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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
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).

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
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.

References

1.Chandonnet, CJ, Kahlon, PS, Rachh, P, et al. Health care failure mode and effect analysis to reduce NICU line-associated bloodstream infections. Pediatrics 2013;131:e1961e1969.CrossRefGoogle ScholarPubMed
2.Zervou, FN, Zacharioudakis, IM, Ziakas, PD, Mylonakis, E. MRSA colonization and risk of infection in the neonatal and pediatric ICU: a meta-analysis. Pediatrics 2014;133:e1015e1023.CrossRefGoogle ScholarPubMed
3.Hocevar, SN, Edwards, JR, Horan, TC, Morrell, GC, Iwamoto, M, Lessa, FC. Device-associated infections among neonatal intensive care unit patients: incidence and associated pathogens reported to the National Healthcare Safety Network, 2006–2008. Infect Control Hosp Epidemiol 2012;33:12001206.CrossRefGoogle Scholar
4.Cernada, M, Aquar, M, Brugada, M, et al. Ventilator-associated pneumonia in newborn infants diagnosed with an invasive bronchoalveolar lavage technique: a prospective observational study. Pediatr Crit Care Med 2013;14:5561.CrossRefGoogle ScholarPubMed
5.Srinivasan, R, Asselin, J, Gildengorin, G, Wiener-Kronish, J, Flori, HR. A prospective study of ventilator-associated pneumonia in children. Pediatrics 2009;123:11081115.CrossRefGoogle ScholarPubMed
6.Fischer, JE, Allen, P, Fanconi, S. Delay of extubation in neonates and children after cardiac surgery: impact of ventilator-associated pneumonia. Intensive Care Med 2002;26:942949.CrossRefGoogle Scholar
7.Foglia, E, Meier, MD, Elward, A. Ventilator-associated pneumonia in neonatal and pediatric intensive care unit patients. Clin Microbiol Rev 2007;20:409425.CrossRefGoogle ScholarPubMed
8.Apisarnthanarak, A, Holzmann-Pazgal, G, Hamavas, A, Olsen, MA, Fraser, VJ. Ventilator-associated pneumonia in extremely preterm neonates in a neonatal intensive care unit: characteristics, risk factors, and outcomes. Pediatrics 2003;30:17411746.Google Scholar
9.Tuan, TM, Chen, LH, Yu, HM. Risk factors and outcomes for ventilator-associated pneumonia in neonatal intensive care unit patients. J Perinat Med 2007;35:334338.Google Scholar
10.Garland, JS. Strategies to prevent ventilator-associated pneumonia in neonates. Clin Perinatol 2010;37:629643.CrossRefGoogle ScholarPubMed
11.Cernada, M, Brugada, M, Golombek, S, Vento, M. Ventilator-associated pneumonia in neonatal patients: an update. Neonatology 2014;105:98107.CrossRefGoogle ScholarPubMed
12.Han, J, Liu, Y. Effect of ventilator circuit changes on ventilator-associated pneumonia: a systemic review and meta-analysis. Respir Care 2010;55:467474.Google Scholar
13.Makhoul, IR, Kassis, I, Berant, M, Hashman, N, Revach, M, Sujov, P. Frequency of change of ventilator circuit in premature infants: impact on ventilator-associated pneumonia. Pediatr Crit Care Med 2001;2:127132.CrossRefGoogle ScholarPubMed
14.Samransamruajkit, R, Jirapaiboonsuk, S, Siritantiwat, S, et al. Effect of frequency of ventilator circuit changes (3 vs 7 days) on the rate of ventilator-associated pneumonia in PICU. J Crit Care 2010;25:5661.CrossRefGoogle ScholarPubMed
15.Stamm, AM. Ventilator-associated pneumonia and frequency of circuit changes. Am J Infect Control 1998;26:7173.CrossRefGoogle ScholarPubMed
16.Han, JN, Liu, YP, Ma, S, et al. Effects of decreasing the frequency of ventilator circuit changes to every 7 days on the rate of ventilator-associated pneumonia in a Beijing hospital. Respir Care 2001;46:891896.Google Scholar
17.Stoller, JK, Orens, DK, Fatica, C, et al. Weekly versus daily changes of in-line suction catheters: impact on rates of ventilator-associated pneumonia and associated costs. Respir Care 2003;48:494499.Google ScholarPubMed
18.Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309332.CrossRefGoogle ScholarPubMed
19.Zhou, Q, Lee, SK, Jiang, SY, et al. Efficacy of an infection control program in reducing ventilator-associated pneumonia in a Chinese neonatal intensive care unit. Am J Infect Control 2013;41:10591064.CrossRefGoogle Scholar
20.Tsai, MH, Hsu, JF, Chu, SM, et al. Incidence, clinical characteristics and risk factors for adverse outcome in neonates with late-onset sepsis. Pediatr Infect Dis J 2014;33:e7e13.CrossRefGoogle ScholarPubMed
21.Tsai, MH, Chu, SM, Hsu, JF, et al. Risk factors and outcomes for multidrug-resistant gram-negative bacteremia in the NICU. Pediatrics 2014;133:e322e329.CrossRefGoogle ScholarPubMed
22.National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470–485.Google Scholar
23.Morris, AC, Kefala, K, Simpson, AJ, et al. Evaluation of the effect of diagnostic methodology on the reported incidence of ventilator-associated pneumonia. Thorax 2009;64:516522.CrossRefGoogle ScholarPubMed
24.Baltimore, RS. The difficulty of diagnosing ventilator-associated pneumonia. Pediatrics 2003;112:14201421.CrossRefGoogle ScholarPubMed
25.Tan, B, Xian-Yang, X, Zhang, X, et al. Epidemiology of pathogens and drug resistance of ventilator-associated pneumonia in Chinese neonatal intensive care units: a meta-analysis. Am J Infect Control 2014;42:902910.CrossRefGoogle ScholarPubMed
26.Yuan, TM, Chen, LH, Yu, HM. Risk factors and outcomes for ventilator associated pneumonia in neonatal intensive care unit patients. J Perinat Med 2007;35:334338.CrossRefGoogle ScholarPubMed
27.Shorr, AF, Duh, MS, Kelly, KM, Kollef, MH; CRIT Study Group. Red blood cell transfusion and ventilator-associated pneumonia: a potential link? Crit Care Med 2004;32:666674.CrossRefGoogle ScholarPubMed
28.Memish, ZA, Cunningham, G, Oni, GA, Djazmati, W. The incidence and risk factors of ventilator-associated pneumonia in Riyadh hospital. Infect Control Hosp Epidemiol 2000;21:271273.CrossRefGoogle ScholarPubMed
29.Shalini, T, Malik, GK, Jain, A, Kohli, N. Study of ventilator associated pneumonia in neonatal intensive care unit: characteristics, risk factors, and outcome. Internet J Med Update 2010;5:1219.Google Scholar
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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
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