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Objective To investigate the efficiency of closed tracheal suction system (CTSS) using novel splash-proof ventilator circuit component on ventilator-associated pneumonia (VAP) and the colonization of multiple-drug resistant bacteria (MDR) in patients undergoing mechanical ventilation (MV) prevention.Methods A prospective single-blinded randomized parallel controlled intervention study was conducted. 330 severe patients admitted to the intensive care unit (ICU) of the First Hospital of Jiaxing from January 2014 to May 2016 were enrolled, and they were divided into open tracheal suction group, closed tracheal suction group, and splash-proof suction group on average by random number table. The patients in the three groups used conventional ventilator circuit component, conventional CTSS, and CTSS with a novel splash-proof ventilatorcircuit component for MV and sputum suction, respectively. The incidence of VAP, airway bacterial colonization rate, MDR and fungi colonization rate, duration of MV, length of ICU and hospitalization stay, and financial expenditure during hospitalization, as well as the in-hospital prognosis were recorded.Results After excluding patients who did not meet the inclusion criteria, incomplete data, backed out and so on, 318 patients were enrolled in the analysis finally. Compared with the open tracheal suction group, the total incidence of VAP was decreased in the closed tracheal suction group and splash-proof suction group [20.95% (22/105),21.90% (23/105) vs. 29.63% (32/108)], but no statistical difference was found (both P > 0.05), and the incidence of VAP infections/1000 MV days showed the same change tendency (cases: 14.56, 17.35 vs. 23.07). The rate of airway bacterial colonization and the rate of MDR colonization in the open tracheal suction group and splash-proof suction group were remarkably lower than those of closed tracheal suction group [32.41% (35/108), 28.57% (30/105) vs. 46.67% (49/105), 20.37% (22/108), 15.24% (16/105) vs. 39.05% (41/105)] with significantly statistical differences (allP 0.05). Compared with theclosed tracheal suction group, the duration of MV, the length of ICU and hospitalization stay were shortened in the open tracheal suction group and splash-proof suction group [duration of MV (days): 8.00 (4.00, 13.75), 8.00 (5.00, 13.00) vs. 9.00 (5.00, 16.00); the length of ICU stay (days): 10.00 (6.00, 16.00), 11.00 (7.00, 19.00) vs. 13.00 (7.50, 22.00); the length of hospitalization stay (days): 16.50 (9.25, 32.00), 19.00 (10.50, 32.50) vs. 21.00 (10.00, 36.00)], and financial expenditure during hospitalization was lowered [10 thousand Yuan: 4.95 (3.13, 8.62), 5.47 (3.84, 9.41) vs. 6.52 (3.99, 11.02)] without significantly statistical differences (allP > 0.05). Moreover, no significantly statistical difference was found in the in-hospital prognosis among the three groups.ConclusionsCTSS performed using novel splash-proof ventilator circuit component shared similar advantages in preventing VAP with the conventional CTSS. Meanwhile, it is superior because it prevented the colonization of MDR and high price in the conventional CTSS.Clinical Trail Registration Chinese Clinical Trial Registry, ChiCTR-IOR-16009694.
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Objective To evaluate systematically the effect of ventilator circuit changes on incidence of ventilator-associated pneumonia(VAP).Methods Literatures about the effect of ventilator circuit changes on occurrence of VAP were searched from PubMed,Cochrane Library,CNKI,VIP,and Wanfang database,incidence of VAP in pa-tients who received circuit changes at different intervals was compared,odds ratio (OR)and 95%CI were as effect index of the study,RevMan 5.2 software was used for data analysis.Results A total of 12 literatures were included,including 18003 patients using ventilators.According to the interval of ventilator circuit changes,patients were divided into 1-day group (n=191),2-day group(n=8932),3-day group(n=228),and 7-day group(n=8652).Meta analysis showed that circuit changed every 7 days had a lower risk of VAP than that changed once ev-ery day (OR,3.72[95%CI,1.50,9.23]),there was no significant difference in risk of VAP between 7-day group and 2-day group (OR,1.17[95%CI,1.00,1.37])as well as 7-day group and 3-day group(OR,0.77 [95%CI, 0.49,1 .23]).Conclusion Patients who received circuit changes every 7 days have a lower risk of developing VAP than those who received circuit changes once per day,so change the ventilator circuit in patients with mechanical ventilation every 7 days is more reasonable.
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ObjectiveTo evaluate the effects of ventilator circuit change frequency on ventilatorassociated pneumonia (VAP).MethodsMeta-analysis of effects of ventilator circuit change frequency on VAP was conducted with study-level data from 1995 to 2010 in Pubmed,Embase,Web of Science databases.ResultsNine articles were included (sample size:20 326 mechanically ventilated patients).Analysis of six articles showed that the incidence of VAP in ventilator circuit change every 2 or 3 days was 4.05％,while 3.65％ in ventilator circuit change every 7 days.Compared with change ventilator circuit every 2 or 3 days,the risk ratio (RR) of VAP in weekly changes was 0.77 [0.54,1.09] ( P =0.14 ).Analysis three articles showed that compared to ventilator circuit change every 7 days with 15.89％ incidence of VAP,the incidence of VAP in circuit change more than 14 days was 14.9％,and RR was 0.98 [0.69,1.39](P =0.91 ).ConclusionsRegular ventilator circuit change frequency in various intervals can't difference in the incidence of VAP in mechanical ventilation patients.
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ObjectiveTo investigate the disinfection effects of two different methods on the ventilator circuits. MethodsThe ventilator circuits which had been used by patients were disinfected by the artificial brushing method and the strict program of the full automatic cleaning-disinfecting machine,respectively.Samples from circuits were cultured after disinfection,and the numbers of bacterium colony forming unit (CFU) were counted. ResultsThe qualified rate of disinfection of the ventilator circuits by the strict program of the full automatic cleaning-disinfecting machine was 100％,which was significantly higher than that by artificial brushing method.50 samples disinfected by artificial brushing method were selected,among which 14 samples had pathogenic bacteria.100 samples disinfected by the strict program of the full automatic cleaning-disinfecting machine were selected and total bacterial count≤5 cfu/cm2. ConclusionsThe sterilization of the ventilator circuits with the full automatic cleaning-disinfecting machine is effective and safe,which can make the disinfection work more standardized.
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OBJECTIVE To explore disinfection effect of ventilator circuits and monitor the best one from two methods for sampling bacterial culture of pre-and post-mechanical physical disinfection ventilator circuit as well as different culture media.METHODS Pre-and post-disinfection ventilator circuits were sampled and cultured by the direct smudge method and the dilution method respectively which simultaneously the ordinary nutrient agar and the blood cultures used.RESULTS Bacterical positive rate of the direct smudge method was significantly higher than that of the dilution method in pre-and post-disinfection ventilator circuits(P0.05).CONCLUSIONS The direct smudge method is superior to the dilution method in monitoring the disinfection effect of ventilator circuit,it can effectively reduce the false negative rate and make the disinfection effect examination to be more accurate.
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OBJECTIVE To compare the effect with the three methods to disinfect the ventilator circuits.(METHODS) To disinfect the ventilator circuits,three methods were used:A,soaking with chlorine compoud(disinfectant);B:soaking with 0.5% peracetic acid;C,sterilizing with ethylene oxide.Samples were taken to(bacteria) culture before and after disifection in every three methods.Biological supervision and the amount of colony were also taken at the same time.RESULTS The results of bacteria culture pre-disinfection were all positive.The amount of bacteria of ventilator circuits was between 70 000-120 000CFU/cm~2.The eligible rate of biological(supervision) in method C was 100% and its positive rate of bacteria culture was 0%.The eligible rate of biological supervision in method A was 86.25% and its positive rate of bacteria culture was 16.25%.The eligible rate of(biological) supervision in method B was 90% and its positive rate of bacteria culture was 13.78%.It was significant when method C was compared with methods A and B and the value P was less than 0.01.CONCLUSIONS It is(serious) about the pollution in ventilator circuits.The soaking methods are apt to be effected by the factors of(environment) and manual operation.Therefore it could be(ineligible) and being polluted after disinfection.The method of sterilization is the best for disinfection.
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BACKGROUND: Ventilator associated pneumonia (VAP) is the most serious nosocomial infection of intensive care units. Several studies have investigated the relationship between the interval of ventilator circuit changes and the incidence of pneumonia in foreign countries, but there are no reports about it in Korea yet. So we performed this study to compare the clinical and cost impact between 3 days and 7 days interval in ventilator circuit changes. METHODS: Seoul National University Hospital is a 1,500-bed, university affiliated, tertiary and acute care hospital. All patients admitted to medical intensive care unit (MICU) and surgical intensive care unlt (SICU) between April 1, 1998 and October 31, 1998, requiring mechanical ventilation were included. Patients were divided into two groups of a-cay circuit changes and weekly changes. Daily surveillance was conducted using the criteria of VAP of the National Nosocomial Infection Surveillance System. Incidence of VAP and risk factors for VAP were evaluated. Standard microbiologic methods were used for the identification of clinical and environmental isolates. Statistical analysis was done by SAS Program (version 6.12), analysis of difference in variables was performed using chi-square test and t-test. Analysis of odds ratios was done with logistic regression analysis. RESULTS: VAP developed at a rate of 12.2 per 1,000 ventilator-days in the 3 days change group and 15.6 per 1,000 ventilator-days in the weekly change group (P=0.7240). The only statistically significant risk factor of VAP was duration of mechanical ventilation, The risk of VAP in patients with more than 7 days was 2.23 times higher than in patients with 7 days and below (OR; 2.2296). Estimated annual savings of nursing time by extending ventilator circuit change interval from 3 days to 7 days were 26,806 min 48 sec and estimated savings of cost by reduction of nursing times was calculated as 6,701,700 won. CONCLUSIONS: Weekly ventilator circuit changes in patients undergoing ventilation therapy in the ICU do not contribute to increased the rates of VAP and are cost-effective.