Has new technology of use of disposable suction liners reduced ventilator associated pneumonia in the Nairobi hospital intensive care unit?

Abstract

Introduction: Patients who are admitted in the intensive care units (ICU) are at risk of hospital-acquired (nosocomial) infection as a secondary illness. The second most common nosocomial infection on these critically ill patients after urinary tract infections is pneumonia. Majority of the nosocomial pneumonias are from the use of mechanical ventilation. The pneumonia from the mechanical ventilation is often referred to as ventilator-associated pneumonia (VAP) Objectives/Aims: The aim of this study was to evaluate the impact of the use of disposable suction liners at the Nairobi hospital intensive care unit. The specific objective was to determine and compare the incidence of VAP in the ICU of The Nairobi Hospital before and after introduction of the disposable suction liners. Methods: This retrospective cohort study research was undertaken at The Nairobi Hospital which is a private hospital in the capital city of Kenya. The study included data from all the patients admitted in the intensive care unit (ICU) between the year 2012 and 2015. Results: The study cohort had a population of 2504 patients; 1208 (48.2%) were from the exposed group (2014 and 2015) while 1296 (51.8%) were from the unexposed group (2012 and 2013). Overall the incidences of VAP for the exposed and unexposed groups respectively were 5.0 and 63.3 per 1000 patients; RR [95% CI]; 12.74 [5.58-29.07] (p<0.001). Conclusion: The study concluded that VAP can be significantly reduced by the introduction of suction liners in ICUs. This is evident from the data as VAP was reduced by 13 times between the two cohorts. Additionally, it can be concluded that certain known practices like early gastric feeding; nasal intubation in preference to other modes of intubation and isolation practice reduced the risk of VAPs in ventilated patients in critical care units. These practices should be enhanced when and as applicable in all ventilated patients. Importantly, the use of disposable suction liners had the best outcome of reduced VAPs in ventilated patients and therefore was highly recommended