Background
Methods
Settings
Design and population
HOSPITAL-ACQUIRED PNEUMONIA (HAP) | ||||
Radiology | Microbiology | Laboratory | Vital signs | Pharmacy |
- ≥ 1 chest imaging test results with pneumonia-related findings (e.g., air-space disease, consolidation, infiltrate, focal opacification). | - Gram stain of sputum or pleural fluid sample with ≥ 25 neutrophils and ≤ 10 squamous epithelial cells per low power field x100. | - WBC ≤ 4000/mm3 or; - WBC ≥ 12,000/mm3 or; - Abnormal trends in WBC for ≥ 48 h. | - Temperature > 38°C or abnormal trends in temperature ≥ 48 h; - RR > 25 breaths/min.; - O2 desaturations < 94%; - HR > 100 beats/min | - A HAP-related antimicrobial agenta is started, and is continued for ≥ 4 days. |
VENTILATOR-ASSOCIATED EVENT (VAE) | ||||
Ventilator settings | Microbiology | Laboratory | Vital signs | Pharmacy |
- ↑ daily min. FiO2 of ≥ 0.2 point or ↑ daily min. PEEP values of ≥ 3cmH2O sustained for ≥ 48 h, as compared to a baseline period of ≥ 48 h of stability or improvements on the ventilator in terms of FiO2 or PEEP values. | - Culture meeting one of the following thresholds and growing a recognized pathogenb: a) EA: ≥ 105 CFU/ml b) BAL: ≥ 104 CFU/ml c) LT: ≥ 104 CFU/g; d) PSB: ≥ 103 CFU/ml e) Gram stain of resp. secretions (see: HAP) | - WBC ≤ 4000/mm3 or; - WBC ≥ 12,000/mm3 or; - Abnormal trends in WBC for ≥ 48 h. | - Temperature > 38°C or <36°C for 48 h, or abnormal trends in temperature ≥ 48 h. | - A new antimicrobial agenta is started, and is continued for ≥ 4 days. |
ICU Database | Radiology | |||
- Presence of an endotracheal tube and of mechanical ventilation | - For descriptive purposes, whether chest imaging test results provide evidence of pneumonia, pulmonary edema, atelectasis or ARDS. | |||
CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTION (CLABSI) | ||||
Radiology | Microbiology | Laboratory | Vital signs | Pharmacy |
- Chest imaging test results with evidence of at least one central line in place. | - Recognized pathogen(s)b identified from ≥ 1 blood specimens by a culture based micro-biologic testing method, with the organism identified in blood not related to an infection at another site. | - WBC ≤ 4000/mm3 or; - WBC ≥ 12,000/mm3 or; - Abnormal trends in WBC for ≥ 48 h. | - Temperature > 38°C or; <36°C for ≥ 48 h or; - Abnormal trends in temperatures for ≥ 48 h; -hypotension with systolic pressure ≤ 90 mmHg. | - A CLABSI-related antimicrobial agenta is started, and is continued for ≥ 4 days. |