# Presentation: 689542

## Ventilator Associated Pneumonia

- Chesley Richards, MD, MPH
- Deputy Director
- Division of Healthcare Quality Promotion
- National Center for Infectious Disease
- Centers for Disease Control and Prevention

## Healthcare associated pneumonia

**Ventilator associated pneumonia**

- HEALTHCARE ASSOCIATED PNEUMONIA

## Slide 3

## Stone PW, Braccia D, Larson E.  Systematic review of economic analysis of health care-associated infections.  Am J Infect Control 2005;33:501-9.

| Estimated Annual Hospital Cost of HAI 
by Site of Infection 
  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- |
| Major Site of Infection |  | Total infections | Hospital Cost per
Infection 
(2002 $) | Total annual
hospital cost
(in millions $) | Deaths
Per year |
| Surgical Site Infection | 290,485 |  | $25,546 | 7,421 | 13,088 |
| Central line associated-Bloodstream Infection | 248,678 |  | $36,441 | 9,062 | 30,665 |
| Ventilator-associated Pneumonia | 250,205 |  | $9,969 | 2,494 | 35,967 |
| Catheter associated-Urinary Tract Infection | 561,667 |  | $1,006 | 565 | 8,205 |

- Stone PW, Braccia D, Larson E.  Systematic review of economic analysis of health care-associated infections.  *Am J Infect Control* 2005;33:501-9.

- Roberts RR, Scott RD, Cordell R, Solomon SL, Steele L, Kampe LM, Trick WE, Weinstein RA.  The use of economic modeling to determine the hospital costs associated with nosocomial infections.  *Clin Infect Dis* 2003;36:1424-32.

- Klevens RM, Edwards JR, Richards CL, Horan T, Gaynes R, Pollock D, Cardo D.  Estimating healthcare-associated infections in U.S. hospitals, 2002.  *Public Health Reviews* (in press)

## Ventilator associated Pneumonia

**Do prevention interventions exist? **
- CDC/HICPAC, professional organizations
**How effective are prevention interventions? **
- Individual interventions recommended and have effects
- Prevention impact less clear cut than with surgical site infection and bloodstream infection
- Reasonably vary by patient population
- Impact from bundles under study presently (Keystone)
**Can we measure? **
- VAP definitions difficult to apply and clinicians differ on diagnosis
- Low likelihood that we can measure accurately using ICD 9/10 codes, even if present on admission variable in place

## 	Pooled Means and Key Percentiles of the Distribution of Ventilator-associated Pneumonia (VAP) Rates, By Type of ICU, NHSN DA Module, 2006

-  VAP rate**                                               				Percentile
- 	No. of	Ventilator-	Pooled	10%	25%	50%	75%	 90%
-  Type of ICU	Units	Days	Mean			(median)
- Burn	  12	  10,098	  12.3
- Coronary	  48	  35,727	    2.8	0.0	0.0	1.3	4.5	   6.6
- Cardiothoracic	  48	  46,710	    5.7	0.0	1.4	4.0	8.1	  19.4
- Medical	  64	109,277	    3.1	0.0	0.9	2.8	4.6	    7.2
- Medical-Surgical
-    Major teaching	  58	  84,530	    3.6	0.0	1.3	         2.5        5.1          7.3
-    All others	  99	135,546	    2.7	0.0	        0.0        1.6       3.8	    6.2
- Pediatric Med-Surg	  32	  32,936	    2.5	0.0	 0.0	 1.0	2.8	    6.1
- Neurosurgical	  15	  13,799	    7.0
- Surgical	   61	  73,205	    5.2	0.0	1.8	4.1	6.4	  10.0
- Trauma	  19	  32,297	   10.2

**	****Pooled Means and Key Percentiles of the Distribution of Ventilator-associated Pneumonia (VAP) Rates, By Type of ICU, NHSN DA Module, 2006**

- ** _Number of ventilator-associated pneumonia _
-     Number of ventilator-days

- x 1000

- NHSN Report. AJIC 2007;35:290-310

## Issues for Coding

- Terminology
- Controversies regarding diagnosis
- Will ventilator-associated pneumonia be recorded?
- Pneumonia vs pneumonitis?
- Present on admission vs acquired in ICU
- Resources
- HICPAC/CDC Guideline for the prevention of healthcare associated pneumonia
- _[http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5303a1.htm](http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5303a1.htm)_
- ATS/IDSA guideline
**Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia**

## Comparison of terminologyICD-9 Codes vs Surveillance events

- Pneumonia, Lung infection
- Aspiration pneumonia
*Clostridium difficile* colitis
- Urinary tract infection
- Septicemia and Severe infection
- Postop wound infection/Deep wound disruption **without procedure**
- Postop wound infection/deep wound disruption **with procedure**

- Healthcare associated pneumonia
**Ventilator associated pneumonia**
- Clostridium difficile colitis
- Urinary tract infection (UTI)
**Catheter-associated UTI**
- Blood stream infection (BSI)
- Primary BSI
**Central line associated BSI**
- Secondary BSI
**Surgical site infection**

- *Hughes JS, et al. *Heal Care Fin Rev* 2006. These groups map to specific ICD-9 codes

_**CDC Surveillance Events**_

_**Potentially Preventable Complication Groups***_

- ?