Cost-Effectiveness Analysis of a Silver-Coated Endotracheal Tube to Reduce the Incidence of Ventilator-Associated Pneumonia

Shorr, Andrew F.; Zilberberg, Marya D.; Kollef, Marin H.

doi:10.1086/599005

Cited by 63 publications

(41 citation statements)

References 33 publications

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“…28 This cost could be prohibitive to patients in low-income areas, where access to such a device would provide great therapeutic benefit. Finally, using an embedding technique rather than a coating technique is promising for greater retention of antibacterial effects over time.…”

Section: Discussionmentioning

confidence: 99%

Reduced adhesion of Staphylococcus aureus to ZnO/PVC nanocomposites

Geilich

Webster

2013

IJN

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Abstract:In hospitals and clinics worldwide, medical device surfaces have become a rapidly growing source of nosocomial infections. In particular, patients requiring mechanical ventilation (and, thus, intubation with an endotracheal tube) for extended lengths of time are faced with a high probability of contracting ventilator-associated pneumonia. Once inserted into the body, the endotracheal tube provides a surface to which bacteria can adhere and form a biofilm (a robust, sticky matrix that provides protection against the host immune system and antibiotic treatment). Adding to the severity of this problem is the spread of bacterial genetic tolerance to antibiotics, in part demonstrated by the recent and significant increase in the prevalence of methicillin-resistant Staphylococcus aureus. To combat these trends, different techniques in biomaterial design must be explored. Recent research has shown that nanomaterials (materials with at least one dimension less than 100 nm) may have the potential to prevent or disrupt bacterial processes that lead to infections. In this study, polyvinyl chloride (PVC) taken from a conventional endotracheal tube was embedded with varying concentrations of zinc oxide (ZnO) nanoparticles. S. aureus biofilms were then grown on these nanocomposite surfaces during a 24-hour culture. Following this, biofilms were removed from the surfaces and the number of colony forming units present was assessed. Bacterial proliferation on the samples embedded with the highest concentration of ZnO nanoparticles was 87% less when compared to the control, indicating that this technique is effective at reducing biofilm formation on PVC surfaces without the use of antibiotics.

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Section: Discussionmentioning

confidence: 99%

Reduced adhesion of Staphylococcus aureus to ZnO/PVC nanocomposites

Geilich

Webster

2013

IJN

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“…A cost-effectiveness analysis of silver-coated ETTs in preventing VAP used the following assumptions in the model: tube placement in all nonelective intubations, VAP risk of 9.7% using uncoated ETTs, VAP relative risk reduction of 24% using silver-coated ETTs, marginal hospital costs of $16,620, and a cost of $90 for the silvercoated tube and $2 for the uncoated tube. 173 The cost savings per case of VAP prevented was determined to be $12,840. Using these same assumptions, a breakeven point was estimated to be $388, meaning that the cost of the coated tube would have to increase to $388 to offset the savings per case.…”

Section: Subglottic Secretion Drainagementioning

confidence: 99%

Endotracheal Tubes: Old and NewDiscussion

et al. 2014

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The development and evolution of the endotracheal tube (ETT) have been closely related to advances in surgery and anesthesia. Modifications were made to accomplish many tasks, including minimizing gross aspiration, isolating a lung, providing a clear facial surgical field during general anesthesia, monitoring laryngeal nerve damage during surgery, preventing airway fires during laser surgery, and administering medications. In critical care management, ventilator-associated pneumonia (VAP) is a major concern, as it is associated with increased morbidity, mortality, and cost. It is increasingly appreciated that the ETT itself is a primary causative risk for developing VAP. Unfortunately, contaminated oral and gastric secretions leak down past the inflated ETT cuff into the lung. Bacteria can also grow within the ETT in biofilm and re-enter the lung. Modifications to the ETT that attempt to prevent bacteria from entering around the ETT include maintaining an adequate cuff pressure against the tracheal wall, changing the material and shape of the cuff, and aspirating the secretions that sit above the cuff. Attempts to reduce bacterial entry through the tube include antimicrobial coating of the ETT and mechanically scraping the biofilm from within the ETT. Studies evaluating the effectiveness of these modifications and techniques demonstrate mixed results, and clear recommendations for which modification should be implemented are weak.

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“…However, the recommendations included in the guidelines are not unequivocal in this respect [15]. It appears that using such tubes is warranted in patients in whom ventilatory support is expected to last longer than 48 hours, as such patients are at high risk of VAP occurrence [23].…”

Section: Intubation and Mechanical Ventilationmentioning

confidence: 99%

Anaesthesiology and intensive care Possibilities of modification of risk factors for ventilator-associated pneumonia (VAP) in cardiac surgery patients

Wróblewska¹,

Stępniak²,

Burnos³

et al. 2013

kitp

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StreszczeniePacjent poddawany operacji kardiochirurgicznej wymaga intensywnej opieki, której jakość może w dużym stopniu zminimalizować ryzyko wystąpienia powikłań pooperacyjnych w tej grupie chorych. Do czynników mających wpływ na zmniejszenie ryzyka respiratorowego zapalenia płuc (VAP) należy opieka nad pacjentem zaintubowanym i wentylowanym mechanicznie, utrzymywanie pacjenta w pozycji półleżącej z uniesieniem klatki piersiowej, żywienie enteralne, przeciwdziałanie kolonizacji jamy ustno-gardłowej oraz stosowanie sukralfatu zamiast antagonistów receptorów H2 w celu zobojętnienia kwasu żołądkowego w profilaktyce owrzodzeń stresowych żołądka. Tak jak w przypadku innych postaci zakażeń szpitalnych, podstawowym elementem zapobiegania VAP jest właści-wa higiena rąk personelu medycznego. Słowa kluczowe: intensywna opieka, kardiochirurgia, respiratorowe zapalenie płuc. Kardiochirurgia i Torakochirurgia Polska 2013; 10 (4) 389 ANAESTHESIOLOGY AND INTENSIVE CARE AbstractPatients undergoing cardiac surgery require intensive care, the quality of which may significantly reduce the risk of postoperative complications in this patient group. Factors which decrease the risk of ventilator-associated pneumonia (VAP) include care provided to intubated and mechanically ventilated patients, maintenance of a semirecumbent position with elevation of the chest, enteral feeding, prevention of oropharyngeal colonization, and the use of sucralfate instead of H2 receptor antagonists in the prophylaxis of stress ulcers of the stomach. Similarly to other forms of nosocomial infections, the main element of VAP prophylaxis is proper hand hygiene of healthcare workers.

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Cost-Effectiveness Analysis of a Silver-Coated Endotracheal Tube to Reduce the Incidence of Ventilator-Associated Pneumonia

Abstract: "Cost-effectiveness analysis of a silver-coated endotracheal tube to reduce the incidence of ventilator-associated pneumonia

Cited by 63 publications

References 33 publications

Reduced adhesion of Staphylococcus aureus to ZnO/PVC nanocomposites

Reduced adhesion of Staphylococcus aureus to ZnO/PVC nanocomposites

Endotracheal Tubes: Old and NewDiscussion

Anaesthesiology and intensive care Possibilities of modification of risk factors for ventilator-associated pneumonia (VAP) in cardiac surgery patients

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