreaccurate diagnostics. But until those are availablewe're still in a position

Ventilatorassociated Events Training

gt;gt; Have done or are doing VAE now. Great, great. How many of you like it as compared to the Inaudible Conversations Okay. All right. I'm not sure how to take that. I saw a lot of up and down hands there. All right.

Well the objectives today are to reviewventilator associated events, the definitions and the surveillance methods, describe importantchanges made to VAE surveillance in 2014, review the use of the VAE calculator anddescribe how to correctly enter VAE into NHN, and HSN, and then accurately apply theVAE algorithm to some example cases. So we will do have some case studies. I have the fortunate place of being the lastpresenter so I expect that you'll all look like this at the end laughter; veryhappy to leave, but I'm going to take it that you're really happy with my presentation.

All right. So let's get started. To begin with, let's just I just would liketo give you a little background and the rational for the change in the definitions. So why the switch from thetraditional pneumonia VAP to VAE? Well, we all know that ventilatorassociated pneumonia is or VAP is an important complicationof mechanical ventilation. But of course, it's also true thatother types of adverse events occur

in critically ill patients whorequire mechanical ventilation. Currently, there's no valid reliabledefinition for VAP so there's no gold standard, whether we're talking about definitionsused in public health and surveillance, al research or even bedsidediagnosis and al care of patients. More accurate diagnostics are needed, butuntil then and when those are available, we still have a need to conductsurveillance for complications in mechanically ventilated patientsand track prevention progress. The traditional new VAP that weare have used over the years,

those definitions includemany subjective elements and they're neither particularlysensitive or specific for VAP. This is particularly challengingin a era in which public reporting of health care associated conditionrates is becoming more common, which you're all very familiar with, and in which comparisons amongfacilities are being made and pay for performance programsare incorporated incorporating some of these conditions.

So we needed a new approach. And the goals of changing the approach to VAPsurveillance were to improve the reliability of the definitions, reduce burden ofsurveillance and enhance the ability to use surveillance data to driveimprovements in patient care and safety. With these issues in mind, we set out tomodify the approach to VAP surveillance to achieve face validity or alcredibility and to improve the reliability of the definitions, and to reducethe burden of surveillance. A working group convened in 2011to revamp the VAP surveillance.

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