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One-Week versus 2-Day Ventilator Circuit Change in Neonates with Prolonged Ventilation: Cost-Effectiveness and Impact on Ventilator-Associated Pneumonia

Published online by Cambridge University Press:  22 December 2014

Shih-Ming Chu ,
Mei-Chin Yang ,
Hsiu-Feng Hsiao ,
Jen-Fu Hsu ,
Reyin Lien ,
Ming-Chou Chiang ,
Ren-Huei Fu ,
Hsuan-Rong Huang ,
Kuang-Hung Hsu  and
Ming-Horng Tsai
Shih-Ming Chu
Affiliation:
Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan College of Medicine, Chang Gung University, Taoyuan, Taiwan
Mei-Chin Yang
Affiliation:
Department of Respiratory Therapy, Chang Gung Memorial Hospital, Yunlin, Taiwan School of Business, Executive MBA Program in Health Care Management, Chang Gung University, Taoyuan, Taiwan
Hsiu-Feng Hsiao
Affiliation:
Department of Respiratory Therapy, Chang Gung Memorial Hospital, Yunlin, Taiwan
Jen-Fu Hsu
Affiliation:
Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan College of Medicine, Chang Gung University, Taoyuan, Taiwan
Reyin Lien
Affiliation:
Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan College of Medicine, Chang Gung University, Taoyuan, Taiwan
Ming-Chou Chiang
Affiliation:
Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan College of Medicine, Chang Gung University, Taoyuan, Taiwan
Ren-Huei Fu
Affiliation:
Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan College of Medicine, Chang Gung University, Taoyuan, Taiwan
Hsuan-Rong Huang
Affiliation:
Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan College of Medicine, Chang Gung University, Taoyuan, Taiwan
Kuang-Hung Hsu
Affiliation:
Laboratory for Epidemiology, Department of Health Care Management, Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
Ming-Horng Tsai*
Affiliation:
College of Medicine, Chang Gung University, Taoyuan, Taiwan Division of Neonatology and Pediatric Hematology/Oncology, Chang Gung Memorial Hospital, Yunlin, Taiwan
*
Address correspondence to Ming-Horng Tsai, MD, and Kuang-Hung Hsu, PhD, Division of Neonatology and Pediatric Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, No. 707, Gongye Rd., Sansheng, Mailio Township, Yunlin, Taiwan, R.O.C. (mingmin.tw@yahoo.com.tw and khsu@mail.cgu.edu.tw).
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Abstract

Objective

To investigate the impact of 1-week ventilator circuit change on ventilator-associated pneumonia and its cost-effectiveness compared with a 2-day change.

Design

An observational cohort study.

Setting

A tertiary level neonatal intensive care unit in a university-affiliated teaching hospital in Taiwan.

Patients

All neonates in the neonatal intensive care unit receiving invasive intubation for more than 1 week from July 1, 2011, through December 31, 2013.

Intervention

We investigated the impact of 2 ventilator circuit change regimens, either every 2 days or 7 days, on ventilator-associated pneumonia of our cohort.

Measurements and Main Results

A total of 361 patients were maintained on mechanical ventilators for 13,981 days. The 2 groups did not differ significantly in any demographic characteristics. The rate of ventilator-associated pneumonia was comparable between the 2-day group and the 7-day group (8.2 vs 9.5 per 1,000 ventilator-days, P=.439). The durations of mechanical ventilation and hospital stay, and rates of bloodstream infection and mortality, were also comparable between the 2 groups. Switching from a 2-day to a 7-day change policy would save our neonatal intensive care unit a yearly sum of US $29,350 and 525 working hours.

Conclusion

Decreasing the frequency of ventilator circuit changes from every 2 days to once per week is safe and cost-effective in neonates requiring prolonged intubation for more than 1 week.

Infect Control Hosp Epidemiol 2014;00(0): 1–7

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 3 , March 2015 , pp. 287 - 293
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

*

Shih-Ming Chu and Mei-Chin Yang contributed equally to this study.

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