Nebulizadores: fonte de contaminação bacteriana em pacientes com fibrose cística?

Abstract

Objective: To determine whether nebulizers are a source of microbial contamination in patients with cystic fibrosis, as well as whether the technique and frequency of disinfection of these devices is appropriate. Methods: This was a cross-sectional, uncontrolled observational study. Samples were collected from 28 patients with cystic fibrosis. Samples were collected at the homes of the patients, who were not previously informed of the purpose of the visit. Three samples were collected from each patient: one from the nebulizer chamber, one from the mask/mouthpiece, and one from the patient (oropharyngeal swab/sputum). The samples were properly stored and taken for analyses. The patients, their parents, or their legal guardians completed a questionnaire regarding nebulizer cleaning and disinfecting methods. Results: We collected 84 samples from the 28 patients. Of those 28 patients, 15 (53.5%) were male. The median age of the patients was 11 years (range, 1-27 years). Of the 28 patients, 15 presented with positive oropharyngeal swab/sputum sample cultures. The most common bacterial isolates were Staphylococcus aureus (in 8 patients) and Pseudomonas aeruginosa (in 4 patients). Although the samples obtained from the nebulizers presented with various pathogens in culture, no specific species predominated. In 27 cases (96.7%), there were no associations between the samples obtained from the nebulizers and those obtained from the patients in terms of the results of the cultures. Cleaning and disinfection of nebulizers were inappropriate in 22 cases (78.6%). Conclusions: In this sample of patients, despite the inappropriate disinfection techniques, nebulizers were not found to be a source of microbial contamination.Keywords: Cystic fibrosis; Nebulizers and vaporizers; Disinfection. ResumoObjetivo: Determinar se os nebulizadores de pacientes com fibrose cística são fonte de contaminação microbiana e verificar se a técnica e a frequência de desinfecção dos nebulizadores é apropriada. Métodos: Estudo de corte transversal observacional, sem grupo controle. Foram coletadas amostras de 28 pacientes com fibrose cística, no domicílio do paciente, sem aviso prévio sobre o motivo da visita. Foram colhidas três amostras por paciente: do reservatório do nebulizador, da máscara/bocal e do próprio paciente (swab da orofaringe/escarro). As amostras foram acondicionadas adequadamente e levadas para análise. Os pacientes, seus pais ou responsáveis preencheram um questionário sobre métodos de limpeza e desinfecção dos nebulizadores. Resultados: Foram obtidas 84 amostras dos 28 pacientes. Destes, 15 (53,5%) eram do gênero masculino. A mediana de idade foi de 11 anos (variação: 1-27 anos). Dos 28 pacientes, 15 apresentaram culturas de escarro/orofaringe positivas. As bactérias encontradas com maior frequencia foram Streptococcus aureus (8/15) e Pseudomonas aeruginosa (4/15). A cultura obtida dos nebulizadores identificou diversos patógenos, sem nenhum predominante. Não houve associações entre os resultados das culturas obtidas dos ...

Effect that an educational program for cystic fibrosis patients and caregivers has on the contamination of home nebulizers

“…Likewise, Blau et al, ( 14 ) in a study on bacterial contamination of nebulizers in the home treatment of CF patients, evaluated 29 nebulizer systems and found contamination in 19 (65%), P. aeruginosa being identified in 10 (35%). In contrast, in a study conducted in Brazil by Brzezinski et al, ( 3 ) only 6 (21%) of 28 nebulizers evaluated were contaminated with bacteria related to CF. The main difference between that study and ours is that, in the former, sample collection occurred at home visits, and it is of note that the samples were left at room temperature before being taken for analysis.…”

“…The main difference between that study and ours is that, in the former, sample collection occurred at home visits, and it is of note that the samples were left at room temperature before being taken for analysis. ( 3 ) …”

“…( 1 ) The increasingly frequent need for prescribing inhaled medications to these patients has led to greater use of home nebulizers. ( 2 , 3 ) It is accepted that pathogens are commonly isolated from nebulizers, and there is a concern that nebulizer equipment may be a contributing source of bacterial infection into the lower airways of these patients. ( 2 , 4 ) …”

“…( 1 ) A necessidade de prescrição cada vez mais frequente de medicações por via inalatória para esses pacientes tem levado ao maior uso de nebulizadores para o uso domiciliar. ( 2 , 3 ) É reconhecido que patógenos são comumente isolados nos nebulizadores, e existe uma preocupação de que esses equipamentos possam contribuir como uma fonte de infecção bacteriana para as vias aéreas inferiores nesses pacientes. ( 2 , 4 ) …”

An evaluation of different steam disinfection protocols for cystic fibrosis nebulizers

“…Despite the use of steam disinfection, some of our patients' devices showed multiple, bacterial contamination at their annual nebulizer quality check (personal unpublished data). As concordance between bacteria isolated from the nebulizer and from patient sputa was rarely verified [4,8,23,24], the source of bacteria contaminating the nebulizer parts is poorly understood.…”