magistrsko delo
Barbara Kastelic (Author), Karmen Godič Torkar (Reviewer), Mojca Jevšnik (Mentor), Tadeja Matos (Co-mentor)

Abstract

Uvod: Preprečevanje okužb, povezanih z zdravstvom, je del vsakdanjih prizadevanj vseh zdravstvenih delavcev in sodelavcev v vseh zdravstvenih ustanovah. Bolnišnično okolje je lahko vzrok okužb, ki so povezane z zdravstvom. Z nadgradnjo čistilnih postopkov, na primer uporabo aerosolnega razkuževanja, smo lahko pri preprečevanju prenosa okužb, povzročenih z večkratno odpornimi mikroorganizmi bolj učinkoviti. Namen: Ugotoviti, ali je tveganje za pridobitev okužbe, povezane z zdravstvom pri pacientu, ki ga namestimo v sobo, v kateri je predhodno ležal pacient, ki je bil koloniziran ali okužen z večkratno odpornimi mikroorganizmi večje, če sobo samo končno očistimo, kot tveganje, če čiščenje sobe nadgradimo z aerosolnim razkuževanjem. Metode dela: Z uporabo seta GlowCheck, ki temelji na zaznavanju fluorescentnih oznak, in seta 3M™ Clean-Trace™ ATP, s katerim smo izmerili ostanke organskih nečistoč, smo nadzirali učinkovitost postopkov čiščenja. Postopke čiščenja smo nadzirali tudi z mikrobiološkimi brisi površin ter vzorčenjem zraka. Postopke ročnega čiščenja smo nadgradili z aerosolnim razkuževanjem in primerjali rezultate meritev pred in po izvedenih dogovorjenih postopkih. V petih izbranih bolniških sobah za izolacijo je bilo v obdobju petih mesecev odvzetih 80 brisov površin in 10 vzorcev zraka. Rezultati: Nadzor čiščenja bolniških sob za izolacijo s fluorescentnimi oznakami v primerjavi z nadzorom, ki temelji na merjenju vrednosti ATP bioluminiscence, ni zanesljiv način, saj dopušča možnosti za pristranskost in hkrati za lažno negativne rezultate. Merjenje ATP bioluminiscence na površinah poda jasen rezultat uspešnosti čiščenja– vrednost, za katero vemo, ali je ustrezna ali ne. Aerosolno razkuževanje z vodikovim peroksidom kot nadgradnja ročnega čiščenja površin, se ni izkazalo za nujno potrebno metodo. Mikrobiološke preiskave odvzetih vzorcev površin so potrdile, da so bili že ročni postopki čiščenja ustrezni v 96 %, stanje se po aerosolnem razkuževanju ni spremenilo. Mikrobiološke preiskave odvzetih vzorcev zraka pa so pokazale, da se je kakovost zraka po izvedenem aerosolnem razkuževanju izboljšala s 96 % na 100 %. Razprava in sklepi: Ugotovili smo, da aerosolno razkuževanje prostorov in površin kot nadgradnja končnega čiščenja bolniških sob za izolacijo, zmanjša stopnjo kontaminacije. Zdi se, da aerosolno razkuževanje vpliva na kakovost zraka v bolniški sobi, saj po izvedenem aerosolnem razkuževanju v zraku ni bilo prisotnih gliv, kot enega izmed pokazateljev učinkovitosti tega razkuževanja. Mikrobiološke preiskave so stroškovno manj sprejemljive, na rezultate je potrebno čakati dalj časa, še vedno pa predstavljajo najbolj natančno metodo nadzora, s katero preverjamo učinkovitost postopkov čiščenja, zato se za rutinske nadzore nad postopki čiščenja pogosto uporabljajo hitre metode, s katerimi okvirno ocenimo kakovost postopkov čiščenja. Hitre metode za nadzor nad postopki čiščenja so motivacijsko bolj učinkovite kot mikrobiološki nadzor. Kot hitra metoda za nadzor čistosti se je v naši raziskovalni nalogi za boljšo pokazala metoda z merjenjem vrednosti ATP, saj lahko rezultate primerjamo s priporočenimi vrednostmi za posamezne kontrolne točke, medtem ko je nadzor s pomočjo fluorescentnih označevalcev lahko zelo subjektivna metoda oziroma lahko poda tudi lažno pozitivne rezultate, ker je fluorescentna oznaka sicer fizično odstranjena, vendar ni pa nujno, da so odstranjene tudi nečistoče.

Keywords

magistrska dela;sanitarno inženirstvo;z zdravstvom povezane okužbe;večkratno odporni mikroorganizmi;ATP bioluminiscenca;vodikov peroksid;bolnišnice;čiščenje;

Data

Language: Slovenian
Year of publishing:
Typology: 2.09 - Master's Thesis
Organization: UL ZF - University College of Health Studies
Publisher: [B. Kastelic]
UDC: 614
COBISS: 5494123 Link will open in a new window
Views: 1392
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Other data

Secondary language: English
Secondary title: Aerosol decontamination as supplementation of terminal cleaning in hospital rooms, occupied by patient colonised with multidrug resistant microorganisms
Secondary abstract: Introduction: The prevention of hospital-acquired infections should be everyone’s concern in hospital. There is evidence that contaminated surfaces contribute to the transmission of hospital-acquired infections. Vapour aerial decontamination is being introduced to lower the possibility of transmission of multidrug-resistant organisms onto the next room occupant. Aim: The purpose of this master’s thesis is to confirm that environmental cleaning is essential in reducing hospital-acquired infections. Furthermore to determine the efficiency of hydrogen peroxide vapour as an aerial decontamination system as supplementation of manual techniques for terminal cleaning in hospital rooms, especially in those occupied by patients colonised with multidrug-resistant microorganisms. Method: Terminal cleaning was evaluated with GlowCheck fluorescent markers and 3M™ Clean-Trace™ ATP bioluminiscence method. We gathered 80 samples of different surfaces and 10 samples of air from 5 different rooms. The most important method for evaluating terminal cleaning was the growth of bacterial cultures. We assessed pre- and post-aerial decontamination measurements. Results: Assesment of terminal cleaning in isolation rooms with adenosine triphosphate bioluminscence assay showed to be a more reliable method than using fluorescent markers. Gaseous decontamination with hydrogen peroxide as supplementation of terminal cleaning of surfaces in the isolation room did not show the best results. The overall adequacy defined by fluorescent markers, aerobic colony count and ATP bioluminiscence control was 96% after the terminal cleaning was performed. After the gaseous decontamination with hydrogen peroxide the results did not change. We have found that gaseous decontamination with hydrogen peroxide has some positive impact on air quality in isolation rooms. Adequacy changed from 96% to 100% before and after gaseous decontamination. Discussion and conclusions: We have established that gaseous disinfection as supplementation of traditional cleaning of hospital isolation rooms reduces the contamination of surfaces. There is evidence that hospital environment, if cleaned insufficiently, contributes to the acquisition of multidrug-resistant infection. It seems that gaseous disinfection with hydrogen peroxide also influences on quality of air in a hospital room, because we managed to prove that after gaseous disinfection was performed there were no fungi or yeast present in the air samples, but we aren't able to confirm this with certainty. Aerobic colony counts is an extremly expensive method of evaluating cleanliness in hospitals and, while time consuming, we must acknowledge that it is the most accurate one. Therefore we are implementing some other methods for inspection of environmental cleaning in hospitals which are easier to perform and provide us with immediate information about the efficiency of the cleaning procedure. That is the reason why these methods are more frequently used as routine supervision. In our study the measurement of organic adenosine triphosphate (ATP) on surfaces was showed as a more sensitive, objective and rapid tool than the method based on fluorescent markers removal. We think that ATP bioluminiscence assay is better because we have determined the cutoff ATP values which define what a clean surface is. We think that evaluation of terminal cleaning with fluorescent markers may not provide accurate or objective information about the levels of cleanliness achieved.
Secondary keywords: master's theses;sanitary engineering;hospital acquired infections;multi-drug resistant microorganisms;ATP bioluminiscence;hydrogen peroxide;hospitals;cleaning;
Type (COBISS): Master's thesis/paper
Study programme: 0
Thesis comment: Univ. v Ljubljani, Zdravstvena fak., Oddelek za sanitarno inženirstvo
Pages: 54 str., [3] str. pril.
ID: 10961374