VAP - Ventilator Associated Pneumonia

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.Trish Ostryzniuk 17:13, 2013 May 6 (EDT)

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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edit dx infobox
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 Collection instructions for the QA_Infection_Audit

Ventilator Associated Pneumonia (VAP) Criteria

• 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. (Sometimes it is an upper respiratory tract infection (URTI) and not a pneumonia at all). The time frame for looking at the VAP criteria listed below is within a day or two of when the positive culture was sent. --LKolesar 15:29, 2013 April 22 (EDT)

Code the diagnosis VAP only if these criteria are met. 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 these criteria .:

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 in a unit before onset of infection, or new infection.

• If a patient had a CAP or HAP 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. If it is the same original organism, then the CAP or HAP has not completely been resolved. Do not code these as a VAP.

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.

VAP vs aspiration prior to admission

If there is a possibility of aspiration prior to hospitalization, how do we know if this is not a VAP when the positive cultures come back 2-3 days later?

• Answer from Dr. Olafson: Usually pts who have aspiration pneumonia will have some evidence of infiltrates on CXR right away. They will often have an increased WBC or fever and even may begin to have purulent secretions within the first day. If a pt who has possibly aspirated prior to arrival to hospital then look for these signs. If the pt has evidence of any of these signs within the first day or two, then it is an aspiration pneumonia (CAP), not a VAP.

Early VAPs are often related to aspiration at the time of intubations so these need to be coded as VAPs when they meet the criteria.

Time window for VAP

You need to look for the WBC, fever, sputum and CXR signs either the day before, day of or day after the positive culture.

coding VAP when moving patients between units in the city

When a patient with VAP is moved to your unit, code it as an "admit diagnosis". 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" is found. If no unit has the VAP as an acquired the data processor will contact you to clarify whether this is correct.

• which collector would be contacted, the last or the first? Ttenbergen 13:03, 2012 October 4 (CDT)
• if this is something we do all the time should it be accomodated in Transfer Tracker.mdb? Ttenbergen 13:03, 2012 October 4 (CDT) Template:Potential Change

Yeast in Sputum & VAP

Sputum +ve yeast: Do not code as a yeast associated VAP'. This is considered to be colonization unless treated specifically.Not a VAP if yeast also at other sites; so basically don’t ever code as a cause of VAP or pneumonia. As a general rule, yeast does not cause pneumonia at all except in immunosuppressed patients in which case they have disseminated infection with yeast at many sites (ie multiple sites other than lung will be positive).-Posted by Trish Ostryzniuk 12:09, 2012 October 4 (CDT), on behalf of Dr. Kumar and reviewed by Dr. Olafson.

VAP acquired in ICU then transferred to Ward

If a patient has a VAP in the ICU that is not yet resolved 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.

Arrived with community acquired pneumonia and develops VAP

If a patient is admitted with a CAP and then develops what looks like a VAP it is only a VAP if it is a different organism than the CAP organism.

Long term ventilator patients with pneumonia

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)

This was confirmed again by Dr.Garland on May 9,2013.

Alternative diagnoses

see Category:Pneumonia

Data use

Used in:

• Quarterly report

Reporting of complication 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 occurring in that unit.

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.