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Effect of a ventilator-focused intervention on the rate of Acinetobacter baumannii infection among ventilated
Regev Cohen1, Zvi Shimoni1, Riad Ghara2
1Infectious Diseases Unit, Sanz Medical Center, Laniado Hospital, Netanya, Israel; Technion Israel Institute of Technology, Haifa, Israel.
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.
Insights
A strict ventilator care policy significantly reduced Acinetobacter baumannii infections in ventilated patients. This enhanced protocol lowered infection rates and prolonged the time to bacterial acquisition.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Hospital Epidemiology
Background:
- Acinetobacter baumannii is a major cause of ventilator-associated pneumonia (VAP).
- Ventilator equipment contamination frequently leads to VAP.
- Current evidence-based guidelines for ventilator equipment care are insufficient.
Purpose of the Study:
- To assess the impact of a strict ventilator care policy on Acinetobacter baumannii infection rates.
- To evaluate the effect of the policy on patient outcomes related to A. baumannii.
Main Methods:
- An institution-wide policy for ventilator care was implemented.
- The policy included routine exchange of breathing circuits and filters.
- Sputum cultures and patient outcomes were analyzed pre- and post-intervention.
Main Results:
- Health care-associated A. baumannii acquisition decreased significantly (33% vs. 16%).
- The median time to A. baumannii acquisition increased significantly (21 vs. 59 days).
- A. baumannii VAP risk was substantially reduced (odds ratio, 0.39).
Conclusions:
- A stricter ventilator care standard than currently published guidelines can effectively reduce A. baumannii acquisition.
- Implementing this policy leads to decreased adverse outcomes in ventilated patients.
- Enhanced ventilator hygiene protocols are crucial for infection control in intensive care settings.
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