Study on Dynamic Environmental Exposome of ICU and the Establishment of Microbial Transmission Model Between Environment and Host

Study Overview
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Brief Summary
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HAI (Hospital-acquired infection) is very common in ICU，and lack of understanding of environmental exposure omics and environment-host microbial interactions restricts the prevention and control of HAI. In this project, the investigators try to analyze the spatial and temporal distribution characteristics and evolution of microorganisms and their functions in the ICU environment through metagenome.

Detailed Description
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This observational study aims to analyze the spatial and temporal distribution characteristics and evolution of microorganisms and their functions in the ICU environment. The investigators will conduct weekly air microbiome sampling and microbiome sampling at 5 high-frequency contact points in different types of ICU units in three hospitals for one consecutive year, and collect dynamic pharyngeal swabs from ICU ward health care workers and dynamic clinical specimens (endotracheal aspiration, and bronchoalveolar lavage fluid) from patients with ventilator-associated pneumonia in ICU ward. With DNA high-throughput sequencing technology, the investigators will analyze the spatial and temporal distribution characteristics and evolution of microorganisms and their functions in the ICU environment, and provide support for HAI prevention.

Official Title
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Study on Dynamic Environmental Exposome of ICU and the Establishment of Microbial Transmission Model Between Environment and Host

Conditions
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Hospital Acquired Infection, Ventilator-associated Pneumonia

Intervention / Treatment
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* Procedure: Expectoration care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: With mechanical ventilation Age ≥18 years Anticipated ICU stay for more than 2 days With two or more of the following ventilator-associated pneumonia (VAP) risk factors VAP risk factors: Age ≥ 60 years old; Patients with chronic lung disease; Long-term bedridden; Unconsciousness; Sputum is not easily coughed up; Antibiotics have been used before mechanical ventilation; Long-term use of H receptor blockers and proton pump inhibitors. Exclusion Criteria: Patients who have not signed the informed consent Pregnant Systemic diseases and recent use of related drugs History of infectious diseases, such as tuberculosis or PPD positive History of hypertension and poor blood pressure control (SBP / DBP > = 140mmHg) With severe mental illness Long term use of traditional Chinese medicine, probiotics, gastric mucosal protective agents, proton pump inhibitors, chemotherapy or immunosuppressive drugs, etc.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| open ICU<br>open ICU: open ICU | Procedure: Expectoration care<br>* Endotracheal aspiration: from discarded samples after expectoration care BALF (bronchoalveolar lavage fluid): if patients with fiber bronchoscope examination, take the rest of the BALF after examination Oropharyngeal swabs<br>* Other names: Oropharyngeal swabs;|
| negative ICU<br>negative ICU: negative-pressure laminar flow ward | Procedure: Expectoration care<br>* Endotracheal aspiration: from discarded samples after expectoration care BALF (bronchoalveolar lavage fluid): if patients with fiber bronchoscope examination, take the rest of the BALF after examination Oropharyngeal swabs<br>* Other names: Oropharyngeal swabs;|
| positive ICU<br>positive ICU: laminar flow ward | Procedure: Expectoration care<br>* Endotracheal aspiration: from discarded samples after expectoration care BALF (bronchoalveolar lavage fluid): if patients with fiber bronchoscope examination, take the rest of the BALF after examination Oropharyngeal swabs<br>* Other names: Oropharyngeal swabs;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Community of microbiome in ICU | the dynamic changes of metagenomic/16s sequencing data | 1 year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Environment exposure, Microbial Colonization, Microbiome