Ventilator Associated Pneumonia Rate

Ventilator Associated Pneumonia (VAP) Rate is the number of cases of (old:VAP - Ventilator Associated Pneumonia, new: Pneumonia, ventilator-associated (VAP)) per 1000 invasive ventilator days.

Indicators
Indicator:	Ventilator Associated Pneumonia (VAP) Rate
Created/Raw:	Created
Program:	Critical Care
Start Date:	Jan 1 2013
End Date:
Reports:	Critical Care Program Quality Indicator Report, Directors Quarterly and Annual Report (Critical Care), STB ICUs VAP Rate, CLIBSI Rate Summary, WRHA ICU Hospital-Acquired Conditions

• Cargo

• SMW:

• Categories

• Default form:

Used in aggregate form as "per location" and/or "per timeframe", e.g. by month/quarter/year x Ward/Unit x Hospital

QI domain

• Safe

Reported as

Number of cases of Pneumonia, ventilator-associated (VAP) per 1000 Ventilator-days

Significance

• VAP is a device-associated infection, the device being the artificial airway-ventilator-circuit system. VAP is associated with worse patient outcomes and higher costs.
• Factors affecting the incidence of VAP include those from patients (severity of illness, comorbidities, etc.) and processes of care.
• VAP rate is a measure of the incidence of VAP.

Sampling Plan / Procedure

Inclusion Criteria

• 100% sampling for all patients on invasive mechanical ventilation as indicated by presence of T48 T - Invasive mechanical ventilation at 2300 hrs (TISS Item)
• 100% sampling for all cases with VAP incidence following the criteria listed in VAP - Ventilator Associated Pneumonia

Exclusion Criteria

Exclude non-invasive ventilation.

Frequency

• Recording the date the VAP occurred.
• Daily recording of dates of patient being on invasive mechanical ventilation at 2300 HR
• Total number of ventilated days are calculated and reported on a monthly, quarterly or yearly basis based on the daily data.
• Time Reference is calendar month, quarter or year.

Definition and Derivation

Numerator

Num = Total VAP Cases in a calendar period

Denominator

Denom =Total Vent Days on the same period as the numerator

Formula

VAP Rate = Num / Denom * 1000

Example

• Time Reference: Calendar Dates from Jan 1, 2017 to March 31, 2017
• Total VAP cases = 5
• Total days patients are on invasive ventilator at 2300 HR = 688
• VAP Rate per 1000 days = (5 / 688) * 1000 = 7.3%

Data Sources

• Ventilator Days at 23 HR
  • Starting Oct 1, 2020, the above TISS28 element is collected as part of the CCI Collection but not at 2300HR , before this they were part of TISS28 Data.mdb. The presence of Vent at 2300 hour is imputed or assigned by inference using this method - if patient is present at 23HR and the TISS28 element T18 - Invasive Mechanical Ventilation (TISS Item) is marked, then the patient is assumed to have ventilator at 2300 hour.
  • Jan 2013 to Sept 2020 - Daily data for Invasive are taken on TISS28 element T - Invasive mechanical ventilation at 2300 hrs (TISS Item). The TISS form is being marked daily by ICU bed side nurses and quality checked by the Database Data Collectors.
  • June 1988 to Dec 2012 - Daily data for Invasive Mech Vent are taken on TISS76-Form elements # 29 or 30 which are saved at

S:\MED\MED_CCMED\CCMDB\Legacy_TMS_Data\Legacy_TMS_Data.mdb

• VAP
  • Starting Jan 2019, VAP is part of the ICD10 collection with code J95.88 Pneumonia, ventilator-associated (VAP) under the Acquired Diagnosis / Complication. The date is the Dx Date of the VAP - Ventilator Associated Pneumonia diagnosis
  • Aug 2009 to Dec 2018, the dates when VAP occurred were taken from the Tmp project QA Infection.

SAS Program

• The SAS program to get the VAP is X:\Julie\SAS_CFE\CFE_macros\Pre_ICD10_AcqDx.sas
• The SAS program to get the Ventilator Days is X:\Julie\SAS_CFE\CFE_macros\Read_TISS76_TISS28_TISSinCCI.sas
  • macro %tisscci23hr shows the generation of Vent present at 23 HR
• The SAS program to get the VAP rate is X:\Julie\SAS_CFE\CFE_macros\VAPCLICAM.sas

Report Users

• Critical Care Directors, Critical Care Unit Managers and WRHA Outcome Improvement Team Committee
• St Boniface Cardiac Sciences Program (STB site only)
• HSC Infection Prevention & Control (HSC site only)
• WRHA Infection Prevention & Control