 Hi everyone, I'm Ariana Longley and I'm the Chief Operating Officer here at the Patient Safety Movement Foundation. And I am here today with Dr. Benjamin Wang to do an interview around ventilator-associated pneumonia. And so we have a great interview set for you all today to learn a little bit about Dr. Wang and also around some of these policy issues that we think that we might be able to achieve and we hope that you all who are listening in today might have an idea how we can push this forward and we know that in order to improve patient safety we have to get everyone involved and if you're out there listening and have an idea, put your ideas in the comment box below here on YouTube, send us an email and get engaged. We really need to think about this in a new way and really pleased to be with Dr. Wang to get some of his thoughts. So Dr. Wang, thanks for being with us today. It's my pleasure. Thank you so much for the warm introduction, Ariana. And please just call me Benjamin, for the sake of personability, please. Sounds good, Benjamin. Well, thanks for being with us. I'd love to just get us started off with, tell us a little bit about yourself and what made you care about ventilator-associated pneumonia or what we'll call VAP? So I'm a physician and a biochemist by education and training, but about 10 years ago I was taking care of patients in the ICU. And a young 19-year-old young lady came under my care and because she had just given birth and some complications had occurred, she ended up on a ventilator. And my team and I watched this young lady basically get worse on the ventilator and over the course of the next couple of weeks, catch a pneumonia and ultimately pass away. And something about her, I mean, maybe it was the age or the point in which my training, but it didn't seem right to me that these things were happening to patients that were otherwise healthy and young and had their whole lives to look forward to. And as kind of the junior physician on the team, my job was to go into the literature and see if we could have changed that. And lo and behold, I discovered, hey, wait a minute, she caught a pneumonia. She got ventilator-associated pneumonia because of the device we were using in these patients. And that's kind of an interesting theme along with many of these hospital-acquired infections. They're not because people are sick or they come into the setting necessarily, but they're often device-related. And at that point I said, you know, somebody should do something about it. If we don't do something about it, then more of these kind of stories are gonna happen. And I just didn't feel like I could live with myself if I didn't try and do something. So I started a little company to make better devices to prevent those pneumonias. That's awesome, Benjamin. And I think it just shows how many people out there can make an impact, right? You started off your career in critical care as an MD and now we're taking that knowledge that you learned while in medical school and training to be a physician and now are turning that into an entrepreneurial project and company that can impact patients. And I think that value of all that knowledge that you have from your training can now really extend much more broadly. Well, I appreciate that. You know, we do the best we can here at NEVAP. Yeah, good. Well, we're excited to kind of get into VAP as this issue now and I love that we started off with this patient example, right? It's all about how this affects people. These aren't just statistics. These are women, men, black, white. It really impacts everyone. So anyway, I'd love to kind of get into the second question, which is really, why don't you kind of give for the audience listening in background around VAP as a patient safety issue so they can understand why this is important? So the story really starts decades ago when we started to realize when you put a breathing tube into a patient for a longer period of time, the breathing tube is a foreign object that really doesn't belong there. And then when you put them on anesthesia and they can't call for themselves, the breathing tube will end up being a NITIS for infection, which means basically the device causes these infections down the road. We knew decades ago that when you put a breathing tube into a person, their risk of an ammonia increases 600 to 2,000%. And it was so common in these longer term, mechanically ventilated patients that we started to give these entities a name and we started to study them and we called them ventilator associate ammonias because for some reason, when people got put on a ventilator, they developed these specific types of ammonias. Now, they're an interest, this is an interesting condition because it's unlike any condition you see anywhere else. You don't see the types of bacteria and fungus that like to cause these infections in the community. And you don't even see it outside of the ICU. The types of bacteria and the types of infections that are causing these patients are unique, but they are also very hard to treat and many times they're antibiotic resistant just by the nature of the types of bacteria that they grow. So, as physicians, we learn that if somebody comes in from the community, they're likely to have a handful of these types of infections. The types of infections that you see in the ICU are just dramatically different, difficult to treat and deadly many cases. Now, before 2009, the whole world was looking at this and basically saying this is the biggest infection problem we have in the world. You can't provide normal medical care without running into this infection and it was true. But at the same time, it was very hard to diagnose different parts of the world and different institutions had different criteria. And if you weren't looking carefully, you missed it. And patients were worse for wear because we'd lack surveillance. And this was such a big problem that the United States government basically, the Centers for Medicare and Medical Services said, you know what? We can't tolerate these kinds of infections. Hospitals have to do a better job. And so since 2009, they've instituted penalties for having these infections. But what that also did was hospitals because they couldn't solve this problem because patients were still coming in with these infections. As a response to those penalties, many hospitals decided to call the infection something else. That was a first kind of a bad thing that happened because now hospitals were just calling the infection something else, avoiding the penalties. And patients were getting sick and hospitals weren't doing the job. So the government intervention in this case had quite the opposite effect that had in other places like bloodstream infections and catheter related infections and IV infections and that such. But for ventilator-associated ammonia, it had the opposite effect. It pushed the problem under the radar. Now the CDC and CMS got together and they said, you know, we know this continues to be a problem. We know when we survey the hospital length of stay and the mortality rate from these ICU patients that we see from the very outside of it from 50,000 feet and nothing has changed. So we have to figure out a way to create better surveillance. So they brought a group of very smart people together, put them in a room and said, come up with a better surveillance criteria. And they created a new surveillance criteria called ventilator-associate events or VAE. And the idea was the ventilators have these are electronic devices and they record the settings on the ventilators. So if you want to catch changes in ventilator settings, then you can do that fairly automatically because it's in the medical record. That way you can hopefully get away from the subjectivity of one doctor calling it one type of pneumonia and another doctor calling another in a hospital saying, you know, we have a lot less of these infections. And that way, hopefully the surveillance will get better. So they did this, they brought these people together and they created this definition, but it turns out that years later, researchers started to investigate these definitions and see if they really worked. And it turns out the definition for ventilator-associated events only covers about 12 to 15% of ventilator-associated pneumonias. Which means the vast majority of these pneumonias, number one, were not being surveyed, were not being recorded. And instead we were trying to measure something that had no correlation in terms of cost control or patient safety. So after enough data came out in 2019, the Center for Medicare and Medical Services basically said, we're gonna do away with this VAE definition in terms of surveillance. So hospitals don't even have to survey or report the number of VAEs they are seeing. Now you can imagine, that's probably not good if you have no surveillance or reporting requirements for hospitals to do this. All the while patients are the ones that are the ones dying and suffering from these conditions. Now, not all the hospitals listened during the pandemic. And actually the CDC came out with a report about two weeks ago that showed the number, the incidents of VAE that was reported to the CDC from 1,400 hospitals during the pandemic increased every quarter for 2020. Sometimes by as much as 45%. Now we knew these criteria were not good. People were not very honest about reporting them. But what we are seeing in terms of ventilator associated pneumonia, that is that it is one of the leading causes of sepsis and death in COVID patients. And when we look across the pond at our counterparts in Europe, they're seeing rates of ventilator associated pneumonia in COVID patients that are 45, 50% and responsible for an additional average stay of two to three weeks. So if you're wondering why this is a big problem, it's because this is the reason why hospitals are doing so poorly during the pandemic. If we could get people off the ventilator sooner and healthier, we'd be in a completely different situation with the pandemic today. Wow, Benjamin. Yeah, you've clearly shown that this is a huge issue and that, although we've been trying to make changes and there's been additional research, now we have the research to show what we're doing isn't really working. So I'd love to just move on to the next kind of section of the interview and talk about coming from this world where you spend probably nearly 100% of your time thinking about VAP every day. What are these attempted solutions to mitigate the prevalence of VAP? And if you can talk specifically around potential policy solutions or reimbursement measures, that would be great. Yeah, so for the most part, I mean, many of the innovative solutions I've seen out, developed in the community are basically trying to again mitigate the fluid and bacteria from entering into the lungs. There are really three things that we can do judiciously in this fashion to improve the situation. And number one is to find ways that we can reduce the number of pathogens that are necessarily in the airway, in the mouth, the nose, and in the trachea leading into the lungs while a patient is intubated. Number two is we can remove the fluid that facilitates the passage of these pathogens into the lungs. And really number three is we have to find ways to get people off ventilators faster because the sooner you get them off, the less ventilator-associated ammonia you see in them. And these, for the most part, they're not rocket science and can be done. It's simply when you go and talk to customers, the end clinicians, you hit a wall because it's not a problem if you can hide the problem from the payers. Now, from a policy standpoint, that's what's really holding back a lot of innovation is if you allow hospitals to cover up that they have this enormous problem, they don't wanna solve it. They're not going to solve it. Just like climate change. For us, in medicine, antibiotic resistance and infection and these kind of complications are our climate change. If we do nothing and we allow the status quo, eventually we're not going to be able to do the things that we want to do in medicine. A lot of our advances in our technologies rely on the fact that we can do surgery, that we can anesthetize a patient, that we can help them breathe for them when they cannot do that. If we lose that ability, a lot of what we do in medicine, in modern medicine disappears and is not safe to perform. But from a policy standpoint, I mean, the negative incentives that government has put in place are not working. You know, they haven't worked from the beginning. They haven't put the focus on these infections but have basically incentivized hospitals to run the other way and decide that they don't have any of them. So if there's one policy change that needs to begin, it has to do with surveillance and penalties. Hospitals are not gonna come clean and look for a solution if they think they can hide. But at the same time, they only wanna hide this problem because there are negative incentives in place. The first thing we should do is ask CMS to remove the penalties for these types of infections so that hospitals can begin to estimate and come clean with the fact that there are these complications. And that will have ripple effects in terms of innovation too. We're not solving the problem today as it is but that's not to say that in the future solutions can't appear to address this problem. If it's necessary to do better surveillance, the key with ventilator associated pneumonia and some of these other hospital-acquired infections is the fact that they are unlike things that we see in the community. If the government really wants to quantify and survey the problem carefully, all they have to do is carefully look at the types of infections and the antibiotics prescribed in these cases. And I know for a fact that it's in everybody's interest to have better antibiotic surveillance but also stewardship because these are the only drugs that we have in modern medicine that the more we use, the less effective they become. And we have to look at them more as a resource rather than a way to avoid addressing real systemic problems in our healthcare system. Absolutely. I think you bring up really good points that here at the patient safety movement we bring up all the time that we can't continue doing the same thing over and over again and expecting a different result. We have to get new minds together, get new conversations to happen. And so we've been so thankful to talk with you today, Benjamin, because you're planting these ideas for everyone who's watching now, maybe there's something that everyone can do. And so I'd love to just kind of end with what, if someone's watching who is caring for a loved one or might have been a patient themselves or might be a health worker in a similar situation to you, they just wanna do something to hopefully change the outcome for future patients or administrators who are collecting that data. What are, if we focus on maybe those three first and can leave the policymakers last, what can these people do that are watching today to try to help? I think they can, I'd love to tell everybody that they could do something different. And I'm sure that everybody has a place to play a role to play in the movement to change this situation. I mean, one of the best ways is to basically be an advocate and to look where other people aren't looking. I mean, from a patient standpoint or even a clinician standpoint, when you see something that you don't understand, if you see if a loved one or a friend gets sick and you've never even heard, you can't imagine the bacteria that you hear that's growing or the infection problem that's growing, read a little bit, learn about it and be an advocate. Go out there and say something to somebody about it because the more that we kind of gloss over and accept that this is something, it's a problem that we're not willing to understand, the less attention will be brought to these problems. Quite frankly, many of these patients who are in the ICU right now are the ones who are there because they got ventilator-associated pneumonia. We know that from the data. From a clinician and then administrative level, I mean, yes, we can see these problems very clearly and we should listen to the research and be attentive of what is happening in our healthcare system because I tell this to people who are trying to be leaders in healthcare all the time. It's great to put in hard work and to inspire other people along. Think about what is your legacy when you leave that hospital, when you leave that room with that patient, when you leave and retire and go on to do whatever it is you wanna do, what is the legacy that we leave for future generations or even just the patient that is going to be discharged from the hospital? I like to think that we should all strive to leave something better than it was before. And one of those ways that we can do that is we can prevent more of these infections and save more lives. That's what I would tell people, just be attentive, look at the details. Yeah, I love that. And when I think about hopefully people from the public seeing this video, it is. It's the speak up, listen and observe and ask those questions. I think there's still so much work we all have to do to make sure that patients and their family members know that they can speak up and ask those questions. And if they don't understand something, that it's okay and step back a bit and ask that provider, hey, use language I can understand, so beautiful. Well, thank you so much, Benjamin, for joining us today. Any last minute thoughts before we close? No, no, I just, I'm always very hopeful and optimistic. I really do believe that we can solve this problem together. We just have to make it our priority to do so. Absolutely, so thank you so much, Benjamin. And for everyone who's watched, leave comments below and let us know what you think and how you can help, how you think other people can help. So thank you very much, have a great day. You too, have, take care, bye-bye. Bye.