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    Ventilator-Associated Event (VAE)

    Uploaded by

    eryxsp
    This document provides information for reporting a ventilator-associated event (VAE) in the National Healthcare Safety Network (NHSN). It includes sections to record patient demographic information, event details, and pathogens identified. To be classified as a VAE, a patient must meet the criteria for ventilator-associated condition (VAC), infection-related ventilator-associated complication (IVAC), or possible/probable ventilator-associated pneumonia (PVAP). Specific criteria include increases in daily minimum ventilator settings or signs of infection with antimicrobial treatment. Identified pathogens are also documented along with their antimicrobial resistance patterns.

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    © All Rights Reserved
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    Ventilator-Associated Event (VAE)

    Uploaded by

    eryxsp
    71 views6 pages
    This document provides information for reporting a ventilator-associated event (VAE) in the National Healthcare Safety Network (NHSN). It includes sections to record patient demographic information, event details, and pathogens identified. To be classified as a VAE, a patient must meet the criteria for ventilator-associated condition (VAC), infection-related ventilator-associated complication (IVAC), or possible/probable ventilator-associated pneumonia (PVAP). Specific criteria include increases in daily minimum ventilator settings or signs of infection with antimicrobial treatment. Identified pathogens are also documented along with their antimicrobial resistance patterns.

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    critical care

    Original Title

    57.112_vae_blank

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    This document provides information for reporting a ventilator-associated event (VAE) in the National Healthcare Safety Network (NHSN). It includes sections to record patient demographic information, event details, and pathogens identified. To be classified as a VAE, a patient must meet the criteria for ventilator-associated condition (VAC), infection-related ventilator-associated complication (IVAC), or possible/probable ventilator-associated pneumonia (PVAP). Specific criteria include increases in daily minimum ventilator settings or signs of infection with antimicrobial treatment. Identified pathogens are also documented along with their antimicrobial resistance patterns.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    71 views6 pages

    Ventilator-Associated Event (VAE)

    Uploaded by

    eryxsp
    This document provides information for reporting a ventilator-associated event (VAE) in the National Healthcare Safety Network (NHSN). It includes sections to record patient demographic information, event details, and pathogens identified. To be classified as a VAE, a patient must meet the criteria for ventilator-associated condition (VAC), infection-related ventilator-associated complication (IVAC), or possible/probable ventilator-associated pneumonia (PVAP). Specific criteria include increases in daily minimum ventilator settings or signs of infection with antimicrobial treatment. Identified pathogens are also documented along with their antimicrobial resistance patterns.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 6

    Form Approved

    OMB No. 0920-0666


    Exp. Date: 11/30/2019
    www.cdc.gov/nhsn

    Ventilator-Associated Event (VAE)


    Page 1 of 4 *required for saving **required for completion
    Facility ID: Event #:
    *Patient ID: Social Security #:
    Secondary ID: Medicare #:
    Patient Name, Last: First: Middle:
    *Gender: F M Other *Date of Birth:
    Ethnicity (Specify): Race (Specify):
    *Event Type: VAE *Date of Event:
    Post-procedure VAE: Yes No Date of Procedure:
    NHSN Procedure Code: ICD-10-PCS or CPT Procedure Code:
    *MDRO Infection Surveillance:
    Yes, this infections pathogen & location are in-plan for Infection Surveillance in the MDRO/CDI Module
    No, this infections pathogen & location are not in-plan for Infection Surveillance in the MDRO/CDI Module
    *Date Admitted to Facility: *Location:
    * Location of Mechanical Ventilation Initiation: ______________ *Date Initiated: __ /__ /_____ *APRV: Yes No
    Event Details
    *Specific Event: VAC IVAC PVAP
    *Specify Criteria Used:

    STEP 1: VAC (1 REQUIRED)


    Daily min FiO2 increase 0.20 (20 points) for 2 days OR Daily min PEEP increase 3 cm H2O for 2 days

    after 2+ days of stable or decreasing daily minimum values.

    STEP 2: IVAC
    Temperature > 38C or < 36 OR White blood cell count 12,000 or 4,000 cells/mm3
    AND
    A new antimicrobial agent(s) is started, and is continued for 4 days

    STEP 3: PVAP
    Criterion #1: Positive culture of one of the following specimens, meeting quantitative or semi-quantitative thresholds as
    outlined in protocol, without requirement for purulent respiratory secretions:
    Endotracheal aspirate Lung tissue

    Bronchoalveolar lavage Protected specimen brush

    OR

    Criterion #2: Purulent respiratory secretions (defined in the protocol) plus organism(s) identified from one of the
    following specimens:

    Sputum Lung tissue


    Endotracheal aspirate Protected specimen brush
    Bronchoalveolar lavage
    OR
    Criterion #3: One of the following positive tests (as outlined in the protocol):
    Organism(s) identified from
    Diagnostic test for Legionella species
    pleural fluid
    Lung histopathology Diagnostic test for selected viral pathogens

    collected after 2 days of mechanical ventilation and within +/- 2 days of onset of increase in FiO 2 or PEEP.
    *Secondary Bloodstream Infection: Yes No
    **Died: Yes No VAE Contributed to Death: Yes No
    Discharge Date: *Pathogens Identified: Yes No *If Yes, specify on pages 2-3
    Assurance of Confidentiality: The voluntarily provided information obtained in this surveillance system that would permit identification of any individual or institution is collected with a guarantee that it will
    be held in strict confidence, will be used only for the purposes stated, and will not otherwise be disclosed or released without the consent of the individual, or the institution in accordance with Sections 304,
    306 and 308(d) of the Public Health Service Act (42 USC 242b, 242k, and 242m(d)).
    Public reporting burden of this collection of information is estimated to average 25 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and
    maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information
    Form Approved
    OMB No. 0920-0666
    Exp. Date: 11/30/2019
    www.cdc.gov/nhsn
    unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden
    to CDC, Reports Clearance Officer, 1600 Clifton Rd., MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-0666).
    CDC 57.112 (Front), Rev 5 v8.6
    Form Approved
    OMB No. 0920-0666
    Exp. Date: 11/30/2019
    www.cdc.gov/nhsn
    Ventilator-Associated Event (VAE)
    Page 2 of 4
    Pathogen
    #
    Gram-positive Organisms

    _______
    Staphylococcus coagulase-negative VANC
    SIRN
    (specify species if available):
    ____________
    ____Enterococcus faecium DAPTO GENTHL LNZ VANC
    _______ S NS N SRN SIRN SIRN
    ____Enterococcus faecalis

    ____Enterococcus spp.
    (Only those not identified to the
    species level)

    _______
    Staphylococcus CIPRO/LEVO/MOXI CLIND DAPTO DOXY/MINO ERYTH GENT LNZ
    SIRN SIRN S NS N SIRN SIRN SIRN SRN
    aureus
    OX/CEFOX/METH RIF TETRA TIG TMZ VANC
    SIRN SIRN SIRN S NS N SIRN SIRN
    Pathogen
    #
    Gram-negative Organisms

    Acinetobacter AMK AMPSUL AZT CEFEP CEFTAZ CIPRO/LEVO COL/PB


    _______ SIRN SIRN SIRN SIRN SIRN SIRN SIRN
    (specify species)
    ____________ GENT IMI MERO/DORI PIP/PIPTAZ TETRA/DOXY/MINO
    SIRN SIRN SIRN SIRN SIRN

    TMZ TOBRA
    SIRN SIRN

    Escherichia coli AMK AMP AMPSUL/AMXCLV AZT CEFAZ CEFEP CEFOT/CEFTRX


    _______ SIRN SIRN SIRN SIRN SIRN S I/S-DD R N SIRN

    CEFTAZ CEFUR CEFOX/CETET CIPRO/LEVO/MOXI COL/PB


    SIRN SIRN SIRN SIRN SRN

    ERTA GENT IMI MERO/DORI PIPTAZ TETRA/DOXY/MINO


    SIRN SIRN SIRN SIRN SIRN SIRN

    TIG TMZ TOBRA


    SIRN SIRN SIRN

    _______
    Enterobacter AMK AMP AMPSUL/AMXCLV AZT CEFAZ CEFEP CEFOT/CEFTRX
    (specify species) SIRN SIRN SIRN SIRN SIRN S I/S-DD R N SIRN
    ____________ CEFTAZ CEFUR CEFOX/CETET CIPRO/LEVO/MOXI COL/PB
    SIRN SIRN SIRN SIRN SRN

    ERTA GENT IMI MERO/DORI PIPTAZ TETRA/DOXY/MINO


    SIRN SIRN SIRN SIRN SIRN SIRN

    TIG TMZ TOBRA


    SIRN SIRN SIRN

    ____Klebsiella AMK AMP AMPSUL/AMXCLV AZT CEFAZ CEFEP CEFOT/CEFTRX


    _______ SIRN SIRN SIRN SIRN SIRN S I/S-DD R N SIRN
    pneumonia
    CEFTAZ CEFUR CEFOX/CETET CIPRO/LEVO/MOXI COL/PB
    ____Klebsiella SIRN SIRN SIRN SIRN SRN
    oxytoca ERTA GENT IMI MERO/DORI PIPTAZ TETRA/DOXY/MINO
    SIRN SIRN SIRN SIRN SIRN SIRN

    TIG TMZ TOBRA


    SIRN SIRN SIRN

    CDC 57.112 (Back), Rev 5, v8.6


    Form Approved
    OMB No. 0920-0666
    Exp. Date: 11/30/2019
    www.cdc.gov/nhsn
    Ventilator-Associated Event (VAE)
    Page 3 of 4
    Pathogen
    #
    Gram-negative Organisms (continued)

    Pseudomonas AMK AZT CEFEP CEFTAZ CIPRO/LEVO COL/PB GENT


    _______ SIRN SIRN SIRN SIRN SIRN SIRN SIRN
    aeruginosa
    IMI MERO/DORI PIP/PIPTAZ TOBRA
    SIRN SIRN SIRN SIRN

    Pathogen
    #
    Fungal Organisms
    Candida
    (specify species if ANID CASPO FLUCO FLUCY ITRA MICA VORI
    _______ available) SIRN S NS N S S-DD R N SIRN S S-DD R N S NS N S S-DD R N
    ____________
    Pathogen
    #
    Other Organisms
    Organism 1 _______ _______ ______ _______ _______ ______ ______ ______ ______
    _______ (specify) Drug 1 Drug 2 Drug 3 Drug 4 Drug 5 Drug 6 Drug 7 Drug 8 Drug 9
    ____________ SIRN SIRN SIRN SIRN SIRN SIRN SIRN SIRN SIRN

    Organism 1 _______ _______ ______ _______ _______ ______ ______ ______ ______
    _______ (specify) Drug 1 Drug 2 Drug 3 Drug 4 Drug 5 Drug 6 Drug 7 Drug 8 Drug 9
    ____________ SIRN SIRN SIRN SIRN SIRN SIRN SIRN SIRN SIRN

    Organism 1 _______ _______ ______ _______ _______ ______ ______ ______ ______
    _______ (specify) Drug 1 Drug 2 Drug 3 Drug 4 Drug 5 Drug 6 Drug 7 Drug 8 Drug 9
    ____________ SIRN SIRN SIRN SIRN SIRN SIRN SIRN SIRN SIRN

    Result Codes
    S = Susceptible I = Intermediate R = Resistant NS = Non-susceptible S-DD = Susceptible-dose dependent N = Not tested

    GENTHL results: S = Susceptible/Synergistic and R = Resistant/Not Synergistic

    Clinical breakpoints have not been set by FDA or CLSI, Sensitive and Resistant designations should be based upon
    epidemiological cutoffs of Sensitive MIC 2 and Resistant MIC 4

    Drug Codes:
    AMK = amikacin CEFTRX = ceftriaxone FLUCY = flucytosine OX = oxacillin
    AMP = ampicillin CEFUR= cefuroxime GENT = gentamicin PB = polymyxin B
    GENTHL = gentamicin high level
    AMPSUL = ampicillin/sulbactam CETET= cefotetan PIP = piperacillin
    test
    AMXCLV = amoxicillin/clavulanic acid CIPRO = ciprofloxacin IMI = imipenem PIPTAZ = piperacillin/tazobactam
    ANID = anidulafungin CLIND = clindamycin ITRA = itraconazole RIF = rifampin
    AZT = aztreonam COL = colistin LEVO = levofloxacin TETRA = tetracycline
    CASPO = caspofungin DAPTO = daptomycin LNZ = linezolid TIG = tigecycline
    TMZ =
    CEFAZ= cefazolin DORI = doripenem MERO = meropenem
    trimethoprim/sulfamethoxazole
    CEFEP = cefepime DOXY = doxycycline METH = methicillin TOBRA = tobramycin
    CEFOT = cefotaxime ERTA = ertapenem MICA = micafungin VANC = vancomycin
    CEFOX= cefoxitin ERYTH = erythromycin MINO = minocycline VORI = voriconazole
    CEFTAZ = ceftazidime FLUCO = fluconazole MOXI = moxifloxacin

    CDC 57.112 (Back), Rev 5, v8.6


    Form Approved
    OMB No. 0920-0666
    Exp. Date: 11/30/2019
    www.cdc.gov/nhsn
    Ventilator-Associated Event (VAE)
    Page 4 of 4
    Custom Fields
    Label Label
    ______________________ ____/____/____ ______________________ ____/____/_____
    _
    _______________________ _____________ ______________________ ______________
    _
    _______________________ _____________ ______________________ ______________
    _
    ________________________ ______________ ______________________ ______________
    _ _
    ________________________ ______________ ______________________ ______________
    _ _
    ________________________ ______________ ______________________ ______________
    _ _
    ________________________ ______________ ______________________ ______________
    _ _
    Comments

    CDC 57.112 (Back), Rev 5, v8.6


    Form Approved
    OMB No. 0920-0666
    Exp. Date: 11/30/2019
    www.cdc.gov/nhsn

    CDC 57.112 (Back), Rev 5, v8.6

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