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Learning Objective 1: Ventilator circuits can prevent VAP contributes to a significant portion of nosocomial infection in critical patients. It carries certain mortality and morbidity.
Learning Objective 2: Routine weekly change of circuit seems having no significant effect on preventing VAP in this analysis. However, the tubing should still be monitored closely.
Ventilator associated pneumonia (VAP) contributes to a significant portion of nosocomial infection in critical patients. It carries certain mortality and morbidity in modern intensive care units. Ventilator tubing hygiene is always considered a risk actor. However, whether routine maintenance of ventilator circuits can prevent VAP or not is still a controversial topic. Thus, we performed a retrospective study to see if weekly changes of the circuit help in preventing VAP.
Methods: This is a retrospective cohort study. From Nov. 2007 to Dec. 2008, all patients’ charts admitted to a pediatric intensive care unit were reviewed. Patients were enrolled if they have records of using ventilators. VAP cases were defined by the record of the institution’s infection control committee. Patients were excluded if they have previously proved VAP. Patients with weekly change of circuit were defined as frequent change group. Demographic data were also collected. Poisson regression models were used for person-day data analysis and testing confounding factors.
Results:
During the study period, 848 person-days of weekly change group and 850 person-days of reference group were collected. The incidence was 5.9 cases per 1,000 patient-days in weekly change group and 3.8 cases per 1,000 patient-days in the reference group. The hazard ration was 1.71 (95%CI, 0.41 ~ 7.12). Body weight and age had no significant effect on the results. The pathogen of those VAP cases were diverse including Pesudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumonia, Staphylococcus aureus, Staphylococcus aureus and Streptococcus pneumaniae.
Conclusion:
Routine weekly change of circuit seems having no significant effect on preventing VAP in this analysis. However, the tubing should still be monitored closely. If the tubing is contaminated with vomit, blood, or thick sputum, it should still be replaced. Further larger scale prospective study should be performed to elucidate this issue.