974 Description of Specific Event Criteria Used to Report Ventilator-Associated Pneumonia to the National Healthcare Safety Network and Implications for a Simplified Definition

Sunday, March 21, 2010
Grand Hall (Hyatt Regency Atlanta)
Margaret A. Dudeck, MPH, CPH , Centers for Disease Control and Prevention, Atlanta, GA
Shelley S. Magill, MD, PhD , Centers for Disease Control and Prevention, Atlanta, GA
Jonathan R. Edwards, MStat , Centers for Disease Control and Prevention, Atlanta, GA
Teresa C. Horan, MPH , Centers for Disease Control and Prevention, Atlanta, GA
Background: Ventilator-associated pneumonia (VAP) is a significant cause of morbidity and mortality in hospitalized patients. Facilities reporting healthcare-associated infections to the National Healthcare Safety Network (NHSN) conduct VAP surveillance using CDC pneumonia (PNEU) definition criteria for 3 specific events: clinical pneumonia (PNU1), pneumonia with laboratory evidence (PNU2), and pneumonia in immunocompromised patients (PNU3). The CDC PNEU definition also includes alternate age-specific criteria for infants, children, or adults ≥ 70 years. In 09/2008, CDC began collecting information on specific event criteria (i.e., signs/symptoms, laboratory, x-ray findings) used to identify VAPs reported to NHSN.
Objective: To describe event-level characteristics of VAP reported to NHSN and determine how these characteristics might inform development of simplified PNEU surveillance definitions.
Methods: We included VAP data reported to NHSN with an event date from 09/2008-09/2009. We calculated descriptive statistics on the types of facilities reporting these data and the patient care locations to which VAP events were attributed. We calculated the distribution of the 3 specific VAP events and the distribution of criteria used in defining these events as reported to NHSN.
Results: A total of 3820 VAPs were reported; 3219 (85%) were from teaching facilities, and 3220 (92%) were from intensive care units. 465 (12%) were reported in immunocompromised patients. Sixty percent of VAP events were PNU1, 39% PNU2, and 1% PNU3. Of the 209 PNU1 reported in infants, 54 (26%) met only the alternate criteria, representing 1.4% of VAPs. Of the 38 PNU1 reported in children, 5 (13%) met only the alternate criteria, accounting for 0.1% of VAPs. Most PNU3 (43, 84%) also met the criteria for PNU2, with the remaining accounting for 0.2% of VAPs. The most commonly used criteria among all VAP were: new or progressive infiltrate (3383, 88%), fever (2959, 77%), new onset of purulent sputum (2607, 68%), and leukocytosis or leukopenia (2511, 66%). The most commonly reported laboratory evidence for PNU2 and PNU3 was positive quantitative culture from lower respiratory tract (LRT) specimen (1067, 70%). In contrast, certain signs/symptoms and laboratory criteria were uncommonly reported, such as altered mental status (2%) and histopathologic exam (0.3%).
Conclusions:  Based on our analysis, possible simplifications to current PNEU criteria for VAP surveillance include: 1) modifying alternate criteria for infants and children; 2) eliminating PNU3; and 3) eliminating or streamlining signs/symptoms and laboratory evidence to reflect those criteria used to identify the majority of VAPs. Such changes would not substantially reduce the number of reported VAP and may reduce data collection burden.