Developing a new national approach to surveillance for ventilator-associated events: Executive summary

doi:10.1016/j.ajic.2013.07.001

American Journal of Infection Control

Volume 41, Issue 11, November 2013, Pages 1096-1099

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https://doi.org/10.1016/j.ajic.2013.07.001 Get rights and content

In September 2011, the Centers for Disease Control and Prevention (CDC) convened a Ventilator-Associated Pneumonia (VAP) Surveillance Definition Working Group to organize a formal process for leaders and experts of key stakeholder organizations to discuss the challenges of VAP surveillance definitions and to propose new approaches to VAP surveillance in adult patients (Table 1). The charges to the Working Group were to (1) critically review a draft, streamlined VAP surveillance definition developed for use in adult patients; (2) suggest modifications to enhance the reliability and credibility of the surveillance definition within the critical care and infection prevention communities; and (3) propose a final adult surveillance definition algorithm to be implemented in the CDC’s National Healthcare Safety Network (NHSN), taking into consideration the potential future use of the definition algorithm in public reporting, interfacility comparisons, and pay-for-reporting and pay-for-performance programs.

References (2)

M. Klompas et al.
Multicenter evaluation of a novel surveillance paradigm for complications of mechanical ventilation
PLoS One
(2011)
M. Klompas et al.
Objective surveillance definitions for ventilator-associated pneumonia
Crit Care Med
(2012)

Cited by (14)

Antibiotic Use in Neonatal Intensive Care Units in China: A Multicenter Cohort Study
2021, Journal of Pediatrics
Citation Excerpt :
Sepsis caused by coagulase-negative Staphylococcus (CONS) was diagnosed if all 3 of the following criteria were fulfilled: (1) infection-related clinical manifestations; (2) two positive cultures drawn within 2 days of each other, or 1 positive blood culture together with an abnormal white blood cell count, C-reactive protein level, or procalcitonin level within 2 days; and (3) susceptible antibiotics were given or planned for 5 or more days.16 VAP was diagnosed based on modified criteria from the US Centers for Disease Control and Prevention17 and the published literature.18 UTI was defined as bacterial counts of more than 104 colony-forming units per milliliter from urine obtained by sterile catheter.
To provide national-level antibiotic use data from Chinese neonatal intensive care units to inform future antimicrobial stewardship using a large contemporary cohort of preterm infants in China.
This retrospective cohort study enrolled all infants less than 34^0/7 weeks of gestation admitted to 25 tertiary neonatal intensive care units across China between May 1, 2015, and April 30, 2018. The antibiotic use rate (AUR) was defined as the number of days an infant was prescribed with 1 or more antibiotics divided by the total length of hospital stay.
Among 24 597 eligible infants, 21 736 (88.4%) infants received antibiotics. The median AUR was 441 per 1000 patient-days (IQR, 242-692 per 1000 patient-days). The median duration of each antibiotic course was 9 days (IQR, 6-14 days). Overall, 64.6% infants received broad-spectrum antibiotics, with a median broad-spectrum AUR of 250 per 1000 patient-days (IQR, 0-500 per 1000 patient-days), accounting for 70.7% of all antibiotic use days. Overall, 68.7% of all antibiotic use occurred among infants without infection-related morbidities, with a median duration of 8 days (IQR, 6-13 days) for each course. Only 22.9% episodes of culture-negative sepsis were prescribed with antibiotics for 7 or fewer days, and 34.7% were treated with antibiotics for more than 14 days. For early antibiotic use, the median duration of antibiotic therapy within 7 days after birth was 7 days (IQR, 4-7 days).
A high AUR among infants without infections, prolonged antibiotic durations, and excessive use of broad-spectrum antibiotics were the main problems of antibiotic use in Chinese neonatal intensive care units and should be high-impact focuses for future stewardship interventions.
Influence of changing endotracheal tube cuff management on antibiotic use for ventilator-associated pneumonia in a tertiary intensive care unit
2017, Critical Care and Resuscitation
Background: Routine deflation of the endotracheal tube (ETT) cuff of critically ill patients receiving MV is common in Australia and New Zealand. Literature about ventilator-associated pneumonia (VAP) and antibiotic use rates with different ETT cuff maintenance practices is lacking.
Objective: To determine the impact of a change in ETT cuff maintenance from a minimal leak technique to pressure manometry on the administration of antibiotics for VAP.
Design, setting and participants: A prospective, pre–post observational study conducted in a metropolitan tertiary referral intensive care unit. We analysed data from 178 patients receiving MV for > 48 hours during 13 weeks of minimal leak test ETT cuff technique (pre-intervention, n = 92) or 13 weeks of cuff pressure manometry (postintervention, n = 86), separated by 3 weeks’ “wash-out”.
Main outcome measures: Primary outcome was the number of patients receiving antibiotics for the indication of VAP. Secondary outcomes were incidence of ventilator-associated surveillance events, lengths of stay (LOSs) and mortality.
Results: Antibiotics were administered for VAP in 24 patients (26.1%) in the pre-intervention period compared with 11 post-intervention patients (12.8%). The univariate antibiotic administraion rate per 100 ventilation days was 15.3% (95% CI, 12.6%–18.4%) v 6.8% (95% CI, 4.9%–9.3%), and the incident rate ratio (IRR) was 0.45 (95% CI, 0.31–0.64); P < 0.001). After adjustment for ventilation duration, IRR was 0.55 (95% CI, 0.24–1.27); P = 0.160. The ventilator-associated complication incidence rate was lower in the post-intervention group (11.4% v 16.3%; IRR, 0.70 [95% CI, 0.51–0.95]; P = 0.018). After adjustment for duration of MV, IRR was 0.66 (95% CI, 0.25–1.70); P = 0.387. Antibiotic administration for VAP was associated with increased ICU and hospital LOSs, but not with mortality.
Conclusions: ETT cuff pressure manometry is associated with a reduced rate of antibiotic administration for a diagnosis of VAP compared with a minimal leak test technique.
Validation of the Korean National Healthcare-associated Infections Surveillance System (KONIS): an intensive care unit module report
2017, Journal of Hospital Infection
Citation Excerpt :
The diagnostic criteria for PNEU are complex and often subjective, and interobserver variability in the diagnosis by infection control personnel is high [16]. Due to these challenges, CDC and NHSN implemented surveillance of ventilator-associated events in January 2013 in order to circumvent the subjectivity and inaccuracy of the definition of VAP [17]. However, KONIS still performs surveillance according to old PNEU standards, including VAP, for consistent monitoring data.
National surveillance data should be validated to identify methodological problems within the surveillance programme and data quality issues.
To test the validity of healthcare-associated infection (HAI) rate data from the Korean National Healthcare-associated Infections Surveillance System (KONIS).
Records from intensive care units of 12 (14.8%) of 81 participating hospitals for January–March 2014 were examined. The validation team reviewed 406 medical records of 110 patients with 114 reported HAIs – including 34 urinary tract infections (UTIs), 57 bloodstream infections (BSIs) and 23 cases of pneumonia (PNEU) – and 296 patients with no reported HAIs during one-day visits conducted in August and September 2014. The reviewers' diagnosis of HAI was regarded as the reference standard; in ambiguous cases, the KONIS Steering Committee confirmed the diagnosis of HAI.
Sensitivity values for UTIs, BSIs and PNEU were 85.3%, 74.0% and 66.7%, and specificity values were 98.7%, 99.1% and 98.7%, respectively. Positive predictive values were 85.3%, 94.7% and 78.3%, and negative predictive values were 98.7%, 94.6% and 97.7%, respectively. Sensitivity for PNEU was lower than that for UTIs and BSIs. The hospitals participating in KONIS infrequently reported conditions that were not HAIs. Sensitivity for BSIs was lower in this study than in KONIS validation studies conducted in 2008 and 2010.
KONIS data are generally reliable; however, sensitivity for BSIs exhibited a decrease. This study shows the need for ongoing validation and continuous training of surveillance personnel to maintain the accuracy of surveillance data.
The next frontier of healthcare-associated infection (HAI) surveillance metrics: Beyond device-associated infections
2024, Infection Control and Hospital Epidemiology
The evolution of catheter-associated urinary tract infection (CAUTI): Is it time for more inclusive metrics?
2019, Infection Control and Hospital Epidemiology
Neonatal Outcomes following Culture-negative Late-onset Sepsis among Preterm Infants
2020, Pediatric Infectious Disease Journal

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: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention, the American Association for Respiratory Care, the Association for Professionals in Infection Control and Epidemiology, the Council of State and Territorial Epidemiologists, or the Infectious Diseases Society of America.

: This article is an executive summary of a report from the Centers for Disease Control and Prevention Ventilator-Associated Pneumonia Surveillance Definition Working Group, entitled “Developing a new, national approach to surveillance for ventilator-associated events” and published in Critical Care Medicine. The full report provides a comprehensive description of the Working Group process and outcome.

: This article is being jointly published by American Journal of Infection Control, Infection Control and Hospital Epidemiology, American Journal of Critical Care, The Society of Healthcare Epidemiology of America, Association for Professionals in Infection Control and Epidemiology, American Association for Respiratory Care, American Association of Critical-Care Nurses, American Thoracic Society, American College of Chest Physicians, and the Infectious Diseases Society of America.

: Supported by the Centers for Disease Control and Prevention (CDC).

: Conflicts of interest: Dr Klompas received grant support from the CDC, US Food and Drug Administration, and the Office of the National Co-ordinator for Health IT. Dr Balk received grant support from the CDC and bioMérieux for participation in the EPIC CAP study (CDC) and the Procalcitonin in ICU antibiotic stewardship study (CDC and bioMérieux). Dr Deutschman received grant support from the National Institute of General Medical Sciences. Dr Diekema received grant support from Merck, Cerexa, bioMériuex, PurThread Technologies, and Pfizer. Dr Klompas received support for travel from the CDC, Society of Healthcare Epidemiologists of America, Association for Professionals in Infection Control and Epidemiology, and the Duke University Infection Control Outreach Network. Dr Balk received support for travel from the CDC and Critical Care Societies Collaborative. Dr Burns received support for travel from the American Association of Critical-Care Nurses (AACN; meeting unrelated to this study). Drs Deutschman and Lipsett received support for travel from the Society of Critical Care Medicine. Ms Greene received support for travel from the Department of Health and Human Services/CDC. Ms Greene consults for INC. Dr Hess consulted for Philips Respironics, ResMed, Pari, and Breathe and received honorarium from Covidien and Maquet. Ms Greene lectured for Premier, Advanced Sterilization Products, and APIC. Dr Burns lectured for AACN (annual national conference). Ms Greene presented speeches for Covidien and Maquet. Dr Septimus received an honorarium for a lecture. Dr Klompas received support from the Society of Healthcare Epidemiologists of America for the development of educational presentations. Ms Greene is employed by the Rochester General Hospital. Dr Lipsett has board membership with the Society of Critical Care Medicine. Dr Deutschman received a stipend for his Presidency with the Society of Critical Care Medicine. Dr Deutschman received royalties from Elsevier for the textbook, Evidence-based Practice of Critical Care Medicine. Dr Burns receives royalties from McGraw-Hill for books endorsed by AACN. Ms Greene receives royalties from Up-To-Date, Jones and Bartlett, and McGraw-Hill. The remaining authors disclose no conflicts.

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Brief reportDeveloping a new national approach to surveillance for ventilator-associated events: Executive summary

Multicenter evaluation of a novel surveillance paradigm for complications of mechanical ventilation

PLoS One

Objective surveillance definitions for ventilator-associated pneumonia

Crit Care Med

Brief report
Developing a new national approach to surveillance for ventilator-associated events: Executive summary