2001 OPEN FORUM Abstracts
EFFECT OF EXTENDING CLOSED SYSTEM SUCTION CATHETER INTERVAL ON VENTILATOR ASSOCIATED PNEUMONIA RATES
Virginia DeFilippo, MS, RRT, Jeffrey Topal, MD, Lynn Tanoue, MD, Patricia Reagan-Cirincione, Ph.D., Yale-New Haven Hospital, New Haven, Connecticut
Background: Closed system suction catheters (CSSC) are changed at 24 hour intervals by manufacturer recommendation. Several studies have examined extending CSSC changes from 24 hours to 7 days using Ventilator Associated Pneumonia Rate (VAPR) as an outcome measure for practice change, with no statistically significant change in VAPR noted. We evaluated the effect on VAPR of changing CSSC from every 24 hours to 7-day intervals with the ventilator circuit change at our institution. Additionally, we evaluated the number of CSSC failures during the first 2 months of the study.
Method: The study was conducted in the Medical Intensive Care Unit (MICU). Respiratory Care and MICU staff were informed of the study. For a six-month period, mechanically ventilated patients had CSSCs changed on a 7-day interval when the ventilator circuit was changed rather than a daily change. VAPR was used as an outcome measure. Historical data on VAPR from the 6 months prior to the practice change were used as a comparative baseline. A CSSC could be changed at less than 7 days depending on the integrity of the unit as assessed by the respiratory care practitioner. All CSSCs requiring change-out before 7 days due to integrity or other issues were tracked. Respiratory Care staff were instructed to record any CSSC failures during the first 2 months of the study. Staff recorded the reason for the failure and the number of days the CSSC was used. A CSSC failure was defined as any situation in which the respiratory therapist deemed the integrity of the CSSC to be unsatisfactory. During the study, there were 169 ventilated patients with 1,342 ventilator days and 25,745 ventilator hours. Average ventilator length of stay was 6.35 days. Epidemiology and Infection Control staff monitored VAPRs. VAPR data was collected in compliance with National Nosocomial Infection Surveillance (NNIS) criteria. One way Analysis of Variance (ANOVA) was performed for statistical analysis.
Results: Daily vs. 7 Day CCCS Changes:
|Mean Ventilator Days||253.3||223.7||p = .33|
|Mean VAPR||13.7||3.6||p = .04|
CSSC Failure Data:
|Avg # of days use before catheter failure||4.5|
|% Catheter failures to catheters used||7.07%|
Conclusion: There was a significant reduction in VAPR with CSSC changes every seven days versus daily changes. The seven-day catheter failure rate was 7.07%. Since the sample size was small a further confirmation of these findings is recommended.