Infection prevention
of oral and gastric secretions. Maintaining consistent cuff pressure is crucial in preventing the entry of pathogenic bacteria into the lungs, thereby reducing the risk of VAP. (Fig 1)
Intervention details: secretion management Automatic Subglottic Secretion Removal Device: This device facilitates the continuous or intermittent removal of secretions that accumulate above the endotracheal tube cuff. By preventing the aspiration of these secretions into the lower respiratory tract, the device reduces the likelihood of infection. (Fig 2).
Statistical method The chi-square test was used to determine the statistical significance of the intervention’s impact on VAP rates. 7 A chi-square test is a statistical test used to
compare observed results with expected results. The test shows if a variance between observed data and expected data is due to chance, or if there is an actual relationship between the variables being studied.8 The test compared the observed frequencies
of VAP in both groups with the expected frequencies if there were no association between the intervention and VAP status. The chi-square statistic and p-values indicated the level of significance.
Results The study results revealed a stark contrast in VAP rates between the two groups. In the pre-intervention group, 59 out of 78 patients (75.6%) developed VAP. In the post-intervention
Fig 1: Example of an automatic cuff controller. The device is set to the desired pressure (normally between 20-30 cmH2
O) and a cuff controller line is attached to the pilot balloon line of the endotracheal tube.
group, only 8 out of 83 patients (9.6%) developed VAP. The chi-square statistic was 72.0969, with a p-value of <0.00001, indicating a highly significant difference. The chi-square statistic with Yates correction was 69.4059, also with a p-value of <0.00001. See Chart 1.
Interpretation The chi-square test results demonstrate a highly significant reduction in VAP incidence post- intervention. The p-values are far below the threshold of 0.05, confirming that the observed reduction in VAP cases is not due to chance. The intervention’s effectiveness is evident, highlighting the importance of adopting such measures in critical care units.
Cost savings analysis Based on NHS England’s cost estimates for VAP (£10,000-£20,000 per patient), the financial analysis reveals substantial cost savings: 1. Pre-intervention VAP Rate: The rate was calculated as 59/78 = 0.756.
2. Expected VAP rates in post-intervention group if intervention was not initiated: Based on the pre-intervention rate, the expected VAP cases were 0.756 * 83 = 62.748.
3. Reduction in VAP Cases: The reduction was 62.748 - 8 = 54.748.
Fig 2: Example of an automatic subglottic secretion removal device. The device is set to the desired vacuum pressure and a line is attached from the device to the subglottic port of the endotracheal tube.
4. Cost Savings: l Minimum Savings: 54.748 cases * £10,000 = £547,480
l Maximum Savings: 54.748 cases * £20,000 = £1,094,960
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www.clinicalservicesjournal.com I December 2024
Over a two-month period, the NHS could save between £547,480 (low estimate) and £1,094,960 (high estimate). The calculation does not consider the cost of consumables and devices used for VAP prevention as that will vary depending on the supplier. Overall, having investigated the current market, the annual cost of consumables is negligible compared with the possible savings, with the main initial cost coming from procuring the devices. Furthermore, approximately 60% of all ICU patients are mechanically ventilated and, in our Trust, 3,600 patients were admitted to ICU in 2023, resulting in around 2,000 mechanically ventilated patients. This indicates that the intervention could lead to even more substantial cost savings across a larger patient population.
Device limitations The study also identified limitations associated with the Automatic Subglottic Secretion Removal Device. Not all patients had an endotracheal tube with a subglottic port, and some patients exhibited sensitivity to the device, making them intolerant to it. As a result, much of the data reflects the impact of the Automatic Cuff Pressure Controller, highlighting the need for further studies to compare the individual and combined effects of both devices.
Discussion The significant reduction in VAP incidence and associated cost savings highlight the intervention’s effectiveness. The Automatic Cuff
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