1995 OPEN FORUM Abstracts
EXTENDING VENTILATOR CIRCUIT CHANGE INTERVAL BEYOND TWO DAYS REDUCES LIKELIHOOD OF VENTILATOR ASSOCIATED PNEUMONIA (VAP)
I. Fink, MS, RRT, S. Krause, RN, L. Barrett, MS. Hines VA Hospital and Loyola Univ. Chicago, Hines IL.
Ventilator circuits have been associated with VAP and the CDC recommends >=48 hours change intervals. To determine impact on VAP of extending change interval beyond 2 days, all ventilated patients in our RICU and MICU were studied prospectively over four years using the CDC criteria (1988) to define VAP. In 1991 and 1992 circuits were changed every 2 days, followed by 7 day (1993), and 30 day (1994) change intervals. Ventilator days did not differ between years (p=0.92). Adult ventilators with wick type humidifers were used with standard circuits until heated wire circuits were added in 1994. Compared to 2 day intervals in 1991-2, VAP / 1000 ventilator days decreased in both RICU and MICU with both 7 and 30 day change intervals. In the combined units, the difference in the number of ventilator days before patients developed VAP was not significant between intervals (p=0.11). By logistic regression analysis, the odds of developing VAP under the policy of 7 day interval changes was significantly less than with the 2 day interval changes (odds ratio = 0.254;p=0.0048). There is some suggestion that there is no difference in risk of VAP between 7 and 30 day change intervals. Extending intervals resulted in supply and labor savings by >$20,000.
SEE ORIGINAL IMAGE
In conclusion, extending vent circuit change intervals beyond 2 days reduced the rate of VAP / 1000 vent days and appears to reduce the likelihood of developing VAP while substantially decreasing labor and supply costs.