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Master's Dissertation
DOI
https://doi.org/10.11606/D.22.2012.tde-05112012-201527
Document
Author
Full name
Marcelo Alessandro Rigotti
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2012
Supervisor
Committee
Andrade, Denise de (President)
Alves, Leila Maria Marchi
Watanabe, Evandro
Title in Portuguese
Segurança microbiológica na abertura de ampolas com ênfase no procedimento de desinfecção
Keywords in Portuguese
Contaminação de medicamentos
controle de infecções
Desinfecção
Serratia marcescens
Staphylococcus aureus
Abstract in Portuguese
O cuidado a saúde incorpora continuamente, novas tecnologias relacionadas a produtos e processos que podem trazer riscos, especialmente, quando não possuem embasamento técnico-científico. Ampolas de plástico são amplamente utilizadas no preparo de injetáveis, no entanto, a contaminação biológica das soluções na sua abertura é ainda questionável. Sabe-se que o risco de infecção tem etiologia multifacetada envolvendo aspectos complexos da microbiota endógena e das condições ambientais. O objetivo do estudo é contribuir para com a segurança microbiológica da abertura de ampolas com base no procedimento de desinfecção e, assim, minimizar os riscos de contaminação biológica no preparo de injetáveis. Trata-se de um experimento de laboratório que permitiu avaliar a esterilidade do conteúdo das ampolas e, consequentemente produziu evidencias acerca da segurança microbiológica no preparo de injetáveis. Para determinação se a abertura de ampolas possibilita veiculação bacteriana para as soluções utilizaram-se dois métodos de desinfecção do gargalo um com suabe e outro com algodão ambos umedecidos em álcool a 70%. Das 120 ampolas de plástico com água esterilizada 60 tiveram seus gargalos contaminados intencionalmente com Serratia marcescens (ATTCC 14756) e outra metade com Staphylococcus aureus resistente à meticilina (MRSA) (ATTCC 43300) na ordem de 106 UFC/mL. Na abertura das respectivas ampolas utilizaram-se os princípios e o rigor de assepsia em termos de higiene das mãos e uso de luvas esterilizadas. Na avaliação da positividade das culturas uma alíquota da solução de cada ampola foi pipetada em caldo nutriente e incubada a 35ºC por 14 dias. A fricção dos gargalos das ampolas com suabe ou bolas de algodão embebidas em 3 ml de álcool a 70% não foi eficaz na redução da contaminação do conteúdo destas ampolas. Evidencia-se que houve maior contaminação nas ampolas, intencionalmente contamindas com Serratia marcescens, que receberam desinfecção com suabe 19 (63,3%) comparado as ampolas 15 (50%) que foram desinfetadas com bolas de algodão embebidas em álcool. As ampolas contaminadas com Staphylococcus aureus resistente à meticilina independentemente de utilizar suabe ou bolas de algodão embebidas em álcool, a contaminação do conteúdo das ampolas foi alta 24 (80%) e 18 (60%), respectivamente. Das 60 (100%) ampolas contaminadas com Serratia marcescens 34 (56,7%) apresentaram contaminação da água destilada e, das 60 (100%) ampolas contaminadas com Staphylococcus aureus resistente à meticilina, 42 (70%) apresentaram contaminação. A elucidação do processo de contaminação do conteúdo de ampolas de plástico durante sua abertura é urgente, especialmente considerando a possibilidade do contato da solução com o meio externo e vice- versa. Consta-se que a temática carece de mais investimentos de pesquisa dado a relevância do procedimento de desinfecção na redução da carga microbiana.
Title in English
Microbiological safety in opening ampoules with an emphasis on disinfection procedure.
Keywords in English
Disinfection
Drug contamination
Infection control
Serratia marcescens
Staphylococcus aureus
Abstract in English
The health care incorporates continuously new technologies related to products and administration processes that may pose risks, especially when there is no technical- scientific basis. Plastic ampoules are widely used in the preparation of injectables, however, biological contamination in solutions at its opening is still questionable. It is known that the risk of infection presents a multifaceted etiology involving complex aspects of endogenous microbiota and environmental conditions. The present investigation was carried out in order to contribute to the microbiological safety of opening ampoules based on disinfection procedure and thereby minimize the risk of biological contamination in the preparation of injectables. This is a laboratory experiment that allowed to evaluate the sterility of ampoules´ contents and consequently produced evidences regarding the microbiological safety in the preparation of injectables. To determine whether the opening of ampoules allows the carrying of bacteria into the solutions it was used two methods of ampoule neck disinfection, one with cotton balls and another with cotton swab both soaked with 70% alcohol. Of the 120 plastic ampoules containing sterile water, 60 had the ampoules necks intentionally contaminated with Serratia marcescens (ATTCC 14756) and the other half with methicillin-resistant Staphylococcus aureus (MRSA) (ATTCC 43300) of the order of 106 CFU/mL. At the opening of respective ampoules it was used the principles of strict asepsis and rigor in terms of hand hygiene and use of sterile gloves. In the evaluation of positive cultures an aliquot of solution from each ampoule was pipetted in nutrient broth and incubated at 35 °C for 14 days. Rub the ampoules necks with swab or cotton balls soaked with 70% alcohol in 3 ml was not effective in decreasing contamination of contents of those ampoules. It is evident that there were more contamination in ampoules intentionally contaminated with Serratia marcescens which received disinfection with swabs 19 (63.3%) if compared ampoules disinfected with cotton balls soaked in alcohol 15 (50%). Ampoules contaminated with methicillin-resistant Staphylococcus aureus neither swab nor cotton balls soaked in alcohol was effective, contamination of the contents of the ampoules 24 was high (80%) and 18 (60%), respectively. Of the 60 (100%) ampoules contaminated with Serratia marcescens 34 (56.7%) had distilled water contaminated, and from 60 (100%) ampoules contaminated with methicillin-resistant Staphylococcus aureus, 42 (70%) were contaminated. The elucidation of contamination process of contents of plastic ampoules during its opening is an urgent need, especially considering the possibility of contact of the solution with the external environment and vice versa. The evidence suggests that the issue needs more research investments given the relevance of the disinfection procedure in decreasing microbial load.
 
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Publishing Date
2013-01-10
 
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