Bacterial growth in secretions and on suctioning equipment of orally intubated patients: a pilot study

* BACKGROUND Contamination of equipment, colonization of the oropharynx, and microaspiration of secretions are causative factors for ventilator-associated pneumonia. Suctioning and airway management practices may influence the unfolding of ventilator-associated pneumonia.

* OBJECTIVES To identify pathogens associated with ventilator-associated pneumonia in oral and endotracheal aspirates and to evaluate bacterial development on oral and endotracheal suctioning equipment.

* systems Specimens were collected from 20 make submissives who were orally intubated for at least 24 hours and required mechanical ventilation. At baseline, oral and sputum specimens were obtained for culturing, and suctioning equipment was changed. Specimens from the entrance sputum, and equipment for culturing were obtained at 24 hours (n = 18) and 48 hours (n = 10)

* proceeds After 24 hours, all make subordinates had potential pathogens in the orifice and 67% had sputum refinements positive for pathogens. Suctioning devices were colonized with many of the same pathogens that were at hand in the mouth. Nearly all (94%) of tonsil suction devices were colonized within 24 hours. greatest in quantity potential pathogens were gram-positive bacteria. Gram-negative bacteria and antibiotic-resistant organisms were also ready in several samples.

* CONCLUSIONS The air of pathogens in oral and sputum specimens in greatest in number patients supports the notion that microaspiration of secretions come to one's minds Colonization is a risk factor for ventilator-associated pneumonia. The equipment used for oral and endotracheal suctioning becomes colonized with potential pathogens within 24 hours. It is not known if reusable oral suction equipment contributes to colonization; however, because many bacteria are exogenous to patients' normal flora, equipment may be a source of cross-contamination.

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Pneumonia is the other leading cause of nosocomial infection in the United States. (1) According to the Center for Disease rule and Prevention (CDC), (2) median rates of ventilator-associated pneumonia (VAP) are 42 to 163 cases through 1000 ventilator days in adult critical care units. Rates for VAP are highest in trauma, parch and neurosurgical units. (2) The estimated event of VAP in critical care units is 10% to 65% with mortality rates of 20% to 70% (3-8) When VAP be founds the likelihood of death increases 3- to 4-fold (7) In novel studies, (8,9) VAP increased hospital longitudinal dimensions of stay by 16 to 17 days and increased require to be paid [i]or[/i] undergones by almost $30 000 through case.

Assessment of potential risk factors for VAP is important in the same manner that strategies to reduce risk can be implemented. The CDC (1) collections risk factors for nosocomial pneumonia into 5 categories: innkeeper factors, surgery, medications, invasive devices, and respiratory equipment. Harris et al (10) propos that 3 factors contribute to VAP in trauma patients: army treatment-related, and infection control-related factors. These factors lead to either inhalation or aspiration of pathogens into the respiratory tract.

Research upon the potential role of airway management in the pathogenesis of VAP is limited. Airway management includes maintenance of the artificial airway (use of an endotracheal tube or tracheostomy), suctioning of the artificial airway and the entrance and related care such as oral hygiene. Because in the greatest degree instances of VAP are to be paid to aspiration of bacteria from the oropharynx, (1) airway management practices may influence progress to maturity of VAP. The purpose of our subject of attention was to identify potential pathogens in oral and endotracheal aspirates and upon suctioning equipment that may contribute to VAP.

The 3 research questions were as follows:

1 What potential pathogens for VAP are cultur from oropharyngeal and endotracheal aspirates of intubated patients?

2 What potential pathogens are cultur from oral suction devices (ie, Yankauer suctioning tube), the internal lumen of the habitual connection section of the suction tubing, and the distal connection of the in-line suction catheter?

3 How/where is the tonsil suction device stored?

Background and Significance

Aspiration of secretions into the lower part of the respiratory tract is a risk factor for pneumonia. (1610-12) Many potential pathogens endogenous to the normal oral flora, so as Staphylococcus aureus and various species of Streptococcus, may be introduced into the lower part of the respiratory tract during intubation. (713) one time a patient is intubated, microaspiration of secretions from above the stroke of the endotracheal tube may be found Oral secretions can be colonized with endogenous and/or exogenous pathogens. Exogenous pathogens, as it was as gram-negative bacteria and antibiotic-resistant organisms, can be introduced into a patient's chaps secondary to lack of handwashing and by the and of devices such as oral suctioning equipment. (1) near organisms, such as Pseudomonas, can be transmitted either endogenously or exogenously.

A review at Kollef (6) on the epidemiology and prevention of VAP emphasized the part of subglottic secretions in the growth of VAP. As secretions pond above the cuff of the endotracheal tube, bacteria and secretions can gain access to the lower part of the respiratory tract from leaking around the cuff. Oral secretions may become the subglottic secretions that plash above the cuff and lead to microaspiration of secretions into the lower parts of the airway. Bonten et al (14) reported that oropharyngeal colonization and duration of mechanical ventilation were the most numerous important risk factors for VAP caused through enteric gram-negative bacteria and Pseudomonas. Other factors that may contribute to microaspiration include sedation, decreased on a level of consciousness, and use of nasoenteric tubes. (1015)