WEEKLY VENTILATOR CIRCUIT CHANGES - A STRATEGY TO REDUCE COSTS WITHOUT AFFECTING PNEUMONIA RATES

Background: Mechanical ventilator circuits are commonly changed at 48- h intervals. This frequency may be unnecessary because ventilator-asso ciated pneumonia often results from aspiration of pharyngeal secretion s and not from the ventilator circuit, We compared the ventilator-asso ciated pneumonia rates and costs associated with 48-h and 7-day circui t changes. Methods: Ventilator circuits were changed at 48-h intervals during the control period (November 1992 to April 1993) and at 7-day intervals during the study period (June 1993 to November 1993). Nosoco mial pneumonias were prospectively identified using the criteria of th e Centers for Disease Control and Prevention, The annual cost differen ce of changing circuits at 48-h and 7-day intervals was calculated usi ng the distribution of ventilator days for the control and study perio ds. Results: There were 1,708 patients, 9,858 ventilator days, and a p neumonia rate of 9.64 per 1,000 ventilator days in the control group ( 48-h circuit changes), There were 1,715 patients, 9,160 ventilator day s, and 8.62 pneumonias per 1,000 ventilator days when circuits were ch anged at 1-week intervals (study group), Using a logistic regression m odel, there were significantly greater odds of developing a ventilator -associated pneumonia in surgical patients (odds ratio 1.77, P = 0.02) and patients in critical care units (odds ratio 1.54, P = 0.05), but no significant risk of ventilator-associated pneumonia in patients in whom circuits were changed at 1-week intervals (odds ratio 0.82, P = 0 .22). Changing circuits at 7-day intervals resulted in a 76.6% ($111,5 30) reduction in the annual cost for materials and salaries. Conclusio ns: We found no difference in pneumonia rates with ventilator circuit changes at 48-h and 7-day intervals. Ventilator circuits can be safely changed at weekly intervals, resulting in large cost savings.