VAP - Ventilator Associated Pneumonia

Legacy Content

This page is about the pre-ICD10 diagnosis coding schema. See the ICD10 Diagnosis List, or the following for similar diagnoses in ICD10:Pneumonia, ventilator-associated (VAP)

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Category/Organ System:	Category: Infection (old)
Type:	[[:Category: Medical Problem (old)]][[Category: Medical Problem (old)]]
Main Diagnosis:	Pneumonia
Sub Diagnosis:	PNEUMONIA-VAP (ventilator acq'd)
Diagnosis Code:	3900-Ventilator Associated Pneumonia
Comorbid Diagnosis:	No
Charlson Comorbid coding (pre ICD10):	0
Program:	Critical Care and Medicine
Status:	Currently Collected
Start Date:	July 1, 2006

• See: QA_Infection_Audit#A._VAP for Collection Instructions

• see Quarterly report

• For other pneumonia we are also collecting see:

Pneumonia Etiology not clear (code 36-00)

CAP Community acquired pneumonia

HAP Hospital acquired pneumonia

When to code VAP

Ventilator Associated Pneumonia (VAP) Criteria:

• NOTE: We are tracking HOSPITAL ACQUIRED VAP's & not patient's who have acquired an pneumonia while on long term home ventilators (LTV) in the community. If a LTV patient is admitted from the community with an pneumonia, they are to coded as Community Acquired Pneumonia (CAP). (as per Dr. Bruce Light).TOstryzniuk 17:38, 15 December 2008 (CST)

If a patient has been on a device to assist respiration (ventilator) continuously through a tracheostomy or endotracheal tube (ETT) for at least 48 hours in a unit before onset of infection, or new infection.

and if they demonstrate new, worsening or persistent infiltrate on x-ray compatible with pneumonia

and if at least one of the following criteria is met:

• Fever (T > 38) with no other cause
• Leukopenia WBC(<4X10(9)) or leukocytosis (>12x 10(9)).
• Altered mental status with no other causes in >69 year old.

and if at least one of the following criteria is met:

• New onset of purulent secretions
• Change in character of sputum
• Increased volume of purulent secretions
• Increased suction requirement
• New onset of worsening cough
• New onset of dypsnea (SOB) or tachypnea (increased Resp Rate)
• Increased oxygen or ventilation requirement

and if at least one of the following criteria is met:

• Pathogen isolated from sputum in the last 48 hours
• Positive blood cultures not related to another infection
• Positive pleural fluid culture.

Clarification as of October 5, 2011 meeting

• Data collectors use this criteria only when they code VAP's. The doctors may or may not be calling it a VAP but this has no bearing on the way we collect the information. Be sure to adhere strictly to the above criteria only.

Clarification of coding VAP when moving patients between units in the city

When coding VAP's they are coded as "complication" when they occur at a specific center. However, when these patients are transferred to other centers and the VAP is still being treated, then the VAP should be coded as part of the admitting diagnosis. When Julie looks at VAP rates in ICU's she only looks for the VAP code in the complication slots. The site where the patient had the VAP occur in complication codes is the site that is given the credit. A unit where a patient has a VAP in the admitting diagnosis is not included in stats for VAP rates. When a VAP appears in the admission code slots, Julie tracks back to where patient came from and makes sure that the ICU prior to the transfer, coded the VAP in their complications, if not, you will get a query to audit the diagnosis.

VAP acquired in ICU then transferred to Ward

If a patient has a VAP in the ICU that is not yet resolved and is still being treated when the patient is transferred to a ward, the ward should code the VAP in the admit diagnosis. If VAP was resolved in the ICU before the patient was sent to the ward, then don't code it.

Template:Discussion Should they really only code it if it is being treated? What about a DC treat? Ttenbergen 16:44, 7 July 2011 (CDT)

• If the patient is admitted to the ward and being treated actively for the VAP, I code it as such. If they have discontinued treatment but were iniatially treated for it on the ward I would still capture it.--CMarks 12:58, 5 August 2011 (CDT)

Template:Discussion Collectors used to collect this as a HAP. Would it be correct to add that they should NOT collect it as a HAP Ttenbergen 16:44, 7 July 2011 (CDT)?

• • The criteria for a HAP is different from a VAP. I have coded them as such.--CMarks 12:58, 5 August 2011 (CDT)

Arrived w community acquired pneumonia and develops VAP

If a patient is admitted with a CAP and then develops a VAP (e.g. grows staph aureus and they now diagnose VAP and change antibiotics, the pneumonia is still active when patient discharged to medicine ward), then code it as a VAP.

Reporting of VAP when patients move units

When the Statistician links admissions in the database between ICU'a & medicine wards in the city, those patient that have VAP in admitting diagnosis are excluded from complication statistics. The patient encounter that had the VAP coded in the acquired diagnosis slot is the unit that is given credit for the complication occuring in that unit. TOstryzniuk 14:10, 16 June 2008 (CDT)