| ObjectiveTo analyze commprehensively the distribution of the lower respiratory tract pathogens of ICU patients who were intubated or tracheostomy with invasive mechanical ventilation o And analyze comprehensively the staff hands'contamination rate and types of pathogens. All of those patients are used one-time ventilator pipes. To understand the relationship between the patients in integrated ICU and ventilator-associated pneumonia.To find the regulation of nosocomial infection occurrented in Hospital.So as to prevent effectively the ventilator-associated pneumonia and nosocomial infection in ICU.MethodsThe 25 patients onset of invasive mechanical ventilation stayed in ICU, constitutes by 18 males and 7 females. The youngest is 14 years old, and the maximum is 89 years, The mean age of the entire group was 61.40±17.41 years. They are composed of 3 cases of nasal intubation and tracheotomy 22 patients such as 3 cases of chronic obstructive pulmonary disease (COPD),2 cases of lung cancer, 2 cases of severe asthma,5 cases of cerebral infarction 8 cases of severe traumatic brain injury,3 cases of myasthenia gravis and 2 cases of organophosphate poisoning. The time of Mechanical ventilation is between of 5 to 152 days. The diagnostic criteria of VAP found in 1999 Chinese Society of Respiratory Diseases credits "hospital-acquired pneumonia diagnosis and treatment guidelines (draft)".That is to say:(1) Among intubated and mechanically ventilated patients, the development of 48 hrs or later is known as ventilator-associated pneumonia (VAP); (2) Appearance of new infiltrates or new inflammatory lesions on new chest x-ray after the onset of invasive mechanical ventilation 48 hrs or later; (3) signs of pulmonary consolidation and (or) wet rales, and one of the following conditions:①blood WBC＞10.0×109/ L or<4.0×109/L, with or not with a left shift;②body temperature> 38.0℃, with purulent respiratory secretions;③a new pathogen is isolated from bronchial secretions after the onset of invasive mechanical ventilation. Patients on invasive mechanical ventilation were taken samples in proper order after 3d,7d, 10d, The sites taken samples were the lower respiratory tract,Y interface,threaded pipe,pipe set exhaled water bottles and humidification bottle. Using sacrificing suction tube of sterile draw sputum samples from lower respiratory tract secretions. Over the same period, to collect swab samples from the staff-hands in ICU. Ventilator pipes were replaced once per 10 days. But the Ventilator pipes must be changed if it wascontaminated with pathogens. To Collect the sputum samples and the samples of Y interface,threaded tubes at the same time, until the patients stopped using a breathing machine or departed from ICU or death. Collected samples were inoculated into MH agar plate. To separate the pathogenic bacteria through conventional methods. And the bacteria isolated from the samples were identified by BD company PHOENTX-100 Automatic Identification System. Count data on trends in x2 test, with P<0.05 indicated statistical significance and all data using SPSS 13.0 software package for data processing. ResultsThis study on the comprehensive ICU 25 patients with invasive mechanical ventilation occurred VAP 16 cases. This result was concluded with monitoring results of lower respiratory tract and ventilator tube. The incidence rate is 64.0% of VAP. A total of 185 strains bacteria were obtained in the breathing circuit of the 25 patients. and 224 strains of bacteria were isolated, more than 60% of sputum specimens were isolated from two or more pathogens:Among those strains G-bacteria were the most common kinds of bacteria(75.0%), main kinds of those G-bacteria were pseudomonas aeruginosa (26.79%); and fungus was the second commonest kind of bacteria(14.29%); Gram-positive bacteria were the third commonest kind of bacteria, main kinds of those G+bacteria were Staphylococcus aureus (3.57%). A total of 484 strains bacteria obtained from patients lower respiratory tract,and 372stains were isolated:G-bacteria were the most common kinds of bacteria(73.66%%)also, main kinds of the G-bacteria were pseudomonas aeruginosa(29.30%%),baumannii (18.28%); fungus were the second commonest kind of bacteria, also, with Candida albicans (15.05%). The pathogens of the lower respiratory tract were 74.13% similar with those of ventilator-pipe Y; and were 68.22% similar with those of ventilator-pipe coil.28 strains of pathogens were isolated from Submission staff hand swab samples and among those strains G-bacteria were the most common kinds of bacteria (57.14%). The pathogens of the breathing circuit were more than61% similar with those of the lower respiratory airway tract. The ventilator pipe contamination rates were 20.25%,53.73%,73.44% after 3d,7d,10d.With the time passing of invasive mechanical ventilation, pathogen contamination rate of ventilator pipe was significantly raised with statistically significant (P＜0.01). Conclusions1. High incidence of ventilator associated pneumonia rates (VAP) in comprehensive ICU, so we must be focused on this problem;2. Shorten the cycle time of changing ventilator circuit, because the longer of the ventilator circuit be used, the higher rate of ventilator-pipe pollution, which would be increasing the dangerous of ventilator-associated pneumonia;3. Risk of VAP duration of mechanical ventilation, the patients with mechanical ventilation should be Withdrawn from Ventilator as early as possible;4. Patients who were onset of invasive mechanical ventilation, exist multiple infection with lower respiratory tract and ventilator pipeline. The pathogens of lower respiratory tract infection have relativity with those of breathing circuit pollution. We must strengthen sterilization and aseptic environment;5. VAP in patients with Gram-negative bacilli (75.00%) and fungi (14.29%), with the two pathogens account for almost 90% of VAP patients, need to use specific antibiotics to enhance the control of pathogens in the two categories;6. Comprehensive ICU ventilator-associated pneumonia mostly mixed infection that frequently add to off-line difficulties, so need to understand the distribution of pathogens, focusing on prevention of cross infection;7. Effective intervention measures should be t carried out to control the ventilator pipe pollution, and to shorten the duration of mechanical ventilation, and to reduce the rate of VAP.
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