Interprofessional Collaborative to Reduce Unconventional Replacement Rates of Ventilator Circuits in Surgical Intensive Care Units

Background: In recent decades, ventilator-associated pneumonia (VAP) has been one of the major issues in global critical care medicine. Previous studies have shown that irregular and frequent circuit tubing replacements may increase the incidence of VAP. Therefore, the purpose of this study is to reduce the rate of unconventional replacement of ventilator circuit tubes and to explore the necessity and timing of replacing heat and moisture exchangers (HMEs) with heated humidifiers (HHs). Methods: This study aims to establish a quality control circle to reduce the incidence of unconventional replacement of ventilator circuit tube in the surgical intensive care unit (SICU). Pre-intervention data were collected from April 2018 to March 2019 and analyzed to identify the primary and second causes of unconventional replacement of ventilator circuit tube: 1) clinical judgment by nursing staff regarding excessively viscous sputum, and 2) prolonged duration of general anesthesia surgery (Figure 1). Using the PDCA (Plan-Do-Check-Act) method from August 2019 to October 2019, we implemented targeted interventions. These included an education program for nurse to accurately assess sputum viscosity and the development of a standard operating procedure (SOP) for respiratory therapists’ tube-changing procedures. The effectiveness of these interventions was regularly reviewed and necessary adjustments were made to ensure continuous improvement. The results indicate that these measures effectively reduce the rate of unconventional replacement of ventilator circuit tube, enhancing patient care quality and safety in the SICU. Results: The results of this study show that the overall rate of unconventional replacement of ventilator circuit tubes decreased from 38.1% before the intervention to 16.0% after the intervention. The analysis of causes revealed that the rate of unconventional replacement of ventilator circuit tube due to clinical judgment by nurse decreased from 23.52% before the intervention to 10.10% after the intervention. Additionally, the rate of unplanned extubations due to prolonged duration of general anesthesia decreased from 20.3% before the intervention to 0% after the intervention (Figure 2). Conclusions: Health education for nurses and the development of standard operating procedures can significantly reduce the unconventional replacement rate of ventilator circuits. Reducing this rate not only improves the work efficiency of respiratory therapists but also decreases the incidence of VAP.