Inactivation of biofilms in endotracheal tube by cold atmospheric plasma treatment for control and prevention of ventilator‐associated pneumonia

Abstract

AbstractVentilator‐associated pneumonia (VAP) is a type of hospital‐acquired infection with high mortality and morbidity rates that is seen in critically ill patients who are connected to mechanical ventilators in intensive care units. Conventional infection control measures may remain insufficient for control and prevention of VAP. In the present study, biofilms of most common pathogens, which are responsible for VAP, namely Pseudomonas aeruginosa, Acinetobacter baumannii, Staphylococcus aureus, and Candida albicans, were grown in the lumen of endotracheal tubes (ETs) under low shear to mimic the biofilm formation in clinical settings using the drip flow reactor system. Antibiofilm efficacies of two different plasma treatment methods were tested on the biofilms that were grown in ETs. In the first method, deionized water (DIW), phosphate‐buffered saline (PBS) solution, and N‐acetylcysteine (NAC) solution were treated with air dielectric barrier discharge (DBD) plasma and then nebulized on the biofilms. In the second method, air plasma afterglow (APA), which was generated using a DBD jet electrode, was flown through the lumen of ETs. Effects of two different plasma treatment methods on biofilms were evaluated using colony‐counting and XTT assays. The quantity of extracellular polymeric substance (EPS) was evaluated with the safranin assay. Scanning electron microscopy (SEM) was used to visualize the effect of various plasma treatment methods on biofilms. Cytotoxic effects of two different plasma treatment methods were tested on the human tracheal epithelial cell line. Our results suggest that the nebulized plasma‐treated NAC solution had a superior antibiofilm effect as compared with DIW and PBS. Two different plasma treatment methods used effectively inactivated biofilms and significantly reduced the quantity of EPS without a significant damage to the human tracheal epithelial cell line. Furthermore, SEM images showed the inactivation of microbial cells mainly through membrane damage.