TY - JOUR
T1 - Effect of open and closed endotracheal suctioning on cross-transmission with Gram-negative bacteria
T2 - A prospective crossover study
AU - Jongerden, Irene P.
AU - Buiting, Anton G.
AU - Leverstein-Van Hall, Maurine A.
AU - Speelberg, Ben
AU - Zeidler, Shimriet
AU - Kesecioglu, Jozef
AU - Bonten, Marc J.
N1 - Funding Information: The authors received a grant from The Netherlands Organisation for Health Research and Development (ZonMw project number 62300037 ); M.J.B. has received research funding from The Netherlands Organization of Scientific Research ( NWO Vici 918.76.611 ).
PY - 2011/6
Y1 - 2011/6
N2 - Objective: Cross-transmission of Gram-negative bacteria increases the likelihood of acquisition of infections and emergence of antibiotic resistance in intensive care units. Respiratory tracts of mechanically ventilated patients are frequently colonized with Gram-negative bacteria and endotracheal suctioning may facilitate cross-transmission. It is unknown whether closed suction systems, as compared with open suction systems, prevent cross-transmission. The objective was to determine whether closed suction systems, as compared with open suction systems, reduce the incidence of cross-transmission of Gram-negative bacteria in intensive care units. Design: We performed a prospective crossover study in which both systems were tested unitwide in four intensive care units. Setting: Two intensive care units from a university hospital and two from a teaching hospital participated in the trial between January 2007 and February 2008. Patients: All patients admitted to the intensive care unit for >24 hrs were included. Intervention: Closed suction systems and open suction systems were used for all patients requiring mechanical ventilation during 6-month clusters with the order of systems randomized per intensive care unit. Measurements and Main Results: Acquisition and cross-transmission rates of selected Gram-negative bacteria were determined through extensive microbiological surveillance and genotyping. Among 1,110 patients (585 with closed suction systems and 525 with open suction systems), acquisition for selected Gram-negative bacteria was 35.5 and 32.5 per 1,000 patient-days at risk during closed suction period and open suction period, respectively (adjusted hazard ratio, 1.14; 95% confidence interval, 0.9-1.4). During closed suction period, adjusted hazard ratios for acquisition were 0.66 (95% confidence interval, 0.45-0.97) for Pseudomonas aeruginosa and 2.03 (95% confidence interval, 1.15-3.57) for Acinetobacter species; acquisition rates of other pathogens did not differ significantly. Adjusted hazard ratios for cross-transmission during closed suction period 0.9 (0.4-1.9) for P. aeruginosa, 6.7 (1.5-30.1) for Acinetobacter, and 0.3 (0.03-2.7) for Enterobacter species. Overall cross-transmission rates were 5.9 (closed suction systems) and 4.7 (open suction systems) per 1,000 patient-days at risk. Conclusion: Closed suction systems failed to reduce cross-transmission and acquisition rates of the most relevant Gram-negative bacteria in intensive care unit patients.
AB - Objective: Cross-transmission of Gram-negative bacteria increases the likelihood of acquisition of infections and emergence of antibiotic resistance in intensive care units. Respiratory tracts of mechanically ventilated patients are frequently colonized with Gram-negative bacteria and endotracheal suctioning may facilitate cross-transmission. It is unknown whether closed suction systems, as compared with open suction systems, prevent cross-transmission. The objective was to determine whether closed suction systems, as compared with open suction systems, reduce the incidence of cross-transmission of Gram-negative bacteria in intensive care units. Design: We performed a prospective crossover study in which both systems were tested unitwide in four intensive care units. Setting: Two intensive care units from a university hospital and two from a teaching hospital participated in the trial between January 2007 and February 2008. Patients: All patients admitted to the intensive care unit for >24 hrs were included. Intervention: Closed suction systems and open suction systems were used for all patients requiring mechanical ventilation during 6-month clusters with the order of systems randomized per intensive care unit. Measurements and Main Results: Acquisition and cross-transmission rates of selected Gram-negative bacteria were determined through extensive microbiological surveillance and genotyping. Among 1,110 patients (585 with closed suction systems and 525 with open suction systems), acquisition for selected Gram-negative bacteria was 35.5 and 32.5 per 1,000 patient-days at risk during closed suction period and open suction period, respectively (adjusted hazard ratio, 1.14; 95% confidence interval, 0.9-1.4). During closed suction period, adjusted hazard ratios for acquisition were 0.66 (95% confidence interval, 0.45-0.97) for Pseudomonas aeruginosa and 2.03 (95% confidence interval, 1.15-3.57) for Acinetobacter species; acquisition rates of other pathogens did not differ significantly. Adjusted hazard ratios for cross-transmission during closed suction period 0.9 (0.4-1.9) for P. aeruginosa, 6.7 (1.5-30.1) for Acinetobacter, and 0.3 (0.03-2.7) for Enterobacter species. Overall cross-transmission rates were 5.9 (closed suction systems) and 4.7 (open suction systems) per 1,000 patient-days at risk. Conclusion: Closed suction systems failed to reduce cross-transmission and acquisition rates of the most relevant Gram-negative bacteria in intensive care unit patients.
KW - antibiotic resistance
KW - cross infection
KW - crosstransmission
KW - infection control
KW - intensive care
KW - mechanical ventilation
KW - suction
UR - http://www.scopus.com/inward/record.url?scp=79957630142&partnerID=8YFLogxK
U2 - https://doi.org/10.1097/CCM.0b013e3182120815
DO - https://doi.org/10.1097/CCM.0b013e3182120815
M3 - Article
SN - 0090-3493
VL - 39
SP - 1313
EP - 1321
JO - Critical Care Medicine
JF - Critical Care Medicine
IS - 6
ER -