Secagem de endoscópios e sua implicação na contaminação microbiana: quão seguro é o uso?
DOI:
https://doi.org/10.5327/Z1414-44251053Palavras-chave:
Endoscópio gastrointestinal, Controle de infecção, Segurança do paciente, Armazenamento de produtos, Contaminação de equipamentosResumo
Objective: To evaluate the drying practices employed in endoscopy facilities and determine the occurrence of microbiological growth in ready-to-use equipment. Methods: This is a cross-sectional study with the evaluation of the drying step of endoscopes in eight services of gastrointestinal endoscopy. The processing of 22 gastrointestinal endoscopes was monitored, and a microbiological evaluation was carried out in 60 endoscope channels after high-level disinfection and subsequent storage. Results: External drying was not carried out in 50.0% (11/22) of equipment after cleaning, and 27.2% (6/22) did not undergo internal drying of the channels. Contamination was detected in 21.9% (7/32) of the samples of stored endoscope channels, with microbial loads ranging from 2.0x101 to 2.5x105 CFU/mL. Furthermore, we identified microbial growth in 32.1% (9/28) of the channels after high-level disinfection, with microbial loads ranging from <101 to a maximum of 1.3x103 CFU/mL. Pseudomonas sp. accounted for 50.0% (6/12) of isolated microorganisms found in endoscope channels. Conclusion: The presence of infectious agents associated with inadequate practices, especially during the drying step, evidently contributes to the maintenance of microbial contamination in endoscopes, posing risks to subsequent patients.
Referências
Rutala WA, Weber DJ. Reprocessing semicritical items: an overview and an update on the shift from HLD to sterilization for endoscopes. Am J Infect Control. 2023;51(11S):A96-A106. https://doi.org/10.1016/j.ajic.2023.01.002 DOI: https://doi.org/10.1016/j.ajic.2023.01.002
Day LW, Muthusamy VR, Collins J, Kushnir VM, Sawhney MS, Thosani NC, et al. Multisociety guideline on reprocessing flexible GI endoscopes and accessories. Gastrointest Endosc. 2021;93(1):11-33.e6. https://doi.org/10.1016/j.gie.2020.09.048 DOI: https://doi.org/10.1016/j.gie.2020.09.048
Alfa MJ. Medical instrument reprocessing: current issues with cleaning and cleaning monitoring. Am J Infect Control. 2019;47S:A10-A16. https://doi.org/10.1016/j.ajic.2019.02.029 DOI: https://doi.org/10.1016/j.ajic.2019.02.029
Deb A, Perisetti A, Goyal H, Aloysius MM, Sachdeva S, Dahiya D, et al. Gastrointestinal endoscopy-associated infections: update on an emerging issue. Dig Dis Sci. 2022;67(5):1718-32. https://doi.org/10.1007/s10620-022-07441-8 DOI: https://doi.org/10.1007/s10620-022-07441-8
McCafferty CE, Aghajani MJ, Abi-Hanna D, Gosbell IB, Jensen SO. An update on gastrointestinal endoscopy-associated infections and their contributing factors. Ann Clin Microbiol Antimicrob. 2018;17(1):36. https://doi.org/10.1186/s12941-018-0289-2 DOI: https://doi.org/10.1186/s12941-018-0289-2
Alfa MJ. Quality systems approach for endoscope reprocessing: you don't know what you don't know!. Gastrointest Endosc Clin N Am. 2020;30(4):693-709. https://doi.org/10.1016/j.giec.2020.06.005 DOI: https://doi.org/10.1016/j.giec.2020.06.005
Alfa MJ, Singh H. Impact of wet storage and other factors on biofilm formation and contamination of patient-ready endoscopes: a narrative review. Gastrointest Endosc. 2020;91(2):236-47. https://doi.org/10.1016/j.gie.2019.08.043 DOI: https://doi.org/10.1016/j.gie.2019.08.043
Kovaleva J. Endoscope drying and its pitfalls. J Hosp Infect. 2017;97(4):319-28. https://doi.org/10.1016/j.jhin.2017.07.012 DOI: https://doi.org/10.1016/j.jhin.2017.07.012
Wallace MM, Keck T, Dixon H, Yassin M. Borescope examination and microbial culture results of endoscopes in a tertiary care hospital led to changes in storage protocols to improve patient safety. Am J Infect Control. 2023;51(4):361-6. https://doi.org/10.1016/j.ajic.2022.09.009 DOI: https://doi.org/10.1016/j.ajic.2022.09.009
Ofstead CL, Wetzler HP, Heymann OL, Johnson EA, Eiland JE, Shaw MJ. Longitudinal assessment of reprocessing effectiveness for colonoscopes and gastroscopes: results of visual inspections, biochemical markers, and microbial cultures. Am J Infect Control. 2017;45(2):e26-e33. https://doi.org/10.1016/j.ajic.2016.10.017 DOI: https://doi.org/10.1016/j.ajic.2016.10.017
Bashaw MA. Guideline implementation: processing flexible endoscopes. AORN J. 2016;104(3):225-36. https://doi.org/10.1016/j.aorn.2016.06.018 DOI: https://doi.org/10.1016/j.aorn.2016.06.018
Beilenhoff U, Biering H, Blum R, Brljak J, Cimbro M, Dumonceau JM, et al. Reprocessing of flexible endoscopes and endoscopic accessories used in gastrointestinal endoscopy: Position Statement of the European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology Nurses and Associates (ESGENA) – Update 2018. Endoscopy. 2018;50(12):1205-34. https://doi.org/10.1055/a-0759-1629 DOI: https://doi.org/10.1055/a-0759-1629
Brasil. Ministério da Saúde. Agência Nacional de Vigilância Sanitária. Resolução-RDC no 6, de 10 de março de 2013. Dispõe sobre os requisitos de Boas Práticas de Funcionamento para os serviços de endoscopia com via de acesso ao organismo por orifícios exclusivamente naturais. Brasília: Diário Oficial da União; 2013.
Reprocessing Guideline Task Force, Petersen BT, Cohen J, Hambrick 3rd RD, Buttar N, Greenwald DA, et al. Multisociety guideline on reprocessing flexible GI endoscopes: 2016 update. Gastrointest Endosc. 2017;85(2):282-294.e1. https://doi.org/10.1016/j.gie.2016.10.002 DOI: https://doi.org/10.1016/j.gie.2016.10.002
Alfa MJ, Olson N, Murray BL. Comparison of clinically relevant benchmarks and channel sampling methods used to assess manual cleaning compliance for flexible gastrointestinal endoscopes. Am J Infect Control. 2014;42(1):e1-e5. https://doi.org/10.1016/j.ajic.2013.08.007 DOI: https://doi.org/10.1016/j.ajic.2013.08.007
Centers for Disease Control and Prevention. Duodenoscope surveillance sampling & culturing. Reducing the risks of infection [Internet]. 2018 [accessed Dec. 2, 2022]. Available from: https://www.fda.gov/media/111081/download
Ofstead CL, Wetzler HP, Snyder AK, Horton RA. Endoscope reprocessing methods: a prospective study on the impact of human factors and automation. Gastroenterol Nurs. 2010;33(4):304-11. https://doi.org/10.1097/SGA.0b013e3181e9431a DOI: https://doi.org/10.1097/SGA.0b013e3181e9431a
Kenters N, Tartari E, Hopman J, El-Sokkary RH, Nagao M, Marimuthu K, et al. Worldwide practices on flexible endoscope reprocessing. Antimicrob Resist Infect Control. 2018;7:153. https://doi.org/10.1186/s13756-018-0446-6 DOI: https://doi.org/10.1186/s13756-018-0446-6
Barbosa JM, Souza ACS, Tipple AFV, Pimenta FC, Leão LSNO, Silva SRMC. Endoscope reprocessing using glutaraldehyde in endoscopy services of Goiânia, Brazil. Arq Gastroenterol. 2010;47(3):219-24. https://doi.org/10.1590/s0004-28032010000300002 DOI: https://doi.org/10.1590/S0004-28032010000300002
Thaker AM, Muthusamy VR, Sedarat A, Watson RR, Kochman ML, Ross AS, et al. Duodenoscope reprocessing practice patterns in U.S. endoscopy centers: a survey study. Gastrointest Endosc. 2018;88(2):316-322.e2. https://doi.org/10.1016/j.gie.2018.04.2340 DOI: https://doi.org/10.1016/j.gie.2018.04.2340
Madureira RAS, Oliveira AC. Processamento endoscópico: quais são os gaps na prática clínica? Rev Eletr Enferm. 2021;23:66550. https://doi.org/10.5216/ree.v23.66550 DOI: https://doi.org/10.5216/ree.v23.66550
Latta S. ANSI/AAMI ST91:2021. Flexible and semi-rigid endoscope processing in health care facilities. Arlington: Association for the Advancement of Medical Instrumentation; 2021.
Barakat MT, Huang RJ, Banerjee S. Comparison of automated and manual drying in the elimination of residual endoscope working channel fluid after reprocessing (with video). Gastrointest Endosc. 2019;89(1):124-132.e2. https://doi.org/10.1016/j.gie.2018.08.033 DOI: https://doi.org/10.1016/j.gie.2018.08.033
Nerandzic M, Antloga K, Litto C, Robinson N. Efficacy of flexible endoscope drying using novel endoscope test articles that allow direct visualization of the internal channel systems. Am J Infect Control. 2021;49(5):614-21. https://doi.org/10.1016/j.ajic.2020.08.034 DOI: https://doi.org/10.1016/j.ajic.2020.08.034
Alfa MJ, Sitter DL. In-hospital evaluation of contamination of duodenoscopes: a quantitative assessment of the effect of drying. J Hosp Infect. 1991;19(2):89-98. https://doi.org/10.1016/0195-6701(91)90101-d DOI: https://doi.org/10.1016/0195-6701(91)90101-D
Yassin M, Clifford A, Dixon H, Donskey CJ. How effective are the alcohol flush and drying cycles of automated endoscope reprocessors? Stripped endoscope model. Am J Infect Control. 2023;51(5):527-32. https://doi.org/10.1016/j.ajic.2023.02.008 DOI: https://doi.org/10.1016/j.ajic.2023.02.008
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