 Hi everyone, I'm Arianna 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 Arianna and please just call me Benjamin for you know 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 you know what made you care about ventilator associated pneumonia or what we'll call that. 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 you know their whole lives to look forward to um and as kind of the junior physician on the team my job was to go into the literature and 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 and that's kind of an interesting theme along with many of these hospital prior 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 um somebody should do something about it if we don't do something about it more of these kind of stories are going to happen and um I 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 pneumonia. That's awesome Benjamin and you know I think it just shows how many people out there can make an impact right you know 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 entrepreneur 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 and you know we we do the best we can here at Neatham. Yeah good well um we're excited to kind of get into VAP as this issue now and you know I love that we started off with this patient example right it's all about how how this affects people these aren't just statistics these are you know women men black white you know 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. Yeah 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 down the road um we we knew decades ago that when you put a breathing tube into a person their risk of an ammonia increases 600 to 2000 percent and it was it it was so common in these longer-term mechanically ventilated patients that we started to give them give these entities a name and we started to study them and and we called them ventilator associated ammonias because for some reason when people got put on a ventilator they develop these specific types of mnemonias now they're 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 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 caused in 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 um you know while we as physicians we learn that if somebody comes in from the community they're likely to have you know 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 worse for wear because you know we lacked surveillance and this was such a big problem that you know 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 if 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 and hospitals weren't doing 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 and you know IV infections and that such but for ventilator associate ammonia it had the opposite effect it pushed the problem under under the radar now the CDC and and and CMS got together and they said you know we are we know this is continues to be a problem we know when we survey the hospital length of stay and the problem you know the mortality rate from these ICU patients that we see from the very outside of it from 50 000 feet and none nothing has changed so we have to figure out a way to create better surveillance so they got 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 our electronic devices and they record the 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 one 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 um researchers started to investigate these definitions and see if they really worked and it turns out the definition for ventilator associate events only covers about 12 to 15 percent of ventilator associate moneys which means the vast majority of these moneys 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 going to 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 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 patients are the ones that are are the ones um um dying and suffering from these conditions um 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 incidence of VAE that was reported to the cdc from 1400 hospitals during the pandemic increased every quarter for 2020 sometimes by as much as 45 percent 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 associate pneumonia that is that it is one of the leading causes of sepsis and death in covid patients and when we look across across the pond at our counterparts in europe they're seeing rates of ventilator associate pneumonia and covid patients that are 45 50 percent and responsible for law you know an additional average stay of two to three weeks so if you're wondering um why this is a big problem it's 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 that's you've clearly shown that this is a huge issue and that you know although we've been trying to make changes and there's been you know 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 session section of the interview and talk about you know coming from this world where you spend probably nearly 100 of your time thinking about that every day you know what are these attempted solutions to mitigate the prevalence of that um 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 that number one is to find ways that we can reduce the 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 the fluid that facilitates the the passage of these pathogens into the lungs and 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 you see in them and these you know for the most part are not they're not rocket science and 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 from the payers now from a policy standpoint that's 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 want to solve it they're not going to solve it um just like climate change you know um for us you know 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 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 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 if there's one policy change that needs to begin um it has to do with surveillance and and penalties hospitals are not going to come clean and look for a solution if they think they can hide um but at the same time they only want to hide this problem because there are negative incentives in place you know um the first thing we should do is ask um cms to remove the penalties for these types of infections so that hospitals can begin to um estimate and and come clean with the fact that there are these complications and that will have ripple effects in terms of innovation too uh we're not solving the problem today as it is but that's not to that's not to say that in the future solutions can't appear to address this problem um if they if it's necessarily 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 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 um 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 and we have to look at them more as a resource rather than a way to avoid um addressing real systemic problems in our healthcare system absolutely um you know i think you bring up really good points that you know 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 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 you know if if someone's watching who is caring for a loved one or might have been a patient themselves uh or might be a health worker in a similar situation to you they just want to do something to hopefully change the outcome for future patients or administrators who are collecting that data um you know what are if we focus on maybe those three first and can leave the policymakers last what what can these people do that are watching today to try to help i think they can um you know i'd love to tell everybody that they could do something different and i'm sure they everybody has a place to play in um a role to play in this in in the movement to change this um situation um 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 you can't imagine the bacteria that you hear that's that's growing or the infection problem that's growing read a little bit learn about it and and be an advocate go out there and and say something to somebody about it because you know 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 more uh the less attention will be brought to these problems um quite frankly many of these patients who are in the ICU right now are are the ones who are are there because they got ventilator associated pneumonia we know that from the data um from a clinician and and then administrative level i mean yes you know we can we we can see these problems very clearly and we should listen to um the research and be attentive of of what is um what is happening in our healthcare system because um you know i i tell this to to people who are trying to be leaders in healthcare all the time you know 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 do whatever it is you want to 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 you know i like to think that we should all strive to leave something better than it was before and and one of those ways that we can do that is we can prevent more of these infections and save more lives um that's what i would tell people you know just just be attentive watch the look at the details yeah i love that and you know when i think about hopefully people from the public seeing this video it is it's the speak up listen and observe and and ask those questions i think there's still so much um 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 and you know step step back a bit and ask that provider you know hey use language i can understand um so beautiful well thank you so much uh benjamin for joining us today any last minute thoughts before we close no no um i i just i'm i'm always very hopeful and optimistic i really do believe that we can solve this problem together um we just have to make it our priority to do so absolutely so thank you so much benjamin and uh 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