Avaliação da higiene das mãos na remoção da microbiota transitória dos punhos

• Autor(a) principal: García, Darío Bordas
• Data de Publicação: 2014
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da Universidade Estadual de Maringá (RI-UEM)
• Texto Completo: http://repositorio.uem.br:8080/jspui/handle/1/2016
• topic: Higienização; Antissépticos; Higienização das mãos; Punhos; Profissionais da saúde; Sabão; Brasil.; Antiseptics; Hand hygiene; Wrists; Soap; Brazil.; Ciências da Saúde; Medicina

In Brazil, the hand hygiene of health professionals is considered adequate when the hands are rubbed in all their faces, spaces between the fingers, joints, nails, tips of the fingers and wrists, performing the technique in seven steps. One controversial aspect is whether the friction of the wrists (i.e., step seven) is effective and necessary, since in many countries the recommended technique for hand hygiene is based on the Ayliffe's six-steps classic technique, which does not include the hygiene of wrists. To investigate the efficacy of hand hygiene technique performed in seven steps, for the removal of transient microbiota from wrists. The study was conducted using three 6x6 Latin squares utilizing the following test microorganisms: Escherichia coli, Staphylococcus aureus and Candida albicans. The treatments with the products (ethyl alcohol 70%, alcohol gel, povidone-iodine, chlorhexidine and plain liquid soap) and their respective controls (pre-treatment) were made into three 6x5 blocks (i.e., 6 volunteers versus 5 products, using a block for each test microorganism). The wrists were contaminated with 0.02 mL of the test microorganism and after drying, hand hygiene was performed using 3 mL of each product. The test microorganism was recovered from the wrists by rubbing the skin with the aid of a glass rod and saline solution containing neutralizers. The removal rate was determined by the logarithmic reduction factor (i.e., the mean log10 of the pre-treatment values minus the mean log10 of the post-treatment values). The possibility of contamination of the fingers with the microbiota of the wrists during hand hygiene (step seven) was investigated by the streak technique of the fingers on the surface of nutrient agar. The results were estimated by analysis of variance. A value of P < 0.05 was considered significant. A comparison of the efficacy of hand antisepsis with 3 mL and 5 mL of ethyl alcohol 70% (w/w) for removing Staphylococcus aureus from artificially contaminated wrists was also included in the study, performing 20 tests. The average removal rates were compared using the Student's t test. A value of P < 0.05 was considered significant. . On average, 6.45 (E. coli), 6.44 (S. aureus) and 5.89 (C. albicans) log10 colony forming units were recovered from control volunteers' wrists. Povidone-iodine and alcoholic preparations showed greater efficacy than plain soap and chlorhexidine for removing the test microorganisms from wrists. Contamination of the fingers of 3 volunteers treated with alcoholic preparations and antiseptic agents was observed during the assays of S. aureus block. The average removal rate of S. aureus from wrists for volunteers treated with 3 mL and 5 mL, expressed by the logarithmic reduction factor, was 4.85 ± 0.94 and 5.51 ± 0.84, respectively, and these differences were significant (P = 0.02344). The contamination of the fingers occurred in 65% (13/20) of the subjects treated with 3 mL of 70% ethyl alcohol and in none of those treated with 5 mL. The results suggest that the efficacy of rubbing the wrists (i.e., step seven) in the hand hygiene technique depends on the product used and the type of transient microbiota present in wrists. The data also suggest a limited efficacy of hand antisepsis with 3 mL of 70% ethyl alcohol (w/w) for removing S. aureus from artificially contaminated wrists. A higher volume of alcohol (e.g., 5 mL) should be considered in hand antisepsis with alcoholic preparations using the seven-steps technique.