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| {{DX tag | Infection | Medical Problem| [[:Category: Pneumonia | Pneumonia ]]| PNEUMONIA-VAP (ventilator acq'd) | 3900-Ventilator Associated Pneumonia | No | 0 |'''Critical Care and Medicine''' | Currently Collected | July 1, 2006 | |}} | | {{DX tag | Infection | Medical Problem| [[:Category: Pneumonia | Pneumonia ]]| PNEUMONIA-VAP (ventilator acq'd) | 3900-Ventilator Associated Pneumonia | No | 0 |'''Critical Care and Medicine''' | Currently Collected | July 1, 2006 | |}} |
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| For patients with VAP, [[QA Infection VAP]] may need to be entered.
| | See criteria in [[Pneumonia, ventilator-associated (VAP)]]. |
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| == Follow Criteria Strictly for this one! ==
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| <!--Dr. Robert, Olafson and Garland have advised that for VAP:-->Data collectors should '''follow criteria''' listed below regardless of what a physician writes in chart as a DX. If patient meets criteria VAP below, code as VAP. If patient does not meet all listed criteria, then '''do not code as VAP'''. It may qualify as a [[HAP]] or [[CAP]].
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| If a patient has a [[Acquired Diagnosis / Complication]] of VAP, consider [[#VAP Attribution Transfer Rule]] and code [[QA Infection VAP]] if applicable.
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| === Criteria ===
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| '''IF''' a patient has been on a device to assist respiration (ventilator) either continuously or intermittently through a tracheostomy or endotracheal tube (ETT) for at least '''48 hours before [[#onset of infection]], or new infection.''' Start counting the 48 hours from the time of intubation no matter where this intubation occurs '''before''' or '''during''' an admission to the ICU. <!--per Dr. Olafson.-->
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| '''AND''' if they demonstrate new, worsening or persistent infiltrate on x-ray compatible with pneumonia
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| '''AND if at least one''' of the following criteria is met:
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| * Fever (T > 38) with no other cause
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| * Leukopenia WBC(<4X10(9)) or leukocytosis (>12x 10(9)).
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| * Altered mental status with no other causes in >69 year old.
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| '''AND if at least one''' of the following criteria is met:
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| * New onset of purulent secretions
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| * Change in character of sputum
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| * Increased volume of purulent secretions
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| * Increased suction requirement
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| * New onset of worsening cough
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| * New onset of dypsnea (SOB) or tachypnea (increased Resp Rate)
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| * Increased oxygen or ventilation requirement
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| '''AND if at least one''' of the following criteria is met:
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| * Pathogen (not on the [[#Pathogen exclusion list]]) isolated from sputum in the last 48 hours
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| * Positive blood cultures not related to another infection
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| * Positive pleural fluid or lung tissue culture.
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| ==== Timeframe for reviewing criteria ====
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| The time frame for looking at the VAP criteria is '''within 1-3 days on either side''' of when the positive culture was '''sent'''.
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| == Additional Information==
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| === Onset of infection ===
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| The onset of an infection (pneumonia) can begin prior to the 48 hours on a ventilator. It is important to rule out these patients in the VAP criteria because often we do not have a positive culture sent until after the 48 hrs on a ventilator. If a patient has '''at least 2 symptoms from the list below''' within the first 48 hours on a ventilator, it is not a VAP because the onset of infection is prior to the 48 hour mark.
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| * CXR infiltrates (see [[#CXR implications]]
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| * increased WBC or fever (with no other infective source identified)
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| * starting to have purulent secretions
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| * increased ventilation requirements (for no other reason).
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| ==== CXR implications ====
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| Whenever a positive sputum culture is reported, the data collector should check to see if this is, first of all, a pneumonia and then, to see if it is a [[CAP]], [[HAP]] or VAP. If the CXR does not give evidence of a pneumonia, code
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| it as (old: [[Tracheobronchitis]])/(ICD10: [[Bronchitis, infectious or noninfectious]]/[[Respiratory disorder, postprocedure/postop NOS]]).
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| Infiltrates that are present on admission (ie CAP) need to persist/ worsen and also meet the VAP criteria to code VAP.
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| === VAP Attribution Transfer Rule ===
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| If a patient meets all criteria of a VAP '''after the first 48 hours''' on your ICU, code VAP as a [[Acquired Diagnosis / Complication]] and enter [[QA Infection VAP]] .
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| If a patient meets all criteria of a VAP '''within the first 48 hours''' on your medicine ward of ICU, code VAP as an '''[[Admit Diagnosis]]''', not as a [[Acquired Diagnosis / Complication]]. '''Don't''' enter a [[QA Infection VAP]] for these patients.'''
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| For these patients, inform the sending ICU collector to code the VAP in their [[Acquired Diagnosis / Complication]] and enter the [[QA Infection VAP]].
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| If you code VAP as an [[Admit Diagnosis]] the [[statistician]] will track back to previous units until the one where the VAP was an [[Acquired Diagnosis / Complication]] is found. If no unit has the VAP as an acquired the [[data processor]] will contact you to clarify whether this is correct.
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| ====VAP can't be Medicine complication====
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| VAP cannot be coded as a [[Acquired Diagnosis / Complication]] on a Medicine ward but can be used as an [[Admit Diagnosis]] if patient came from an ICU and requires ongoing treatment for this problem.
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| === Pathogen exclusion list ===
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| The following organisms are excluded because they are common upper respiratory tract commensurable, colonizers or contaminants, and are unusual causes of VAP.
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| * Normal respiratory flora, normal oral flora, mixed respiratory flora, mixed oral flora, altered oral flora or any other similar results indicating isolation of commensal flora of the oral cavity or upper respiratory tract.
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| * Candida Species (specified or unspecified)
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| * [[:Category:Yeast/fungus | Yeast]] (might be a [[HAP]] or [[CAP]])
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| * coagulase-negative staphyllococcus species (specified or unspecified) '''except [[Staphylococcus aureus]] including [[MRSA]]'''
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| * Enterococcus species (specified or unspecified)
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| Patients might be treated for infection with these pathogens, but we should still not code them as VAP. In that case you might be able to code it as a [[HAP]] or [[CAP]].
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| === Recurrent/ongoing pneumonia ===
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| If a patient had any pneumonia (incl [[HAP]] or [[CAP]] previously during the same admission and then develops pneumonia again, meeting the VAP criteria, it is only a VAP if it is a '''new organism''' and has persistent or worsening infiltrates. If it is the same original organism, then the pneumonia has not completely been resolved. Do not code these as a VAP.
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| ===Long term ventilator patients with pneumonia===
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| If a LTV patient is admitted from the community with an pneumonia, '''C'''ommunity '''A'''cquired '''P'''neumonia ([[CAP]]) should be coded as [[Admit Diagnosis]], not VAP, even though it is technically a VAP. <!--as per Dr. Bruce Light 2008, Dr.Garland on May 9,2013 -->
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| We are tracking '''Hospital Acquired VAP's''', not patients who have acquired an pneumonia while on long term home ventilators (LTV) in the community.
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| After 48hrs in the hospital an LTV patient could still become a VAP as an [[Acquired Diagnosis / Complication]].
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| == Data use ==
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| Used in:
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| * [[Quarterly report]]
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| === Reporting of complication when patients move units ===
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| The VAP rates we report are based only on [[Acquired Diagnosis / Complication]] occurring in a unit. If VAP is coded as an [[Admit Diagnosis]], we check if the patient came from one of the ICUs where we collect data, and if so, make sure that the VAP is coded as a [[Acquired Diagnosis / Complication]] and [[QA Infection VAP]] there.
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| If a VAP [[Admit Diagnosis]] doesn't have a corresponding [[Acquired Diagnosis / Complication]] in the previous unit, the [[data processor]] will ask the collector to audit.
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| == See Also == | | == See Also == |
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| * alternate diagnoses [[:Category:Pneumonia]] | | * alternate diagnoses [[:Category:Pneumonia]] |
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| {{discussion}}
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| * [http://www.cdc.gov/nhsn/pdfs/pscmanual/6pscvapcurrent.pdf CDC article for VAP see page 6-2].
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| Searched for the CDC document and found [https://www.cdc.gov/nhsn/pdfs/pscmanual/6pscvapcurrent.pdf this]. The document is from January 2017. Are there any changes to what was used before that we need to integrate into our documentation?
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| [[Category:Pneumonia]] | | [[Category:Pneumonia]] |
| [[Category:QAInfection]] | | [[Category:QAInfection]] |