ESKAPE-Oriented Microbiological Quality Control of Reprocessed Mechanical Ventilators: Implications for Ventilator-Associated Pneumonia and Economic Evaluation

Microbiological verification of reprocessed mechanical ventilators serves as a quality control measure aimed at interrupting potential transmission routes of pathogens before patient intubation. The aim of this study was to describe the microbiological findings and operational costs of the post-reprocessing surveillance program for mechanical ventilators at Hospital Juárez de México and to contextualize these costs using a hypothetical VAP-associated economic reference. This retrospective observational study included 1456 post-reprocessing microbiological evaluation events involving mechanical ventilators previously used by patients with laboratory-confirmed ventilator-associated pneumonia (VAP). All events meeting the surveillance eligibility criteria during the study period were included. Inspiratory and expiratory limbs were sampled for bacterial culture, with microbial identification by mass spectrometry. Any bacterial growth was considered residual contamination, and the ventilator underwent a new complete cycle of cleaning and high-level disinfection. An institutional analysis was applied to estimate operational costs and to contextualize the potential VAP-associated economic burden using the culture-positive ventilators as a hypothetical reference calculation, without assuming that each positive device represented a prevented VAP episode. Residual bacterial contamination was detected in 95 evaluation events (6.5%), with recovery of organisms including Acinetobacter baumannii and Pseudomonas aeruginosa. The operational cost of the microbiological surveillance program was 40,993 USD. Using institutional VAP cost estimates, a hypothetical calculation assigning the annual VAP cost to each of the 95 culture-positive evaluation events produced a reference value of 1,285,650 USD. Under this reference calculation, the difference between the VAP-associated reference value and program cost was 1,244,657 USD, corresponding to a cost ratio of 31.4:1. These estimates are hypothetical and depend on assumptions regarding infection probability and preventive effectiveness; they do not represent demonstrated economic savings. The break-even probability of device-attributable VAP per culture-positive evaluation event was 3.19%, assuming full institutional coverage of VAP-associated costs and complete prevention of these episodes through additional reprocessing. Within this defined surveillance population, microbiological surveillance of reprocessed mechanical ventilators is a useful quality-control strategy prior to patient intubation.