医院呼吸机管路污染及病原菌分布现状调查

Investigation on contamination and pathogen distribution on ventilator circuits in hospital

目的了解医院呼吸机管路污染和病原菌分布状况,为提出呼吸机相关性肺炎防控措施的提供依据。方法对两种不同配置的呼吸机管路进行调查采样,对管路内不同部位进行细菌总数检测和细菌鉴定,并进行比较。结果呼吸机管路越靠近患者端污染越重,两种配置呼吸机管路使用7 d近患者端污染状况有明显差异,使用30 d的管路细菌总数明显高于使用7 d的管路。湿化水污染严重,呼吸机送气口污染较轻,但不使用细菌过滤器的回气口有明显污染。管路内细菌种类鉴定次数排名前3的是铜绿假单胞菌、粘质沙雷菌和洋葱伯克霍尔德菌,两医院优势菌不同。结论国内不同配置的呼吸机管路均存在明显污染,尤其是呼吸机近患者端污染严重,对没有气道阻塞性疾病的患者,应考虑使用细菌过滤型湿热交换器替代加湿器;湿化水应为无菌水并每天更换,并加强监测;应加强患者呼吸道分泌物的检验和近患者端管路污染的监测,设置适宜的换管周期。

Objective To investigate the contamination and distribution of pathogen on ventilator circuits in hospital, pro- vide the reference for improving the measures of Ventilator - associated pneumonia（VAP） control and prevention. Methods Two kinds of ventilators with different configuration were investigated and sampled, the total bacterial count and kind of bacterial on ventilator circuits were detected and compared. Results The parts of ventilator circuit closer to patient was contaminated more heavily. There was significant difference between two kinds of ventilators with different configuration after used for 7days. The total bacterial count of ventilator circuits after using for 30 days was more than that 7 days. The water in humidifier bottle was contaminated heavily. The contamination of expiratory ports was light, but several inspiratory ports without bacterial filters were contaminated heavily. Pseudomonas aeruginosa, Serratia marcescens and Burkholderia cepacia were the first three pathogens. The common pathogens in two hospital were different. Conclusion The ventilator circuits of different configuration in hospital are contaminated obviously, especially the parts of ventilator circuit closer to patient. It should consider using the Heat and Moisture Exchanger with bacteria filtering capability instead of humidifier for the patient without airway obstructive disease, using sterile water for humidifier every day and strengthening supervision, increasing bac- teriologic test of respiratory secretion of patients and parts of ventilator circuit closer to them, and setting appropriate re- placement cycle of ventilator circuits.