Kathleen M McMullen1, Anthony F Boyer2, Noah Schoenberg2, Hilary M Babcock3, Scott T Micek4, Marin H Kollef2. 1. Hospital Epidemiology and Infection Prevention Department, Barnes-Jewish Hospital, St Louis, MO. Electronic address: kmm2742@bjc.org. 2. Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St Louis, MO. 3. Division of Infectious Diseases, Washington University School of Medicine, St Louis, MO. 4. St Louis College of Pharmacy, St Louis, MO.
Abstract
BACKGROUND: The National Healthcare Safety Network (NHSN) has recently supported efforts to shift surveillance away from ventilator-associated pneumonia to ventilator-associated events (VAEs) to decrease subjectivity in surveillance and minimize concerns over clinical correlation. The goals of this study were to compare the results of an automated surveillance strategy using the new VAE definition with a prospectively performed clinical application of the definition. METHODS: All patients ventilated for ≥2 days in a medical and surgical intensive care unit were evaluated by 2 methods: retrospective surveillance using an automated algorithm combined with manual chart review after the NHSN's VAE methodology and prospective surveillance by pulmonary physicians in collaboration with the clinical team administering care to the patient at the bedside. RESULTS: Overall, a similar number of events were called by each method (69 vs 67). Of the 1,209 patients, 56 were determined to have VAEs by both methods (κ = .81, P = .04). There were 24 patients considered to be a VAE by only 1 of the methods. Most discrepancies were the result of clinical disagreement with the NHSN's VAE methodology. CONCLUSIONS: There was good agreement between the study teams. Awareness of the limitations of the surveillance definition for VAE can help infection prevention personnel in discussions with critical care partners about optimal use of these data.
BACKGROUND: The National Healthcare Safety Network (NHSN) has recently supported efforts to shift surveillance away from ventilator-associated pneumonia to ventilator-associated events (VAEs) to decrease subjectivity in surveillance and minimize concerns over clinical correlation. The goals of this study were to compare the results of an automated surveillance strategy using the new VAE definition with a prospectively performed clinical application of the definition. METHODS: All patients ventilated for ≥2 days in a medical and surgical intensive care unit were evaluated by 2 methods: retrospective surveillance using an automated algorithm combined with manual chart review after the NHSN's VAE methodology and prospective surveillance by pulmonary physicians in collaboration with the clinical team administering care to the patient at the bedside. RESULTS: Overall, a similar number of events were called by each method (69 vs 67). Of the 1,209 patients, 56 were determined to have VAEs by both methods (κ = .81, P = .04). There were 24 patients considered to be a VAE by only 1 of the methods. Most discrepancies were the result of clinical disagreement with the NHSN's VAE methodology. CONCLUSIONS: There was good agreement between the study teams. Awareness of the limitations of the surveillance definition for VAE can help infection prevention personnel in discussions with critical care partners about optimal use of these data.
Authors: Shelley S Magill; Qunna Li; Cindy Gross; Margaret Dudeck; Katherine Allen-Bridson; Jonathan R Edwards Journal: Crit Care Med Date: 2016-12 Impact factor: 7.598