Abstract
Studies suggest that decreased ventilator-circuit-change frequency results in decreased or unchanged incidence of VAP in acute care settings. However, few data have emerged from the subacute setting. This study compares the results of increasing the interval between ventilator circuit changes from 7 to 14 days in a subacute environment and also evaluates the incidence of nosocomial infection in patients with tracheostomies who were not receiving mechanical ventilation (MV). METHOD: During the first 6 months, tubing was changed every 7 days and during the second 6 months every 14 days for patients receiving MV ≥ 6 h/day. Once a patient achieved 24 consecutive hours of spontaneous breathing, that patient was placed into the tracheostomy group. Aerosol circuits for the tracheostomy group were changed 3 times/week throughout the study. Study patients were evaluated by clinical criteria for presence of leukocytosis, fever, purulent secretions, evidence of new infiltrate on chest film, and confirmation by the medical director. All patients with a length of stay < 5 days were excluded. RESULTS: The incidence of VAP with 7-day circuit changes was 3/31 versus 2/18 (p = 0.742) and the incidence of nosocomial pneumonia in the tracheostomy group was 4/22 for 7-day change intervals and 4/16 for 14-day intervals (p = 0.742). Aggregate incidence of pneumonia for ventilated patients (mean MV days = 55.4) was 10.2% and for the tracheostomy group 21%. CONCLUSIONS: 14-day circuit-change intervals result in an incidence of pneumonia that differs little from that seen with 7-day change intervals in this subacute environment. More data are needed to determine the maximum safe interval for circuit changes, especially in long-term patients in alternative care sites. [Respir Care 1996;41(7):601-606]
Get full access to this article
View all access options for this article.