Exposure to reprocessed single-use tracheal suction catheter and ventilator-associated pneumonia risk: A preliminary, single unit–based, matched case-control study

• Published in: Journal of critical care 2016-04, Vol.32, p.145-151
• Main Authors: Gutiérrez, John Mark M., RN, MAN, Millare, Perciveranda A., PhD, RN, Al-Shenqiti, Yousef A., MN, Enaya, Abdallah A., MSN
• Format: Article
• Language: English
• Subjects: Adult; Aged; Case-Control Studies; Case-control studyl; Catheterization - adverse effects; Catheterization - methods; Critical Care; Exogenous VAP; Female; Humans; Intensive Care Units - statistics & numerical data; Logistic Models; Male; Middle Aged; Odds Ratio; Orally intubated, mechanically ventilated patients; Pneumonia, Ventilator-Associated - etiology; Reprocessed single-use suction catheter; Risk Factors; Suction - adverse effects; VAP risk; Ventilator-associated pneumonia
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2015.11.018

Abstract Purpose The reuse of reprocessed single-use suction catheter for suctioning an amount of tracheal secretion among orally intubated, mechanically ventilated patients, who are at risk of acquiring ventilator-associated pneumonia (VAP), has not been thoroughly investigated. This study aimed to examine the association between the repetitive use of reprocessed single-use suction catheter and VAP development. Materials and methods A preliminary, single unit–based investigation was designed as matched case-control study to extract data from hospital's existing 5-year VAP report and inpatients' clinical records. Cases were defined as patients, who developed VAP between December 2009 and October 2014. Controls were defined as patients, who had no evidence of VAP during study period. Six hundred eight controls were frequency matched to 152 cases in 4:1 ratio. Chart-extracted clinical data were stratified and included for conditional logistic regression analysis. Results Analysis showed a significant association between reprocessed single-use tracheal suction catheter exposure and VAP development [odds ratio (OR), 3.64; 95% confidence interval (CI), 2.47-5.35]. A statistically significant increase in VAP risk was found in male intubated patients (OR, 5.33; 95% CI, 1.22-23.3), who are older than 60 years (OR, 8.08; 95% CI, 1.47-44.3), had severe Glasgow Coma Scale scores (OR, 8.27; 95% CI, 1.83-37.3), and received mechanical ventilatory support for more than 96 hours (OR, 9.67; 95% CI, 1.98-47.1). In addition, a statistically significant increase in VAP risk was seen in intensive care unit, where reprocessed tracheal suction catheter changes were routinely provided (OR, 16.0; 95% CI, 2.40-106.7) and unsatisfactory hand hygiene percentage compliance was observed (OR, 8.40; 95% CI, 1.60-44.1). Ventilator-associated pneumonia proportion analysis revealed a higher number of unknown exogenous VAP among exposed cases compared to nonexposed case patients (32.2% vs 13.8%; OR, 2.31; 95% CI, 1.31-4.05; P < .005) that were mechanically ventilated for more than 96 hours (62.5% vs 25.7%; OR, 3.62; 95% CI, 2.40-5.46; P < .0001). Conclusions This current study suggests that exposure to reprocessed single-use tracheal suction catheter may predispose orally intubated, mechanically ventilated patients in developing VAP. Further research studies are recommended to validate these findings. Implications for clinical nursing practice The estimated VAP risk of this traditional-base