Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-11-30T21:38:37.122Z Has data issue: false hasContentIssue false
  • English
  • Français

Prospective, Randomized Study of Ventilator-Associated Pneumonia in Patients With One Versus Three Ventilator Circuit Changes Per Week

Published online by Cambridge University Press:  02 January 2015

Martha N. Long ,
Glenda Wickstrom ,
Anne Grimes ,
Carol F. Benton ,
Becky Belcher  and
Alan M. Stamm
Martha N. Long
Affiliation:
University of Alabama Hospital, Birmingham, Alabama
Glenda Wickstrom
Affiliation:
University of Alabama Hospital, Birmingham, Alabama
Anne Grimes
Affiliation:
University of Alabama Hospital, Birmingham, Alabama
Carol F. Benton
Affiliation:
University of Alabama Hospital, Birmingham, Alabama
Becky Belcher
Affiliation:
University of Alabama Hospital, Birmingham, Alabama
Alan M. Stamm*
Affiliation:
University of Alabama Hospital, Birmingham, Alabama
*
Department of Medicine, UAB, University of Alabama Hospital, 1813 6th Ave S, Birmingham, AL. 35294
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To assess the effect on the rate of ventilator-associated pneumonia (VAP) of decreasing the frequency of ventilator circuit changes from three times to once per week.

Design:

Prospective, randomized trial.

Setting:

Medical intensive care unit (MICU), a 12-bed, critical-care internal medicine unit, and neurosciences intensive care unit (NICU), a 21-bed, predominantly adult neurosurgical unit, of an urban university hospital.

Patients:

All 447 patients requiring mechanical ventilation during October 1992 through June 1993.

Intervention:

Patients were allocated randomly on the basis of permanent medical record numbers: those with odd numbers had circuits changed three times per week, those with even numbers once per week. Intensive-care-unit surveillance was conducted in accordance with definitions and methods of the National Nosocomial Infections Surveillance System.

Results:

In the MICU, the one-change-per-week group had a VAP rate of 7.3 per 1,000 ventilator days, versus 5.9 for the three-per-week group (P=.6). In the NICU, the one-change-per-week group had a rate of 12.2 per 1,000 ventilator days, versus 12.6 for the three-per-week group (P=.9). Considering patients in both units ventilated for no more than 7 days, the one-change-per-week group had a VAP rate of 5.9 per 1,000 ventilator days, versus 9.0 per 1,000 for the three-changes-per-week group (odds ratio [OR], 0.65; 95% confidence interval [CI95], 0.25 to 1.69). Including patients in the two units maintained on mechanical ventilation for more than 7 days, the one-change-perweek group had a VAP rate of 13.2 per 1,000 ventilator days, versus 9.6 per 1,000 for the three-changes-per-week group (OR, 1.37; CI95 0.71 to 2.65).

Conclusions:

Decreasing the frequency of ventilator circuit changes from three times to once per week had no adverse effect on the overall rate of VAP. Less frequent ventilator circuit changes may decrease the incidence of VAP among patients ventilated for no more than 1 week. However, the incidence of VAP may be higher among patients with once weekly circuit changes ventilated for more than 1 week.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 17 , Issue 1 , January 1996 , pp. 14 - 19
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1996

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Wenzel, RP. Hospital-acquired pneumonia: overview of the current state of the art for prevention and control. Eur J Clin Microbial Infect Dis 1989;8:56–60.10.1007/BF01964121CrossRefGoogle ScholarPubMed
2. Cross, AS, Roup, B. Role of respiratory assistance devices in endemic nosocomial pneumonia. Am J Med 1981;70:681–685.10.1016/0002-9343(81)90596-9CrossRefGoogle ScholarPubMed
3. Celis, R, Torres, A, Gatell, JM, Almela, M, Rodriguez-Roisin, R, Agusti-Vidal, A. Nosocomial pneumonia: a multivariate analysis of risk and prognosis. Chest 1988;93:318–324.10.1378/chest.93.2.318CrossRefGoogle ScholarPubMed
4. Leu, H-S, Kaiser, DL, Mori, M, Woolson, RF, Wenzel, RP. Hospital-acquired pneumonia: attributable mortality and morbidity. Am J Epidemiol 1989;129:1258–1267.10.1093/oxfordjournals.aje.a115245CrossRefGoogle ScholarPubMed
5. Torres, A, Aznar, R, Gatell, JM, et al. Incidence, risk, and prognosis factors of nosocomial pneumonia in mechanically ventilated patients. Am Rev Respir Dis 1990;142:523–528.10.1164/ajrccm/142.3.523Google Scholar
6. Fagon, J-Y, Chastre, J, Hance, AJ, Montravers, P, Novara, A, Gibert, C. Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay. Am J Med 1993;94:281–288.10.1016/0002-9343(93)90060-3CrossRefGoogle ScholarPubMed
7. Niederman, MS. Gram-negative colonization of the respiratory tract: pathogenesis and clinical consequences. Semin Respir Infect 1990;5:173–184.Google Scholar
8. Tryba, M. The gastropulmonary route of infection-fact or fiction? Am J Med 1991;91(suppl2A):135S–146S.10.1016/0002-9343(91)90466-BGoogle Scholar
9. Craven, DE, Goularte, TA, Make, BJ. Contaminated condensate in mechanical ventilator circuits: a risk factor for nosocomial pneumonia. Am Rev Respir Dis 1984:129:625–628.Google ScholarPubMed
10. Craven, DE, Lichtenberg, DA, Goularte, TA, Make, BJ, McCabe, WR. Contaminated medication nebulizers in mechanical ventilator circuits: source of bacterial aerosols. Am J Med 1984;77:834–838.10.1016/0002-9343(84)90520-5CrossRefGoogle ScholarPubMed
11. Craven, DE, Connolly, MG, Lichtenberg, DA, Primeau, PJ, McCabe, WR. Contamination of mechanical ventilators with tub ing changes every 24 or 48 hours. N Engl J Med 1982;306:1505–1509.10.1056/NEJM198206243062501Google Scholar
12. Daschner, F, Kappstein, I, Schuster, F, et al. Influence of disposable (‘Conchapak’) and reusable humidifying systems on the incidence of ventilation pneumonia. J Hosp Infect 1988;11:161–168.10.1016/0195-6701(88)90059-XCrossRefGoogle ScholarPubMed
13. Malecka-Griggs, B, Kennedy, C, Ross, B. Microbial burdens in disposable and nondisposable ventilator circuits used for 24 and 48 hours in intensive care units. J Clin Microbiol 1989;27:495–503.10.1128/jcm.27.3.495-503.1989CrossRefGoogle Scholar
14. Cadwallader, HL, Bradley, CR, Ayliffe, GAJ. Bacterial contamination and frequency of changing ventilator circuits. J Hosp Infect 1990;15:54–72.10.1016/0195-6701(90)90022-GCrossRefGoogle Scholar
15. Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.10.1016/0196-6553(88)90053-3Google Scholar
16. Emori, TG, Culver, DH, Horan, TC, et al. National Nosocomial Infections Surveillance System (NNIS): description of surveillance methods. Am J Infect Control 1991;19:19–35.10.1016/0196-6553(91)90157-8CrossRefGoogle ScholarPubMed
17. National Nosocomial Infections Surveillance (NNIS) System. Nosocomials infection rates for interhospital comparison: limitations and possible solutions. Infect Control Hosp Epidemiol 1991:12:609–621.10.2307/30145247Google Scholar
18. Lareau, SC, Ryan, KJ, Diener, CF. The relationship between frequency of ventilator circuit changes and infectious hazard. Am Rev Respir Dis 1978;118:493–496.Google Scholar
19. Craven, DE, Kunches, LM, Kilinsky, V, Lichtenberg, DA, Make, BJ, McCabe, WR. Risk factors for pneumonia and fatality in patients receiving continuous mechanical ventilation. Am Rev Respir Dis 1986;133:792–796.Google ScholarPubMed
20. Dreyfuss, D, Djedaini, K, Weber, P, et al. Prospective study of nosocomial pneumonia and of patient and circuit colonization during mechanical ventilation with circuit changes every 48 hours versus no change. Am Rev Respir Dis 1991;143:738–743.10.1164/ajrccm/143.4_Pt_1.738Google Scholar
21. Boher, M, Lohse, S, Glasby, C, Friel, M, Quan, S, Mandel, R. Impact of 7-day ventilator tubing changes on nosocomial lower respiratory tract infections. 19th Annual Educational and International Conference of the Association for Practitioners in Infection Control; 06 1992; San Francisco, CA Abstract 63.Google Scholar
22. Mermel, L, Eveloff, S, Short, K, et al. The risk of pneumonia associated with use of heated wire versus conventional ventilator circuits-a prospective trial. Fourth Annual Meeting of the Society for Hospital Epidemiology of America; 03 1994; New Orleans, LA. Abstract M44.Google Scholar
23. Kotilainen, HR, Keroack, MA Cost analysis and clinical impact of weekly ventilator circuit changes in intensive care unit patients. Fourth Annual Meeting of the Society for Hospital Epidemiology of America: 03 1994; New Orleans, LA Abstract M45.Google Scholar
24. Edwards, J, Gaynes, R, Culver, D, National Nosocomial Infections Surveillance System. Temporal trends in deviceassociated infection rates in intensive care units in the United States. Third Annual Meeting of the Society for Hospital Epidemiology of America; 04 1993; Chicago, IL. Abstract 19.Google Scholar