Reanimador manual: quando trocar no mesmo paciente
Autor(a) principal: | |
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Data de Publicação: | 2016 |
Tipo de documento: | Tese |
Idioma: | por |
Título da fonte: | Repositório Institucional da UFG |
Texto Completo: | http://repositorio.bc.ufg.br/tede/handle/tede/6497 |
Resumo: | INTRODUCTION: The manual resuscitator is a widely used respiratory assist device that has been reported to be a reservoir and a source of contamination from various microorganisms. At present, there is no criteria to replacement of manual resuscitator when it is in successive use in the same patient. AIM: To evaluate the safest amount of time the manual resuscitator can be successively used in the same patient. METHODS: An open, prospective cohort study was conducted from October to November, 2014 using 30 patient connector valves from manual resuscitator devices obtained from Intensive Care Units of a general hospital located in a region north of Brazil. The samples were collected through swab friction on the manual resuscitator that was used by the same patient, at zero (ready use), 24 and 48 hours. Bacterial identification and antibiotic susceptibility were performed automatically (Vitek 2 Compact®). RESULTS: Of the 30 resuscitators evaluated, 20 (66.6%) were found to be contaminated. There was a significant difference between the microbial load on the manual resuscitators in use at zero and 24 hours (p = 0.03). Associated risk factors for the contamination of manual resuscitators identified were frequency and time of use. The presence of visible soil was not detected on 19 manual resuscitators in use, however, 95.0% were contaminated. The number of microorganisms isolated at zero, 24 and 48 hours were five, 11 and 24, respectively. Thirteen devices were contaminated with two or more bacterial species. Of the Gram-positive cocci, 38.9% (n = 18) were methicillin-resistant Staphylococcus aureus and 11.1% were methicillin-resistant coagulase-negative Staphylococcus, all were constitutive MLSB resistant. Of the Gram-negative rods (n = 36), Acinetobacter baumannii (36.1%), Pseudomonas aeruginosa (19.4%), Serratia marcescens (22.2%) and Proteus spp. (8.3%) dominated. Over 50% of these were resistant to carbapenems, second, third and fourth cephalosporins generations, and ampicillin/sulbactam. CONCLUSION: Manual resuscitators in successive use in the same patient were contaminated even in the absence of visible dirt. Multi- and extensively-resistant bacteria of clinical importance were also detected. Frequency and time of use were identified as risk factors in the contamination of manual resuscitators. The longer the time of use, the greater the number of contaminated resuscitators and bacterial species isolated. These results point to failures in reprocessing, and therefore highlights the importance of having thorough discussions among regulators about the recommendations for the reprocessing of semi-critical medical devices, especially, those for ventilatory assistance. Furthermore, the results highlight the need to replace manual resuscitators every 24 hours after use as a strategy for infection control and to minimize the risk of re-colonization or -infection of the respiratory tract. |
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Souza, Adenícia Custódia Silvahttp://lattes.cnpq.br/5966034868102264Pereira, Milca Severinohttp://lattes.cnpq.br/9304767101674108Souza, Adenícia Custódia Silvahttp://lattes.cnpq.br/5966034868102264Oliveira, Adriana CristinaTipple, Anaclara Ferreira VeigaLeão, Lara Stefânia Netto de OliveiraBrasil, Virginia Viscondehttp://lattes.cnpq.br/9861909209527904Gomes, Giselle Pinheiro Lima Aires2016-11-10T17:49:41Z2016-03-31GOMES, G. P. L. A. Reanimador manual: quando trocar no mesmo paciente. 2016. 118 f. Tese (Doutorado em Enfermagem) - Universidade Federal de Goiás, Goiânia, 2016.http://repositorio.bc.ufg.br/tede/handle/tede/6497INTRODUCTION: The manual resuscitator is a widely used respiratory assist device that has been reported to be a reservoir and a source of contamination from various microorganisms. At present, there is no criteria to replacement of manual resuscitator when it is in successive use in the same patient. AIM: To evaluate the safest amount of time the manual resuscitator can be successively used in the same patient. METHODS: An open, prospective cohort study was conducted from October to November, 2014 using 30 patient connector valves from manual resuscitator devices obtained from Intensive Care Units of a general hospital located in a region north of Brazil. The samples were collected through swab friction on the manual resuscitator that was used by the same patient, at zero (ready use), 24 and 48 hours. Bacterial identification and antibiotic susceptibility were performed automatically (Vitek 2 Compact®). RESULTS: Of the 30 resuscitators evaluated, 20 (66.6%) were found to be contaminated. There was a significant difference between the microbial load on the manual resuscitators in use at zero and 24 hours (p = 0.03). Associated risk factors for the contamination of manual resuscitators identified were frequency and time of use. The presence of visible soil was not detected on 19 manual resuscitators in use, however, 95.0% were contaminated. The number of microorganisms isolated at zero, 24 and 48 hours were five, 11 and 24, respectively. Thirteen devices were contaminated with two or more bacterial species. Of the Gram-positive cocci, 38.9% (n = 18) were methicillin-resistant Staphylococcus aureus and 11.1% were methicillin-resistant coagulase-negative Staphylococcus, all were constitutive MLSB resistant. Of the Gram-negative rods (n = 36), Acinetobacter baumannii (36.1%), Pseudomonas aeruginosa (19.4%), Serratia marcescens (22.2%) and Proteus spp. (8.3%) dominated. Over 50% of these were resistant to carbapenems, second, third and fourth cephalosporins generations, and ampicillin/sulbactam. CONCLUSION: Manual resuscitators in successive use in the same patient were contaminated even in the absence of visible dirt. Multi- and extensively-resistant bacteria of clinical importance were also detected. Frequency and time of use were identified as risk factors in the contamination of manual resuscitators. The longer the time of use, the greater the number of contaminated resuscitators and bacterial species isolated. These results point to failures in reprocessing, and therefore highlights the importance of having thorough discussions among regulators about the recommendations for the reprocessing of semi-critical medical devices, especially, those for ventilatory assistance. Furthermore, the results highlight the need to replace manual resuscitators every 24 hours after use as a strategy for infection control and to minimize the risk of re-colonization or -infection of the respiratory tract.INTRODUÇÃO: O reanimador manual é um dispositivo de assistência respiratória amplamente utilizado que tem sido reportado como reservatório e fonte de contaminação por diversos micro-organismos, e ainda não apresenta critérios definidos para a troca quando em uso sucessivo no mesmo paciente. OBJETIVO: Avaliar o tempo de uso seguro do reanimador manual em uso sucessivo no mesmo paciente. MÉTODO: Trata-se de uma coorte aberta prospectiva, realizada de outubro a novembro de 2014 em 30 válvulas do reanimador manual (conector do paciente) em Unidades de Tratamento Intensivo de um hospital geral da região Norte do Brasil. As amostras foram coletadas por meio de fricção de swab em reanimador manual em uso no mesmo paciente nos tempos zero (pronto uso), 24 e 48 horas. A identificação bacteriana e o antibiograma foram automatizados (Vitek 2 Compact®). RESULTADOS: Dos 30 reanimadores avaliados, 20 (66,6%) estavam contaminados. A carga microbiana entre os tempos zero e 24h de uso dos reanimadores manuais apresentou diferença estatística significativa (p=0,03). A frequência e o tempo de uso foram identificados como fatores de risco associados para a contaminação de reanimadores manuais em uso. Dos 19 reanimadores manuais avaliados como visivelmente limpos, 95,0% apresentaram contaminados. Foram isolados cinco, 11 e 24 tipos de micro-organismos nos tempos zero, 24 e 48 horas respectivamente. Treze dispositivos estavam contaminados por duas ou mais espécies bacterianas. Dentre os cocos gram-positivos (n=18), 38,9% eram Staphylococcus aureus resistentes à meticilina e 11,1% Staphylococcus coagulase negativos resistentes à meticilina, todos com resistência constitutiva ao grupo MLSB. Dentre os bastonetes gram-negativos (n=36), predominaram Acinetobacter baumannii (36,1%), Pseudomonas aeruginosa (19,4%), Serratia marcescens (22,2%) e Proteus spp. (8,3%). Mais de 50% destes apresentaram resistência aos carbapenens, cefalosporinas de segunda, terceira e quarta gerações, e ampicilina/sulbactam. CONCLUSÃO: Os reanimadores manuais em uso sucessivo no mesmo paciente estavam contaminados, mesmo na ausência de sujidade visível, sendo o tempo e a frequência de uso do dispositivo fatores de risco identificados. Bactérias multirresistentes e extensivamente resistentes de importância clínica foram detectadas. Quanto maior o tempo de uso, maior o número de reanimadores contaminados e de espécies bacterianas isoladas. Os resultados apontam para falhas no processamento, e indicam necessidade de discussão entre os órgãos regulamentadores sobre a recomendação para o processamento de produtos para a saúde semicríticos, em especial, os de assistência ventilatória e demonstram ainda a necessidade de troca do reanimador manual a cada 24 horas de uso, como estratégia primária para minimizar o risco de (re)colonização que poderá resultar em infecção do trato respiratório.Submitted by JÚLIO HEBER SILVA (julioheber@yahoo.com.br) on 2016-11-09T14:03:31Z No. of bitstreams: 2 Tese - Giselle Pinheiro Lima Aires Gomes - 2016.pdf: 3158182 bytes, checksum: ba9d36d200045df31c0cbd0972cc94a2 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5)Approved for entry into archive by Jaqueline Silva (jtas29@gmail.com) on 2016-11-10T17:49:41Z (GMT) No. of bitstreams: 2 Tese - Giselle Pinheiro Lima Aires Gomes - 2016.pdf: 3158182 bytes, checksum: ba9d36d200045df31c0cbd0972cc94a2 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5)Made available in DSpace on 2016-11-10T17:49:41Z (GMT). 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dc.title.por.fl_str_mv |
Reanimador manual: quando trocar no mesmo paciente |
title |
Reanimador manual: quando trocar no mesmo paciente |
spellingShingle |
Reanimador manual: quando trocar no mesmo paciente Gomes, Giselle Pinheiro Lima Aires Infecção hospitalar Contaminação de equipamentos Enfermagem Resistência microbiana a medicamentos Genes MDR Unidades de terapia intensiva Cross infection Equipment contamination Nursing Drug resistance microbial Genes MDR Intensive care units ENFERMAGEM::ENFERMAGEM DE SAUDE PUBLICA |
title_short |
Reanimador manual: quando trocar no mesmo paciente |
title_full |
Reanimador manual: quando trocar no mesmo paciente |
title_fullStr |
Reanimador manual: quando trocar no mesmo paciente |
title_full_unstemmed |
Reanimador manual: quando trocar no mesmo paciente |
title_sort |
Reanimador manual: quando trocar no mesmo paciente |
author |
Gomes, Giselle Pinheiro Lima Aires |
author_facet |
Gomes, Giselle Pinheiro Lima Aires |
author_role |
author |
dc.contributor.advisor1.fl_str_mv |
Souza, Adenícia Custódia Silva |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/5966034868102264 |
dc.contributor.advisor-co1.fl_str_mv |
Pereira, Milca Severino |
dc.contributor.advisor-co1Lattes.fl_str_mv |
http://lattes.cnpq.br/9304767101674108 |
dc.contributor.referee1.fl_str_mv |
Souza, Adenícia Custódia Silva |
dc.contributor.referee1Lattes.fl_str_mv |
http://lattes.cnpq.br/5966034868102264 |
dc.contributor.referee2.fl_str_mv |
Oliveira, Adriana Cristina |
dc.contributor.referee3.fl_str_mv |
Tipple, Anaclara Ferreira Veiga |
dc.contributor.referee4.fl_str_mv |
Leão, Lara Stefânia Netto de Oliveira |
dc.contributor.referee5.fl_str_mv |
Brasil, Virginia Visconde |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/9861909209527904 |
dc.contributor.author.fl_str_mv |
Gomes, Giselle Pinheiro Lima Aires |
contributor_str_mv |
Souza, Adenícia Custódia Silva Pereira, Milca Severino Souza, Adenícia Custódia Silva Oliveira, Adriana Cristina Tipple, Anaclara Ferreira Veiga Leão, Lara Stefânia Netto de Oliveira Brasil, Virginia Visconde |
dc.subject.por.fl_str_mv |
Infecção hospitalar Contaminação de equipamentos Enfermagem Resistência microbiana a medicamentos Genes MDR Unidades de terapia intensiva |
topic |
Infecção hospitalar Contaminação de equipamentos Enfermagem Resistência microbiana a medicamentos Genes MDR Unidades de terapia intensiva Cross infection Equipment contamination Nursing Drug resistance microbial Genes MDR Intensive care units ENFERMAGEM::ENFERMAGEM DE SAUDE PUBLICA |
dc.subject.eng.fl_str_mv |
Cross infection Equipment contamination Nursing Drug resistance microbial Genes MDR Intensive care units |
dc.subject.cnpq.fl_str_mv |
ENFERMAGEM::ENFERMAGEM DE SAUDE PUBLICA |
description |
INTRODUCTION: The manual resuscitator is a widely used respiratory assist device that has been reported to be a reservoir and a source of contamination from various microorganisms. At present, there is no criteria to replacement of manual resuscitator when it is in successive use in the same patient. AIM: To evaluate the safest amount of time the manual resuscitator can be successively used in the same patient. METHODS: An open, prospective cohort study was conducted from October to November, 2014 using 30 patient connector valves from manual resuscitator devices obtained from Intensive Care Units of a general hospital located in a region north of Brazil. The samples were collected through swab friction on the manual resuscitator that was used by the same patient, at zero (ready use), 24 and 48 hours. Bacterial identification and antibiotic susceptibility were performed automatically (Vitek 2 Compact®). RESULTS: Of the 30 resuscitators evaluated, 20 (66.6%) were found to be contaminated. There was a significant difference between the microbial load on the manual resuscitators in use at zero and 24 hours (p = 0.03). Associated risk factors for the contamination of manual resuscitators identified were frequency and time of use. The presence of visible soil was not detected on 19 manual resuscitators in use, however, 95.0% were contaminated. The number of microorganisms isolated at zero, 24 and 48 hours were five, 11 and 24, respectively. Thirteen devices were contaminated with two or more bacterial species. Of the Gram-positive cocci, 38.9% (n = 18) were methicillin-resistant Staphylococcus aureus and 11.1% were methicillin-resistant coagulase-negative Staphylococcus, all were constitutive MLSB resistant. Of the Gram-negative rods (n = 36), Acinetobacter baumannii (36.1%), Pseudomonas aeruginosa (19.4%), Serratia marcescens (22.2%) and Proteus spp. (8.3%) dominated. Over 50% of these were resistant to carbapenems, second, third and fourth cephalosporins generations, and ampicillin/sulbactam. CONCLUSION: Manual resuscitators in successive use in the same patient were contaminated even in the absence of visible dirt. Multi- and extensively-resistant bacteria of clinical importance were also detected. Frequency and time of use were identified as risk factors in the contamination of manual resuscitators. The longer the time of use, the greater the number of contaminated resuscitators and bacterial species isolated. These results point to failures in reprocessing, and therefore highlights the importance of having thorough discussions among regulators about the recommendations for the reprocessing of semi-critical medical devices, especially, those for ventilatory assistance. Furthermore, the results highlight the need to replace manual resuscitators every 24 hours after use as a strategy for infection control and to minimize the risk of re-colonization or -infection of the respiratory tract. |
publishDate |
2016 |
dc.date.accessioned.fl_str_mv |
2016-11-10T17:49:41Z |
dc.date.issued.fl_str_mv |
2016-03-31 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/doctoralThesis |
format |
doctoralThesis |
status_str |
publishedVersion |
dc.identifier.citation.fl_str_mv |
GOMES, G. P. L. A. Reanimador manual: quando trocar no mesmo paciente. 2016. 118 f. Tese (Doutorado em Enfermagem) - Universidade Federal de Goiás, Goiânia, 2016. |
dc.identifier.uri.fl_str_mv |
http://repositorio.bc.ufg.br/tede/handle/tede/6497 |
identifier_str_mv |
GOMES, G. P. L. A. Reanimador manual: quando trocar no mesmo paciente. 2016. 118 f. Tese (Doutorado em Enfermagem) - Universidade Federal de Goiás, Goiânia, 2016. |
url |
http://repositorio.bc.ufg.br/tede/handle/tede/6497 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.relation.program.fl_str_mv |
4506162830365041981 |
dc.relation.confidence.fl_str_mv |
600 600 600 600 |
dc.relation.department.fl_str_mv |
2756753233336908714 |
dc.relation.cnpq.fl_str_mv |
5647390027954931658 |
dc.relation.sponsorship.fl_str_mv |
-961409807440757778 |
dc.rights.driver.fl_str_mv |
http://creativecommons.org/licenses/by-nc-nd/4.0/ info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
http://creativecommons.org/licenses/by-nc-nd/4.0/ |
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Universidade Federal de Goiás |
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