Association between implementation of CDC recommendations and ventilator-associated pneumonia at selected US...

To assess whether selected recommendations in the Centers for Disease Control and Prevention "Guideline for Prevention of Nosocomial Pneumonia" were being implemented and having an impact on the occurrence of ventilator-associated pneumonia (VAP) at US hospitals, we surveyed hospitals participating in the National Nosocomial Infections Surveillance (NNIS) system.

We mailed a questionnaire to the infection control practitioner of each NNIS hospital in 1995 and used data from the NNIS system to calculate annual rates of VAP.

Of the 188 hospitals surveyed, 179 (95%) returned completed questionnaires. Of these, 175 (98%) had implemented the recommended change of mechanical-ventilator breathing circuits at 48-hour or greater intervals. Of 110 hospitals using the hygroscopic condenser-humidifiers or heat-moisture exchangers with ventilators, 102 (93%) changed the hygroscopic condenser-humidifiers or heat-moisture exchangers routinely, and of 98 hospitals using bubbling humidifiers, 96 (98%) used sterile water to fill these humidifiers. Other practices for which the guideline provides no recommendation and their frequency of use by NNIS hospitals include use of hygroscopic condenser-humidifiers or heat-moisture exchangers (110/179 [61%]) and use of bacterial filters in anesthesia machines (128/171 [61%]). There was a significant decrease in the VAP rate from 1987 to 1998.

Most NNIS hospitals had implemented selected recommendations in the Centers for Disease Control and Prevention "Guideline for Prevention of Nosocomial Pneumonia" before the final publication of the revised guideline. Further studies are needed to assess the impact of these recommendations on the occurrence of VAP.