It’s 1A all the way on banning routine changes
Draft pneumonia prevention guidelines by the Centers for Disease Control and Prevention included the following recommendations for mechanical ventilators and breathing circuits:
A. Mechanical ventilators
1. Do not routinely sterilize or disinfect the internal machinery of mechanical ventilators. Category IB (Strongly recommended for implementation and supported by some clinical or epidemiologic studies and by strong theoretical rationale.)
B. Ventilator circuits with humidifiers
1. Do not change routinely, on the basis of duration of use, the ventilator circuit (i.e., ventilator tubing and exhalation valve, and the attached humidifier) that is in use on an individual patient. Rather, change the circuit when it is visibly soiled or mechanically malfunctioning. Category IA (Strongly recommended for implementation and strongly supported by well-designed experimental, clinical, or epidemiologic studies.)
2. Sterilize reusable breathing circuits and bubbling or wick humidifiers, or subject them to high-level disinfection between their uses on different patients. Category IB
3. Periodically drain and discard any condensate that collects in the tubing of a mechanical ventilator, taking precautions not to allow condensate to drain toward the patient. Decontaminate hands with soap and water or a waterless antiseptic agent after performing the procedure or handling the fluid. Category IA
4. No Recommendation for placing a filter or trap at the distal end of the expiratory-phase tubing of the breathing circuit to collect condensate. Unresolved Issue (Practices for which insufficient evidence or no consensus regarding efficacy exists.)
5. Do not place bacterial filters between the humidifier reservoir and the inspiratory-phase tubing of the breathing circuit of a mechanical ventilator. Category II (Suggested for implementation and supported by suggestive clinical or epidemiologic studies or by strong theoretical rationale.)
C. Humidifier fluids
1. Use sterile or pasteurized water to fill bubbling humidifiers. Category IB
2. No recommendation for preferential use of a closed, continuous-feed humidification system. Unresolved Issue
D. Ventilator breathing circuits with heat-moisture exchangers
1. When cost-effective and unless medically contraindicated, use a heat-moisture exchanger (HME) to prevent pneumonia in a patient receiving mechanically assisted ventilation. Category II
2. Change an HME that is in use on a patient when it malfunctions mechanically or becomes visibly soiled. Category IB
3. Do not change routinely more frequently than every 48 hours, an HME that is in use on a patient. Category IB
4. Do not change routinely (in the absence of gross contamination or malfunction) the breathing circuit attached to an HME while it is in use on a patient. Category II
Reference
1. Centers for Disease Control and Prevention. Healthcare Infection Control Practices Advisory Committee. Draft Guideline For Prevention Of Healthcare-Associated Pneumonia. Atlanta; 2002.
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