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.

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.

[Monitoring the physical processes of sterilization in hospitals in the state of Goiás]. / O monitoramento de processos físicos de esterilização em hospitais do interior do estado de Goiás.

The objective of this descriptive study was to identify the physical, chemical and biological controls of the sterilization process by saturated steam in Pasteur autoclaves at Material and Sterilization Centers (MSC). The data was obtained by interviewing the worker responsible for the MSC of the largest hospital in every city in the interior of Goiás that had population of at least 20,000, in the period from August 2005 to June 2006. A total 44 municipalities participated. The analysis was performed using SPSS software. In 31 (94.0%) hospitals there were no nurses exclusive to the MSC, the workers responsible for the center were nursing aides and technicians. Most did not perform any physical, chemical and biological control of the sterilization process, and, in one case only these controls were performed simultaneously. Failing to monitor the sterilization cycles, and thus not ensuring the quality of the processes, is a risk to the population being assisted.

O monitoramento de processos físicos de esterilização em hospitais do interior do estado de Goiás / Monitoring the physical processes of sterilization in hospitals in the state of Goiás / Monitoreo de procesos físicos de esterilización en hospitales del interior del estado de Goiás

Estudo descritivo com o objetivo de identificar a realização de controles físicos, químicos e biológicos dos processos de esterilização pelo vapor saturado sob pressão e em estufas de Pasteur em Centros de Material e Esterilização - CME. Os dados foram obtidos por meio de entrevista ao responsável pelo CME do maior hospital de todas as cidades do interior do Estado de Goiás, com número de habitantes igual ou superior a 20.000, no período de agosto de 2005 a junho de 2006. Participaram 44 municípios. Foi utilizado o programa SPSS, para análise. Em 31 (94,0 por cento) hospitais não havia enfermeiros exclusivos no CME, os responsáveis eram técnicos e auxiliares de enfermagem. A maioria não realizava os controles físicos, químicos e biológicos dos processos de esterilização e, em apenas um, esses eram realizados simultaneamente. O descumprimento da monitorização dos ciclos de esterilização, impedindo a garantia da qualidade dos processos, representa risco à população assistida.

The objective of this descriptive study was to identify the physical, chemical and biological controls of the sterilization process by saturated steam in Pasteur autoclaves at Material and Sterilization Centers (MSC). The data was obtained by interviewing the worker responsible for the MSC of the largest hospital in every city in the interior of Goiás that had population of at least 20,000, in the period from August 2005 to June 2006. A total 44 municipalities participated. The analysis was performed using SPSS software. In 31 (94.0 percent) hospitals there were no nurses exclusive to the MSC, the workers responsible for the center were nursing aides and technicians. Most did not perform any physical, chemical and biological control of the sterilization process, and, in one case only these controls were performed simultaneously. Failing to monitor the sterilization cycles, and thus not ensuring the quality of the processes, is a risk to the population being assisted.

Estudio descriptivo que objetivó identificar la realización de controles físicos, químicos y biológicos de procesos de esterilización por vapor saturado bajo presión y en estufas de Pasteur en Centros de Material y Esterilización - CME. Datos obtenidos mediante entrevistas a responsables de CME del mayor hospital de todas las ciudades del interior del estado de Goiás, con número de habitantes mayor a 20.000, en período de agosto 2005 a junio 2006. Participaron 44 municipios. Se utilizó el programa SPSS para el análisis. En 31 (94 por ciento) hospitales no había enfermeros exclusivos en el CME, los responsables eran técnicos y auxiliares de enfermería. La mayoría no realizaba controles físicos, químicos y biológicos de los procesos de esterilización y, en apenas uno, estos eran realizados simultáneamente. El incumplimiento del monitoreo de los ciclos de esterilización, impidiendo la garantía de calidad de procesos, representa un riesgo para la población atendida.

Avaliação arquitetônica dos centros de material e esterilização de hospitais do interior do estado de Goiás / Evaluation architectural of the central supply of hospitals from towns in the state of Goiás / Evaluación arquitectónica de los centros de material y esterilización de hospitales del interior del estado de Goiás

Estudo descritivo, realizado com objetivo de caracterizar a estrutura arquitetônica dos Centros de Material e Esterilização de hospitais de cidades do interior do Estado de Goiás quanto à conformidade com a legislação vigente, e analisar possíveis implicações na assistência. A população foi constituída por 44 hospitais de cidades com população igual ou superior a 20.000 habitantes, cadastrados no DATASUS. Os dados foram obtidos por meio de observação direta, utilizando um check list construído com base na RDC nº 50. O banco de dados foi processado no programa Epi-info, versão 2004. Os resultados foram agrupados em: padrões arquitetônicos gerais e específicos, aspectos arquitetônicos e risco: buscando entender esta interface. A maioria não atende a RDC nº 50, referente ao total da área construída do CME. Em 34 (77,2%) os CME não possuíam áreas preconizadas para obedecer ao fluxo correto do reprocessamento dos artigos e 17 (39,5%) CME associam o expurgo a setores da área limpa. Vinte e três (52,2%) não possuíam pias para a higienização de mãos em nenhuma área do CME. A maioria dos CME não atende aos padrões arquitetônicos recomendados o que pode representar risco para o reprocessamento de artigos e para os trabalhadores.

Descriptive study, carried with the aim of characterizing the structure architectural of the central supply of hospitals from towns in the state of Goiás how much to conformity with the current law, and analize possible implications in the assistance. The population was constituted 44 hospitals of cities with populations similar or over 20.000 inhabitants registered in the DATASUS. The data were obtained through straight observation, using a check list built base on the RDC nº 50. The data base was processed in the Epi-info program, version 2004. The results were grouped in: general and specific architectural standards, architectural aspects at risk: seeking to understand this interface. The majority do not care for the RDC nº 50, equivalent to the total área built of the CME In 34 (77,2%) the CME did not have praised areas to obey the correct flow of the reprocessing of articles and in 17 (39,5%) CME that associate the expurgation to the sectors of the clean area. Twenty three (52,2%) do not have washbasin for the hygienic cleaning of the hands in neither of the areas of CME. The most CME does not meet the architectural standards recommended which can represent risk to the reprocessing of articles and for the workers

Estudio descriptivo, realizado con objetivo de caracterizar la estructura arquitectónica de los Centros de Material y Esterilización de los hospitales de ciudades del interior del Estado de Goiás de acuerdo a la legislación vigente, y analizar posibles implicaciones en la asistencia. La población se constituida por 44 hospitales de las ciudades con la población igual o superior a 20.000 habitantes, catastrados en el DATASUS. Los datos han sido obtenidos a través de observación directa, utilización de un check list contraído con base en la RDC No. 50. El banco de datos ha sido estructurado y procesado en el programa Epi-info, versión 2004. Los resultados han sido agrupados en: patrones arquitectónicos generales y específicos, aspectos arquitectónicos y riesgo: intentando entender esta interfase. La mayoría no atiende a RDC Nº 50, referente al total del área construida del CME. En 34 (77,2%) los CME no poseían áreas preconizadas para obedecer al flujo correcto del reprocesamiento de los artículos en 17 (39,5%) CME asocian la purificación a sectores del área limpio. Veintitrés (52,2%) no poseían pilas para la higiene de manos en ningún área del CME. La mayoría de CME no responde a las normas recomendadas de arquitectura que pueden representar riesgos para la reelaboración de los artículos y de los trabajadores