1995 OPEN FORUM Abstracts
IMPACT OF SEVEN (7) DAY VENTILATOR CIRCUIT CHANGES ON RATES OF LOWER RESPIRATORY TRACT INFECTION (LRI) IN A PEDIATRIC POPULATION. A PILOT STUDY.
Billy Lamb, BS, CPFT, Charles Foster, BA, RRT, Joyce Hayes, RN, M.P.H. Cardinal Glennon Children's Hospital, St. Louis, MO.
INTRODUCTION: Seven day ventilator circuit change (SDVCC) schedules are being adopted by many hospitals due to cost containment and based upon data that show that SDVCC are not associated with an increased incidence of lower respiratory infection (LRI). We hypothesized that SDVCC would not increase the LRI rate in our pediatric ventilator patient population and that quantitative cultures of the inspiratory ventilator circuits would show no growth after seven days. METHOD: Due to cost containment strategy, we choose NOT to use a prospective randomized methodology; therefore, as a pilot, we implemented SDVCC for all patients in our intensive care units. Due to concerns of the physician faculty, as a quality control, inspiratory ventilator circuit cultures were performed (sampling at the outlet of the humidifier, the patient wye and the temperature probe inlet) using quantitative culture technique on each study patient's ventilator circuit after seven days. Routine surveillance from 1989 - 1993 showed no growth in cultures of inspiratory ventilator circuits of patients receiving M/W/F circuit changes. Patients that were ventilated<seven days were excluded from the study. LRI/1000 ETT DAY (LRI/ETT) were monitored. LRI was defined according to 1988 CDC guidelines for nosocomial pneumonia. The control group consisted of all ventilated patients Jan.-April 1993 (M/W/F circuit changes), the study group, all ventilated patients Jan.-April 1994 (SDVCC). The control group consisted of 49 patients, mean age 9.63 months (range 0-180; median 1 month). The study group consisted of 46 ventilator patients, mean age 8.04 months (range 0-160; median 0)
Results: Quantitative cultures of the vent. circuits revealed no growth in the study group; retrospective data show no growth in cultures in the control group. LRI for the control group = 13; LRI for the study group = 10. LRI/ETT in the Control group were 4.36 (13 LRI; 3018 ETT days); LRI/ETT for the Study group were 3.30 (10 LRI; 3150 ETT days). These data show no significant difference in LRI/ETT between the control group and study group (X² = 0.32). Circuit cost for the control group was $4.55 per ventilator day; the study group (SDVCC) $2.49 per ventilator day. EXPERIENCE: Our study methodology was not designed to prove SDVCC Statistically Related to lowering Lower Respiratory Infections. Variables such as days on antibiotics, days intubated, ventilator type, NG tube days, patient position, diagnosis and others may contribute to the incidence of LRI in ventilated patients. CONCLUSION: Pediatric SDVCC are not associated with an increase in LRI & significantly reduce cost as compared to M/W/F vent circuit changes. Prospective, randomized studies are needed to determine if circuit change frequency is statistically related to lower LRI rates in ventilated patients; multiple variables in this patient population make proving this hypothesis very challenging. The SDVCC process was continued at our hospital.