| Summary: | 碩士 === 國立臺灣大學 === 流行病學研究所 === 89 === To keep good quality is the most important thing and goal in medical care. However, cost-benefit is another important issue in modern medicine.It’s always a hot topic about the conflict of reducing costs and keeping high quality of medical care. How to keep balance between costs and quality is always under discussion. Nosocomial infection rate is an important indication for hospital care quality. Invasive procedures such as endotracheal tube insertion and ventilator usage are common risk factors for noscomial infection. Although there have been some studies in U.S. or Europe demonstrated that reducing the frequency of ventilator circuit change will not increase the chance of nosocomial pneumonia. However,in Taiwan we have very rare such data to prove that changing ventilator circuit less frequently will no influence the chance of nosocomial infection.
To evaluate the effect of changing frequency from twice per week to once per week on the ventilator-associated pneumonia, we performed a prospective study with historical control in surgical intensive care units(SICU) of National Taiwan University Hospital during the peroid of 1999/12/01~2000/04/30(as control group) and 2000/12/01~2001/04/30(as study group). All patients stayed at SICU and using ventilator were included. There were no significant difference about the demographic data and risk factors between the control group(1999/12/01~2000/04/30,changing ventilator circuit twice per week) and study group(2000/12/01~2001/04/30,changing ventilator circuit once per week). There were 561 cases(male：female=322：239) in the control group with a mean age of 58.9±8.2 years. Total ventilatordays were 3562 and the infection rate of ventilator-associated pneumonia was 5.9/1000 ventilator days.The mean ventilator-using day was 6.3±11.9 and the mean ICU day was 9.1±13.0. In the study group , there were 623 cases(male：female=402：221) with a mean age of 61.5±5.9 years. The total ventilator days were 3290 and the infection rate of ventilator-associated pneumonia was 3.3/1000 ventilator days. The mean ventilator-using day was 5.3±9.9 and the mean ICU day was 8.0±10.4. The RR of ventilator-associated pneumonia rate was 0.57(95% CI：0.251~1.078，P=0.079). The factors with significant difference between two group were sex，age，lung condition when entering SICU，operation type，days between ventilator using and getting infection，using aerosol therapy or not. By Poisson regression model, the RR was 0.945(95% CI：0.438~2.040，P=0.886). By multivariate analysis, only two factors were significant related to ventilator-associated pneumonia：lung condition when patient entering SICU(RR=0.152， 95% CI：0.065~0.357，P=0.0001)；ventilator using day(RR=8.885，95% CI：1.953~40.434，P=0.005). Survival analysis about the probability of acquired ventilator-associated pneumonia byventilator-using days demonstrated there was no significant difference between the control group and study group.
From this study, we concluded that there was no significant difference for risk of getting ventilator-associated pneumonia either the ventilator circuit was changed twice per week or once per week.
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