Meyer E, Schuhmacher M, Ebner W, Dettenkofer M
Department of Environmental Health Sciences, University Medical Center Freiburg, Freiburg, Germany.
Infection. 2009 Feb;37(1):49-51. doi: 10.1007/s15010-008-7444-1. Epub 2008 Oct 30.
To ascertain the desirability of replacing closed suction systems after 72 h rather than after 24 h (manufacturer's recommendations) because it is possible that a reduction in the frequency of manipulations might reduce the risk of exogenous nosocomial pneumonia. We investigated the presence of time-dependent differences (after 24 h and 72 h) in pathogen survival/growth in artificially contaminated closed suction catheters (OptiFlo).
The trial simulated bacterial contamination of the airways using a suspension of 2 x 10(3) CFU/ml of Staphylococcus aureus or Pseudomonas aeruginosa. Contamination was performed on a total of 80 catheters. Forty were contaminated a total of eight times every 45-60 min. Another 40 catheters underwent the same procedure 24 times over three consecutive days. Microbiological analysis of the catheters took place after 24 h and 72 h, respectively.
The mean S. aureus load was 9.4 CFU/catheter after eight suction procedures and 6.2 CFU/catheter after 24 suction procedures (3 days). Mean growth of P. aeruginosa was 5.3 CFU/catheter, and 8.2 CFU/catheter after 3 days. There was no statistically significant difference between day 1 and 3 for S. aureus (p = 0.474), but there was for P. aeruginosa (p = 0.004).
Our findings show that, from an experimental point of view, it remains controversial whether routine change of closed suction catheters can be extended from 24 h to 72 h. However, clinical evidence suggests that prolonged use of a closed suctioning system is safe.
确定在72小时而非24小时（制造商建议时间）后更换封闭式吸痰系统是否可取，因为减少操作频率可能会降低外源性医院获得性肺炎的风险。我们研究了人工污染的封闭式吸痰导管（OptiFlo）中病原体存活/生长情况随时间（24小时和72小时后）的差异。
该试验使用每毫升含2×10³CFU的金黄色葡萄球菌或铜绿假单胞菌悬液模拟气道细菌污染。共对80根导管进行污染。40根导管每隔45 - 60分钟共污染8次。另外40根导管在连续三天内共进行24次相同操作。分别在24小时和72小时后对导管进行微生物分析。
8次吸痰操作后金黄色葡萄球菌平均载量为每根导管9.4 CFU，24次吸痰操作（3天）后为每根导管6.2 CFU。铜绿假单胞菌平均生长量为每根导管5.3 CFU，3天后为每根导管8.2 CFU。金黄色葡萄球菌在第1天和第3天之间无统计学显著差异（p = 0.474），但铜绿假单胞菌有差异（p = 0.004）。
我们的研究结果表明，从实验角度来看，封闭式吸痰导管的常规更换时间能否从24小时延长至72小时仍存在争议。然而，临床证据表明延长使用封闭式吸痰系统是安全的。
