Instrumental ortopédico de conformação complexa: avaliação do processamento, formação de biofilme e suas implicações
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2016-12-20
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Universidade Federal de Goiás
Resumo
INTRODUCTION: Depth gauge and flexible drill bite cutter are orthopedic surgical
instruments of complex conformation and they are into loanered instrumentation box to
different healthcare facilites. The challenge is to ensure that appropriatly cleaning was
done to prevent the formation of biofilm in these instruments´models. There are no
experimental or clinical studies analyzing the impact of different cleaning protocols on
formation of biofilm on surfaces those two surgical instruments. OBJECTIVES: To
validate and to evaluate laboratory method to formation of biofilms in stainless steel. To
evaluate microbial load and to determine formation of biofilms after laboratory
contamination and processing for several cycles in surgical instruments of complex
conformation used in surgeries of orthopedic implants. METHOD: Experimental study
was developed from November/2014 to March/2016, at the Laboratory of Macquarie
University, Sydney (AU). Method´s validation: new forceps halsted hemostatic mosquito
were contaminated within contaminant solution containing S. aureus (ATCC 25923) and
sterilized in saturated steam. Forceps were divided into three groups according to
cleaning: 1) rinsing, 2) manual cleaning and 3) manual cleaning followed by automated
cleaning. After 6th, 13th and 20th three forceps from each protocol were analised for
microbial load and protein amount (Bicinchoninic Acid Assay) and visual analysis by
scanning electronic microscopy. The same method was used on new flexible drill bite
cutters and depth gauges, and analised after 10th and 20th reprocessing. RESULTS:
Method´s validation: forceps submitted to protocols 1 (positive control of cleaning) and 2
showed coccus in biofilms and forceps sumitted to protocol 3 showed organics residues
after 20 reprocessing. No microbial load or residual protein was found. Complex
instruments: flexible drill bite cutters submitted to rinsing presented high amount of
protein with increase of 1699μg of protein from 10th to 20th reprocessing (P = 0.03).
Depth gauge submitted protocol 1 presented high amount of protein, however there was
no statistically significant difference from 10th to 20th processing (P = 0.60). All
instruments submitted to manual and/or automated cleaning did not present residual
protein. It was possible to identify residue and biofilm into lumen of surgical instruments
after 20 reprocessing. CONCLUSION: Experimental techniques to formation and
evaluation of biofilm in surgical instruments manufactures in stainless steel were
validated and 20 inappropriated cleaning processing were enough to buildup biofilm.
Biofilm was formed within lumens of flexible drill bite cutter and depth gauge, after 20
processing despite the instruments were submitted to “gold standard” cleaning, also
accumulation of protein on flexible drill bite cutters. Depth gauge lumen allowed
accumulation of waste using manual cleaning followed by automation cleaning and
manual cleaning allowed buildup residue on its external surface. Manual cleaning
allowed accumulation residue on deep gauge. It was not possible to recover viable S.
aureus in biofilm on instrumental surface, but it indicates that design of instruments
evaluated is not safe to processing. It is presumed have risk ratio for aseptic loss of
prostheses and infection related to healthcare, since they are instruments of difficult
cleaning control and circulate in numerous healthcare facilites using different cleaning
protocols.
Descrição
Palavras-chave
Biofilme, Instrumental cirúrgico ortopédico, Conformação complexa, Infecção hospital, Processamento, Consignação/comodatado, Biofilm, Orthopedic surgical instruments, Surgical instruments complex, Complex devices, Healthcare associated infection, Loaner instrumentation
Citação
LOPES, Lillian Kelly de Oliveira. Instrumental ortopédico de conformação complexa: avaliação do processamento, formação de biofilme e suas implicações. 2016. 244 f. Tese (Doutorado em Enfermagem) - Universidade Federal de Goiás, Goiânia, 2016.