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.

Nasal colonization by gram-negative bacteria in dental surgeons: interfaces between prevention and control measures

The work conditions of dental surgeons (DS), associated with low compliance to precautionary standards, often lead to the colonization and dissemination of infectious agents. To assess the epidemiological and microbiological aspects of nasal colonization by Gram-negative bacteria in DS while teaching (dentistry teachers). The data were collected by application of a questionnaire and a nasal swab. The biochemical identification, the susceptibility profile and the detection of ß-lactamases were carried out in Vitek 2 compact®. 41 (77.3%) DS participated in the study, nine of them (22.0%) presented nasal colonization by Enterobacteriaceae, the participants were predominantly men (27/65.9%), over 50 years of age (24/58.5%). All of them confirmed using procedure gloves and a surgical mask while attending patients, with frequent (95.5%) hand washing although a statistical difference was found regarding personal habits (p=0.03). Enterobacter aerogenes (60.0%) was the most prevalent species, followed by Citrobacter koseri (20.0%). The intrinsic production of AmpC ß-lactamase by E. aerogenesspecies, which is multiresistant to antimicrobials, was present in the nasal cavity of 14.6% of the DS. There were high levels of nasal colonization by Enterobacteriaceae in teaching DS (22.0%), 14.6% had been colonized by multiresistant microorganisms and the results were associated with inadequate personal habits.

Contaminação de torniquetes para punção intravenosa periférica / Contamination of tourniquets for peripheral intravenous puncture

Objetivo: Identificar a presença de contaminação em torniquetes para punção intravenosa periférica e caracterizar o perfil dos Staphylococcus spp. e leveduras isolados. Métodos Estudo transversal que inseriu análise de 18 torniquetes para punção intravenosa periférica em uso no hospital. Os torniquetes foram imersos em caldo BHI por 24h e cultivados em meios seletivos para isolamento e identificação de Staphylococcus spp. e leveduras. O método disco-difusão foi empregado para analisar o perfil de suscetibilidade dos Staphylococcus spp. aos antimicrobianos. Resultados Treze (72,2%) torniquetes apresentaram crescimento de algum micro-organismo sendo 11 (52,4%) Staphylococcus coagulase-negativo, dois (9,5%) Staphylococcusaureus, quatro (19%) Rodothorulamucilaginosa, três (14,3%) Candidaalbicans. 61,5% dos Staphylococcus spp. apresentaram resistência a oxacilina. Os profissionais da equipe não relataram protocolos para limpeza, desinfecção ou substituição controlada destes materiais na instituição. Conclusão Foi identificada a contaminação de torniquetes por micro-organismos patogênicos com perfil de resistência aos antibióticos muito utilizados em instituições hospitalares.

Objectives: To identify the presence of contamination on tourniquets for peripheral intravenous puncture and to characterize the profile of the Staphylococcus spp. and the isolated yeasts. Methods Cross-sectional study in which 18 tourniquets for peripheral intravenous puncture in use at a hospital were analyzed. The tourniquets were immersed in BHI broth for 24h and cultivated in selective media for isolation and identification of Staphylococcus spp. and yeasts. The disk-diffusion method was employed to analyze the susceptibility profile of the Staphylococcus spp. to the antimicrobial agents. Results The growth of some microorganism was identified on 13 (72.2%) tourniquets: 11 (52.4%) coagulase-negative Staphylococcus, two (9.5%) Staphylococcus aureus, four (19%) Rodothorula mucilaginosa, three (14.3%) Candida albicans. 61.5% of the Staphylococcus spp. were oxacillin-resistant. The team professionals did not mention protocols for cleaning, disinfection or controlled replacement of these materials at the institution. Conclusion The contamination of tourniquets by pathogenic microorganisms was identified, with a resistance profile to the antibiotics that are frequently used in hospitals.

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.

Methicillin-resistant Staphylococcus sp. colonizing health care workers of a cancer hospital

The aim of the study was to analyze epidemiological and microbiological aspects of oral colonization by methicillin-resistant Staphylococcus of health care workers in a cancer hospital. Interview and saliva sampling were performed with 149 health care workers. Antimicrobial resistance was determined by disk diffusion and minimum inhibitory concentration. Polymerase Chain Reaction, Internal Transcribed Spacer-Polymerase Chain Reaction and Pulsed Field Gel Electrophoresis were performed for genotypic characterization of methicillin-resistant Staphylococcus. Risk factors were determined by logistic regression. Methicillin-resistant Staphylococcus colonization prevalence was 19.5%, denture wearing (p = 0.03), habit of nail biting (p = 0.04) and preparation and administration of antimicrobial (p = 0.04) were risk factors identified. All methicillin-resistant Staphylococcus were S. epidermidis, 94.4% of them had mecA gene. Closely related and indistinguishable methicillin-resistant S. epidermidis were detected. These results highlight that HCWs which have contact with patient at high risk for developing infections were identified as colonized by MRSE in the oral cavity, reinforcing this cavity as a reservoir of these bacteria and the risk to themselves and patients safety, because these microorganisms may be spread by coughing and talking.