Evaluación de los riesgos ocupacionales asociados a indicadores bioquímicos en conductores profesionales / Evaluation of occupational risks associated to biochemical indicators in professional drivers

Introducción: en el campo de la Seguridad y Salud Laboral, el transporte por carretera sigue enfrentándose a una serie de condicionantes. La implantación de actuaciones en materia preventiva en las empresas del sector se viene realizando de una manera gradual, impulsada por el interés de las administraciones estatales y autonómicas, empresarios y trabajadores, y sus organizaciones respectivas. Objetivo: evaluar ergonómicamente los principales riesgos asociados a dicha actividad. Materiales y métodos: la evaluación consta de tres fases: la identificación y evaluación de riesgos a que están sometidos los conductores profesionales, la valoración de patologías potenciales asociadas a la actividad, la identificación de indicadores bioquímicos comprometidos con la actividad. Resultados: se destaca en la primera fase los accidentes de tránsito, los períodos largos de conducción sin descanso y las características de la vía. La segunda fase se desarrolla a partir de un reconocimiento médico y una encuesta para conocer las patologías potenciales, señalándose a los trastornos músculo-esqueléticos, la diabetes, los trastornos gastrointestinales y las alteraciones cardiovasculares como las de mayor presencia. En la tercera y última fase se analizan los indicadores bioquímicos: colesterol, glucosa, triglicéridos y apolipoproteína B. Finalmente se muestran las causas que pudieran condicionarlos, así como algunos elementos que deben ser considerados para minimizar su influencia en la salud de los conductores. Conclusiones: como resultado de la evaluación se determinaron los principales riesgos ergonómicos y se reafirma el criterio existente de considerar que las profesiones estresantes comprometen a diversas estructuras somáticas y sensoriales, cuyas manifestaciones son medibles y permiten inferir el desgaste sufrido por el organismo (AU).

Introduction: in the field of Occupational Security and Health, highway transportation is still affronting a series of conditionings. The implantation of preventive actions in transport enterprises is been taking place gradually, forced by the interest of government and autonomic administrations, businessmen and workers and their respective organizations. Aim: to evaluate ergonomically the main risks associated to driving. Materials and Methods: the evaluation has three stages: the identification and assessment of the risks professional drivers are at, the assessment of potential pathologies associated to the activity, the identification of bio-chemical indicators involved in the activity. Outcomes: driving long periods without break and highway’s characteristics stood out in the first stage. The second stage is developed beginning from a medical examination and a survey to know the potential pathologies, being the musculoskeletal disorders, diabetes, gastrointestinal and cardiovascular disorders the ones with higher presence. In the first and last stage biochemical indicators are analyzed: cholesterol, glucose, triglycerides and apolipoprotein B. Finally, the causes that may condition them are showed, and also several elements that should be considered to minimize their influence on drivers´ health. Conclusions: the main ergonomic risks were determined as a result of the assessment and it also was reaffirmed the existent criteria of considering that stressing professions compromise several somatic and sensorial structures, the manifestations of which are measurable and allow to infer the burnout the organism suffered (AU).

Observation of discoloration of chemical indicator cards in different positions in pressure steam sterilization bags and sterilization effect / 中国实用护理杂志

ObjectiveTo observe the discoloration of chemical indicator cards in different positions in pressure steam sterilization bags and stetilization effect.MethodsFrom January 2009 to January 2011,168 packages needing sterilization were divided into group A and group B randomiy with 84 packages in each.We put chemical indicator cards on different positions in the packages.Then discoloration of chemical indicator cards and the qualified rate of bacteriology detection were observed.ResultsThere were 9cases of uneven discoloration in group A,and the incidence rate was 10.71％,higher than group B.The unqualified rate of bacteriology detection in group A was 2.38％,higher than group B(1.19％),but the difference was not statistically significant.ConclusionsChemical indicator cards could reflect the effect of sterilization,but placing them in different positions can appear different results.The chemical indicator cards that placed between the two packing layer could provide powerful evidence for sterilization effects for clinicians,and avoid unnecessary economic waste in Sterilization and Supply Center,which is worthy of being widely used in Sterilization and Supply Center.

Indicadores químicos e biológicos da eficácia de esterilização por autoclave ou estufa / Chemical and biological indicators of the efficacy of sterilization by wet or dry heat

Objetivo: Este estudo avaliou a eficácia da esterilização de autoclaves e estufas em clínicas odontológicas usando indicadores químicos e biológicos. Metodologia: Foram analisados 51 aparelhos de autoclave ou estufa, utilizando-se indicadores químicos internos (fita ComplyTM, 3M), externos (fita adesiva 1222, 3M) e biológicos (Attest 1262, 3M) para autoclaves, e indicadores químicos internos (fita ComplyTM 00311, 3M) e externos (fita Indair 1226, 3M) para estufas. Os diferentes testes para determinar a eficiência das autoclaves ou estufas foram realizados todos ao mesmo tempo em cada aparelho, com os indicadores posicionados no centro dos equipamentos. Resultados: Um total de 37 dentistas (72,5%) fazia uso de autoclaves no consultório e 14 (27,4%) utilizavam estufas. Em autoclaves, os indicadores químicos externos demonstraram sucesso da esterilização em todos os aparelhos avaliados, sendo que os indicadores químicos internos apresentaram 94,5% de sucesso e os biológicos, 97,2%. Em estufas, houve sucesso de indicadores químicos externos em todos os aparelhos testados, sendo que os indicadores químicos internos obtiveram apenas 78,5% de eficiência. Conclusão: A esterilização em autoclaves e estufas é eficaz; contudo, diferentes indicadores devem ser utilizados simultaneamente para certificar o sucesso do processo de esterilização.

Purpose: To evaluate the efficacy of sterilization by wet or dry heat in dental offices using chemical and biological indicators. Methods: Fifty-one sterilizers were analyzed using an internal (ComplyTM tape, 3M) and an external chemical indicator (adhesive tape 1222, 3M) and a biological indicator (Attest 1262, 3M) for wet heat, and an internal (ComplyTM 00311 tape, 3M) and an external chemical indicator (Indair 1226 tape, 3M) for dry heat. Different indicators (centrally positioned) were used at the same time in each device. Results: Thirty-seven (72.5%) dentists used wet heat sterilization systems in their dental offices and 14 (27.4%) used dry heat sterilizers. External chemical indicators for wet heat systems were successful, but internal chemical indicators and biological indicators had 94.5% and 97.2% of success, respectively. In addition, external chemical indicators were satisfactory concerning all dry heat devices, but internal chemical indicators had only 78.5% of efficiency. Conclusion: Wet heat and dry heat are reliable sterilization systems; notwithstanding, different indicators should be simultaneously used to certify that sterilization has been successfully carried out.

Chemical Monitoring Testing Package Application for High Pressure-steam Sterilization:An Observation and Analysis / 中华医院感染学杂志

OBJECTIVE To observe and compare the application result of two kinds of chemical indicator(CI)card contained in high pressure-steam sterilization chemical monitoring testing package for providing correct credible evidence of supplying material in each batch after high pressure-steam sterilization and to avoid resource lost because of fault estimation.METHODS The chemical monitoring testing package was made according Sterilization Criteria published in 2002,with the 3M 1250 and 1243 CI cards and 1292 biology indicator(BI) to observe the results in tested package after sterilization.RESULTS The BI in chemical monitoring testing package was all qualified,the qualified rate of 1250 was 70%,while of 1243 was 100%.CONCLUSIONS If there is no BI for monitoring,1243 CI card should be chosen in high pressure-steam sterilization chemical monitoring testing package for supplying material in each batch after high pressure-steam sterilization which is not influenced by moisture and the contacted material and is easy to read and evaluate,the resource lost caused by fault estimation can be avoided.

3M Standardized CI PCD:Its Application and Evaluation / 中华医院感染学杂志

OBJECTIVE To apply 3M standardized chemical indicator(CI) process challenge device(PCD) to the practice of batch monitoring to guarantee sterility assurance.METHODS The standardized CI PCD and biological indicator(BI) PCD to two different sterilizers were applied with the test parameters of 132 ℃,3.5min and 8min,and 134 ℃,3.5min and 8min,respectively.RESULTS A total of 310 trials of CI PCD were obtained as negative results,with the ink moved into the accept area of the moving-front style indicator,and 240 trials of BI PCD were obtained as negative results.CONCLUSIONS Standardized CI PCD can provide further sterility assurance with more accurate monitoring and batch release capabilities.

Avaliação do desempenho da limpeza e desinfecção das máquinas lavadoras desinfectadoras automáticas em programas com diferentes tempos e temperaturas / Evaluation of cleaning and disinfection processes performed by automatic washing machine in programs presenting different time and temperature

A limpeza é, inegavelmente, o núcleo central de todas as atividades relacionadas ao reprocessamento de artigos médico-hospitalares. A lavadora desinfectadora é uma nova tecnologia, que trouxe grandes vantagens, como padronização dos procedimentos de limpeza, documentação do processo e diminuição do risco ocupacional de ordem biológica. Atualmente, existem equipamentos que disponibilizam programas com diferentes tempo e temperatura. Para subsidiar a escolha de programas, propôs-se nesta pesquisa investigar o desempenho das lavadoras desinfectadoras nos distintos programas (Norma Alemã, BGA 94ºC/10 minutos; Norma da Grã-Bretanha, DHSS/HTM 90ºC/1segundo; Norma da Grã-Bretanha, DHSS/HTM 82ºC/2minutos; Norma da Holanda, RIVM 90ºC/5 minutos; Norma da Suécia, SPRI/SIS 85ºC/1minuto; Norma da Suécia, SPRI/SIS 85ºC/3 minutos; ciclo com temperatura 70ºC e tempo 30 minutos para Pasteurização), avaliando-se o desempenho dos testes de limpeza e termodesinfecção em equipamento validado. Conforme as recomendações das Normas ISO 15883-1/1999 e HTM2030 (NHS States,1997), para avaliação do desempenho da limpeza foram utilizados três testes: Soil Test, Biotrace Pro-tect e Test Kit Proteína. Como resultado dos testes do desempenho da limpeza, constatou-se resíduo de sujidade após avaliação com Soil-Test em 1,3% dos instrumentais, do total de 313 avaliados (cinco instrumentais de complexidade crítica, dois deles não desmontáveis-Kerrison e Goiva). Na avaliação de resíduo de proteína com teste Biotrace Pro-tect constatou-se que, dos 65 instrumentais avaliados, 60 (92%) apresentaram resultado satisfatório. Os cinco instrumentais (8%) que apresentaram resíduo de sujidade com Soil-Test, também apresentaram, após avaliação com teste Biotrace Pro-tect, resíduo de proteína. Na avaliação realizada com o Test Kit Proteína, 141(100%) instrumentais apresentaram ausência de proteína. Para avaliação do desempenho da termodesinfecção, ) os instrumentais escolhidos para experimento foram intencionalmente contaminados com sangue humano e em seguida submetidos aos processos de termodesinfecção em diferentes programas. A contagem de UFC dos microrganismos viáveis foi feita antes e após a termodesinfecção, partindo-se da contaminação inicial de 107 e 108 UFC. Quanto aos resultados destes testes, de modo uniforme, todos os ciclos apresentaram desempenho satisfatório de <102 UFC, resultado esse entendido como ausência de crescimento microbiano, considerando-se a diluição empregada. Nos cálculos dos valores da Letalidade Mínima e DAL - Nível de Segurança de Desinfecção, os protocolos aprovados foram: Norma Alemã, BGA 94ºC/10 minutos; Norma da Grã-Bretanha, DHSS/HTM 90ºC/1 segundo; Norma da Holanda, RIVM 90ºC / 5 minutos; Norma da Suécia, SPRI/SIS 85ºC / 1 minuto; Norma da Suécia, SPRI/SIS 85ºC/ 3 minutos. Os protocolos que não alcançaram os valores preconizados da Letalidade Mínima de 10 minutos e DAL =10-2 após validação foram: Norma da Grã-Bretanha, DHSS/HTM 82ºC / 2 minutos; Temperatura 70ºC e Tempo de 30 minutos para Pasteurização. Como conclusão, a presente pesquisa evidenciou desempenhos satisfatórios das Máquinas Lavadoras Desinfectadoras tanto na limpeza mecânica quanto na desinfecção, em todos os programas testados, com diferentes tempos e temperaturas apesar do DAL e A0 de alguns programas terem sido reprovados. Evidenciou que em instrumentais de conformação complexa, especialmente quando não desmontáveis, a remoção completa dos resíduos não ocorre nas máquinas, sugerindo que a limpeza destes seja manual, utilizando-se artefatos adequados.

Cleaning is undeniably the main focus of all activities related to the reprocessing of medical and hospital supplies. The washer-disinfector machine represents a new technology that has brought great advantages as the standardization of the cleaning procedures, the process registering and the reduction of occupational hazards coming from biological sources. Nowadays, there are equipments with programs presenting different time and temperature. In order to subside the choice of programs, this essay aims to investigate the performance of washer-disinfectors in the following different programs (German Federal Health Authority BGA, 94ºC/10 minutes; British Standard DHSS/HTM, 90º C/1 second; British Standard DHSS/HTM, 82º C/2 minutes; The Netherlands RIVM, 90º C/5 minutes; Swedish Standards Institute SPRI/SIS, 85ºC/1 minute; Swedish Standard Institute SPRI/SIS, 85ºC/3minutes; cycle temperature 70ºC and pasteurization time 30 minutes), evaluating the performance of cleaning and thermo disinfection tests in validated equipment. According to recommendations in ISO 15883-1/1999 and HTM 2030 (NHS States, 1997) for evaluating the cleaning and disinfection processes, three tests were performed: Soil Test, Biotrace Pro-tect and Test Kit Protein. As a result of the cleaning tests performance, soiling was found after evaluation with Soil Test performed in 1,3% of the instruments (5 of them presenting critical complexity, 2 of them not dismountable - Kerrison and Rongeur). In 65 instruments evaluated by Biotrace Pro-tect, 60 instruments (92%) presented good results. Five instruments (8%) presented soiling after evaluation with Soil Test, and after Biotrace Pro-tect evaluation presented protein contamination. After the evaluation performed with Test Kit Protein no instrument presented protein contamination (141 instruments, 100%). To evaluate the thermo disinfection performance the instruments chosen for the test were intentionally contaminated with human blood and after that were under thermo disinfection processes in different programs. The counting of possible present microorganisms was done before and after the thermo disinfection process, starting from an initial contamination of 107 and 108 UFC. Concerning the results of these tests, in general all cycles presented a good performance (<102 UFC), which was understood as the absence of microbiological growth, considering the dilution given. To calculate the Minimal Lethality and DAL - Disinfection Assurance Level, the approved protocols were: German Federal Health Authority BGA, 94ºC/10 minutes; British Standard DHSS/HTM, 90ºC/1 second; The Netherlands RIVM, 90ºC/5 minutes; Swedish Standards Institute SPRI/SIS, 85ºC/1 minute and Swedish Standards Institute SPRI/SIS, 85ºC/3 minutes. The protocols that did not reach the professed values for Minimal Lethality of 10 minutes and DAL = 10 -2 after validation were: British Standard DHSS/HTM, 82ºC/2 minutes; temperature 70ºC and pasteurization time 30 minutes. Concluding, this study evidenced the good performance of the washer-disinfector machines for mechanic cleaning as for disinfection in all tested programs with different time and temperature. It also demonstrated that for instruments with complex shape, specially the not dismountable ones, the complete soiling remove do not occur on the machines and suggests that this cleaning requires handicraft employing adequate material.