Skip Navigation
Skip to contents

J Korean Acad Nurs : Journal of Korean Academy of Nursing

Search
Advanced Search
OPEN ACCESS
mobile search button mobile menu button

Articles

Page Path
HOME > J Korean Acad Nurs > Volume 41(2); 2011 > Article
Original Article
Endotracheal Colonization and Ventilator-associated Pneumonia in Mechanically Ventilated Patients according to Type of Endotracheal Suction System
Kyeong-Sook Cha, Ho-Ran Park
Journal of Korean Academy of Nursing 2011;41(2):175-181.
DOI: https://doi.org/10.4040/jkan.2011.41.2.175
Published online: April 30, 2011

1Registered Nurse, Department of Infection Control, St. Vincent's Hospital, Suwon, Korea.

2Professor, College of Nursing, The Catholic University of Korea, Seoul, Korea.

Address reprint requests to: Park, Ho-Ran. College of Nursing, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul 137-701, Korea. Tel: +82-2-2258-7406, Fax: +82-2-2258-7772, hrpark@catholic.ac.kr
• Received: August 2, 2010   • Accepted: April 15, 2011

© 2011 Korean Society of Nursing Science

  • 14 Views
  • 0 Download
  • 6 Scopus
prev next
Full Article

Download PDF Download PDF

  • Purpose
    This study was conducted to identify endotracheal colonization and the incidence of ventilator-associated pneumonia related to the type of endotracheal suction system.
  • Methods
    The participants in this study were ICU patients hospitalized between October 2009 to March 2010 who used ventilators for over 48 hr with closed (CSS, n=30) or open (OSS, n=32) suction systems. To standardize the pre-intervention suction system, a suctioning protocol was taught to the ICU nurses. Collected data were analyzed using χ2-test, Fisher's exact test, Wilcoxon rank sums test, Wilcoxon test, Log-rank test and Poisson regression.
  • Results
    Endotracheal colonization was higher in OSS than CSS from day 1 to day 8 while using a ventilator and there was a significant difference between the two groups. The CSS reached 50% of endotracheal colonization by the 4th day, whereas for the OSS, it was the 2nd day (p=.04). The incidence of ventilator-associated pneumonia showed no significant difference.
  • Conclusion
    For patients with a high risk of pneumonia, CSS must be used to lower endotracheal colonization.
  • Keywords: Suction; Colonization; Ventilator-associated Pneumonia
  • 1. Blackwood B. The practice and perception of intensive care staff using the closed suctioning system. Journal of Advanced Nursing. 1998;28:1020–1029.ArticlePubMedPDF
  • 2. Cardeñosa Cendrero JA, Solé-Violán J, Bordes Benítez A, Noguera Catalán J, Arroyo Fernández J, Saavedra Santana P, et al. Role of different routes of tracheal colonization in the development of pneumonia in patients receiving mechanical ventilation. Chest. 1999;116:462–470.ArticlePubMed
  • 3. Combes P, Fauvage B, Oleyer C. Nosocomial pneumonia in mechanically ventilated patients, a prospective randomised evaluation of the stericath closed suctioning system. Intensive Care Medicine. 2000;26:878–882.ArticlePubMedPDF
  • 4. Deppe SA, Kelly JW, Thoi LL, Chudy JH, Longfield RN, Ducey JP, et al. Incidence of colonization, nosocomial pneumonia, and mortality in critically ill patients using a trach care closed-suction system versus an open-suction system: Prospective, randomized study. Critical Care Medicine. 1990;18:1389–1393.ArticlePubMed
  • 5. Diaz E, Rodríguez AH, Rello J. Ventilator-associated pneumonia: Issues related to the artificial airway. Respiratory Care. 2005;50:900–909.PubMed
  • 6. Feldman C, Kassel M, Cantrell J, Kaka S, Morar R, Goolam Mahomed A, et al. The presence and sequence of endotracheal tube colonization in patients undergoing mechanical ventilation. The European Respiratory Journal. 1999;13:546–551.ArticlePubMed
  • 7. Grap MJ, Munro CL. Preventing ventilator-associated pneumonia: Evidence-based care. Critical Care Nursing Clinics of North America. 2004;16:349–358.ArticlePubMed
  • 8. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. American Journal of Infection Control. 2008;36:309–332.ArticlePubMed
  • 9. Hoshi K, Sasaki C, Ejima Y, Hasegawa R, Wagatsuma T, Matsukawa S. Effect of tube guide assembly of closed suction system on airway pressure gradient. Journal of Anesthesia. 2004;18:59–61.ArticlePubMedPDF
  • 10. Jung JW, Choi EH, Kim JH, Seo HK, Choi JY, Choi JC. Comparison of a closed with an open endotracheal suction: Costs and the incidence of ventilator-associated pneumonia. Tuberculosis and Respiratory Diseases. 2008;65:198–206.Article
  • 11. Kim MS, Ahn YM, Park IO, Choi SJ, Yoo MY. The effects of open endotracheal suctioning (ETS) and close ETS on oxygen saturation and heart rate in premature infants with respiratory distress syndrome. Journal of Korean Academy of Nursing. 1998;28:529–539.ArticlePDF
  • 12. Knaus WA, Wagner DP, Draper EA, Zimmerman JE, Bergner M, Bastos PG, et al. The APACHE III prognostic system: Risk prediction of hospital mortality for critically ill hospitalized adults. Chest. 1991;100:1619–1636.ArticlePubMed
  • 13. Kollef MH, Prentice D, Shapiro SD, Fraser VJ, Silver P, Trovillion E, et al. Mechanical ventilation with or without daily changes of in-line suction catheters. American Journal of Respiratory and Critical Care Medicine. 1997;156:466–472.ArticlePubMed
  • 14. Korean Association of Critical Care Nurse. Clinical care nursing in ICU. 2004;Seoul, Koonja Publishing.
  • 15. Korean Association of Infection Control Nursing. KAICN text of infection control. 2006;Seoul, Dong-Bang Han Publishing.
  • 16. Korean Society for Nosocomial Infection Control. Management of nosocomial infection. 2006;3rd ed. Seoul, Han-Mi Medical Publishing.
  • 17. Lee ES, Kim SH, Kim JS. Effects of a closed endotracheal suction system on oxygen saturation, ventilator-associated pneumonia, and nursing efficacy. Journal of Korean Academy of Nursing. 2004;34:1315–1325.ArticlePubMedPDF
  • 18. Lee SO, Kim ES, Kim HY, Park ES, Jin HY, Ki HK, et al. Korean nosocomial infections surveillance system, intensive care unit module report: Data summary from July 2007 through June 2008. Korean Journal of Nosocomial Infection Control. 2008;13:69–82.
  • 19. Lorente L, Lecuona M, Jiménez A, Mora ML, Sierra A. Tracheal suction by closed system without daily change versus open system. Intensive Care Medicine. 2006;32:538–544.ArticlePubMedPDF
  • 20. Lorente L, Lecuona M, Martín MM, García C, Mora ML, Sierra A. Ventilator-associated pneumonia using a closed versus an open tracheal suction system. Critical Care Medicine. 2005;33:115–119.ArticlePubMed
  • 21. Luaces Cubells C, Fernández Santervás Y, Cambra Lasoasa FJ, Gené Giralt A, López Navarro JA, Gibert Agulló A. Routes of endotracheal colonization in patients with mechanical ventilation. Anales Españoles de Pediatría. 1997;46:20–23.
  • 22. Myrianthefs PM, Kalafati M, Samara I, Baltopoulos GJ. Nosocomial pneumonia. Critical Care Nursing Quarterly. 2004;27:241–257.ArticlePubMed
  • 23. Park MY. Open vs closed endotracheal suction system: A hemodynamics comparison. 2002;Seoul, Ewha Womans University. Unpublished master's thesis.
  • 24. Rosenthal VD, Maki DG, Jamulitrat S, Medeiros EA, Todi SK, Gomez DY, et al. International nosocomial infection control consortium (INICC) report, data summary for 2003-2008, issued June 2009. American Journal of Infection Control. 2010;38:95–104.ArticlePubMed
  • 25. Shin HJ, Kim JA, Kwon EO, Noh WK, Kim MY, Noh JS, et al. The effects of hyperventilation and hyperoxygenation before and after endotracheal suctioning using closed-suction system on mechanically ventilated patients. Clinical Nursing Research. 2006;12:97–109.
  • 26. Siegel JD, Rhinehart E, Jackson M, Chiarello L. Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resistant organisms in healthcare settings, 2006. American Journal of Infection Control. 2007;35:S165–S193.ArticlePubMed
  • 27. Teasdale G, Jennett B. Assessment of coma and impaired consciousness: A practical scale. Lancet. 1974;2:81–84.PubMed
  • 28. The Korean Society of Infectious Diseases. Infectious diseases. 2007;Seoul, Koonja Publishing.
  • 29. Topeli A, Harmanci A, Cetinkaya Y, Akdeniz S, Unal S. Comparison of the effect of closed versus open endotracheal suction systems on the development of ventilator-associated pneumonia. The Journal of Hospital Infection. 2004;58:14–19.ArticlePubMed
Figure 1
A comparison of same organisms (≥3) repeatedly isolated from the sputum of patients in study groups. CSS=closed suction system; OSS=open suction system.
jkan-41-175-g001.jpg
Figure 2
A comparison of endotracheal colonization rates in study groups. CSS=closed suction system; OSS=open suction system.
jkan-41-175-g002.jpg
Table 1
General Characteristics of Participants
jkan-41-175-i001.jpg

CSS=closed suction system; OSS=open suction system; ICU=intensive care unit; APACHE III=acute physiology and chronic health evaluation III; *Wilcoxon rank sum test; †Fisher's exact test.

Table 2
A Comparison of Endotracheal Colonization in Study Participants
jkan-41-175-i002.jpg

CSS=closed suction system; OSS=open suction system; MRSA=methicill-in-resistant staphylococcus aureus; IR=imipenem resistance; ESBL=extend-ed-spectrum β-lactamase; †Patients=patients with endotracheal colonization who isolate new bacillus 24 hours after using a ventilator.

Table 3
Incidence of Ventilator-Associated Pneumonia in Study Groups
jkan-41-175-i003.jpg

CSS=closed suction system; OSS=open suction system. *Relative risk; †95% confidence interval; ‡Ventilator-days/patient-days; §(No. of Ventilator-associated pneumonia/No. of Patient-days)×1,000; ∥(No. of Ventilator-associated pneumonia/No. of Ventilator-days)×1,000.

Figure & Data

REFERENCES

    Citations

    Citations to this article as recorded by  

      • Cite
        CITE
        export Copy Download
        Close
        Download Citation
        Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.
        Format:
        • RIS — For EndNote, ProCite, RefWorks, and most other reference management software
        • BibTeX — For JabRef, BibDesk, and other BibTeX-specific software
        Include:
        • Citation for the content below
        Endotracheal Colonization and Ventilator-associated Pneumonia in Mechanically Ventilated Patients according to Type of Endotracheal Suction System
        J Korean Acad Nurs. 2011;41(2):175-181.   Published online April 30, 2011
        DOI: https://doi.org/10.4040/jkan.2011.41.2.175
        Close
      • XML DownloadXML Download
      Figure
      • 0
      • 1
      We recommend
      Endotracheal Colonization and Ventilator-associated Pneumonia in Mechanically Ventilated Patients according to Type of Endotracheal Suction System
      Image Image
      Figure 1 A comparison of same organisms (≥3) repeatedly isolated from the sputum of patients in study groups. CSS=closed suction system; OSS=open suction system.
      Figure 2 A comparison of endotracheal colonization rates in study groups. CSS=closed suction system; OSS=open suction system.

      Figure 1

      Figure 2

      Endotracheal Colonization and Ventilator-associated Pneumonia in Mechanically Ventilated Patients according to Type of Endotracheal Suction System

      General Characteristics of Participants

      CSS=closed suction system; OSS=open suction system; ICU=intensive care unit; APACHE III=acute physiology and chronic health evaluation III; *Wilcoxon rank sum test; †Fisher's exact test.

      A Comparison of Endotracheal Colonization in Study Participants

      CSS=closed suction system; OSS=open suction system; MRSA=methicill-in-resistant staphylococcus aureus; IR=imipenem resistance; ESBL=extend-ed-spectrum β-lactamase; †Patients=patients with endotracheal colonization who isolate new bacillus 24 hours after using a ventilator.

      Incidence of Ventilator-Associated Pneumonia in Study Groups

      CSS=closed suction system; OSS=open suction system. *Relative risk; †95% confidence interval; ‡Ventilator-days/patient-days; §(No. of Ventilator-associated pneumonia/No. of Patient-days)×1,000; ∥(No. of Ventilator-associated pneumonia/No. of Ventilator-days)×1,000.
      Table 1 General Characteristics of Participants

      CSS=closed suction system; OSS=open suction system; ICU=intensive care unit; APACHE III=acute physiology and chronic health evaluation III; *Wilcoxon rank sum test; †Fisher's exact test.

      Table 2 A Comparison of Endotracheal Colonization in Study Participants

      CSS=closed suction system; OSS=open suction system; MRSA=methicill-in-resistant staphylococcus aureus; IR=imipenem resistance; ESBL=extend-ed-spectrum β-lactamase; †Patients=patients with endotracheal colonization who isolate new bacillus 24 hours after using a ventilator.

      Table 3 Incidence of Ventilator-Associated Pneumonia in Study Groups

      CSS=closed suction system; OSS=open suction system. *Relative risk; †95% confidence interval; ‡Ventilator-days/patient-days; §(No. of Ventilator-associated pneumonia/No. of Patient-days)×1,000; ∥(No. of Ventilator-associated pneumonia/No. of Ventilator-days)×1,000.

      Table 1

      Table 2

      Table 3

      J Korean Acad Nurs : Journal of Korean Academy of Nursing
      © Korean Society of Nursing Science.
      Close layer
      TOP