title: Developing a new, national approach to surveillance for ventilator-associated events*.
abstract: OBJECTIVE
  To develop and implement an objective, reliable approach to surveillance for ventilator-associated events in adult patients.
  
  
  METHODS
  The Centers for Disease Control and Prevention (CDC) convened a Ventilator-Associated Pneumonia (VAP) Surveillance Definition Working Group in September 2011. Working Group members included representatives of stakeholder societies and organizations and federal partners.
  
  
  RESULTS
  The Working Group finalized a three-tier, adult surveillance definition algorithm for ventilator-associated events. The algorithm uses objective, readily available data elements and can identify a broad range of conditions and complications occurring in mechanically ventilated adult patients, including but not limited to VAP. The first tier definition, ventilator-associated condition (VAC), identifies patients with a period of sustained respiratory deterioration following a sustained period of stability or improvement on the ventilator, defined by changes in the daily minimum fraction of inspired oxygen or positive end-expiratory pressure. The second tier definition, infection-related ventilator-associated complication (IVAC), requires that patients with VAC also have an abnormal temperature or white blood cell count, and be started on a new antimicrobial agent. The third tier definitions, possible and probable VAP, require that patients with IVAC also have laboratory and/or microbiological evidence of respiratory infection.
  
  
  CONCLUSIONS
  Ventilator-associated events surveillance was implemented in January 2013 in the CDC's National Healthcare Safety Network. Modifications to improve surveillance may be made as additional data become available and users gain experience with the new definitions.
authors.affiliation: 1Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA. 2Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. 3Infection Control Department, Brigham and Women's Hospital, Boston, MA. 4Society for Healthcare Epidemiology of America, Arlington, VA. 5Division of Pulmonary and Critical Care Medicine, Rush University School of Medicine, Chicago, IL. 6Critical Care Societies Collaborative-American Association of Critical-Care Nurses, American College of Chest Physicians, American Thoracic Society, Society of Critical Care Medicine. 7School of Nursing, Critical and Acute Care, University of Virginia, Charlottesville, VA. 8Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. 9Division of Infectious Diseases, University of Iowa Carver College of Medicine, Iowa City, IA. 10Healthcare Infection Control Practices Advisory Committee Surveillance Working Group, Atlanta, GA. 11Infection Prevention and Control Department, Rochester General Health System, Rochester, NY. 12Association for Professionals in Infection Control and Epidemiology, Washington, DC. 13Department of Medicine, Medical College of Wisconsin, Milwaukee, WI. 14Department of Cardiology, Zablocki VA Medical Center, Milwaukee, WI. 15Hospital Epidemiology and Quality Improvement, The Clinical Center, National Institutes of Health, Bethesda, MD. 16Department of Respiratory Care, Massachusetts General Hospital, Boston, MA. 17Department of Anesthesia, Harvard Medical School, Boston, MA. 18American Association for Respiratory Care, Irving, TX. 19Division of Pulmonary and Critical Care Medicine, Tufts Medical Center, Boston, MA. 20Division of Pulmonary and Critical Care Medicine, Washington University, St. Louis, MO. 21Division of Pulmonary, Critical Care, and Sleep, Warren Alpert Medical School at Brown University, Rhode Island Hospital, Providenc
authors.forename: Shelley S
authors.initials: SS
authors.lastname: Magill
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authors.lastname: Klompas
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authors.lastname: Balk
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Burns
authors.forename: Clifford S
authors.initials: CS
authors.lastname: Deutschman
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authors.lastname: Diekema
authors.forename: Scott
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authors.lastname: Fridkin
authors.forename: Linda
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authors.lastname: Greene
authors.forename: Alice
authors.initials: A
authors.lastname: Guh
authors.forename: David
authors.initials: D
authors.lastname: Gutterman
authors.forename: Beth
authors.initials: B
authors.lastname: Hammer
authors.forename: David
authors.initials: D
authors.lastname: Henderson
authors.forename: Dean
authors.initials: D
authors.lastname: Hess
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Hill
authors.forename: Teresa
authors.initials: T
authors.lastname: Horan
authors.forename: Marin
authors.initials: M
authors.lastname: Kollef
authors.forename: Mitchell
authors.initials: M
authors.lastname: Levy
authors.forename: Edward
authors.initials: E
authors.lastname: Septimus
authors.forename: Carole
authors.initials: C
authors.lastname: VanAntwerpen
authors.forename: Don
authors.initials: D
authors.lastname: Wright
authors.forename: Pamela
authors.initials: P
authors.lastname: Lipsett
mesh_terms: D000465:Algorithms; D002487:Centers for Disease Control and Prevention, U.S.; D006801:Humans; D007362:Intensive Care Units; D061214:Patient Safety; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods*; D012121:Respiration, Artificial / Q000009:adverse effects*; D014481:United States; D055397:Ventilator-Induced Lung Injury / Q000453:epidemiology*