Korean J Nosocomial Infect Control.  2000 Jun;5(1):9-21.

A Prospective Study on the lncidence of Ventilator-associated Pneumonia in Patients with Circuit Changes every 3 days Versus Weekly Changes

• Oh HS
• Choi YK
• Lee BN
• Shim MY
• Choi HS
• Kim EC
• Choi KW

Abstract

BACKGROUND
Ventilator associated pneumonia (VAP) is the most serious nosocomial infection of intensive care units. Several studies have investigated the relationship between the interval of ventilator circuit changes and the incidence of pneumonia in foreign countries, but there are no reports about it in Korea yet. So we performed this study to compare the clinical and cost impact between 3 days and 7 days interval in ventilator circuit changes.
METHODS
Seoul National University Hospital is a 1,500-bed, university affiliated, tertiary and acute care hospital. All patients admitted to medical intensive care unit (MICU) and surgical intensive care unlt (SICU) between April 1, 1998 and October 31, 1998, requiring mechanical ventilation were included. Patients were divided into two groups of a-cay circuit changes and weekly changes. Daily surveillance was conducted using the criteria of VAP of the National Nosocomial Infection Surveillance System. Incidence of VAP and risk factors for VAP were evaluated. Standard microbiologic methods were used for the identification of clinical and environmental isolates. Statistical analysis was done by SAS Program (version 6.12), analysis of difference in variables was performed using chi-square test and t-test. Analysis of odds ratios was done with logistic regression analysis.
RESULTS
VAP developed at a rate of 12.2 per 1,000 ventilator-days in the 3 days change group and 15.6 per 1,000 ventilator-days in the weekly change group (P=0.7240). The only statistically significant risk factor of VAP was duration of mechanical ventilation, The risk of VAP in patients with more than 7 days was 2.23 times higher than in patients with 7 days and below (OR; 2.2296). Estimated annual savings of nursing time by extending ventilator circuit change interval from 3 days to 7 days were 26,806 min 48 sec and estimated savings of cost by reduction of nursing times was calculated as 6,701,700 won.
CONCLUSIONS
Weekly ventilator circuit changes in patients undergoing ventilation therapy in the ICU do not contribute to increased the rates of VAP and are cost-effective.

Keyword

Ventilator associated pneumonia (VAP); Ventilator circuit changes; 3 days change; Weekly change; Cost-effective

MeSH Terms

Cross Infection
Humans
Incidence
Income
Critical Care
Intensive Care Units
Korea
Logistic Models
Nursing
Odds Ratio
Pneumonia
Pneumonia, Ventilator-Associated*
Prospective Studies*
Respiration, Artificial
Risk Factors
Seoul
Ventilation
Ventilators, Mechanical