Descontaminação no reuso de bacias para banho com alcool após a limpeza: estudo experimental randomizado
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Data
2018-08-28
Autores
Ramos, Melissa Santiloni Montanha
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Universidade Estadual Paulista (Unesp)
Resumo
No contexto da prática assistencial hospitalar, percebe-se a despreocupação de se escolher o método de descontaminação, conforme o potencial de risco do material (não-crítico, semicrítico, crítico) em disseminar patógenos e, consequentemente, infecções cruzadas, empregado em cuidados de higiene de pacientes acamados. A contento, indiscriminadamente, bacias de banho têm sido submetidas à desinfecção de baixo nível, com álcool 70% p/v, aplicado por toda extensão por 30 segundos, após limpeza manual com água corrente e detergente neutro seguida de secagem. Contudo, há literatura recomendando para procedimentos de desinfecção intermediários e de baixo nível em superfícies lisas que o tempo de exposição ao álcool etílico ou isopropílico seja ≥ 60 segundos, nas concentrações de 60 a 90% p/v. Objetivo geral. Avaliar a eficácia do álcool 80% p/v, aplicado por 30 e 60 segundos, no processamento manual de bacias de banho inoxidáveis, após limpeza com água corrente e detergente neutro. Método. Estudo experimental randomizado, com delineamento anterior-posterior, unicego, realizado em centro único (Hospital Público do Estado de São Paulo), em unidade de internação, com média de 150 banhos mensais. Com poder de 80% e confiabilidade de 95%, estimou-se amostra mínima de 50 bacias igualmente distribuídas aleatoriamente em dois grupos: 25 no grupo 30s e 25 no grupo 60s, utilizando-se teste de proporções pareado (dois momentos). Testes microbiológicos antes e após às intervenções foram realizados para os dois grupos. O grupo 30s passou pela intervenção após esfregaço do álcool 80% p/v por 30 segundos e no grupo 60s por esfregaço do mesmo desinfetante por 60 segundos, conforme procedimento operacional padrão proposto. Resultados. Verificou-se eficácia relativa do álcool etílico 80% p/v na descontaminação manual no reuso de bacias de banho inoxidáveis, mesmo elevada de 60% para 64%, quando ampliado o tempo de aplicação de 30 para 60 segundos, após submetê-las à limpeza com água corrente e detergente neutro. Apesar de redução considerável de microrganismos hospitalares, após esfregaço de 30s (5,8 vezes), quanto no de 60s (8,3 vezes), a ação do desinfetante não foi suficiente para descontaminar 36% das bacias, elevando-se para 44% quando o tempo de intervenção foi 30s. Observou-se em ambos grupos maior prevalência de sobrevida de bactérias gram-negativas não fermentadoras, com destaque à Pseudomonas aeruginosa que, apesar de não apresentarem resistência múltipla, 14 cepas foram resistentes à carbapenases, sendo 11 ao imepenen e três ao meropenen. Conclusões. Bacias de banho no leito inoxidáveis descontaminadas para reuso com álcool 80% p/v após limpeza com água corrente e detergente neutro apresentam risco de infecção para pacientes, podendo desempenhar papel de fômites, incluindo cepas importantes para a vigilância, como possíveis produtoras de espectro estendido-beta lactamase (ESBL) e Klebsiella pneumoniae (KPC), Enterococcus Resistente à Vancomicina (VRE) e multirresistentes (resistente a um ou mais antimicrobianos de três ou mais classes). Produto. Relatório final de pesquisa enviado à Agência Nacional de Vigilância Sanitária (ANVISA) brasileira e à Comissão de Controle de Infecção Relacionada à Assistência à Saúde (CCIRAS) local, recomendando bacias de banho inoxidáveis reusáveis como materiais semicríticos, demandando desinfecção de alto nível ou substitui-las por banho no leito descartável. ABSTRACT Introduction. In the hospital care practice context, the lack of concern for choosing the decontamination method, according to the risk potential of the material (non-critical, semi critical, critical) in disseminating pathogens and, consequently, cross-infection, used in hygiene of bedridden patients. Indiscriminately, bath bowls have been subjected to low level disinfection with 70% w/v alcohol, applied for 30 seconds at all times, after manual cleaning with running water and neutral detergent followed by drying. However, there is a literature recommending for intermediate and low-level disinfection procedures on smooth surfaces that the time of exposure to ethyl or isopropyl alcohol is ≥60 seconds at concentrations of 60 to 90% w/v. General objective. To evaluate the efficacy of 80% w / v alcohol, applied for 30 and 60 seconds, in the manual processing of stainless bath bowls, after cleaning. General objective. To evaluate the efficacy of 80% w/v alcohol, applied for 30 and 60 seconds, in the manual processing of stainless bath bowls, after cleaning with running water and neutral detergent. Method. A randomized experimental study, with an anterior-posterior design, single-blind, performed in a single center (Public Hospital of the State of São Paulo), in an inpatient unit, with an average of 150 monthly baths. With 80% power and 95% reliability, a minimum sample of 50 basins was randomly distributed in two groups: 25 in the 30s group and 25 in the 60s group, using a paired proportions test (two moments). Microbiological tests before and after the interventions were performed for both groups. The 30s group underwent the intervention after 80% w/v alcohol smear for 30 seconds and in the 60s group by smearing the same disinfectant for 60 seconds, according to the proposed standard operating procedure. Results. Relative efficacy of 80% w/v ethyl alcohol in manual decontamination in the reuse of stainless bath basins, even from 60% to 64%, was verified when the application time was extended from 30 to 60 seconds, after subjecting them to cleaning with running water and neutral detergent. Despite a considerable reduction of hospital microorganisms, after 30s (5.8 times) and 60s (8.3 times) smear, the action of the disinfectant was not sufficient to decontaminate 36% of the basins, rising to 44% when the intervention time was 30s. A higher prevalence of non-fermenting gram-negative bacteria was observed in both groups, especially Pseudomonas aeruginosa, which, despite not having multiple resistance, 14 strains were resistant to carbapenases, 11 being imepenen and 3 being meropenen. Conclusions. 80% w / v alcohol reuse baths after cleaning with running water and neutral detergent present a risk of infection for patients, and may play a role of fomites, including strains important for surveillance, as possible producers of extended spectrum (ESBL) and Klebsiella pneumoniae (KPC), Vancomycin Resistant Enterococcus (VRE) and multiresistant (resistant to one or more antimicrobials of three or more classes). Product. Final research report sent to the Brazilian National Health Surveillance Agency (ANVISA) and the local Health Care-Related Infection Control Commission (CCIRAS), recommending reusable stainless bath basins as semi-critical materials, requiring high level disinfection or replacing them, by bathing them in the disposable bed.
Introduction. In the hospital care practice context, the lack of concern for choosing the decontamination method, according to the risk potential of the material (non-critical, semi critical, critical) in disseminating pathogens and, consequently, cross-infection, used in hygiene of bedridden patients. Indiscriminately, bath bowls have been subjected to low level disinfection with 70% w/v alcohol, applied for 30 seconds at all times, after manual cleaning with running water and neutral detergent followed by drying. However, there is a literature recommending for intermediate and low-level disinfection procedures on smooth surfaces that the time of exposure to ethyl or isopropyl alcohol is ≥60 seconds at concentrations of 60 to 90% w/v. General objective. To evaluate the efficacy of 80% w / v alcohol, applied for 30 and 60 seconds, in the manual processing of stainless bath bowls, after cleaning. General objective. To evaluate the efficacy of 80% w/v alcohol, applied for 30 and 60 seconds, in the manual processing of stainless bath bowls, after cleaning with running water and neutral detergent. Method. A randomized experimental study, with an anterior-posterior design, single-blind, performed in a single center (Public Hospital of the State of São Paulo), in an inpatient unit, with an average of 150 monthly baths. With 80% power and 95% reliability, a minimum sample of 50 basins was randomly distributed in two groups: 25 in the 30s group and 25 in the 60s group, using a paired proportions test (two moments). Microbiological tests before and after the interventions were performed for both groups. The 30s group underwent the intervention after 80% w/v alcohol smear for 30 seconds and in the 60s group by smearing the same disinfectant for 60 seconds, according to the proposed standard operating procedure. Results. Relative efficacy of 80% w/v ethyl alcohol in manual decontamination in the reuse of stainless bath basins, even from 60% to 64%, was verified when the application time was extended from 30 to 60 seconds, after subjecting them to cleaning with running water and neutral detergent. Despite a considerable reduction of hospital microorganisms, after 30s (5.8 times) and 60s (8.3 times) smear, the action of the disinfectant was not sufficient to decontaminate 36% of the basins, rising to 44% when the intervention time was 30s. A higher prevalence of non-fermenting gram-negative bacteria was observed in both groups, especially Pseudomonas aeruginosa, which, despite not having multiple resistance, 14 strains were resistant to carbapenases, 11 being imepenen and 3 being meropenen. Conclusions. 80% w / v alcohol reuse baths after cleaning with running water and neutral detergent present a risk of infection for patients, and may play a role of fomites, including strains important for surveillance, as possible producers of extended spectrum (ESBL) and Klebsiella pneumoniae (KPC), Vancomycin Resistant Enterococcus (VRE) and multiresistant (resistant to one or more antimicrobials of three or more classes). Product. Final research report sent to the Brazilian National Health Surveillance Agency (ANVISA) and the local Health Care-Related Infection Control Commission (CCIRAS), recommending reusable stainless bath basins as semi-critical materials, requiring high level disinfection or replacing them, by bathing them in the disposable bed.
Introduction. In the hospital care practice context, the lack of concern for choosing the decontamination method, according to the risk potential of the material (non-critical, semi critical, critical) in disseminating pathogens and, consequently, cross-infection, used in hygiene of bedridden patients. Indiscriminately, bath bowls have been subjected to low level disinfection with 70% w/v alcohol, applied for 30 seconds at all times, after manual cleaning with running water and neutral detergent followed by drying. However, there is a literature recommending for intermediate and low-level disinfection procedures on smooth surfaces that the time of exposure to ethyl or isopropyl alcohol is ≥60 seconds at concentrations of 60 to 90% w/v. General objective. To evaluate the efficacy of 80% w / v alcohol, applied for 30 and 60 seconds, in the manual processing of stainless bath bowls, after cleaning. General objective. To evaluate the efficacy of 80% w/v alcohol, applied for 30 and 60 seconds, in the manual processing of stainless bath bowls, after cleaning with running water and neutral detergent. Method. A randomized experimental study, with an anterior-posterior design, single-blind, performed in a single center (Public Hospital of the State of São Paulo), in an inpatient unit, with an average of 150 monthly baths. With 80% power and 95% reliability, a minimum sample of 50 basins was randomly distributed in two groups: 25 in the 30s group and 25 in the 60s group, using a paired proportions test (two moments). Microbiological tests before and after the interventions were performed for both groups. The 30s group underwent the intervention after 80% w/v alcohol smear for 30 seconds and in the 60s group by smearing the same disinfectant for 60 seconds, according to the proposed standard operating procedure. Results. Relative efficacy of 80% w/v ethyl alcohol in manual decontamination in the reuse of stainless bath basins, even from 60% to 64%, was verified when the application time was extended from 30 to 60 seconds, after subjecting them to cleaning with running water and neutral detergent. Despite a considerable reduction of hospital microorganisms, after 30s (5.8 times) and 60s (8.3 times) smear, the action of the disinfectant was not sufficient to decontaminate 36% of the basins, rising to 44% when the intervention time was 30s. A higher prevalence of non-fermenting gram-negative bacteria was observed in both groups, especially Pseudomonas aeruginosa, which, despite not having multiple resistance, 14 strains were resistant to carbapenases, 11 being imepenen and 3 being meropenen. Conclusions. 80% w / v alcohol reuse baths after cleaning with running water and neutral detergent present a risk of infection for patients, and may play a role of fomites, including strains important for surveillance, as possible producers of extended spectrum (ESBL) and Klebsiella pneumoniae (KPC), Vancomycin Resistant Enterococcus (VRE) and multiresistant (resistant to one or more antimicrobials of three or more classes). Product. Final research report sent to the Brazilian National Health Surveillance Agency (ANVISA) and the local Health Care-Related Infection Control Commission (CCIRAS), recommending reusable stainless bath basins as semi-critical materials, requiring high level disinfection or replacing them, by bathing them in the disposable bed.
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Palavras-chave
Álcool, Desinfetantes, Descontaminação, Utilização de equipamentos, Cuidados de Enfermagem, Alcohol, Disinfectants, Decontamination, Use of equipment, Nursing care