Weekly ventilator circuit changes. A strategy to reduce costs without affecting pneumonia rates.
نویسندگان
چکیده
BACKGROUND Mechanical ventilator circuits are commonly changed at 48-h intervals. This frequency may be unnecessary because ventilator-associated pneumonia often results from aspiration of pharyngeal secretions and not from the ventilator circuit. We compared the ventilator-associated pneumonia rates and costs associated with 48-h and 7-day circuit changes. METHODS Ventilator circuits were changed at 48-h intervals during the control period (November 1992 to April 1993) and at 7-day intervals during the study period (June 1993 to November 1993). Nosocomial pneumonias were prospectively identified using the criteria of the Centers for Disease Control and Prevention. The annual cost difference of changing circuits at 48-h and 7-day intervals was calculated using the distribution of ventilator days for the control and study periods. RESULTS There were 1,708 patients, 9,858 ventilator days, and a pneumonia rate of 9.64 per 1,000 ventilator days in the control group (48-h circuit changes). There were 1,715 patients, 9,160 ventilator days, and 8.62 pneumonias per 1,000 ventilator days when circuits were changed at 1-week intervals (study group). Using a logistic regression model, there were significantly greater odds of developing a ventilator-associated pneumonia in surgical patients (odds ratio 1.77, P = 0.02) and patients in critical care units (odds ratio 1.54, P = 0.05), but no significant risk of ventilator-associated pneumonia in patients in whom circuits were changed at 1-week intervals (odds ratio 0.82, P = 0.22). Changing circuits at 7-day intervals resulted in a 76.6% ($111,530) reduction in the annual cost for materials and salaries. CONCLUSIONS We found no difference in pneumonia rates with ventilator circuit changes at 48-h and 7-day intervals. Ventilator circuits can be safely changed at weekly intervals, resulting in large cost savings.
منابع مشابه
Heat-and-moisture exchangers used with biweekly circuit tubing changes: effect on costs and pneumonia rates.
In 1991, heat-and-moisture exchangers were introduced with biweekly ventilator circuit tubing changes, resulting in elimination of multiple pieces of respiratory equipment and reduced labor costs. The annual savings were $157,000, totalling $1.5 million since the onset of the program. There have been no increases in rates of ventilator-associated pneumonia.
متن کاملWeekly versus daily changes of in-line suction catheters: impact on rates of ventilator-associated pneumonia and associated costs.
BACKGROUND An earlier randomized, controlled trial showed that weekly or as-needed (as opposed to daily) changes of in-line suction catheters were associated with substantial cost savings, without a higher rate of ventilator-associated pneumonia (VAP). To examine the impact of decreasing the frequency of in-line suction catheter changes in our medical intensive care unit, we conducted an observ...
متن کاملExtending ventilator circuit change interval beyond 2 days reduces the likelihood of ventilator-associated pneumonia.
OBJECTIVE To determine the risk of acquiring ventilator-associated pneumonia (VAP) and the impact on costs when extending ventilator circuit change intervals beyond 2 days to 7 and 30 days. DESIGN Prospective 4-year review of mechanically ventilated patients. SETTING The respiratory and medical ICUs of an 800-bed tertiary teaching Veterans Affairs hospital. PATIENTS All adult patients rec...
متن کاملEffect of ventilator circuit changes on ventilator-associated pneumonia: a systematic review and meta-analysis.
BACKGROUND Recent guidelines concerning prevention of ventilator-associated pneumonia recommend that ventilator circuits should not be changed routinely, but in practice circuit changes at regular intervals persist. METHODS We searched the MEDLINE, EMBASE, and SCOPUS databases and reviewed citations to identify articles that reported the results of randomized controlled trials and sequential ...
متن کاملNurses’ knowledge of evidence- based guidelines for preventing ventilator-associated pneumonia in intensive care units
Background and Purpose: Implementing the guidelines to prevent VAP has been shown to have a significant effect on reducing the incidence of VAP. Studies indicate that ICU staff have poor knowledge and low implementation rate of the standard preventive measures related to VAP. The present study aims to evaluate the knowledge of nurses in the intensive care unit in University hospitals of Sari. ...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
عنوان ژورنال:
- Anesthesiology
دوره 82 4 شماره
صفحات -
تاریخ انتشار 1995