1998 OPEN FORUM Abstracts
THE EFFECT OF EXTENDED CIRCUIT CHANGE INTERVALS ON THE INCIDENCE OF VENTILATOR ASSOCIATED PNEUMONIA.
Mary Turley, RRT, John Votto, DO, Janet Brancifort, BS, RRT, M. Collins, RN, Hospital for Special Care, New Britain, CT.
Hospital for Special Care is a 200 bed chronic disease and rehabilitation hospital. With the steady growth of our ventilator dependent patient population and the need to provide quality cost effective patient care we reviewed all areas of our practice for improvement. This study compares the ventilator associated pneumonia (VAP) rates and cost reductions with 7 day, 14 day, and 21 day ventilator circuit changes. Methods: During Phase 1 circuits were changed every 7 days, during Phase 2 circuits were changed every 14 days and during Phase 3 circuits were changed every 21 days. Data was analyzed for a 6 month time period, from January to June, during each phase. Infectious Disease monitored the occurrence of VAP during this period, using clinical criteria consistent with the CDC. Data was also obtained for ventilator circuit costs and practitioner time spent doing circuit changes. There was no change in mechanical ventilation practice during this time. Heated wire circuits and heat moisture exchange systems were used and patients were on a closed suction catheter system. Results: Based on 8,760 ventilator days (48 patients) in Phase 1 the VAP rate was 1.75/1000 ventilator days. Practitioners spent 416 hours doing circuit changes and circuit costs were $25,444 during this time. In Phase 2 there were 10,950 ventilator days (60 patients) and the VAP rate was 1.64/1000 ventilator days. Practitioners spent 260 hours doing circuit changes and circuit costs were $18,639. In phase 3 there were 14,118 ventilator days (75 patients) and the VAP rate was 1.47/1000 ventilator days. Practitioners spent 208 hours doing circuit changes and circuit costs were $13,090. CONCLUSION: Our results would suggest, that in the long term ventilator dependent patient population, ventilator circuits can be changed at a 21 day interval without a significant change in the occurrence of VAP and with a significant savings in circuit costs and practitioner time.
The 44th International Respiratory Congress Abstracts-On-Disk®, November 7 - 10, 1998, Atlanta, Georgia.