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Evaluating cross contamination on a shared ventilator
  1. Donald Joseph Doukas1,
  2. Lorenzo Paladino2,
  3. Christopher Hanuscin2,
  4. Jonathan McMahon1,
  5. John Quale3,
  6. Isha Bhatt3,
  7. Julie Eason4,
  8. Mark Silverberg2
  1. 1 Emergency Medicine and Internal Medicine, SUNY Downstate and Kings County Hospital Center, Brooklyn, New York, USA
  2. 2 Emergency Medicine, SUNY Downstate and Kings County Hospital Center, Brooklyn, New York, USA
  3. 3 Infectious Diseases, SUNY Downstate and Kings County Hospital Center, Brooklyn, New York, USA
  4. 4 Respiratory Therapy, SUNY Downstate, Brooklyn, New York, USA
  1. Correspondence to Dr Donald Joseph Doukas, Emergency Medicine and Internal Medicine, Kings County Hospital Center, Brooklyn, NY 11207, USA; donald.doukas{at}


Background Disasters have the potential to cause critical shortages of life-saving equipment. It has been postulated that during patient surge, multiple individuals could be maintained on a single ventilator. This was supported by a previous trial that showed one ventilator could support four sheep. The goal of our study is to investigate if cross contamination of pathological agents occurs between individuals on a shared ventilator with strategically placed antimicrobial filters.

Methods A multipatient ventilator circuit was assembled using four sterile, parallel standard tubing circuits attached to four 2 L anaesthesia bags, each representing a simulated patient. Each ‘patient’ was attached to a Heat and Moisture Exchange filter. An additional bacterial/viral filter was attached to each expiratory limb. ‘Patient-Lung’ number 1 was inoculated with an isolate of Serratia marcescens, and the circuit was run for 24 hours. Each ‘lung’ and three points in the expiratory limb tubing were washed with broth and cultured. All cultures were incubated for 48 hours with subcultures performed at 24 hours.

Results Washed cultures of patient 2, 3 and 4 failed to demonstrate growth of S. marcescens. Cultures of the distal expiratory tubing, expiratory limb connector and expiratory limb prefilter tubing yielded no growth of S. marcescens at 24 or 48 hours.

Conclusion Based on this circuit configuration, it is plausible to maintain four individuals on a single ventilator for 24 hours without fear of cross contamination.

  • intensive care
  • infectious diseases
  • resuscitation
  • ventilation
  • safety

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  • Handling editor Roland Merchant

  • Funding All materials for this experiment were donated by the SUNY Downstate Medical Center departments of Emergency Medicine, Respiratory Therapy, and Infectious Disease.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval The protocol for this study was approved by our Institutional Biosafety Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to the study are included in the article.