Seguridad microbiológica y costo-efectividad del cambio semanal del circuito ventilatorio en combinación con cambio de filtros de calor húmedo. Estudio clínico prospectivo longitudinal
Microbiological safety and cost-effectiveness of weekly breathing circuit changes in combination with heat moisture exchange filters: a prospective longitudinal clinical survey.
Hübner NO, Daeschlein G, Lehmann C, Musatkin S, Kohlheim U, Gibb A, Assadian O, Kobayashi H.
Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany.
GMS Krankenhhyg Interdiszip. 2011;6(1):Doc15. doi: 10.3205/dgkh000172. Epub 2011 Dec 15.
Abstract
Aim: To assess the safety and cost effectiveness of a usage for seven days of breathing circuit systems (BCSs) in combination with heat moisture exchanger filters (HMEF) in operation room anesthesia. Method: In a prospective longitudinal clinical study, the contamination on high-risk surfaces (HMEF together with inner and outer surface of BCS) was monitored over 1, 2, 5, and 7 days. Results of endogenous respiratory patient flora and contamination flora of BCS, HMEF and bag were compared. Costs of prolonged use of BCS together with HMEF up to 7 days were calculated. Results: Neither physiological respiratory flora nor colonizing pathogens of the oropharynx of the ventilated patients were transmitted through the filters at any time. None of the included patients developed a postoperative pneumonia. Using the BCS for 24 hours provides a cost savings of up to 40% versus single use. Extending the change interval from 24 hours to 48 hours saved over 50% compared to change after each patient, and an additional 19% compared to change after 24 hours. In combination with a HMEF BCS can be used up to 7 days without clinical risk on multiple patients in operation room settings.Conclusion: Expanding the usage of berating in combination with usage of moist exchange filters is feasible, microbiologically safe and cost effective, as 41% of material costs per ventilation may be saved. Further research is needed to confirm these results.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3252668/pdf/KHI-06-15.pdf
Contaminación bacteriana de los circuitos ventilatorios internos de la máquina de anestesia
Bacterial contamination of anesthesia machines' internal breathing-circuit-systems.
Spertini V, Borsoi L, Berger J, Blacky A, Dieb-Elschahawi M, Assadian O.
Clinical Institute for Hospital Hygiene, Medical University of Vienna, Vienna, Austria.
GMS Krankenhhyg Interdiszip. 2011;6(1):Doc14. doi: 10.3205/dgkh000171. Epub 2011 Dec 15.
Abstract
Background: Bacterial contamination of anesthesia breathing machines and their potential hazard for pulmonary infection and cross-infection among anesthetized patients has been an infection control issue since the 1950s. Disposable equipment and bacterial filters have been introduced to minimize this risk. However, the machines' internal breathing-circuit-system has been considered to be free of micro-organisms without providing adequate data supporting this view. The aim of the study was to investigate if any micro-organisms can be yielded from used internal machines' breathing-circuit-system. Based on such results objective reprocessing intervals could be defined.Methods: The internal parts of 40 anesthesia machines' breathing-circuit-system were investigated. Chi-square test and logistic regression analysis were performed. An on-site process observation of the re-processing sequence was conducted. Results: Bacterial growth was found in 17 of 40 machines (43%). No significant difference was ascertained between the contamination and the processing intervals. The most common contaminants retrieved were coagulase negative Staphylococci, aerobe spore forming bacteria and Micrococcus species. In one breathing-circuit-system, Escherichia coli, and in one further Staphylococcus aureus were yielded.Conclusion: Considering the availability of bacterial filters installed on the outlet of the breathing-circuit-systems, the type of bacteria retrieved and the on-site process observation, we conclude that the contamination found is best explained by a lack of adherence to hygienic measures during and after re-processing of the internal breathing-circuit-system. These results support an extension of the re-processing interval of the anesthesia apparatus longer than the manufacturer's recommendation of one week. However, the importance of adherence to standard hygienic measures during re-processing needs to be emphasized.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3252669/pdf/KHI-06-14.pdf
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Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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