1997 OPEN FORUM Abstracts
CLOSED SYSTEM SUCTION CATHETERS: THE EFFECT OF DECREASED FREQUENCY OF CHANGES IN MECHANICALLY-VENTILATED PATIENTS.
Subasree Srinivasan MD, Francina Singh RN MPH CIC, Margaret Wojnar MD, Michael McPeck BS RRT, William Greene MD. Departments of Health Care Epidemiology / Quality Management and Respiratory Care. University Medical Center, State University of New York at Stony Brook.
BACKGROUND: Closed system suction (CSS) catheters, which have been in use in our intensive care units, were being changed at 24 h intervals in accord with the manufacturer's recommendations. Because our ongoing surveillance has determined that ventilator circuit change intervals of 168 h (7 days) has not been associated with adverse outcomes, we proposed changing CSS catheters at 48 h intervals while measuring outcomes. PURPOSE OF STUDY: To compare incidence densities (ID) of ventilator associated pneumonias (VAP) per 1,000 ventilator days with CSS catheter-related problems (if any) between time periods of CSS catheter change intervals of 24 and 48 h. Methods: We conducted prospective data collection and analysis on all patients admitted to the Surgical ICU who required mechanical ventilation >=72 h. Two time periods and two CSS catheter change intervals were analyzed: Period 1 ran from 4/1/96 - 6/30/96 during which CSS catheters were changed at 48 h intervals. Period 2 ran from 7/1/96 - 9/30/96 during which CSS catheters were changed at 24 h intervals. Data collection included ID of VAPs, Severity of Illness Scores (SIC) plus reports of any events that necessitated change of CSS catheter prior to scheduled date. Results: (1) There were 98 admissions requiring >=72 h of mechanical ventilation and the SICs were distributed thusly: 12.2% of patients were SIC 3, 65.5% were SIC 4 and 22.3% were SIC 5, (2) Results (figure) were stratified based on the SIC scores for each period:
(See original for figure)
CONCLUSION: This data from this preliminary study supports the prediction that CSS catheters in our hospital can be safely changed at 48 h intervals without adverse outcomes. Savings in direct costs and labor are advantages. Based on our 1995 actual purchase data, we project direct cost savings of ~ $25,000 per year by changing clinical practice such that CSS catheters are changed at 48 h intervals rather than 24 h. The study continues in the Medical and Surgical intensive care units.
Presented at The Society for Healthcare Epidemiology of America, April 27, 1997.