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Ventilator circuitry in neonatal intensive care: extending the period between changes from 4 to 7 days. A pilot study
Insights
Extending ventilator tubing changes from 4 to 7 days did not increase bacterial colonization in neonates. This finding supports a practice change, leading to significant cost savings in neonatal intensive care units.
Area of Science:
- Neonatal intensive care
- Infectious disease control
- Medical device management
Background:
- Ventilator-associated pneumonia is a significant concern in neonatal intensive care.
- Current protocols often involve frequent changes of disposable ventilator tubing.
- The optimal frequency for changing ventilator circuits requires further investigation to balance infection risk and resource utilization.
Purpose of the Study:
- To evaluate the impact of extending the interval between disposable ventilator tubing changes from 4 to 7 days on bacterial colonization.
- To assess the safety and efficacy of prolonged ventilator circuit use in a neonatal population.
Main Methods:
- A prospective, non-randomized study was conducted in a tertiary neonatal intensive care nursery.
- Bacterial colonization levels were compared between two groups of ventilated infants: those with 4-day circuit changes and those with 7-day changes.
- Samples were collected from inspiratory/expiratory lines and humidifier traps, alongside routine endotracheal aspirates.
Main Results:
- No significant difference in bacterial colonization of ventilator lines was observed between the 4-day and 7-day circuit change groups.
- Analysis of routine endotracheal aspirates also showed no increased risk associated with the extended interval.
Conclusions:
- Extending ventilator tubing change intervals to 7 days is a safe practice in this neonatal population.
- This change in practice resulted in substantial cost savings for the hospital, exceeding $15,000.
- The findings support a revision of ventilator circuit change protocols to optimize resource allocation without compromising patient safety.
Objective:
To determine the effect of increasing the time span between changes of disposable ventilator tubing from 4 to 7 days.
Design:
A prospective non-randomised study comparing levels of bacterial colonisation amongst babies who had ventilator circuits changed on either the 4th or 7th day. Data was collected sequentially with data collection from the '4-day group' preceding data collection from the '7-day group'.
Setting:
A tertiary neonatal intensive care nursery.
Patients:
All babies requiring ventilation at the time when data collection was possible. Ten babies were included in the first group (4 days) and 33 babies in the second group.
Interventions:
Inspiratory and expiratory lines were swabbed and water from the humidifier trap sampled before the line was changed at either 4 or 7 days. Results of routine endotracheal aspirates, taken before and after the change of circuitry, were noted.
Main Outcome Measure:
The level of bacterial contamination of ventilator circuits.
Results And Conclusions:
In this small sample, no differences were found in terms of bacterial colonisation of ventilator lines. This has resulted in a change of practice in the hospital and a cost saving of over $15,000.