Microbiological testing of devices used in maintaining peripheral venous catheters

RESUMEN Objetivo: evaluar el uso de catéteres venosos periféricos basado en el análisis microbiológico de dispositivos (vendajes y llaves de tres vías) y así contribuir a la prevención y control de infecciones. Métodos: se trata de un estudio prospectivo de análisis microbiológico de 30 llaves de tres vías (superficies externas y lumen) y 30 apósitos utilizados en el mantenimiento de los catéteres venosos periféricos de pacientes adultos hospitalizados. Resultados: todas las superficies externas, el 40% de los lúmenes y el 86,7% de los vendajes presentaron crecimiento bacteriano. Las principales especies aisladas en el lumen fueron 50% Staphylococcus coagulasa-negativa, 14.3% Staphylococcus aureus, y 14.3% Pseudomonas aeruginosa. Cincuenta y nueve por ciento de las bacterias resistentes a múltiples fármacos fueron aisladas de las llaves de tres vías, el 42% de los lúmenes, y el 44% del apósito con un predominio de Staphylococcus coagulasa-negativa resistente a la meticilina. Además, se identificaron 18% de bacterias gram-negativas con resistencia a carbapenems entre las bacterias multirresistentes en las superficies externas de las llaves de tres vías. Conclusión: es importante enfatizar el aislamiento de Staphylococcus coagulasa-negativa y bacterias gram-negativas resistentes a la meticilina y carbapenem en muestras de dispositivos, respectivamente, lo que refuerza la importancia de la atención de enfermería en el mantenimiento del medio ambiente biológicamente seguro, así como la prevención y las prácticas de control de la infección. assaRESUMO Objetivo: avaliar o uso de cateteres venosos periféricos com base em análises microbiológicas de dispositivos (curativos e torneiras de três vias - T3Vs) e assim contribuir para a prevenção e controle de infecção. Métodos: estudo prospectivo de análise microbiológica de 30 T3Vs (superfícies externas e lúmens) e 30 curativos utilizados na manutenção dos cateteres venosos periféricos de pacientes adultos hospitalizados. Resultados: todas as superfícies externas, 40% dos lúmens e 86,7% dos curativos apresentaram crescimento bacteriano. As principais espécies isoladas no lúmen foram 50% Staphylococcus coagulase-negativa, 14,3% Staphylococcus aureus e 14,3% Pseudomonas aeruginosa. Cinquenta e nove por cento das bactérias multirresistentes foram isoladas das T3Vs, 42% dos lúmens e 44% dos curativos com predominância de Staphylococcus coagulase-negativa resistente à meticilina. Além disso, 18% das bactérias gram-negativas com resistência aos carbapenêmicos foram identificadas a partir de bactérias multirresistentes nas superfícies externas das T3Vs. Conclusão: é importante enfatizar o isolamento de Staphylococcus coagulase-negativa resistente à meticilina e bactérias gram-negativas resistentes aos carbapenêmicos em amostras de dispositivos, o que reforça a importância do cuidado de enfermagem na manutenção do ambiente biologicamente seguro, assim como práticas de prevenção e controle de infecção.ABSTRACT Objective: to evaluate the use of peripheral venous catheters based on microbiological analysis of devices (dressing and three-way stopcocks) and thus contribute to the prevention and infection control. Methods: this was a prospective study of microbiological analysis of 30 three-way stopcocks (external surfaces and lumens) and 30 dressing used in maintaining the peripheral venous catheters of hospitalized adult patients. Results: all external surfaces, 40% of lumens, and 86.7% of dressing presented bacterial growth. The main species isolated in the lumen were 50% coagulase-negative Staphylococcus, 14.3% Staphylococcus aureus, and 14.3% Pseudomonas aeruginosa. Fifty nine percent of multidrug-resistant bacteria were isolated of the three-way stopcocks, 42% of the lumens, and 44% of the dressing with a predominance of coagulase-negative Staphylococcus resistant to methicillin. Besides, 18% gram-negative bacteria with resistance to carbapenems were identified from multidrug-resistant bacteria on the external surfaces of the three-way stopcocks. Conclusion: it is important to emphasize the isolation of coagulase-negative Staphylococcus and gram-negative bacteria resistant to methicillin and carbapenems in samples of devices, respectively, which reinforces the importance of nursing care in the maintenance of the biologically safe environment as well as prevention and infection control practices

HYGIENIC-SANITARY PROFILE OF HANDLED MEAT SOLD IN BULK IN SUPERMARKET CHAINS IN TERESINA-PI

This study objective was to characterize the hygienic-sanitary profile in ground beef, chilled chicken, ham and sausage manipulated and sold in bulk at supermarket chains in Teresina-PI. Samples of sausage, ham, braised chicken and ground beef sold in bulk were collected at five large supermarket chains in Teresina-PI, identified as SM1, SM2, SM3, SM4 and SM5. Forty samples were analyzed by Faust, Willis and Faust method adapted with alcohol-ether solution in triplicates. Fungus spores, hyphae fragments, eggs (hookworm and Ascaris lumbricoides) and parasite cysts (Entamoeba coli) were found in three of the five supermarket evaluated, as well as many body parts of insects as well as whole insects, these being fleas, mites and ants, in much greater quantities than permitted by law. In two of the five supermarkets chosen for the research no structures were found that could harm human health. It is necessary to implement good hygiene and care practices of meat storage at the analyzed supermarkets and to improve regulatory agencies inspections. In addition, it’s important to promote health education for supermarket workers, in order to avoid food contamination

Microbial and physical-chemical indicators on endoscope reprocessing and monitoring interface - Brazil/Australia

As dificuldades do reprocessamento dos endoscópicos gastrointestinais, o risco de contaminação e os casos de infecções representam desafios amplamente conhecidos na comunidade cientifica. Neste sentido, investigou-se o reprocessamento de endoscópios gastrointestinais subsidiado nos níveis de sujidade, contaminação microbiana e presença de biofilme. Trata-se de um experimento laboratorial realizado em três fases por meio da bioluminescência com adenosina trifosfato (ATP) para avaliação do nível de sujidade; polimerase chain reaction (PCR) para carga bacteriana e cultura microbiana para determinação do nível de contaminação. Ainda, avaliou-se as superfícies internas de canais de endoscópios por microscopia eletrônica de varredura (MEV) quanto à presença de biofilme. A análise estatística dos dados foi subsidiada em medidas de tendência central, testes de Man-Whitney, Wilcoxon e Spearman, p<0,05, por meio do software IBM SPSS Statistics versão 23.0. A avaliação de 99 endoscópios antes e após limpeza manual demonstrou a eficácia do processo na redução de sujidade (p<0,001) e contaminação microbiana (p=0,03), inclusive com baixo percentual da amostra com micro-organismos viáveis. Dos 75 endoscópios avaliados após o reprocessamento evidenciou-se uma redução do nível de sujidade (todos com <50URL, interna e externamente); entretanto a presença de carga bacteriana foi de 3log de bactéria/mL e 10,6% de positividade das culturas. Os micro-organismos isolados dos lavados de endoscópios após o reprocessamento foram Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus hominis, Staphylococcus capitis, Roseomonas gilardii e Micrococcus luteus. Na avaliação dos canais de biópsia de endoscópios provenientes do Brasil observou-se maior contaminação do que os da Austrália (p<0,001). Todos os canais apresentaram biofilme e danos em suas superfícies, entretanto as amostras brasileiras apresentaram particularidades, como, presença de hemácias, neutrófilos e fungos. Assim, observou-se que apesar da baixa carga microbiana nos endoscópios há o risco potencial de infecção cruzada associado ao biofilme, ameaçando a qualidade e segurança do reprocessamento. Adiciona-se a necessidade de avanços tecnológicos e científicos contra o biofilme na prática do reprocessamento de endoscópiosThe difficulties on gastrointestinal endoscope reprocessing, contamination risk and outbreaks are a recognized challenge in science. It was investigated gastrointestinal endoscope reprocessing for dirtiness, contamination level and presence of biofilm. Laboratorial experiment performed in three phases using adenosine triphosphate (ATP) bioluminescence for dirtiness evaluation; polymerase chain reaction (PCR) for bacterial load and microbial culture for contamination level evaluation. In addition, it was evaluated biofilm on endoscope channels internal surfaces by scanning electron microscopy (SEM). Statistics analysis was performed by descriptive analysis, ManWhitney, Wilcoxon and Spearman tests, p<0,05, using IBM SPSS Statistics versão 23.0. Before and after cleaning analysis of 99 endoscopes showed it efficacy on reducing dirtiness (p<0,001) and microbial contamination level (p=0,03), including a small percentage of culturable microorganism. From 75 endoscopes tested after reprocessing demonstrated dirtiness level reduction (all samples <50RUL, from internal and external area); but, also, presence of bacterial load of 3 log of bacteria/mL and 10,6% of culture positive. The microorganisms isolated from endoscope flush after reprocessing were Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus hominis, Staphylococcus capitis, Roseomonas gilardii and Micrococcus luteus. Endoscope biopsy channel analysis showed that samples from Brazil had higher contamination level than the ones from Australia (p<0,001). All channels analyzed presented biofilm and damage on their surfaces, however Brazilian samples showed particularities, like, blood cells, neutrophils and fungus. So, ever with low microbial load on endoscopes there is a potential risk of crossinfection associated with biofilm, compromising reprocessing quality and safety. Additionally, there´s the need of scientific and technologic improvement on endoscope reprocessing against biofil

Microbial and physical-chemical indicators on endoscope reprocessing and monitoring interface - Brazil/Australia

As dificuldades do reprocessamento dos endoscópicos gastrointestinais, o risco de contaminação e os casos de infecções representam desafios amplamente conhecidos na comunidade cientifica. Neste sentido, investigou-se o reprocessamento de endoscópios gastrointestinais subsidiado nos níveis de sujidade, contaminação microbiana e presença de biofilme. Trata-se de um experimento laboratorial realizado em três fases por meio da bioluminescência com adenosina trifosfato (ATP) para avaliação do nível de sujidade; polimerase chain reaction (PCR) para carga bacteriana e cultura microbiana para determinação do nível de contaminação. Ainda, avaliou-se as superfícies internas de canais de endoscópios por microscopia eletrônica de varredura (MEV) quanto à presença de biofilme. A análise estatística dos dados foi subsidiada em medidas de tendência central, testes de Man-Whitney, Wilcoxon e Spearman, p<0,05, por meio do software IBM SPSS Statistics versão 23.0. A avaliação de 99 endoscópios antes e após limpeza manual demonstrou a eficácia do processo na redução de sujidade (p<0,001) e contaminação microbiana (p=0,03), inclusive com baixo percentual da amostra com micro-organismos viáveis. Dos 75 endoscópios avaliados após o reprocessamento evidenciou-se uma redução do nível de sujidade (todos com <50URL, interna e externamente); entretanto a presença de carga bacteriana foi de 3log de bactéria/mL e 10,6% de positividade das culturas. Os micro-organismos isolados dos lavados de endoscópios após o reprocessamento foram Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus hominis, Staphylococcus capitis, Roseomonas gilardii e Micrococcus luteus. Na avaliação dos canais de biópsia de endoscópios provenientes do Brasil observou-se maior contaminação do que os da Austrália (p<0,001). Todos os canais apresentaram biofilme e danos em suas superfícies, entretanto as amostras brasileiras apresentaram particularidades, como, presença de hemácias, neutrófilos e fungos. Assim, observou-se que apesar da baixa carga microbiana nos endoscópios há o risco potencial de infecção cruzada associado ao biofilme, ameaçando a qualidade e segurança do reprocessamento. Adiciona-se a necessidade de avanços tecnológicos e científicos contra o biofilme na prática do reprocessamento de endoscópiosThe difficulties on gastrointestinal endoscope reprocessing, contamination risk and outbreaks are a recognized challenge in science. It was investigated gastrointestinal endoscope reprocessing for dirtiness, contamination level and presence of biofilm. Laboratorial experiment performed in three phases using adenosine triphosphate (ATP) bioluminescence for dirtiness evaluation; polymerase chain reaction (PCR) for bacterial load and microbial culture for contamination level evaluation. In addition, it was evaluated biofilm on endoscope channels internal surfaces by scanning electron microscopy (SEM). Statistics analysis was performed by descriptive analysis, ManWhitney, Wilcoxon and Spearman tests, p<0,05, using IBM SPSS Statistics versão 23.0. Before and after cleaning analysis of 99 endoscopes showed it efficacy on reducing dirtiness (p<0,001) and microbial contamination level (p=0,03), including a small percentage of culturable microorganism. From 75 endoscopes tested after reprocessing demonstrated dirtiness level reduction (all samples <50RUL, from internal and external area); but, also, presence of bacterial load of 3 log of bacteria/mL and 10,6% of culture positive. The microorganisms isolated from endoscope flush after reprocessing were Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus hominis, Staphylococcus capitis, Roseomonas gilardii and Micrococcus luteus. Endoscope biopsy channel analysis showed that samples from Brazil had higher contamination level than the ones from Australia (p<0,001). All channels analyzed presented biofilm and damage on their surfaces, however Brazilian samples showed particularities, like, blood cells, neutrophils and fungus. So, ever with low microbial load on endoscopes there is a potential risk of crossinfection associated with biofilm, compromising reprocessing quality and safety. Additionally, there´s the need of scientific and technologic improvement on endoscope reprocessing against biofil

Endoscope reprocessing and patient safety: evaluation of endoscopes and quality control

Empirical thesis.Bibliography: pages 127-140.Chapter 1. Literature review -- Chapter 2. Temporal trends on endoscope reprocessing -- Chapter 3. Material and methods -- Chapter 4. Assessing manual cleaning of flexible endoscope by measuring soil and microbial contamination levels -- Chapter 5. Evaluation of endoscope reprocessing : high level disinfection -- Chapter 6. Assessing cleaning and bacterial load on endoscopy unit surfaces -- Chapter 7. Endoscope channel contamination evolution -- Chapter 8. A preliminary study on the contribution od endoscope channel damage to biofilm formation -- Chapter 9. General discussion and conclusion -- References.The difficulties in reprocessing gastrointestinal endoscopes and risk of patient to patient transmission of infectious organisms are recognized challenges in medicine. This thesis investigated gastrointestinal endoscope reprocessing both in the clinic and in the laboratory. Analysis of clinical data was performed for assessing soil level, contamination level and biofilm formation in four different settings: before and after manual cleaning, directly after endoscope reprocessing (12 to 48 hours after disinfection), following internal channels extraction for repair (clinically used endoscope from Australia and Brazil) and environmental sampling of endoscopy unit surfaces. Experimental analysis involved investigation of endoscope internal channels for surface damage and its relationship to frequency of use.The tests used for the analysis were adenosine triphosphate (ATP) bioluminescence for presence of soil, polymerase chain reaction (PCR) for bacterial load, microbial culture for viable bacterial numbers, scanning electron microscopy (SEM) for biofilm presence and stylus profilometer for surface roughness. Statistical analysis was performed by descriptive analysis, Mann-Whitney, Wilcoxon and Spearman tests, p 100 RLU and were then samples for microbial load by culturing. The areas with more contamination were the procedure room´s pipe and nursing station chair´s lift. Some potential pathogenic microorganisms were isolated (i.e. Shigella spp. and E.coli).Endoscope biopsy channel analysis showed that samples from Brazil had higher contamination levels than Australian samples (p<0.001). All channels analyzed were contaminated with soil and biofilm and presented damaged surfaces, however Brazilian samples were also contaminated with blood cells, neutrophils and fungus.Clinically used endoscope channels (median=526.82 A) were significantly rougher than new (median=357.8 A) endoscope channels (p=0.03). The increased roughness in used endoscope channels could provide a good environment for bacteria and patients' soil attachment, making cleaning and disinfection harder and contributing for biofilm formation. On in vitro model, tubing damage was consistent and higher than new after 500 passages of biopsy forceps and bacteria attach to internal surface of the tube with 30 minutes of flow contact.We conclude that even with low microbial load on endoscopes there is a potential risk of cross-infection associated with biofilm formation, frequency and quantity of use and time for reprocessing, which can easily compromise the accomplishment of endoscope reprocessing and therefore, patient safety.Mode of access: World wide web1 online resource (xvi, 140 pages) illustrations (some colour

Processo de morte e morrer: evidências da literatura científica de enfermagem

Objetivou-se identificar o perfil das produções e analisar percepções, sentimentos e intervenções efetivas diante o processo de morte e morrer no exercício profissional evidenciados na produção científica da enfermagem no período de 1994 a 2009. Realizou-se uma pesquisa qualitativa, descritiva, por meio de uma revisão sistemática da literatura com metassíntese a partir do método meta-etnográfico. Dez pesquisas atenderam os critérios de inclusão, este conjunto foi submetido à avaliação de qualidade com check list Critical Appraisal Skills Programme. Os sujeitos percebem este processo como passagem, separação e finitude. Este está permeado de sentimentos de frustração e impotência e as intervenções mais efetivas diante deste problema é o desenvolvimento de estratégias de enfrentamento que variam de acordo com a realidade de cada indivíduo