Effects Of Cleaning Times On PVC Tracheostomy Tube Within The Wall Of Bacterial Colonization And Ventilator-associated Pneumonia Incidence

Objective:This topic is based on effects of cleaning times on PVC tracheostomy tube within thewall of bacterial colonization and ventilator-associated pneumonia incidence. Compare every12h and every24h cleaning before and after the casing wall bacterial colonizationdifferences, to understand its colonization bacterial distribution characteristics; analysis ofeffects of different cleaning times on the incidence of VAP in order to reduce the casing wallbacterial colonization and the prevention of VAP.Methods:Jilin University Norman Bethune Hospital general ICU43cases tracheotomy andmechanical ventilation (MV) in patients treated (in accordance with inclusion criteria) wererandomly divided into two groups, the12h group (12h internal casing cleaning and soaking)22cases,24h group (24h internal casing cleaning and soaking)21cases. Two groups ofpatients were in after tracheotomy line MV3th,5th,7th days early morning of sacrificing thesputum (first sputum after waking) for bacterial culture, at the same time cleaning the insidecasing before and after two groups of patients within the casing wall surface (away from theconnection ventilator at joints1.5cm) spiral rubbed repeatedly with sterile throat swab afterbacterial culture and classification. According to the VAP clinical diagnostic criteria formonitoring two groups of patients the incidence of VAP.Results:1.The two groups in sex,ages,acute physiology and chronic health-II (APACHE-II)score and other general clinical information was no significant difference（P＞0.05）;2. Two different cleaning time internal bacterial colonization of the casing wall2.112h group the number of positive cases in the tracheotomy line after the MVtreatment3th,5th,7th days cleaning the casing wall bacterial colonization were13,13,18cases, the positive rates were59.1%,59.1%,81.8%；24h group the number of positive cases,were16,19,18cases, the positive rates were76.2%,90.5%,85.7%. The casing wall in the12h group cleaning before the bacterial colonization positive rate of less than24h group withpositive cases in the5th day a significant difference (x2=5.559, P <0.05).2.212h group3th,5th,7th days cleaning the casing wall in the24h group of patients with tracheal incision MV treatment before planting species number more significantdifference (P=0.043<0.05); cleaning inside the casing after colonization the speciesnumber of more significant difference (x2=6.147, P=0.047<0.05).2.312h group tracheotomy line MV treatment before cleaning inside the casing wall in3th,5th,7th days after the colonization of bacteria and sputum culture bacteria consistentrates were36.4%,40.9%,59.1%;24h group were71.4%,76.2%,71.4%, and3th day and5th day were significant difference.(x2=5.310, x2=5.495, P <0.05);2.4Two groups of43patients with sputum culture pathogens(9cases),12h group22cases of isolated bacteria (43cases), which G+bacteria (9cases), the G-bacteria (28cases),fungi(6cases);24h group21cases of isolated bacteria (62cases), which G+bacteria (12cases), G-bacteria (49cases), fungi (1cases). The two groups of patients sputum culture areacinetobacter baumannii, pseudomonas aeruginosa and staphylococcus aureus the majority;2.5Analysis of colonization factor of within the casing wall2.5.1The single factor analysis:The colonization group and the non-colonization group in sex,age，length of stay andAPACHE-II score and other clinical data was no significant difference (P>0.05);3Different time cleaning the casing wall for the incidence of VAP3.1The two groups of patients length of stay, VAP incidence, mortality was nosignificant difference (P>0.05);3.2VAP patients sputum culture positive in16cases, the positive rate was100%(16/16). VAP patients sputum culture pathogen Staphylococcus aureus2cases,Acinetobacter baumannii6cases, Pseudomonas aeruginosa8cases, Escherichia coli1case,Stenotrophomonas oligotrophic aeromonas2cases， in which a total3cases of patients withtwo kinds of pathogenic strains isolated from sputum culture results.3.3Incidence of VAP,16patients were all within the casing wall bacteria ofcolonization positive,12cases of patients with sputum culture results and consistent withinthe casing wall bacteria colonization strains, accounting for75%(12/16).3.4VAP Logistic regression analysis (VAP within10days after the MV)3.4.1The single-factor analysisVAP group and non-VAP group patients may be related factors no significant difference.(P>0.05).Length of stay and the casing wall of the MV after3th day bacteria colonizationoccurred and there was significant difference (P <0.05).3.4.2VAP multivariate Logistic regression analysis By single-factor analysis, and whether or not affect the incidence of VAP from thevariable length of stay and MV3days after the casing wall bacteria colonization occurs, andnow these two variables, the incidence of VAP as Logistic regression analysis the dependentvariable,The results suggest that the incidence of VAP and the duration of hospitalization,flora colonization of the MV3th day after the casing wall has nothing to do (P>0.05).Conclusion:1.12h cleaning tracheostomy within the casing (24h cleaning tracheostomy within thecasing) can make within the casing wall bacteria colonization rate was significantly lower，within the casing wall to reduce the number of colonization strains by cleaning;2.With the extension of the retention time of inner tracheostomy tube, the inner wallcolonization of bacteria-positive rate increased gradually;3.Within the casing inner wall of colonization strains and sputum culture rate ofbacteria consistent upward trend and the strains of the G-bacteria, probably from the greaterchance of lower respiratory tract;4.VAP patients sputum culture results within the casing wall colonization results ofstrain rate of matching is high, mainly G-bacteria;5.Every12h and24h cleaning tracheostomy within the casing length of stay for patients,VAP incidence (trachea incision line MV10days) and prognosis of no effect.