Avaliação de superfícies hospitalares após implementação de um programa de padronização de procedimentos de limpeza e desinfecção

Abstract

The cleaning/disinfection (C/D) of hospital surfaces is one of the best cost-benefits in the prevention and control of health care-associated infections (HCAI) and has as its purposes the reduction of microbial load and the conservation of furniture. Monitoring methods should be used for periodic assessment of C/D. This study was intended to assess the C/D of hospital surfaces after the implementation of a program for standardizing the C/D procedures. We used the following monitoring methods to assess the C/D of the surfaces: visual inspection, adenosine triphosphate (ATP) bioluminescence, total aerobic colony count (ATT) and identification of Staphylococcus aureus. In the surfaces positive for S. aureus, its resistance to methicillin was tested. The study was developed in three stages: stage I – characterization of high touch surfaces (HTS); stage II – characterization of the professionals attending a Program for Standardizing the C/D Procedures (PSCDP); and stage III – assessment of C/D of HTS. The stage III was divided into two phases of data collection: phase I – performed immediately after the implementation of PSCDP; and phase II – performed two months after the implementation of PSCDP. In the phases I and II, we collected 80 samples, through the monitoring method, from five surfaces (side structure of the bed, bedside table, internal handle of the bathroom door, toilet flush button, and edge of the toilet seat), totaling 320 samples. HTS selected for this investigation, excluding the toilet seat, were poorly maintained. The employees of the hygienization service (HS) had an average age of 36.6 years and a low schooling level, 35.7% reported having incomplete elementary school and 7.1% said they did not attend school. Regarding the assessment of C/D, the averages of adenosine triphosphate were higher, two months after the implementation of PSCDP, when compared to the values immediately after the implementation of the program. By comparing the periods immediately and two months after implementation of PSCDP, there was a statistically significant difference in the quantification of ATP bioluminescence of the toilet flush button (p=0.007) and in the total aerobic colony count of the toilet seat (p=0.040), stressing that, in the first case, there was an increase of ATP bioluminescence, and, in the second, there was a decrease in the count of ATT colonies. Decreases of S. aureus colonies and its methicillin-resistant phenotype took place in the phase II of data collection, excluding the toilet flush button. The averages of the counts of ATP bioluminescence and microorganism colonies were not reduced to the parameters considered optimal, but the deployed PSCDP helped us to improve the sanitary conditions of the studied surfaces. We believe that, in order to improve the C/D indicators in the studied institution, one should replace the decayed furniture, increase the quantity of employees in HS, accomplish continuous trainings, implement a periodic assessment program of the C/D of hospital surfaces and hire a toplevel professional, with expertise in the area of Infection Prevention and Control or in a related area, with a view to managing HS.