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 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

• 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. 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.
• Starting 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
  • Before 2019, 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\\Prep_CCI_TISS.sas
• Part of X:\Julie\SAS_CFE\CC_reports\ChartReport\prepCCChart.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