Wet chemical silver treatment of endotracheal tubes to produce antibacterial surfaces

Antimicrobial materials for endotracheal tubes: A review on the last two decades of technological progress

Ventilator-associated pneumonia (VAP) is an unresolved problem in nosocomial settings, remaining consistently associated with a lack of treatment, high mortality, and prolonged hospital stay. The endotracheal tube (ETT) is the major culprit for VAP development owing to its early surface microbial colonization and biofilm formation by multiple pathogens, both critical events for VAP pathogenesis and relapses. To combat this matter, gradual research on antimicrobial ETT surface coating/modification approaches has been made. This review provides an overview of the relevance and implications of the ETT bioburden for VAP pathogenesis and how technological research on antimicrobial materials for ETTs has evolved. Firstly, certain main VAP attributes (definition/categorization; outcomes; economic impact) were outlined, highlighting the issues in defining/diagnosing VAP that often difficult VAP early- and late-onset differentiation, and that generate misinterpretations in VAP surveillance and discrepant outcomes. The central role of the ETT microbial colonization and subsequent biofilm formation as fundamental contributors to VAP pathogenesis was then underscored, in parallel with the uncovering of the polymicrobial ecosystem of VAP-related infections. Secondly, the latest technological developments (reported since 2002) on materials able to endow the ETT surface with active antimicrobial and/or passive antifouling properties were annotated, being further subject to critical scrutiny concerning their potentialities and/or constraints in reducing ETT bioburden and the risk of VAP while retaining/improving the safety of use. Taking those gaps/challenges into consideration, we discussed potential avenues that may assist upcoming advances in the field to tackle VAP rampant rates and improve patient care. STATEMENT OF SIGNIFICANCE: The use of the endotracheal tube (ETT) in patients requiring mechanical ventilation is associated with the development of ventilator-associated pneumonia (VAP). Its rapid surface colonization and biofilm formation are critical events for VAP pathogenesis and relapses. This review provides a comprehensive overview on the relevance/implications of the ETT biofilm in VAP, and on how research on antimicrobial ETT surface coating/modification technology has evolved over the last two decades. Despite significant technological advances, the limited number of gathered reports (46), highlights difficulty in overcoming certain hurdles associated with VAP (e.g., persistent colonization/biofilm formation; mechanical ventilation duration; hospital length of stay; VAP occurrence), which makes this an evolving, complex, and challenging matter. Challenges and opportunities in the field are discussed.

Antimicrobial polymer modifications to reduce microbial bioburden on endotracheal tubes and ventilator associated pneumonia

Hospital associated infections (HAIs), infections acquired by patients during care in a hospital, remain a prevalent issue in the healthcare field. These infections often occur with the use of indwelling medical devices, such as endotracheal tubes (ETTs), that can result in ventilator-associated pneumonia (VAP). When examining the various routes of infection, VAP is associated with the highest incidence, rate of morbidity, and economic burden. Although ETTs are essential for the survival of patients requiring mechanical ventilation, their use comes with complications. The presence of an ETT in the airway impairs physiological host defense mechanisms for clearance of pathogens and provides a platform for oropharynx microorganism transport to the sterile tracheobronchial network. Antibiotics are administered to treat lower respiratory infections; however, they are not always effective and consequently can result in increased antibiotic resistance. Prophylactic approaches by altering the surface of ETTs to prevent the establishment and growth of bacteria have exhibited promising results. In addition, passive surface modifications that prevent bacterial establishment and growth, or active coatings that possess a bactericidal effect have also proven effective. In this review we aim to highlight the importance of preventing biofilm establishment on indwelling medical devices, focusing on ETTs. We will investigate successful antimicrobial modifications to ETTs and the future avenues that will ultimately decrease HAIs and improve patient care. STATEMENT OF SIGNIFICANCE: Infections that occur with indwelling medicals devices remain a constant concern in the medical field and can result in hospital-acquired infections. Specifically, ventilator associated pneumonia (VAP) occurs with the use of an endotracheal tube (ETT). Infections often require use of antibiotics and can result in patient mortality. Our review includes a summary of the recent collective work of antimicrobial ETT modifications and potential avenues for further investigations in an effort to reduce VAP associated with ETTs. Polymer modifications with antibacterial nature have been developed and tested; however, a focus on ETTs is lacking and clinical availability of new antimicrobial ETT devices is limited. Our collective work shows the successful and prospective applications to the surfaces of ETTs that can support researchers and physicians to create safer medical devices.

Catalytic removal of mercury from waste carbonaceous catalyst by microwave heating

Waste carbonaceous catalyst (WCC) from vinyl chloride monomer (VCM) production is a potential environmental threat due to the mercury toxicity. Microwave heating (MWH) was used to decontaminate WCC. Treatment temperature had a stronger influence on mercury removal than that of treatment time while mercury removal was highly depended on treatment time at lower temperature. When WCC was treated at 350 °C for 60 min, 400 °C for 30 min and 450 °C or more for 10 min, leaching toxicity of mercury conformed to the US EPA standard. 99.98% of total mercury was removed and residual mercury concentration was only 4.5 mg kg^-1 when treated at 500 °C for 30 min. Soluble and exchangeable Hg and Hg combined with labile organics were more easily to be removed than that of Hg bound to crystalline Fe/Al oxides, Hg combined with non-labile organics and HgS. The removal limit for different mercury species may be achieved at 500 °C. Evaporation removal of mercury followed exponential decay model. Activation energy for mercury removal was reduced due to the catalytic effect of MWH. Removal mechanisms of mercury included thermal evaporation, breakdown of molecular bonds, selective stripping of carbonaceous impurities.

Silver-coated endotracheal tube versus non-coated endotracheal tube for preventing ventilator-associated pneumonia among adults: a systematic review of randomized controlled trials

OBJECTIVE

To compare the effects of using silver-coated endotracheal tube (ETT) versus non-coated ETT on the incidence of ventilator-associated pneumonia (VAP) and mortality in adult patients.

METHOD

We searched MEDLINE, the Cochrane Library, EMBASE, and the Chinese Biomedical Literature Database from inception to June 30, 2011. We also retrieved the reference lists of included studies and reviews. Randomized controlled trials (RCTs) comparing silver-coated ETTs versus non-coated ETTs were included. We pooled the results using a random-effect model and conducted subgroup analyses and sensitivity analyses to address the heterogeneity between studies.

RESULTS

We identified two eligible RCTs with a total of 1630 participants. The studies were of high quality according to Cochrane Collaboration's tool for assessing risk of bias. Compared with non-coated ETTs, silver-coated ETTs resulted in lower incidence of VAP (RR=0.64, 95% CI 0.43 to 0.96), device-related adverse events (RR=0.53, 95% CI 0.32 to 0.88), and microbiologic burden (≥10,000 CFU/mL: 0.64, 0.48 to 0.86; ≥100,000 CFU/mL: 0.62, 0.43 to 0.89). However, there was no significant difference in total mortality (RR=1.14, 95% CI 0.99 to 1.30).

CONCLUSION

The limited evidence from meta-analysis of two RCTs showed that using silver-coated ETTs reduced the incidence of VAP, microbiologic burden, and device-related adverse events among adult patients. Additional rigorous randomized trials are needed to confirm these findings.

Surface-immobilised antimicrobial peptoids

Surface modification techniques that create surfaces capable of killing adherent bacteria are promising solutions to infections associated with implantable medical devices. Antimicrobial (AM) peptoid oligomers (ampetoids) that were designed to mimic helical AM peptides were synthesised with a peptoid spacer chain to allow mobility and an adhesive peptide moiety for easy and robust immobilisation onto substrata. TiO(2) substrata were modified with the ampetoids and subsequently backfilled with an antifouling (AF) polypeptoid polymer in order to create polymer surface coatings composed of both AM (active) and AF (passive) peptoid functionalities. Confocal microscopy images showed that the membranes of adherent E. coli cells were damaged after 2-h exposure to the modified substrata, suggesting that ampetoids retain AM properties even when immobilised on substrata.