Reanimador manual: quando trocar no mesmo paciente
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2016-03-31
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Universidade Federal de Goiás
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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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Citação
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.