重症监护室开放式吸引连接管污染状况及更换频率的临床研究

Clinical study on contamination and replacement frequency of open suction tubing in intensive care unit

目的了解重症监护室开放式吸引连接管不同保存时间细菌污染状况,探讨合理的吸引连接管更换频率。方法采用便利抽样法,选取2016年11月-2018年2月金华市中心医院重症监护室内气管插管或气管切开患者为研究对象。在前期预试验的基础上,选取39例患者,分别采集使用后1、3、7 d的吸引连接管头端内口的标本进行细菌培养,并按要求进行患者痰培养。明确吸引连接管头端内口污染的细菌菌属类别,对比不同时间段细菌菌落数,菌属种类数以及与患者痰培养的一致性。结果吸引连接管头端内口细菌主要为铜绿假单胞菌、草绿色链球菌、鲍曼不动杆菌、棒状杆菌,与痰培养结果略有不同;使用后1、3、7 d的吸引连接管头端内口细菌培养阳性率、细菌菌落数、菌属种类数以及与患者痰培养的一致性比较,差异均无统计学意义(P>0.05)。结论重症监护室开放式吸引连接管头端内口污染率较高,但随着时间延长,并不会增加细菌污染程度"可延长吸引连接管更换频率至7 d—次。

Objective To investigate the bacterial contamination of open suction tubing in intensive care units at different dwelling time and to explore the proper replacement frequency of suction tubing. Methods The patients receiving tracheal intubation or tracheotomy in the Intensive Care Unit, Jinhua Municipal Central Hospital from November 2016 to February 2018 were selected by convenient sampling. Based on preliminary pilot experiment, totally 39 patients were selected. Samples from the internal opening of suction tubing connector at days 1, 3 and 7 were obtained for bacterial culture, and the patients' sputum was cultured as required. The type of contaminant bacteria at the internal opening of suction tubing connector was identified. The number of bacterial colony, number of bacterial genus and the consistency with patients* sputum culture at different time points were compared. Results The bacteria at the internal opening of suction tubing connector were mainly pseudomonas aeruginosa, viridans streptococcus, baumanii and corynebacterium, which was slightly different from the findings of sputum culture. There was no statistically significant difference in the positive rate, number of bacterial colony, number of bacterial genus and the consistency with patients' sputum culture at the internal opening suction tubing connector at days 1, 3 and 7 (P > 0.05). Conclusions The internal opening of open suction tubing is highly contaminated, but the bacterial contamination does not worsen over time. The suction tubing may be replaced as long as every 7 days.