Quality indicators for the processing of health products: A mixed-methods study.

OBJECTIVE: to analyze the use of quality assessment indicators and their implementation to improve quality in the processing of health products. METHOD: a mixed-methods study with a multiple case approach using Structure, Process and Results indicators and elaboration of a plan using Appreciative Inquiry, carried out in four central sterile supply departments from hospital units. RESULTS: the indicators for the Cleaning stage presented 47.8% compliance for Structure and 59.0% for Process: in addition 71.8% of the products were clean. In the Preparation operational stage, 50.0% of the Results indicators were in compliance for Structure and 66.7% for Process. In the Sterilization, Storage and Distribution stage, 43.5% compliance was obtained for Structure, 55.7% for Process and 78.6% for Packaging conservation. Appreciative planning proposed improvements to the physical structure, review of processes and protocols, promotion and appreciation of the work done and strengthening of teaching about processing and service management, highlighting the protagonism of the group and of the leaders. CONCLUSION: using indicators was positive in materializing reality; however, it was verified that the improvements proposed are related to people. The affirmative and constructive view of Appreciative Inquiry presented itself as a path to changes and quality improvements.

Reutilización de barrera de tela de algodón estéril en la práctica clínica: estudio observacional longitudinal / Reusing sterile cotton fabric barriers in the clinical practice: an observational and longitudinal study / Reuso de barreira estéril de tecido de algodão na prática clínica: estudo longitudinal observacional

Objetivo: analizar las características de barrera física y biológica de los campos de algodón utilizados como sistema de barrera estéril después de ser sometidos a múltiples usos y procesos en la práctica clínica. Método: estudio observacional longitudinal de seguimiento y evaluación de tela 100% algodón, utilizada como sistema de barrera estéril en un hospital de mediano porte. Se recolectaron muestras antes del uso (después de tres lavados) y después de tres, seis, nueve, 12 y 15 meses de uso y se evaluaron el número, grosor e integridad de los hilos, peso, absorción de agua y penetración húmeda de microorganismos. Resultados: después de 85 lavados, no cambió el número de hilos, aumentó el número de fibras deshilachadas y el volumen de agua absorbida. La prueba microbiológica mediante la metodología estándar alemana obtuvo un resultado negativo y la de penetración húmeda de microorganismos no mostró cambios significativos con el tiempo, a pesar de que una fracción de células microbianas pasó a través de las muestras de doble capa. Conclusión: las propiedades físicas de la tela 100% algodón utilizada como sistema de barrera estéril cambiaron con el uso/procesamiento; sin embargo, no interfirieron significativamente con los resultados obtenidos en las pruebas realizadas a la barrera microbiológica hasta los 85 lavados.

Objective: to analyze the physical and biological barrier characteristics of cotton fields used as a sterile barrier system after multiple use and processing cycles in the clinical practice. Method: an observational and longitudinal study to monitor and evaluate 100% cotton fabric used as a sterile barrier system in a medium-sized hospital. Samples were collected before use (after three washes) and at three, six, nine, 12 and 15 months of use and evaluated for the number, thickness and integrity of threads, weight, water absorption and wet penetration by microorganisms. Results: after 85 washes, the number of threads remained unchanged, and the shredded fibers and the water volume absorbed were increased. The microbiological test using the German standard methodology obtained a negative result and wet penetration by microorganisms did not show significant changes over time, although a percentage of the microbial cells passed through the double-layer samples. Conclusion: the physical properties of 100% cotton used as a sterile barrier system changed with use/processing cycles; however, these alterations did not significantly interfere with the results obtained by the tests performed on the microbiological barrier up to 85 washes.

Objetivo: analisar as características de barreira física e biológica de campos de algodão, que são utilizados como sistema de barreira estéril, após múltiplos usos e processamentos na prática clínica. Método: estudo longitudinal observacional de acompanhamento e de avaliação de tecido 100% algodão que foi utilizado como sistema de barreira estéril em um hospital de médio porte. Amostras foram coletadas antes do uso (após três lavagens) e com três, seis, nove, 12 e 15 meses de uso e avaliadas quanto ao número, à espessura e à integridade dos fios, peso, absorção de água e penetração úmida de micro-organismos. Resultados: após 85 lavagens, o número de fios permaneceu inalterado, porém aumentaram-se as fibras desfiadas e o volume de água absorvido. O teste microbiológico utilizando metodologia padrão alemão obteve resultado negativo; já o de penetração de úmida de micro-organismos não apresentou mudanças significativas ao longo do tempo, embora uma fração das células microbianas tenham passado pelas amostras de dupla camada. Conclusão: as propriedades físicas do tecido 100% algodão, utilizado como sistema de barreira estéril, alteraram com usos/processamentos; entretanto essas não interferiram significativamente nos resultados obtidos pelos testes realizados na barreira microbiológica até 85 lavagens.

Reusing sterile cotton fabric barriers in the clinical practice: an observational and longitudinal study. / Reutilización de barrera de tela de algodón estéril en la práctica clínica: estudio observacional longitudinal.

OBJECTIVE: to analyze the physical and biological barrier characteristics of cotton fields used as a sterile barrier system after multiple use and processing cycles in the clinical practice. METHOD: an observational and longitudinal study to monitor and evaluate 100% cotton fabric used as a sterile barrier system in a medium-sized hospital. Samples were collected before use (after three washes) and at three, six, nine, 12 and 15 months of use and evaluated for the number, thickness and integrity of threads, weight, water absorption and wet penetration by microorganisms. RESULTS: after 85 washes, the number of threads remained unchanged, and the shredded fibers and the water volume absorbed were increased. The microbiological test using the German standard methodology obtained a negative result and wet penetration by microorganisms did not show significant changes over time, although a percentage of the microbial cells passed through the double-layer samples. CONCLUSION: the physical properties of 100% cotton used as a sterile barrier system changed with use/processing cycles; however, these alterations did not significantly interfere with the results obtained by the tests performed on the microbiological barrier up to 85 washes. (1) Clinical use and processing exert an impact on the sterile fabric barrier system. (2) There was weight loss, reduction in size and increase in water absorption volume. (3) The longer the use, the more loose fibers. (4) Penetration by microorganisms did not increase over the 15 months of the study. (5) The physical changes of the fabric did not interfere with the fabric barrier efficiency.

Adenosine triphosphate (ATP) sampling algorithm for monitoring the cleanliness of surgical instruments.

BACKGROUND: Timely detection of cleaning failure is critical for quality assurance within Sterilising Service Units (SSUs). Rapid Adenosine Triphosphate (ATP) testing provides a real time and quantitative indication of cellular contaminants, when used to measure surface or device cleanliness. The aim of this study was to investigate the use of an ATP algorithm and to whether it could be used as a routine quality assurance step, to monitor surgical instruments cleanliness in SSUs prior to sterilisation. METHODS: Cleanliness monitoring using rapid ATP testing was undertaken in the SSUs of four hospitals located in the western (Amazonia) region of Brazil. ATP testing was conducted (Clean Trace, 3M) on 163 surgical instruments, following manual cleaning. A sampling algorithm using a duplicate swab approach was applied to indicate surgical instruments as (i) very clean, (ii) clean, (iii) equivocal or (iv) fail, based around a 'clean' cut-off of 250 Relative Light Units (RLU) and a 'very clean' <100 RLU. RESULTS: The four cleanliness categories were significantly differentiated (P≤0.001). The worst performing locations (hospitals A & C) had failure rates of 39.2% and 32.4%, respectively, and were distinctly different from hospitals B & D (P≤0.001). The best performing hospitals (B & D) had failure rates of 7.7% and 2.8%, respectively. CONCLUSION: The ATP testing algorithm provides a simple to use method within SSUs. The measurements are in real time, quantitative and useful for risk-based quality assurance monitoring, and the tool can be used for staff training. The four-tiered approach to the grading of surgical instrument cleanliness provides a nuanced approach for continuous quality improvement within SSU than does a simple pass/fail methodology.

Significant increased bacterial contamination with endoscope overnight and weekend storage times.

BACKGROUND AND AIM: Forced-air drying (FAD) cabinets are recommended for storage of reprocessed endoscopes, but financial constraints prevent their universal application. The study aimed to determine bacterial contamination in flexible gastroscopes (FG) channels after storage, in a cabinet with filtered air and UV lights, but without FAD. METHODS: Eight FG in clinical use in an endoscopy service of a large Brazilian hospital were sampled: immediately "Time zero" (N = 50), 12 h "Time 1" (N = 25), and 60 h "Time 2" (N = 25) after reprocessing. Following a flush-brush-flush of channels, 40-mL sterile water and 3 cm of the brush were collected. Each sample was divided, filtered onto two 0.22-µm membranes, and incubated in media without or with disinfectant neutralizer. Automated method was used for identification and antibiotic resistance test of isolated bacteria. RESULTS: Bacterial contamination in times "1" and "2" was 5.9 and 16.1 times greater than that of "Time zero," respectively. Number of positive cultures in media with and without neutralizer was similar at times "1" and "2," while media with neutralizer produced more positive cultures at "Time zero." Most bacteria isolated at "Time 2" were Gram-negative rods (52.3%) and showed resistance to one or more antibiotics (65%). CONCLUSION: Bacterial contamination was detected on reprocessed FG stored in non-FAD cabinets overnight (12 h) and increased with longer storage time (60 h). The contamination source is likely to be bacteria in biofilm which multiply in the absence of FAD. Evidence-based criteria should be available for storage time according to the cabinet available.

Changes in the properties of pure cotton surgical gowns and drapes with clinical use and reprocessing.

The impact of repeated in-hospital reprocessing on 100% cotton fabric continues to be debated. We analyzed the properties of surgical gowns and drapes over 15 months of clinical use. The amount of linting fibers and the water absorption rate increased significantly, but microbial and blood penetration was preserved.

Biofilme em parafusos ortopédicos prontos para uso adquiridos por meio de sistema de consiganação/comodato / Biopelícula en tornillos ortopédicos listos para uso adquiridos por medio del sistema de consignación/comodato / Biofilm on patient-ready orthopaedic screws acquired through the loaner system

Resumo Objetivo Avaliar a integridade da superfície e as condições microbiológicas de parafusos prontos para uso em bandejas ortopédicas após múltiplos processamentos. Métodos Após o processamento completo, as bandejas utilizadas em cirurgias de pequenos fragmentos, fornecidas por meio de sistema de consignação/comodato em um hospital brasileiro, foram selecionadas aleatoriamente durante quatro meses. Os parafusos mais utilizados (números 14, 16 e 18 - Grupo 1) e menos utilizados (números 10 e 38 - Grupo 2), portanto, os mais e menos expostos a agentes biológicos, químicos e físicos, foram aleatoriamente removidos e submetidos a inspeção visual (n=126), seguido de cultura bacteriana (n=6 parafusos/bandeja, 9 bandejas), teste de proteínas (n=6 parafusos/bandeja, 9 bandejas) e Microscopia Eletrônica de Varredura (MEV) (n=2 parafusos/bandeja, 9 bandejas). As culturas positivas foram submetidas a métodos automatizados de identificação bacteriana e suscetibilidade antimicrobiana. Resultados Foram detectadas ranhuras em 8,7% dos parafusos, predominantemente no Grupo 2 (8/11). Proteína residual foi detectada em 96,3%, e não houve diferença estatisticamente significativa na quantidade de proteína entre os grupos (P=0,07). Crescimento bacteriano foi identificado em 3/54 parafusos. Danos na superfície e presença de sujidade foram visualizados em todos os parafusos submetidos a MEV. Formação de biofilmes extensos foi detectada em oito parafusos, três do Grupo 1 e cinco do Grupo 2. Conclusão Recuperação de bactérias viáveis, acúmulo de biofilme e danos na superfície foram detectados nos parafusos prontos para uso. Os parafusos costumam permanecer nas bandejas cirúrgicas e serem submetidos a múltiplos processamento, sendo expostos a contaminação e danos repetidas vezes. Esses achados apontam para a necessidade de discutir e repensar a forma como esses implantes de uso único são atualmente disponibilizados para cirurgias.

Resumen Objetivo Evaluar la integridad de la superficie y las condiciones microbiológicas de tornillos listos para uso en bandejas ortopédicas después de múltiples procesamientos. Métodos Después del procesamiento completo, fueron seleccionadas aleatoriamente durante cuatro meses las bandejas utilizadas en cirugías de pequeños fragmentos, proporcionadas mediante el sistema de consignación/comodato en un hospital brasileño. Los tornillos más utilizados (números 14, 16 y 18 - Grupo 1) y menos utilizados (números 10 y 38 - Grupo 2), por lo tanto, los más y menos expuestos a agentes biológicos, químicos y físicos, fueron quitados aleatoriamente y sometidos a inspección visual (n=126), seguido de cultivo bacteriano (n=6 tornillos/bandeja, 9 bandejas), prueba de proteínas (n=6 tornillos/bandeja, 9 bandejas) y microscopía electrónica de barrido (MEB) (n=2 tornillos/bandeja, 9 bandejas). Los cultivos positivos fueron sometidos a métodos automatizados de identificación bacteriana y susceptibilidad antimicrobiana. Resultados Se detectaron ranuras en el 8,7 % de los tornillos, predominantemente en el Grupo 2 (8/11). Se detectó proteína residual en el 96,3 % y no se encontró diferencia estadísticamente significativa en la cantidad de proteína entre los grupos (P=0,07). En 3/54 tornillos se identificó crecimiento bacteriano. Se visualizaron daños en la superficie y presencia de suciedad en todos los tornillos sometidos a MEB. En ocho tornillos se detectó la formación de biopelículas, tres del Grupo 1 y cinco del Grupo 2. Conclusión Se detectó recuperación de bacterias viables, acumulación de biopelícula y daños en la superficie en los tornillos listos para uso. Los tornillos suelen permanecer en las bandejas quirúrgicas y son sometidos a múltiples procesamientos, donde están expuestos a contaminación y daños repetidas veces. Estos descubrimientos señalan la necesidad de discutir y repensar la forma como estos implantes de uso único se ponen a disposición para cirugía actualmente.

Abstract Objective Assess the surface integrity and microbiological conditions of patient-ready screws in orthopaedic trays that had been multiply reprocessed. Methods After full reprocessing, clinical trays used for small fragment surgery provided through a loaner system to a Brazilian hospital were randomly selected during four months. The most (numbers 14, 16 and 18 - Group 1) and least (numbers 10 and 38 - Group 2) frequently implanted screws, therefore, the ones estimated to be the most and least exposed to biological, chemical and physical agents, were randomly removed and subjected to visual inspection (n=126), followed by bacterial culture (n=6 screws/tray, 9 trays), protein test (n=6 screws/tray, 9 trays) and Scanning Electron Microscopy (SEM) (n=2 screws/tray, 9 trays). Positive cultures were subjected to automated bacterial identification and antimicrobial susceptibility tests. Results Grooves were detected on 8.7% screws, predominantly in Group 2 (8/11). Residual protein was detected on 96,3%, and there was no statistically significant difference in the amount of protein between the groups (P=0.07). Bacterial growth was identified in 3/54 screws. Surface damage and soil were visualized on all screws subjected to SEM. Extensive biofilms were detected on eight screws, three from Group 1 and five from Group 2. Conclusion Recovery of bacteria, biofilm accumulation and surface damage were detected on patient-ready screws. Screws frequently remain in surgical trays for multiple reprocessing; thus they are repeatedly exposed to contamination and damage. These findings point to the need to discuss and review the way these single-use implants are currently made available for surgeries.

Biofilme em smartphones de profissionais da saúde: padrão de uso e de descontaminação do aparelho / Biofilm on smartphones of healthcare professionals: pattern of device use and decontamination

Objetivo: avaliar a presença de biofilme nas películas de smartphones de profissionais da saúde, investigar o padrão de uso e de descontaminação dos smartphones no ambiente de assistência à saúde em um hospital de médio porte. Métodos: estudo analítico e transversal, realizado com profissionais de saúde que possuíam smartphone. Foram realizadas entrevistas estruturadas e a presença de biofilme nas películas de vidro dos smartphones foi avaliada pela microscopia eletrônica de varredura. Resultados: todas as amostras de películas foram positivas para presença de biofilme, mesmo após descontaminação com álcool a 70%. Dos participantes, 96,4% utilizavam smartphone no ambiente de trabalho, a maioria utilizava o aparelho para fins pessoais e descontaminavam com álcool a 70% com frequência irregular. Conclusões: o smartphone pode servir como fômite, visto que biofilmes foram detectados na superfície das películas. Esses achados apontam para a necessidade de políticas de controle de infecção relacionadas ao uso dos smartphones.

Objective: to evaluate the presence of biofilm on the protective glass films of smartphones of health professionals, to investigate the pattern of use and decontamination of smartphones in the health care environment of a medium-sized hospital. Methods: analytical and cross-sectional study, carried out with health professionals with smartphones. Structured interviews were carried out and the presence of biofilm on the protective glass films of smartphones was evaluated by scanning electron microscopy. Results: all film samples were positive for the presence of biofilm, even after decontamination with alcohol 70%. 96.4% of the participants used a smartphone in the work environment, most used the device for personal purposes and decontaminated it with alcohol 70% with irregular frequency. Conclusion(s): the smartphones can serve as a fomite, considering that biofilms were detected on the surface of the films. These findings point to the need for infection control policies related to the use of smartphones.

Reprocessing of loaned surgical instruments/implants in Australia and Brazil: A survey of those at the coalface.

BACKGROUND: Acquisition of surgical instruments (SI) and implants by loaner system is a worldwide practice. Although quality of device reprocessing has been reported to be lower in low and middle-income countries compared with higher income countries, few investigations have been conducted on the management and reprocessing of loaned devices. Thus, in this study we evaluate the practices of management and reprocessing of loaner SI and non-sterile implants (NSI) in a high (Australia) and a middle-income (Brazil) country. METHODS: Cross-sectional surveys (hardcopy or online form) was self-administered by sterilising service unit's personnel of Brazilian and Australian hospitals. Only those units that sourced orthopaedic surgical instruments and non-sterile loaned implants from independent companies were eligible. RESULTS: A total of 65 questionnaires from Australia and 168 from Brazil were analysed. Quality indicators regarding structure and work process for the management and reprocessing of loaned SI and NSI was of a higher standard in Australia than in Brazil. However, failures were detected in both countries, for instance delivery delays and improper point-of-use pre-cleaning practices. CONCLUSION: There are key challenges inherent of the multifaceted reusable medical devices loaner system in both countries, such as communication failures, implementation of non-recommended practices, reprocessing of NSI, and other related to structure and process quality indicators, that must be faced. Initial and ongoing education and training should be provided and should embrace the themes of technical proficiency, effective communication and teamwork, and should include all personnel involved in this process, even loaner company staff.

Biofilm accumulation in new flexible gastroscope channels in clinical use.

OBJECTIVE: Assess the accumulation of protein and biofilm on the inner surfaces of new flexible gastroscope (FG) channels after 30 and 60 days of patient use and full reprocessing. DESIGN: Clinical use study of biofilm accumulation in FG channels. SETTING: Endoscopy service of a public hospital. METHODS: First, we tested an FG in clinical use before the implementation of a revised reprocessing protocol (phase 1 baseline; n = 1). After replacement of the channels by new ones and the implementation of the protocol, 3 FGs were tested after 30 days of clinical use (phase 2; n = 3) and 3 FGs were tested after 60 days of clinical use (phase 3; n = 3), and the same FGs were tested in phase 2 and 3. Their biopsy, air, water, and air/water junction channels were removed and subjected to protein testing (n = 21), bacteriological culture (n = 21), and scanning electron microscopy (SEM) (n = 28). Air-water junction channels fragments were subjected to SEM only. RESULTS: For the FGs, the average number of uses and reprocessing cycles was 60 times. Extensive biofilm was detected in air, water, and air-water junction channels (n = 18 of 28). All channels (28 of 28) showed residual matter, and structural damage was identified in most of them (20 of 28). Residual protein was detected in the air and water channels of all FG evaluated (phases 1-3), except for 1 air channel from phase 2. Bacteria were recovered from 8 of 21 channels, most air or water channels. CONCLUSIONS: The short time before damage and biofilm accumulation in the channels was evident and suggests that improving the endoscope design is necessary. Better reprocessing methods and channel maintenance are needed.

Área de armazenamento de produtos para saúde: repensando a frequência da descontaminação de prateleiras / Reusable medical devices storage area: rethinking the shelves decontamination frequency

Objective: To evaluate the potential risk for related events, inherent to the decontamination process of storage area shelves. Method:Related events were recorded in a checklist, previously evaluated by specialists, through direct non-participant observation in 10 work shifts at a Central Sterile Services Department (CSSD) of a large public hospital in the Midwest Brazil. Results:Shelf decontamination was performed at 85 of 160 observed opportunities.The main risk actions for related events were: over handling of the package, up to 10 touches/product, with an average of 3.17 touches, most of them exceeding two touches/ product (58.8%); no hand hygiene before, during or after the procedure; improper handling/displacement of products and improper action in case of product fall on the floor (6.25%). Conclusion:The related events observed during the shelf decontamination process represent a risk for product sterility maintenance, suggesting the need for reflection/discussion about the decontamination frequency of this clean area.

Objetivo: Avaliar o risco potencial para ocorrência de eventos relacionados, inerente ao processo de descontaminação de prateleiras da área de armazenamento e distribuição. Método: A ocorrência de eventos relacionados foi registrada em checklist,previamente avaliado por especialistas, por meio de observação direta não participante em 10 turnos de trabalho em um Centro de Material e Esterilização de um hospital público de grande porte da região Centro-Oeste do Brasil.Resultados: A descontaminação das prateleiras foi realizada em 85 das 160 oportunidades observadas. As principais condutas de risco para eventos relacionados foram:excesso de toques na embalagem, até 10 toques/produto, com média de 3,17 toques, sendo a maioria superior a dois toques/produto (58,8%); não higienização das mãos antes, durante ou após o procedimento;manuseio/deslocamento inadequado dos produtos e conduta inapropriada em caso de queda do produto ao chão (6,25%). Conclusão:Os eventos relacionados observados, durante o processo de descontaminação de prateleiras, representam risco para a manutenção da esterilidade dos produtos,o que sugere a necessidade de uma reflexão/discussão sobre a frequência de descontaminação dessa área limpa.

Evaluation of stainless steel surgical instruments subjected to multiple use/processing.

BACKGROUND: To determine the effect of multiple use and processing cycles on instrument quality over the life of stainless steel, complex designed clinical surgical instruments. METHODS: Steam sterilised surgical instruments due to be discarded from Australian hospitals, because of loss of functionality, were assessed for contaminating protein and bacteria using the bicinchoninic acid protein assay and microbial culture, respectively. Biofilm presence and instrument damage were visually confirmed by scanning electron microscopy (SEM). Instruments were categorised into hinged/serrated, screw, cannulated, flexible, and irregular surfaced (but not hinged) according to their design. RESULTS: Protein contamination ranged from 24 µg on the new screw to 3,756,046 µg contaminating a discarded forceps. The more complex the instrument design the higher the protein contamination. All samples were culture negative, however, biofilm was visually confirmed on 4/8 instruments tested using SEM. SEM also detected soil, holes or black stains on all the instruments. CONCLUSION: "Ready to use" surgical instruments that underwent multiple uses and processing cycles were contaminated with high amounts of protein, and microscopy revealed the presence of soil, structural damage, black stains and biofilm. While less affected new but multiply processed screws also showed soil and biofilm contamination. These findings highlight the need for further research into determining what is the "life" of stainless steel instruments and development of standard criteria for evaluating when to "retire" an instrument.

Reprocessing safety issues associated with complex-design orthopaedic loaned surgical instruments and implants.

BACKGROUND: The acquisition of reusable surgical instruments (RSIs) through loaner system is a worldwide phenomenon, particularly in orthopaedic surgeries. Loaner sets contain high-complex design RSIs, which are very difficult to clean, and also include single use implants, such as screws, that remain in the surgical tray and are subjected to multiple reprocessing until they are implanted. Inadequate cleaning of SI and various exposures of single-use implants to physical, chemical and biological agents can compromise their quality/safety and promote biofilm formation. The difficulty in cleaning is compounded in middle and low-income countries where automated cleaning infrastructure at sterilizing service units is often unavailable, and thus manual cleaning only is performed. Thus, we aimed to determine the condition of orthopaedic loaned sets when delivered to the hospital, assess the quality of complex-design RSIs reprocessed by manual cleaning, and evaluate the effect of multiple reprocessing on single-use implant (screw). METHODS: Flexible medullary reamers (FMRs), depth gauges and screws used for femur intramedullary nailing, in clinical use for >1 year, were obtained from three Brazilian loaner companies and assessed for residual ATP, protein, bacterial contamination, endotoxin and/or biofilm at delivery at the hospital, following cleaning and steam sterilisation. RESULTS: Before cleaning, blood was visible on a RSIs tray, and RSIs/screws were contaminated with high amounts of ATP, protein and bacteria. Visible soil was released during brushing of a FMR lumen and, following cleaning, the inner layer of 34/40 were visible soiled, and over 5/8 were protein test positive. Following sterilisation, biofilm and soil, including fragments appearing to be bone, were detected by scanning electron microscopy on RSIs/screws. A sterilised FMR revealed visible soil on the inner layer. Endotoxin tests were negative. CONCLUSION: The contaminated condition of loaned-complex-designed RSIs/screws upon arrival at the hospital and after reprocessing points to the insufficiency of manual reprocessing and management practices related to this instruments/implants. A multidisciplinary approach involving expert in design/manufacture, regulating, managing, reprocessing and surgeons is suggested to improve RSIs manufacture that enables complete decontamination and maintain the surgical patient safety.

Alcohol fixation of bacteria to surgical instruments increases cleaning difficulty and may contribute to sterilization inefficacy.

BACKGROUND: Alcohol is frequently inappropriately used on surgical instruments to reduce bacterial contamination, but fixes protein to stainless steel. Here we compare the effect of air drying, prolonged soaking in water, and alcohol treatment on cleaning difficulty of contaminated forceps. METHODS: Haltsted-mosquito forceps were contaminated with only Staphylococcus aureus. Instruments were air-dried for 10 (control), 75, or 240 minutes, soaked in water, or air dried then treated with ethanol or isopropanol for 10 seconds. All instruments were prewashed for 15 minutes. Forceps contaminated with blood and S aureus or Pseudomonas aeruginosa were dried and then sprayed or wiped with ethanol, and prewashed. Bacterial viability and soiling were determined by standard plate culture and crystal violet staining, respectively. RESULTS: Soaking or spraying instruments with alcohol significantly reduced viable bacterial numbers, but significantly increased soil attached to forceps, as did air drying. Wiping instruments with alcohol had little effect on bacterial viability, but increased cleaning difficulty. Soaking in water for 75 or 240 minutes increased cleaning difficulty perhaps due to bacterial attachment to forceps. CONCLUSIONS: Treating contaminated instruments with alcohol, allowing them to dry, or allowing them to soak in water for prolonged periods increases cleaning difficulty and should be discouraged.

Patient shoe covers: Transferring bacteria from the floor onto surgical bedsheets.

Forty disposable medical shoe covers were briefly exposed to the surgical floor and were found contaminated by a large number of bacteria. This study also demonstrated live bacteria, including pathogens attached to contaminated shoe covers, can be subsequently transferred to surgical bedsheets. We suggest an infection control policy should be considered to prevent patients returning to their bed with contaminated disposable shoe covers.

Colonização de trabalhadores de áreas de apoio hospitalar por Staphylococcus sp: aspectos epidemiológicos e microbiológicos / Staphylococcus sp. colonization in workers from areas of hospital support: epidemiological and microbiological aspects

Objetivou-se determinar a prevalência de trabalhadores colonizados por Staphylococcus sp., identificar preditores à colonização e avaliar a suscetibilidade aos antimicrobianos dos isolados. Realizou-se aplicação de questionário e coleta de saliva de 130 trabalhadores de áreas de apoio de uma instituição oncológica. Análise microbiológica foi realizada segundo procedimentos padronizados. A prevalência de trabalhadores colonizados por Staphylococcus sp. foi 37,7%, sendo a maioria dos isolados Staphylococcus coagulase-negative. Resistência à meticilina foi detectada em 35,1% dos Staphylococcus coagulase-negative, sendo 12 S. epidermidis e um S. haemolyticus, destes 92,3% possuíam gene mecA. Todos S. aureus foram sensíveis à meticilina. Turno e setor de trabalho foram identificados como preditores para colonização. A colonização de trabalhadores de áreas de apoio que assistem pacientes oncológicos indica que também sejam alvos de políticas de saúde ocupacional que deveriam incluir medidas pré e pós-colonização a serem investigadas/discutidas em estudos futuros com vistas à segurança do trabalhador e do paciente

The objectives were to determine the prevalence of workers colonized by Staphylococcus sp., to identify colonization predictors and, to assess their susceptibility to antimicrobials. A questionnaire was applied and saliva was collected in 130 workers from support areas of an oncology institution. Microbiological analysis was conducted following standard procedures. The prevalence of workers colonized by Staphylococcus sp. was 37.7%, and the isolated majority was Staphylococcus coagulase-negative. Resistance to methicillin was detected in 35.1% of Staphylococcus coagulase-negative, being 12 epidermidis and one S. haemolyticus. From those. 92.3% had the mecA. gene. All S. aureus were sensitive to methicillin. Working shift and sector were identified as predictors for colonization. The colonization in workers from support areas assisting oncology patients indicates that workers should be target of occupational health policies, and it should include pre- and post-colonization measures in investigations/discussions of future studies aiming at worker and patient safety

Enterobacteriaceae isolates from the oral cavity of workers in a Brazilian oncology hospital.

The evaluation of workers as potential reservoirs and disseminators of pathogenic bacteria has been described as a strategy for the prevention and control of healthcare-associated infections (HAIs). The aim of this study was to evaluate the presence of Enterobacteriaceae in the oral cavity of workers at an oncology hospital in the Midwest region of Brazil, as well as to characterize the phenotypic profile of the isolates. Saliva samples of 294 workers from the hospital's healthcare and support teams were collected. Microbiological procedures were performed according to standard techniques. Among the participants, 55 (18.7%) were colonized by Enterobacteriaceae in the oral cavity. A total of 64 bacteria were isolated, including potentially pathogenic species. The most prevalent species was Enterobacter gergoviae (17.2%). The highest rates of resistance were observed for ß-lactams, and 48.4% of the isolates were considered multiresistant. Regarding the enterobacteria isolated, the production of ESBL and KPC was negative. Nevertheless, among the 43 isolates of the CESP group, 51.2% were considered AmpC ß-lactamase producers by induction, and 48.8% were hyper-producing mutants. The significant prevalence of carriers of Enterobacteriaceae and the phenotypic profile of the isolates represents a concern, especially due to the multiresistance and production of AmpC ß-lactamases.

Enterobacteriaceae ISOLATES FROM THE ORAL CAVITY OF WORKERS IN A BRAZILIAN ONCOLOGY HOSPITAL / Enterobacteriaceae isoladas da cavidade bucal de trabalhadores de hospital oncológico do Centro-Oeste brasileiro

The evaluation of workers as potential reservoirs and disseminators of pathogenic bacteria has been described as a strategy for the prevention and control of healthcare-associated infections (HAIs). The aim of this study was to evaluate the presence of Enterobacteriaceae in the oral cavity of workers at an oncology hospital in the Midwest region of Brazil, as well as to characterize the phenotypic profile of the isolates. Saliva samples of 294 workers from the hospital’s healthcare and support teams were collected. Microbiological procedures were performed according to standard techniques. Among the participants, 55 (18.7%) were colonized by Enterobacteriaceae in the oral cavity. A total of 64 bacteria were isolated, including potentially pathogenic species. The most prevalent species was Enterobacter gergoviae (17.2%). The highest rates of resistance were observed for β-lactams, and 48.4% of the isolates were considered multiresistant. Regarding the enterobacteria isolated, the production of ESBL and KPC was negative. Nevertheless, among the 43 isolates of the CESP group, 51.2% were considered AmpC β-lactamase producers by induction, and 48.8% were hyper-producing mutants. The significant prevalence of carriers of Enterobacteriaceae and the phenotypic profile of the isolates represents a concern, especially due to the multiresistance and production of AmpC β-lactamases.

A investigação de trabalhadores dos serviços de saúde como reservatório e disseminadores de bactérias patogênicas tem sido referida como estratégia de prevenção e controle das infecções relacionadas à assistência à saúde. Este estudo buscou avaliar a presença de Enterobacteriaceae na cavidade bucal de trabalhadores de hospital oncológico do Centro-Oeste brasileiro, bem como caracterizar o perfil fenotípico dos isolados. Foi coletada amostra de saliva de 294 trabalhadores pertencentes às equipes de saúde e de apoio. Procedimentos microbiológicos foram realizados segundo técnicas referendadas. Dentre os participantes, 55 (18,7%) estavam colonizados por Enterobacteriaceae na cavidade bucal. Foram isoladas 64 bactérias, incluindo espécies potencialmente patogênicas. A espécie mais prevalente foi Enterobacter gergoviae (17,2%). As maiores taxas de resistências foram observadas para os β-lactâmicos e 48,4% dos isolados foram considerados multirresistentes. Para as enterobactérias pesquisadas, a produção de ESBL e KPC foi negativa. Porém, dentre os 43 isolados do grupo CESP, 51,2% foram considerados produtores de β-lactamase AmpC por indução e 48,8% mutantes hiperprodutores. Considera-se a prevalência de portadores de Enterobacteriaceae significativa e o perfil fenotípico dos isolados preocupante, especialmente pela multirresistência e produção de β-lactamases AmpC.

Pseudomonas spp. ISOLATED FROM THE ORAL CAVITY OF HEALTHCARE WORKERS FROM AN ONCOLOGY HOSPITAL IN MIDWESTERN BRAZIL.

This cross-sectional study, performed in an oncology hospital in Goiania, aimed to characterize the prevalence of oral colonization and antimicrobial susceptibility of Pseudomonas spp. isolated from the saliva of healthcare workers. Microorganisms were subjected to biochemical tests, susceptibility profile, and phenotypic detection. Of 76 participants colonized with Gram negative bacilli, 12 (15.8%) harbored Pseudomonas spp. Of all isolates, P. aeruginosa (75.0%), P. stutzeri (16.7%), and P. fluorescens (8.3%), were resistant to cefoxitin, and therefore likely to be AmpC producers. The results are clinically relevant and emphasize the importance of surveillance to minimize bacterial dissemination and multiresistance.