title: Effect of a ventilator-focused intervention on the rate of Acinetobacter baumannii infection among ventilated patients.
abstract: 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.
authors.affiliation: Infectious Diseases Unit, Sanz Medical Center, Laniado Hospital, Netanya, Israel; Technion Israel Institute of Technology, Haifa, Israel. Electronic address: regevc@laniado.org.il.
authors.forename: Regev
authors.initials: R
authors.lastname: Cohen
authors.affiliation: Infectious Diseases Unit, Sanz Medical Center, Laniado Hospital, Netanya, Israel; Technion Israel Institute of Technology, Haifa, Israel.
authors.forename: Zvi
authors.initials: Z
authors.lastname: Shimoni
authors.affiliation: Infectious Diseases Unit, Sanz Medical Center, Laniado Hospital, Netanya, Israel.
authors.forename: Riad
authors.initials: R
authors.lastname: Ghara
authors.affiliation: Bone Marrow Transplant Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Tel Aviv University, Tel Aviv, Israel.
authors.forename: Ron
authors.initials: R
authors.lastname: Ram
authors.affiliation: Tel Aviv University, Tel Aviv, Israel; Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
authors.forename: Ronen
authors.initials: R
authors.lastname: Ben-Ami
mesh_terms: D000151:Acinetobacter Infections / Q000382:microbiology* / Q000517:prevention & control*; D040981:Acinetobacter baumannii / Q000302:isolation & purification*; D000368:Aged; D004866:Equipment Contamination; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D008297:Male; D053717:Pneumonia, Ventilator-Associated / Q000382:microbiology* / Q000517:prevention & control*; D012121:Respiration, Artificial / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D012122:Ventilators, Mechanical / Q000382:microbiology*
keywords: Bacterial filter; Respirator equipment care; Ventilator-associated pneumonia