1995 OPEN FORUM Abstracts
VENTILATOR ASSOCIATED PNEUMONIA (VAP) IN A SUBACUTE SETTING WITH 7 DAY CIRCUIT CHANGE
R. Thompson, RRT, RPFT, A. Piotrowski, RRT, G. Vukelic, RN, BSN Integrated Health Services at Brentwood, Burbank, Illinois
Introduction: There is little data reported from the subacute environment in regards to VAP. We compared our VAP results in our subacute ventilator unit to 4 published abstracts in Respiratory Care (Vol 39, No. 11, pgs. 1107 - 1108) from acute care facilities with adult patient populations and 7 day ventilator circuit change frequency. Also reported are the nosocomial pneumonia rates for patients with tracheostomies but not receiving mechanical ventilation. Method: 55 patients were studied using clinical criteria of presence of leukocyctosis, fever, purulent secretions and new chest infiltrates. All patients were considered ventilator patients if they received 6 hours or more mechanical ventilation per day. Once a patient was able to achieve 24 consecutive hours of spontaneous breathing that individual would be placed into the tracheostomy group. Ventilator patients used the Infrasonics Adult Star or Aequitron LP-6 ventilators equiped with AnaMed heated wick circuit (Simplex Medical Systems, Inc. No. A8351 or A2668) with AnaMed Water Pump (No. A8000) fed with IPI 3000 ml water (IPI Medical Products, No.3175). Ventilator circuits were changed at 7 day intervals. All tracheostomy patients used Misty-Ox Multi-Fit nebulizers (Medical Moulding, No. 441A) Hudson RCI tracheostomy masks and drainage bags (No. 1075 and No. 1742) with IPI corrugated tubing and 1000 ml water (IPI Medical Products, No. 3100 and No. 1065). Aerosol circuits were changed three times per week. All patients admitted to the ventilator unit received on-site pre-admission clinical evaluations which identified evidence of abnormal chest film or preexisting pneumonia with concurrent review over the 6 month period of the study.
Results: 32 were admitted as ventilator patients and 23 were admitted as tracheostomy patients. The VAP rate for ventilator patients was 1.9 per 1000 ventilator days. The rate of nosocomial pneumonia for tracheostomy patients was 2.0 per 1000 tracheostomy days. The aggregate rate was 2.0/1000 days. The VAP rate from the published abstracts ranged from 2.8 to 8.62/1000 ventilator days with an average of 6.08.
Conclusions: The VAP rate was lower in the subacute environment than the acute care setting. There was no significant difference in facility acquired pneumonia between patients receiving mechanical ventilation and the tracheostomy patients.