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Hastanemizde kullanılan çeşitli dezenfektan ve antiseptiklerin sık görülen dirençli bakteriler üzerine etkisi

Effect of various disinfectants and antiseptic used, on resi̇stant common bacteria in our hospital

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  1. Tez No: 501624
  2. Yazar: SALİHA AYDIN
  3. Danışmanlar: PROF. DR. İLHAMİ ÇELİK
  4. Tez Türü: Tıpta Uzmanlık
  5. Konular: Klinik Bakteriyoloji ve Enfeksiyon Hastalıkları, Clinical Microbiology and Infectious Diseases
  6. Anahtar Kelimeler: Antisepsis, Disinfection, disinfectant effectiveness, qualitative suspension test, nosocomial infection
  7. Yıl: 2018
  8. Dil: Türkçe
  9. Üniversite: Sağlık Bilimleri Üniversitesi
  10. Enstitü: Kayseri Eğitim ve Araştırma Hastanesi
  11. Ana Bilim Dalı: Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Ana Bilim Dalı
  12. Bilim Dalı: Belirtilmemiş.
  13. Sayfa Sayısı: 92

Özet

Giriş ve Amaç: Dezenfektanlar; patojen mikroorganizmaların bulunduğu ya da bulunmasından kuşku duyulan yerler ve kontaminasyon kaynağı olabilecek cihaz ya da malzemeler için kullanılan kimyasal maddelerdir. Canlı doku üzerindeki veya içindeki özellikle deri ve mukozadaki patojen tüm mikroorganizmaların kimyasal maddeler kullanılarak öldürülmesi veya arındırılması işlemine ise antisepsi denilmektedir. Kullanılan kimyasal maddeye de antiseptik denir. Antiseptikler aynı zamanda vücut dokularına ya çok az ya da hiç zarar vermemelidir. Bir dezenfektanın ve antiseptiğin aynı birimde devamlı kullanılması, mikroorganizmaların bu dezenfektan ve antiseptiklere karşı direnç kazanmasına yol açacağından belli aralıklarla direnç gelişimi açısından kontrol edilmesi gerekmektedir. Halen kullanmakta olduğumuz dezenfektan ve antiseptiklere karşı hastanemizde daha önce bir duyarlılık çalışması yapılmamıştır. Bu çalışmada hastalarımızdan izole edilen mikroorganizmaların hastanemizde kullanılan çeşitli dezenfektanlar/ antiseptiklere duyarlılık durumununun belirlenmesi amaçlanmıştır. Gereç ve Yöntem: Bu çalışma Sağlık Bilimleri Üniversitesi Kayseri Eğitim Araştırma Hastanesi Tıbbi Mikrobiyoloji Laboratuvarı'nda yapıldı. Mikroorganizmaların dezenfektan ve antiseptik ajanlara duyarlılığı kalitatif süspansiyon yöntemi ile çalışıldı. Çalışmada; Incidin foam® (2 propanol, etnanol, benzalkolyum klorür, glukoprotamin), Cidex Opa® (%0,55 orto-fitalaldehit), Skinman® Soft Protect (%89 etil alkol, vitamin E, gliserin, pantenol), Dicideral Pro® (%4 klorhekzidin glukonat, izopropanol), Biohand Chx Scrub® (%4 klorhekzidin glukonat, izopropanol), Platex® (%10 luk povidon iyot), Power Clean® (sodyum hipoklorit

Özet (Çeviri)

Introduction and Aim: Disinfectants are chemical materials that are primarily used to disinfect possible sources of contamination such as materials and equipment and surfaces which have -or are suspected to have- pathogenic microorganisms. Antisepsis is a process that kills or decontaminates all pathogenic microorganisms, which are on or inside the living tissue (especially on skin or mucosa) by using chemical materials. The chemical used is also called antiseptic. Antiseptics shall cause little or no damage to body tissues at the same time. Prolonged use of the same disinfectant and antiseptics in the same unit may lead microorganisms to develop resistance to these particular disinfectant and antiseptics; therefore, they shall be controlled for resistance development at regular intervals. There was no previous sensitivity study in our hospital against disinfectant and antiseptics that we have been using. In this study, it was aimed to determine the sensitivity status of various disinfectants and antiseptics used in our hospital by microorganisms isolated from our patients. Materials and Method: This study was performed at the University of Health Sciences, Kayseri Research and Training Hospital, Department of Clinical Microbiology Laboratory. The sensitivity of microorganisms against disinfectants and antiseptics was studied by qualitative suspension method. In the study, it was planned to research the sensitivity status of the Incidin foam® (2-propanol, ethanol, benzalkonium chloride, glucoprotamine), Cidex Opa® (0.55% orthophthalaldehyde), Skinman® Soft Protect (89% ethanol, vitamin E, glycerin, panthenol), Dicideral® (4% chlorhexidine gluconate, isopropanol), Biohand Chx Scrub® (4% chlorhexidine gluconate, isopropanol), Platex® (10% povidone-iodine), Power Clean® (5% sodium hypochlorite) agents on Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococus aureus and on following standard strains: S. aureus NCTC® 12493, A. baumannii ATCC® BAA 1605, K. pneumoniae ATCC® 700603, P. aeruginosa ATCC® 27853. Bacterial strains were prepared as per turbidity of 0.5 McFarland standard. Microdilution was carried out with disinfectant / antiseptic solutions. Passages were made to the solid medium at the end of 1, 5, 10 and 20 minutes contact periods, respectively and it was evaluated whether bacterial growth is seen or not. Results: A hospital strain of A. baumannii growth was seen in the first minute of 89% ethanol, vitamin E, glycerin, panthenol. It was effective as of the 1st minute against other hospital strains and against standard bacterial strains. A hospital strain of K. pneumoniae growth was observed on 2-propanol, ethanol, benzalkonium chloride, glucoprotamine 1th minute contact. In the 1st minute of the 0.55% orthophthalaldehyde contact period, growth of two hospital strains were found; one of which was K. pneumoniae and another was MRSA. In the 1st minute of 4% chlorhexidine gluconate, isopropanol (Dicideral®) contact period, culture positivity of a hospital strain of K. pneumoniae were found. 4% chlorhexidine gluconate, isopropanol (Biohand Chx Scrub®) eight hospital strains A. baumannii and eight hospital strains P. aeruginosa, and standard strains A. baumannii ATCC® BAA-1605 ™, K. pneumoniae ATCC® 700603 ™, P. aeruginosa ATCC® 27853 ™ reproduction was detected at all contact times. In addition, 4% chlorhexidine gluconate, isopropanol (Biohand Chx Scrub®) eight hospital strains of K. pneumoniae were able to reproduce during the 1st, 5th and 10th minutes of action and five hospital strains of K. pneumoniae were detected at the 20th contact period. Two hospital strains of K. pneumoniae and one hospital-acquired strain of P. aeruginosa were detected at the first concentrated duration of 5% sodium hypochlorite. In addition, a hospital strain of K. pneumoniae culture positivity was detected at the 5th and 10th minute contact. Two A. baumannii, three K. pneumoniae and one P. aeruginosa culture positivity were observed in hospital strains at the 1st minute impact on 5% sodium hypochlorite 1/10 dilutions. Furthermore, two K. pneumoniae culture positivity from hospital strains and one K. pneumoniae remnant at the 10th and 20th minute contact were observed during the 5th minute effect. K. pneumoniae ATCC® 700603, six hospital strains A. baumannii, seven hospital strains K. pneumoniae, five hospital strains MRSA and five hospital strains P. aeruginosa culture positivity were detected at the 1st minutewith the bacteria tested in the 1/100 dilution of 5% sodium hypochlorite. During the 5th contact period, three hospital strains A. baumannii, six hospital strains K. pneumoniae, five hospital strains MRSA and five hospital strains P. aeruginosa culture positivity were detected. At the 10th minute contact time, two hospital strains A. baumannii, six hospital strains K. pneumoniae, five hospital strains MRSA and four hospital strains P. aeruginosa growth were detected. At the 20th minute contact time, one hospital strain A. baumannii, five hospital strains K. pneumoniae, four hospital strains MRSA and four hospital strains P. aeruginosa culture positivity were detected. Povidone iodine (Platex®) used without reconstitution, six hospital strains of MRSA, two hospital strains of K. pneumoniae and two hospital strains of P. aeruginosa culture positivity were observed at 1st minute contact. Three hospital strains of MRSA culture positivity were observed after the 5th minute of contact. Six hospital strains of MRSA, one hospital strain P. aeruginosa, one hospital strain A. baumannii and standard strains of S. aureus NCTC® 12493, K. pneumoniae ATCC® 700603 recruitment in %10 povidone-iodine 1/2 reconstitution at 1st minute contact times. After the 5th minute contact, three hospital strains of MRSA culture positivity were observed. %10 povidone-iodine 1/4 dilution resulted in six hospital strains MRSA, one hospital strain P. aeruginosa, two hospital strains A. baumannii, and S. aureus NCTC® 12493, K. pneumoniae ATCC® 700603 in the 1st minute contact durations. At the 5th minute contact, the three hospital strains of MRSA culture positivity were observed. Conclusion: According to the results of our study, Platex® which was used in our hospital; was not influential for hospital strains of MRSA, being nosocomial factor, within recommended time. It would be appropriate to prescribe another agent as an antiseptic in cleaning the surgical site, prior to central artery or venous catheter placement or revision. If povidone iodine use is essential, Platex® shall be used for at least 10 minutes and shall be used without dilution. Dicideral® was observed to be effective among skin antiseptic agents used in our hospital containing chlorhexidine. Biohand Chx Scrub® was found to be ineffective for resistant Gram-negative pathogens even at the twentieth minute. It is deemed inappropriate to be used in our hospital. It is recommended to use bleach without dilution in our hospital. It will be proper to wait for at least twenty minutes to ensure that bleach can be able to affect hospital strains. In very high risk areas and in high-risk areas, it is recommended that agents such as Incidin foam® shall be used as a surface disinfectant. A disinfection policy shall be established in all hospitals so that both patients and healthcare professionals can be protected from hospital infections. Each hospital needs to identify effective antiseptic and disinfectants against their microbial flora.

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