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Contaminação microbiológica dos humidificadores usados em ventiloterapia domiciliária
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A ventiloterapia domiciliária é uma intervenção fundamental na gestão de diversas patologias respiratórias, incluindo a Síndrome da apneia obstrutiva do sono, a Síndrome de hipoventilação-obesidade e múltiplas formas de insuficiência respiratória crónica, como a doença pulmonar obstrutiva crónica e as doenças neuromusculares. Contudo, a utilização prolongada de dispositivos ventilatórios, como máscaras e humidificadores, pode favorecer a colonização microbiológica e, potencialmente, contribuir para eventos infeciosos.
O presente estudo teve como objetivos avaliar a prevalência de contaminação microbiológica em dispositivos de ventiloterapia domiciliária, identificar os microrganismos isolados, explorar os fatores associados à contaminação e investigar a sua relação com infeções respiratórias. A amostra foi constituída por 100 doentes sob ventiloterapia domiciliária, distribuídos em dois grupos de acordo com a presença ou ausência de humidificador. Foram aplicados questionários relativos às práticas de higiene, características clínicas e sociodemográficas, complementados com inspeção visual dos dispositivos e colheita de amostras microbiológicas da máscara e do humidificador.
Os resultados revelaram uma elevada taxa de contaminação nos humidificadores (87,8%) e uma taxa moderada nas máscaras (28,0%). Foram isoladas 54 espécies bacterianas distintas, com predomínio de microbiota cutânea nas máscaras e de microbiota ambiental e oportunista nos humidificadores. Verificaram-se associações estatisticamente significativas entre a contaminação e variáveis como a frequência de troca da máscara, o estado visual do humidificador e a higiene da máscara.
Na análise global, não se observou uma associação estatisticamente significativa entre a contaminação microbiológica e a ocorrência de infeções respiratórias. No entanto, a análise dirigida ao subgrupo de doentes com doença pulmonar obstrutiva crónica revelou um dado particularmente relevante: a presença de contaminação em qualquer componente do circuito ventilatório associou-se de forma significativa à ocorrência de infeções respiratórias (p = 0,024), sugerindo uma maior vulnerabilidade deste grupo às consequências clínicas da colonização microbiana. Para além desta evidência, a idade avançada, a utilização de máscara oronasal e o maior tempo de exposição à terapêutica ventilatória revelaram-se, de forma transversal, fatores significativamente associados à ocorrência de infeções respiratórias.
Este estudo aprofunda a caracterização da carga microbiológica associada à ventiloterapia domiciliária e identifica práticas de manutenção com potencial impacto na segurança clínica dos utilizadores. Os resultados evidenciam a importância de estratégias educativas orientadas para a prevenção da contaminação, especialmente em doentes mais vulneráveis, e sustentam a necessidade de recomendações específicas para a higienização adequada dos dispositivos ventilatórios em contexto domiciliário.
Home mechanical ventilation is a fundamental intervention in the management of various respiratory conditions, including obstructive sleep apnea syndrome, obesity hypoventilation syndrome, and several forms of chronic respiratory failure, such as chronic obstructive pulmonary disease and neuromuscular disorders. However, the prolonged use of ventilatory devices, such as masks and humidifiers, may promote microbial colonisation and potentially contribute to infectious events. This study aimed to assess the prevalence of microbiological contamination in home ventilation devices, identify the isolated microorganisms, explore the factors associated with contamination, and investigate their relationship with respiratory infections. A total of 100 patients undergoing home ventilation were included and divided into two groups according to the presence or absence of a humidifier. Data collection involved questionnaires on hygiene practices, clinical and sociodemographic characteristics, visual inspection of the devices, and microbiological sampling of both masks and humidifiers. The results revealed a high contamination rate in humidifiers (87,8%) and a moderate rate in masks (28,0%). A total of 54 different bacterial species were isolated, with a predominance of skin microbiota in masks and environmental and opportunistic microbiota in humidifiers. Statistically significant associations were found between contamination and variables such as mask replacement frequency, the visual condition of the humidifier, and mask hygiene. In In the overall analysis, no statistically significant association was found between microbiological contamination and the occurrence of respiratory infections. However, the analysis focused on the subgroup of patients with chronic obstructive pulmonary disease revealed a particularly relevant finding: the presence of contamination in any component of the ventilatory circuit was significantly associated with the occurrence of respiratory infections (p = 0,024), suggesting a greater vulnerability of this group to the clinical consequences of microbial colonization. In addition to this evidence, advanced age, the use of oronasal masks, and longer exposure to ventilatory therapy emerged as significant risk factors for respiratory infections across the entire sample. This study provides a detailed characterization of the microbiological burden associated with home mechanical ventilation and identifies maintenance practices with potential impact on patient safety. The findings highlight the importance of educational strategies aimed at preventing contamination, particularly in more vulnerable patients, and support the need for specific guidelines regarding the proper hygiene of ventilatory devices used in the home setting.
Home mechanical ventilation is a fundamental intervention in the management of various respiratory conditions, including obstructive sleep apnea syndrome, obesity hypoventilation syndrome, and several forms of chronic respiratory failure, such as chronic obstructive pulmonary disease and neuromuscular disorders. However, the prolonged use of ventilatory devices, such as masks and humidifiers, may promote microbial colonisation and potentially contribute to infectious events. This study aimed to assess the prevalence of microbiological contamination in home ventilation devices, identify the isolated microorganisms, explore the factors associated with contamination, and investigate their relationship with respiratory infections. A total of 100 patients undergoing home ventilation were included and divided into two groups according to the presence or absence of a humidifier. Data collection involved questionnaires on hygiene practices, clinical and sociodemographic characteristics, visual inspection of the devices, and microbiological sampling of both masks and humidifiers. The results revealed a high contamination rate in humidifiers (87,8%) and a moderate rate in masks (28,0%). A total of 54 different bacterial species were isolated, with a predominance of skin microbiota in masks and environmental and opportunistic microbiota in humidifiers. Statistically significant associations were found between contamination and variables such as mask replacement frequency, the visual condition of the humidifier, and mask hygiene. In In the overall analysis, no statistically significant association was found between microbiological contamination and the occurrence of respiratory infections. However, the analysis focused on the subgroup of patients with chronic obstructive pulmonary disease revealed a particularly relevant finding: the presence of contamination in any component of the ventilatory circuit was significantly associated with the occurrence of respiratory infections (p = 0,024), suggesting a greater vulnerability of this group to the clinical consequences of microbial colonization. In addition to this evidence, advanced age, the use of oronasal masks, and longer exposure to ventilatory therapy emerged as significant risk factors for respiratory infections across the entire sample. This study provides a detailed characterization of the microbiological burden associated with home mechanical ventilation and identifies maintenance practices with potential impact on patient safety. The findings highlight the importance of educational strategies aimed at preventing contamination, particularly in more vulnerable patients, and support the need for specific guidelines regarding the proper hygiene of ventilatory devices used in the home setting.
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Ventiloterapia domiciliária Humidificador Contaminação microbiológica Práticas de higiene Infeções respiratórias Home mechanical ventilation Humidifier Microbiological contamination Hygiene practices Respiratory infections