title: Exposure to reprocessed single-use tracheal suction catheter and ventilator-associated pneumonia risk: A preliminary, single unit-based, matched case-control study.
abstract: OBJECTIVE
  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.
  
  
  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.
  The estimated VAP risk of this traditional-based practice is essential to provide strong basis for infection control measures to reduce, if not totally eliminate, VAP.
authors.affiliation: Department of Nursing, College of Applied Medical Sciences, Shaqra Male Campus, Shaqra University, Riyadh, Saudi Arabia. Electronic address: johnmark_gutierrez01@yahoo.com.
authors.forename: John Mark M
authors.initials: JM
authors.lastname: Gutiérrez
authors.affiliation: Department of Nursing, College of Applied Medical Sciences, Al-Quway'iyah Female Campus, Shaqra University, Riyadh, Saudi Arabia.
authors.forename: Perciveranda A
authors.initials: PA
authors.lastname: Millare
authors.affiliation: Ministry of Health, General Directorate of Health Affairs, Madinah, Saudi Arabia.
authors.forename: Yousef A
authors.initials: YA
authors.lastname: Al-Shenqiti
authors.affiliation: Department of Nursing, College of Applied Medical Sciences, Shaqra Male Campus, Shaqra University, Riyadh, Saudi Arabia.
authors.forename: Abdallah A
authors.initials: AA
authors.lastname: Enaya
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002404:Catheterization / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D053717:Pneumonia, Ventilator-Associated / Q000209:etiology*; D012307:Risk Factors; D013396:Suction / Q000009:adverse effects*
keywords: Case-control studyl; Exogenous VAP; Orally intubated, mechanically ventilated patients; Reprocessed single-use suction catheter; VAP risk; Ventilator-associated pneumonia