Regev Cohen1, Zvi Shimoni2, Riad Ghara3, Ron Ram4, Ronen Ben-Ami5. 1. Infectious Diseases Unit, Sanz Medical Center, Laniado Hospital, Netanya, Israel; Technion Israel Institute of Technology, Haifa, Israel. Electronic address: regevc@laniado.org.il. 2. Infectious Diseases Unit, Sanz Medical Center, Laniado Hospital, Netanya, Israel; Technion Israel Institute of Technology, Haifa, Israel. 3. Infectious Diseases Unit, Sanz Medical Center, Laniado Hospital, Netanya, Israel. 4. Bone Marrow Transplant Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Tel Aviv University, Tel Aviv, Israel. 5. Tel Aviv University, Tel Aviv, Israel; Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Abstract
BACKGROUND: Acinetobacter baumannii is a leading cause of ventilator-associated pneumonia, often as a result of ventilator equipment contamination. Evidence-based guidance on optimal care of ventilator equipment to prevent infection is lacking. Here, we report on a significant and persistent reduction in A baumannii infection rates achieved by introducing a strict policy on ventilator care. METHODS: We implemented an institution-wide ventilator care policy that included routine exchange of breathing circuits and external bacterial filters (every 7-14 days) and replacement followed by routine sterilization of internal bacterial filters (every 4-8 weeks). We analyzed sputum cultures and patient outcomes among ventilated patients before and after the intervention. RESULTS: Between January 2012 and March 2013, 321 patients ventilated for more than 3 days comprised the study cohort. Health care-associated A baumannii acquisition was significantly reduced during the postintervention period (33% vs 16%; odds ratio, 0.39; 95% confidence interval, 0.23-0.67; P = .0008). Additionally, the median time to A baumannii acquisition was significantly longer postintervention (59 vs 21 days; P < .0001). A baumannii ventilator-associated pneumonia risk was also reduced postintervention (odds ratio, 0.39; P = .005). CONCLUSIONS: Implementing a stricter standard of ventilator care than that currently defined in published guidelines can significantly decrease health care-associated A baumannii acquisition and related adverse outcomes among ventilated patients.
BACKGROUND:Acinetobacter baumannii is a leading cause of ventilator-associated pneumonia, often as a result of ventilator equipment contamination. Evidence-based guidance on optimal care of ventilator equipment to prevent infection is lacking. Here, we report on a significant and persistent reduction in A baumannii infection rates achieved by introducing a strict policy on ventilator care. METHODS: We implemented an institution-wide ventilator care policy that included routine exchange of breathing circuits and external bacterial filters (every 7-14 days) and replacement followed by routine sterilization of internal bacterial filters (every 4-8 weeks). We analyzed sputum cultures and patient outcomes among ventilated patients before and after the intervention. RESULTS: Between January 2012 and March 2013, 321 patients ventilated for more than 3 days comprised the study cohort. Health care-associated A baumannii acquisition was significantly reduced during the postintervention period (33% vs 16%; odds ratio, 0.39; 95% confidence interval, 0.23-0.67; P = .0008). Additionally, the median time to A baumannii acquisition was significantly longer postintervention (59 vs 21 days; P < .0001). A baumannii ventilator-associated pneumonia risk was also reduced postintervention (odds ratio, 0.39; P = .005). CONCLUSIONS: Implementing a stricter standard of ventilator care than that currently defined in published guidelines can significantly decrease health care-associated A baumannii acquisition and related adverse outcomes among ventilated patients.