- Implement oral hygeine including the use of chlorhexidine
- asdfasd
- Implement electronic surveillance technologies that support antimicrobial stewardship (in late onset cases of VAP bacteria is often multi-drug resistant, and can have great clinical and economic challenges)
- Considering implementation of Electronic Measurement of hand hygiene compliance. See APSS 2A for details.
Metrics
Topic:
Ventilator-associated Pneumonia Rate (VAP)
Rate of patients on a ventilator for more than 48 hours who develop pneumonia while on the ventilator or within 1day of ventilator removal per 1,000 ventilator-days
Outcome Measure Formula:
Numerator: Ventilator-associated Pneumonia infections based on CDC NHSN definitions for all inpatient units\cite{00009}
Denominator: Total number of ventilator-days for all patients on a ventilator in all tracked units
* Rate is typically displayed as VAP/1000 ventilator days
Metric Recommendations:
Indirect Impact:
All patients with conditions that lead to temporary or permanent ventilation
Direct Impact:
All patients that require invasive ventilation.
Lives Spared Harm:
\(Lives=(VAPRate_{baseline}-VAPRate_{measurement})\ X\ Ventilator\ days_{baseline}\)
Notes:
To meet the NHSN definitions, infections must be validated using the hospital acquired infection (HAI) standards.\cite{00010} Infection rates can be stratified by unit types further defined by CDC.\cite{00011} Infections that were present on admission (POA) are not considered HAIs and not counted.
Data Collection:
VAP and ventilator-days can be collected through surveillance (collected at least once per month and reported monthly) or gathered through electronic documentation. Denominators documented electronically must match manual counts (+/- 5%) for a 3 month validation period.
Mortality (will be calculated by the Patient Safety Movement Foundation):
The PSMF, when available, will use the mortality rates associated with Hospital Acquired Conditions targeted in the Partnership for Patient’s grant funded Hospital Engagement Networks (HEN). The program targeted 10 hospital acquired conditions to reduce medical harm and costs of care. “ At the outset of the PfP initiative, HHS agencies contributed their expertise to developing a measurement strategy by which to track national progress in patient safety—both in general and specifically related to the preventable HACs being addressed by the PfP. In conjunction with CMS’s overall leadership of the PfP, AHRQ has helped coordinate development and use of the national Patient Safety Movement Foundation measurement strategy. The results using this national measurement strategy have been referred to as the “ AHRQ National Scorecard,” which provides summary data on the national HAC rate.\cite{00012}