TY - JOUR
T1 - Effect of a ventilator-focused intervention on the rate of Acinetobacter baumannii infection among ventilated patients
AU - Cohen, Regev
AU - Shimoni, Zvi
AU - Ghara, Riad
AU - Ram, Ron
AU - Ben-Ami, Ronen
PY - 2014/9
Y1 - 2014/9
N2 - 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.
AB - 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.
KW - Bacterial filter
KW - Respirator equipment care
KW - Ventilator-associated pneumonia
UR - http://www.scopus.com/inward/record.url?scp=84906830893&partnerID=8YFLogxK
U2 - 10.1016/j.ajic.2014.06.002
DO - 10.1016/j.ajic.2014.06.002
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C2 - 25179333
AN - SCOPUS:84906830893
SN - 0196-6553
VL - 42
SP - 996
EP - 1001
JO - American Journal of Infection Control
JF - American Journal of Infection Control
IS - 9
ER -