Contaminação Bacteriana E Fúngica Dos Tubos Endotraqueais E Traqueias Respiratórias

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Contaminação Bacteriana E Fúngica Dos Tubos Endotraqueais E Traqueias Respiratórias ANA FERNANDES MORENO FERREIRA DE LEMOS Contaminação Bacteriana e Fúngica dos Tubos Endotraqueais e Traqueias Respiratórias Orientador: Professor Doutor Pedro Faísca Universidade Lusófona de Humanidades e Tecnologias Faculdade de Medicina Veterinária Lisboa 2016 ANA FERNANDES MORENO FERREIRA DE LEMOS - Contaminação Bacteriana e Fúngica dos Tubos Endotraqueais e Traqueias Respiratórias ANA FERNANDES MORENO FERREIRA DE LEMOS Contaminação Bacteriana e Fúngica dos Tubos Endotraqueais e Traqueias Respiratórias Dissertação defendida em provas públicas para a obtenção do Grau de Mestre em Medicina Veterinária no curso de Mestrado Integrado em Medicina Veterinária conferido pela Universidade Lusófona de Humanidades e Tecnologias no dia 31 de Outubro com a seuinte composição de Júri: Presidente: Professor Doutor João Requicha Arguente: Professora Doutora Margarida Simões Orientador: Prodessor Doutor Pedro Faísca Orientador: Professor Doutor Pedro Faísca Co-Orientador: Dr. António Martinho Universidade Lusófona de Humanidades e Tecnologias Faculdade de Medicina Veterinária Lisboa 2016 Universidade Lusófona de Humanidades e Tecnologias,Faculdade de Medicina Veterinária2 ANA FERNANDES MORENO FERREIRA DE LEMOS - Contaminação Bacteriana e Fúngica dos Tubos Endotraqueais e Traqueias Respiratórias Dedicatória À minha família que sempre acreditou em mim. Universidade Lusófona de Humanidades e Tecnologias,Faculdade de Medicina Veterinária3 ANA FERNANDES MORENO FERREIRA DE LEMOS - Contaminação Bacteriana e Fúngica dos Tubos Endotraqueais e Traqueias Respiratórias Agradecimentos No âmbito da realização da dissertação gostaria de agradecer ao professor Dr. António Martinho pela paciência, dedicação e amizade, não só durante este período, mas também ao longo destes 6 anos. Aos Professores Doutores Nuno Cardoso e Rui Onça por todos os conhecimentos transmitidos, ajuda, disponibilidade e boa disposição. À Dra. Mariana Garcez pelo apoio fundamental e orientação em toda a parte experimental deste trabalho. Ao Professor Doutor Pedro Faísca, ao Dr. Mauro Bragança e às adoradas Sra. Isabel e Sra. Manuela que me apoiaram na parte logística deste estudo. A todos os professores com quem tive oportunidade de aprender a ser médica veterinária e a toda a equipa do Hospital Veterinário do Restelo, em especial ao Dr. Jorge Cid, um muito obrigada por tão bem me receberem como estagiária, por todos os conhecimentos transmitidos e pelo óptimo convívio que proporcionaram. Um agradecimento especial à minha avó Maria de Lurdes, pelo carinho e orações em dias de exame e a todos os Morenos, os Ferreira de Lemos e os Dias. Aos meus pais, Maria de Lurdes e Paulo, que me incentivaram a seguir este sonho e o tornaram realidade e aos meus irmãos, Beatriz, Ricardo e Paulo, pela paciência, amizade, ajuda, compreensão nos meus momentos mais difíceis e por me cederem o “espaço de estudo”. Ao Ricardo por ter estado sempre ao meu lado com muita paciência, por me ter dado força e porque sem ele seria impossível este sonho se ter concretizado. A todos os meus amigos, incluindo os meus grandes companheiros de curso, Mariana Pereira Coutinho, Sara Reis, Rita Castro, Margarida Almeida, Mónica Silvério, Joana Dias e Mariana Correia por terem feito parte desta etapa da minha vida e por terem tornado estes 6 anos bastante mais fáceis. Universidade Lusófona de Humanidades e Tecnologias,Faculdade de Medicina Veterinária4 ANA FERNANDES MORENO FERREIRA DE LEMOS - Contaminação Bacteriana e Fúngica dos Tubos Endotraqueais e Traqueias Respiratórias Resumo Introdução: A utilização do tubo endotraqueal (TE) e da traqueia respiratória (TR) é fundamental na prática cirúrgica veterinária e a reutilização dos mesmos é também uma prática recorrente de forma a obter uma diminuição de custos. A avaliação da contaminação microbiológica dos mesmos está amplamente documentada em Medicina Humana. O mesmo não se sucede em Medicina Veterinária, pois devido aos altos custos de manutenção, torna-se impraticável realizar estudos microbiológicos de rotina. Material e Métodos: O presente estudo foi realizado num Hospital de Medicina Veterinária na zona de Lisboa, com o objectivo de determinar a contaminação bacteriana e fúngica nestes equipamentos. Procedeu-se à avaliação clínica e radiográfica de todos os pacientes. Foram recolhidas amostras microbiológicas a partir de 30 TEs e 30 TRs reutilizados, escolhidos aleatoriamente, antes do procedimento cirúrgico e cultivadas em meios de cultura para bactérias e fungos. Este procedimento foi realizado independentemente do sexo, raça e idade do animal, tipo e tempo de cirurgia. Seguido de determinação, caracterização e identificação microbiológica. Resultados: Verificou-se crescimento bacteriano e/ou fúngico total de 73% (44 amostras positivas em 60 amostras). Por fim, correlacionaram-se os resultados com o aparecimento de afecções respiratórias. Conclusão: O estudo de fontes de contaminação em ambientes hospitalares veterinários é uma actividade em crescimento, sendo necessário o desenvolvimento de programas de controlo mais específicos e eficazes, que tenham como pilares básicos um sistema de vigilância efectivo combinado com uma rotina de análises microbiológicas. Palavras-chave: Contaminação microbiológica, tubos endotraqueais, traqueias respiratórias. Universidade Lusófona de Humanidades e Tecnologias,Faculdade de Medicina Veterinária5 ANA FERNANDES MORENO FERREIRA DE LEMOS - Contaminação Bacteriana e Fúngica dos Tubos Endotraqueais e Traqueias Respiratórias Abstract Background: The use of the endotracheal tube (ET) and the tubing of breathing circuit systems (tBCS) is fundamental for the practice of the veterinary surgery and reusing them is also a recurring way of reducing costs. The evaluation of the microbiological contamination is widely documented in Human Medicine. In Veterinary Medicine however, due to high maintenance costs, it is impossible to perform routine microbiological studies. Materials and methods: The current study was done in a Veterinary Medicine Hospital in the Lisbon area, with the objective of defining the bacteriological and fungi contamination of these medical devices. All patients underwent a clinical and radiographic evaluation. Microbiological samples were taken from 30 ET and 30 tBCS reused randomly chosen and were collected before initiating the surgical procedure and cultured for bacteria and fungi. This procedure was performed regardless of the sex, race and age of the animal, type and time of surgery. Followed by determination, characterization and microbiological identification. Results: Bacterial and/or fungal growth was found to be 73% (44 positive samples in 60 samples). In the end the results were correlated with the appearance of respiratory disorders. Conclusion: The study of the sources of contamination in veterinary hospital environments is a growing activity, creating the need to develop more specific and efficient control programs, which will be supported by a basis of a surveillance system combined with a routine of microbiological analysis. Key-words: Microbiological contamination, endotracheal tubes, tubing of breathing circuit systems. Universidade Lusófona de Humanidades e Tecnologias,Faculdade de Medicina Veterinária6 ANA FERNANDES MORENO FERREIRA DE LEMOS - Contaminação Bacteriana e Fúngica dos Tubos Endotraqueais e Traqueias Respiratórias Lista de Abreviaturas e Símbolos % – Percentagem ® – Marca registada > – Maior ASA – American Society of Anesthesiologists ATS – American Thoracic Society BALT – Bronchus-associated lymphoid tissue BCMH – British Columbia Ministry of Health Bpm – Batimentos por minuto CDC – Centers for Disease Control and Prevention CFSPH – Centers for Food Security & Public Health CHRISP – Centre for Healthcare Related Infection Surveillance and Prevention CO2 – Dióxido de Carbono CRA – Circuito Respiratório Anestésico CRAs – Circuitos Respiratórios Anestésicos CSC – Columbia + 5% de Sangue de Carneiro DMUU– Dispositivos Médicos de Uso Único E. coli – Escherichia coli E. coli ExPEcC – e. coli extraintestinal ET – Endotracheal Tube FDA – Food and Drug Administration Ig – Imunoglobulina IICAB – Institute for International Cooperation in Animal Biologics MRSA – Methicillin-Resistant Staphilococcus aureus (Staphylococcus aureus Resistente à Meticilina) NaCl – Cloreto de sódio O2 – Oxigénio ºC – Graus Celsius OE – Óxido de Etileno OVH – Ováriohisterectomia PAM – Pulmonary Alveolar Macrophages Universidade Lusófona de Humanidades e Tecnologias,Faculdade de Medicina Veterinária7 ANA FERNANDES MORENO FERREIRA DE LEMOS - Contaminação Bacteriana e Fúngica dos Tubos Endotraqueais e Traqueias Respiratórias PAV – Pneumonia Associada à Ventilação PNCI – Programa Nacional de Controlo de Infecção PVC – Policloreto de vinil QMDA – Committee on Quality Management and Departmental Administration Rpm – Respirações por minuto S. aureus – Staphylococcus aureus S. epidermidis – Staphylococcus epidermidis S. pseudointermedius – Staphylococcus pseudointermedius S. saprophyticus – Staphylococcus saprophyticus SCENIHR – Scientific Committee on Emerging and Newly Identified Health Risks SRD – Sem Raça Definida SVA – Swedish Veterinary Association TAV– Traqueobronquite Associada à Ventilação tBCS – tubing of Breathing Circuit System TE – Tubo Endotraqueal TEs – Tubos Endotraqueais TR – Traqueia Respiratória TRs – Traqueias Respiratórias UTI – Urinay tract infection α – Alfa β – Beta γ – Gama µm – Micrómetro Índice Índice de Figuras ................................................................................................................................
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