Potential risk for bacterial contamination in conventional reused ventilator systems and disposable closed ventilator-suction systems

Ya-Chi Li, Hui-Ling Lin, Fang-Chun Liao, Sing-Siang Wang, Hsiu-Chu Chang, Hung-Fu Hsu, Sue-Hsien Chen, Gwo-Hwa Wan, Ya-Chi Li, Hui-Ling Lin, Fang-Chun Liao, Sing-Siang Wang, Hsiu-Chu Chang, Hung-Fu Hsu, Sue-Hsien Chen, Gwo-Hwa Wan

Abstract

Background: Few studies have investigated the difference in bacterial contamination between conventional reused ventilator systems and disposable closed ventilator-suction systems. The aim of this study was to investigate the bacterial contamination rates of the reused and disposable ventilator systems, and the association between system disconnection and bacterial contamination of ventilator systems.

Methods: The enrolled intubated and mechanically ventilated patients used a conventional reused ventilator system and a disposable closed ventilator-suction system, respectively, for a week; specimens were then collected from the ventilator circuit systems to evaluate human and environmental bacterial contamination. The sputum specimens from patients were also analyzed in this study.

Results: The detection rate of bacteria in the conventional reused ventilator system was substantially higher than that in the disposable ventilator system. The inspiratory and expiratory limbs of the disposable closed ventilator-suction system had higher bacterial concentrations than the conventional reused ventilator system. The bacterial concentration in the heated humidifier of the reused ventilator system was significantly higher than that in the disposable ventilator system. Positive associations existed among the bacterial concentrations at different locations in the reused and disposable ventilator systems, respectively. The predominant bacteria identified in the reused and disposable ventilator systems included Acinetobacter spp., Bacillus cereus, Elizabethkingia spp., Pseudomonas spp., and Stenotrophomonas (Xan) maltophilia.

Conclusions: Both the reused and disposable ventilator systems had high bacterial contamination rates after one week of use. Disconnection of the ventilator systems should be avoided during system operation to decrease the risks of environmental pollution and human exposure, especially for the disposable ventilator system.

Trial registration: ClinicalTrials.gov PRS / NCT03359148.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Diagram depicting the enrollment and…
Fig 1. Diagram depicting the enrollment and follow-up of the study participants.
Fig 2. Diagram of a ventilator system…
Fig 2. Diagram of a ventilator system including the inlet tube of the HH (A), the HH (B), inspiratory limb (C), Y-adapter (D), 15-cm corrugated tube (E), and the expiratory limb (F).

References

    1. Esteban A, Anzueto A, Alía I, Gordo F, Apezteguía C, Pálizas F, et al. How is mechanical ventilation employed in the intensive care unit? An international utilization review. Am J Respir Crit Care Med. 2000;161:1450–8. doi:
    1. Esteban A, Anzueto A, Frutos F, Alía I, Brochard L, Stewart TE, et al. Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA. 2002;287:345–55.
    1. Hess DR, Kallstrom TJ, Mottram CD, Myers TR, Sorenson HM, Vines DL, et al. Care of the ventilator circuit and its relation to ventilator-associated pneumonia. Respir Care. 2003;48:869–79.
    1. Craven D, Goularte TA, Make B. Contaminated condensate in mechanical ventilator circuits. A risk factor for nosocomial pneumonia? Am Rev Respir Dis. 1984;129:625–8.
    1. Malecka-Griggs B, Kennedy C, Ross B. Microbial burdens in disposable and nondisposable ventilator circuits used for 24 and 48 h in intensive care units. J Clin Microbiol. 1989;27:495–503.
    1. Cadwallader HL, Bradley CR, Ayliffe GA. Bacterial contamination and frequency of changing ventilator circuitry. J Hosp Infect. 1990;15:65–72.
    1. Chu SM, Yang MC, Hsiao HF, Hsu JF, Lien R, Chiang MC, et al. One-week versus 2-day ventilator circuit change in neonates with prolonged ventilation: cost-effectiveness and impact on ventilator-associated pneumonia. Infect Control Hosp Epidemiol. 2015;36:287–293. doi:
    1. Lien TC, Lin MY, Chu CC, Kuo BI, Wang ED, Wang JH. Ventilator-associated pneumonia with circuit changes every 2 days versus every week. Zhonghua Yi Xue Za Zhi (Taipei). 2001;64:161–167.
    1. Hess DR, Kallstrom TJ, Mottram CD, Myers TR, Sorenson HM, Vines DL, et al. Care of the ventilator circuit and its relation to ventilator-associated pneumonia. Respir Care. 2003;48:869–879.
    1. Lacherade JC, Auburtin M, Cerf C, Van de Louw A, Soufir L, Rebufat Y, et al. Impact of humidification systems on ventilator-associated pneumonia: a randomized multicenter trial. Am J Respir Crit Care Med. 2005;172:1276–82. doi:
    1. Jongerden IP, Buiting AG, Leverstein-van Hall MA, Speelberg B, Zeidler S, Kesecioglu J, et al. Effect of open and closed endotracheal suctioning on cross-transmission with gram-negative bacteria: a prospective crossover study. Crit Care Med. 2011;39:1313–21. doi:
    1. Combes P, Fauvage B, Oleyer C. Nosocomial pneumonia in mechanically ventilated patients, a prospective randomised evaluation of the Stericath closed suctioning system. Intensive Care Med. 2000;26:878–82.
    1. Rabitsch W, Köstler WJ, Fiebiger W, Dielacher C, Losert H, Sherif C, et al. Closed suctioning system reduces cross-contamination between bronchial system and gastric juices. Anesth Analg. 2004;99:886–92. doi:
    1. Lorente L, Lecuona M, Martín MM, García C, Mora ML, Sierra A. Ventilator-associated pneumonia using a closed versus an open tracheal suction system. Crit Care Med. 2005;33:115–9.
    1. Vonberg RP, Eckmanns T, Welte T, Gastmeier P. Impact of the suctioning system (open vs. closed) on the incidence of ventilation-associated pneumonia: Meta-analysis of randomized controlled trials. Intensive Care Med. 2006;32:1329–35. doi:
    1. Infection Control Society of Taiwan, Taiwan National Health Research Institutes, Taiwan Society of Pulmonary and Critical Care Medicine. Clinical Practice Guidelines for Pneumonia. 2007. Available from: . Assessed 7 Feb 2018. [In Chinese].
    1. Chung FF, Lin HL, Liu HE, Lien AS, Hsiao HF, Chou LT, et al. Aerosol Distribution During Open Suctioning and Long-Term Surveillance of Air Quality in a Respiratory Care Center Within a Medical Center. Respir Care. 2015;60:30–7. doi:

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner