Heat-moisture exchangers and risk of nosocomial pneumonia.

ICU, 14% [before patient contact] and 25% [after patient con-tact]; cardiac surgery ICU, 6% [before] and 13% [after]). Observations in the medical ICU after introduction of the new, increasingly accessible, alcohol-based, waterless hand antiseptic revealed significantly higher handwashing rates (F<.05). Handwashing compliance improved as accessibility was enhanced: before patient contact, 19%, and after contact, 41%, with one dispenser per four beds; and before contact, 23%, and after contact, 48%, with one dispenser for each bed. The authors concluded that the education and feedback intervention and the patient awareness program failed to improve handwashing compliance. However, introduction of easily accessible dispensers with an alcohol-based waterless handwashing antiseptic led to significantly higher handwash-ing rates among healthcare workers. Availability of an alcohol solution can improve hand disinfection compliance in an intensive care unit AmJRespir Crit Care Med 2000;162:324-327. 2. Bischoff WE, Reynolds TM, Sessler CN, Edmond MB, Wenzel RE Handwashing compliance by health care workers: the impact of introducing an accessible, alcohol-based hand antiseptic. studied the effect of using a single heat-and-moisture exchanger (HME) for «120 hours on the efficiency, resistance , level of bacterial colonization, frequency rate of nosoco-mial pneumonia, and cost compared with changing the HME every 24 hours. In a prospective, randomized, controlled study in a surgical ICU, the study population included 220 consecutive patients requiring mechanical ventilation for 48 hours. Patients were randomized to one of three groups: (1) hygroscopic HME (Aqua+) changed every 24 hours (HHME-24); (2) hydrophobic HME (duration HME) changed every 120 hours (HME-120); and (3) hygroscopic HME (Aqua+) changed every 120 hours (HHME-120). Devices in all groups could be changed at the discretion of the staff when signs of occlusion or increased resistance were identified. Daily measurements of inspired gas temperature, inspired relative humidity, and device resistance were made. Additionally, daily cultures of the patient side of the device were accomplished. The frequency rate of nosocomial pneumonia was made by using clinical criteria. Ventilatory support variables, airway care, device costs, and clinical indicators of humidification efficiency (sputum volume, sputum efficiency) also were recorded. Prolonged use of both hygroscopic and hydrophobic devices did not diminish efficiency or increase resistance. There was no difference in the number of colony-forming units (CFUs) from device cultures over the 5-day period and no difference between CFUs in devices changed every 24 hours compared with devices changed after 120 hours. The average duration of use was 23 ±4 hours in the …