269. Incidence and Characteristics of Ventilator-Associated Events Reported from Long Term Care Hospitals to the National Healthcare Safety Network, 2013-2014
Session: Poster Abstract Session: HAI: Device Associated Infections
Thursday, October 8, 2015
Room: Poster Hall
Background: Ventilator-associated event (VAE) reporting to CDC’s National Healthcare Safety Network (NHSN) began in 2013, and pooled mean VAE rates of 5-11 per 1000 ventilator days have been reported from short-term hospital critical care units. VAE is included in the Centers for Medicare & Medicaid Services Long Term Care Hospital (LTCH) Quality Reporting Program for FY2018 payment determination, but little is known about VAE in LTCHs.

Methods: We analyzed LTCH critical care and ward VAE data reported to NHSN according to surveillance protocols in 2013-14; determined the distribution of specific VAE types (ventilator-associated conditions [VAC] and infection-related ventilator-associated complications and pneumonia [“IVAC-plus”]) and characteristics; calculated pooled mean rates per 1000 ventilator days; and determined rate distributions for locations with ≥20 units reporting >50 ventilator days per year (SAS 9.3).

Results: 136 LTCHs reported 2304 location-months of VAE data from 170 locations. Of 320 VAEs, 185 (58%) were VAC and 135 (42%) were IVAC-plus. Median time from LTCH admission to VAE onset was 14 days (interquartile range [IQR] 7-28), and from mechanical initiation ventilation to VAE onset was 15 days (IQR 7-32); for 230 VAEs (72%) mechanical ventilation initiation was reported to occur on the same day as LTCH admission. VAE rates were low (Table). 

Conclusion: LTCH VAE rates are lower than those reported previously from short-term hospital critical care units. Although many LTCHs admit patients who are already mechanically-ventilated, most LTCH patients with VAEs were reported to have had mechanical ventilation initiated on the LTCH admission day, suggesting the need to better understand how data for mechanically-ventilated patients are shared between facilities during patient transfers. Work is also needed to determine the clinical events corresponding to LTCH VAEs and whether LTCH VAE rates can be reduced through implementation of evidence-based interventions.

Table

 

2013

2014

Location

No. units*

Pooled mean

10%ile

50%ile

90%ile

No. units*

Pooled mean

10%ile

50%ile

90%ile

Critical care

16

2.09

-

-

-

18

1.98

-

-

-

Ward

118 (117)

0.80

0

0

2.79

118 (114)

0.87

0

0

2.99

*No. of units reporting >50 ventilator days/year shown in parentheses. Rate distribution not shown for locations with <20 units.

Shelley S. Magill, MD, PhD, Qunna Li, MSPH, MMs, MBBS, Cindy Gross, MT, SM (ASCP), CIC and Jonathan R. Edwards, MStat, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA

Disclosures:

S. S. Magill, None

Q. Li, None

C. Gross, None

J. R. Edwards, None

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