A zero infection rate for ventilator patients may be as simple as an antimicrobial coating on an endotracheal tube. Unless you are in the ICU or the CFO trying to balance the budget, ventilator-acquired pneumonia (VAP) is not a familiar topic, but its on the list for Hospital-Acquired Conditions that are not reimbursable under the CMS 2011 Final Rule. Considering up to 20% of patients on a ventilator develop pneumonia at a cost of over $10,000+, this issue will surely come up in next years budget discussion.
Endotracheal tubes with a pharmaceutical coating, a technology based on synthetic, small molecules that are electrostatically attracted to certain viruses, fungi, and bacteria, are now being studied. Studies indicate that this method, which has a long shelf life, can prevent bacteria colonization on endotracheal tubes for up to 21 days.
In theory, VAP prevention can be as simple as hand washing and observing sterile techniques. However, each year up to 300,000 patients in the U.S. will develop VAP. Dr. Michael Niederman, professor of medicine and vice-chairman of the Department of Medicine at the State University of New York at Stony Brook and chairman of the Department of Medicine at Winthrop-University Hospital in Mineola, New York, stated, A technology that could offer up to 21 days of protection against bacterial colonization of endotracheal tubes would be a very welcome advance.”
First-generation endotracheal tubes that use a silver coating as an antimicrobial agent have been in use since 2008 and have proven to be effective in preventing infections for up to three days. But unfortunately, the mortality rate of VAP is at its highest when acquired by patients that require mechanical ventilation for more than five days.
Silver-coated endotracheal tubes are priced at $90 to $125 each. These tubes are at a considerably higher cost than non-coated endotracheal tubes, which range from $1 to $3 each. Pharmaceutical antimicrobial endotracheal tubes are also expected to be offered at a premium price, but with the average cost of treating VAP at $10,000, a $100 investment is what I would consider cost avoidance.