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        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">TO investigate the prevalence of bacterial contamination of ventilators and colonization of patients&#44; the bacteria implicated&#44; and predisposing factors in noninvasive home ventilation&#46;</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p class="elsevierStyleSimplePara elsevierViewall">Forty patients on a home noninvasive ventilation program &#40;mean &#91;SD&#93; age&#58; 63&#46;1 &#91;12&#93; years&#59; time on ventilation&#58; 30&#46;7 &#91;25&#93; months&#59; daily use&#58; 8&#46;1 &#91;2&#93; hours&#41; were enrolled in this descriptive cross-sectional study&#46; Microbiological samples for semiquantitative cultures were swabbed from the ventilator &#40;mask and tubing&#41; and the nostrils&#46; A questionnaire was completed on the underlying disease&#44; time on the ventilation program&#44; type of ventilator&#44; presence of a humidifier&#44; and attention to ventilator cleanliness and maintenance&#46; We defined &#8220;colonization&#8221; as the presence of microorganisms in the nostrils without evidence of a host immune response&#44; and &#8220;contamination&#8221; as the presence of surface microorganisms &#40;on tubing or the nasal mask&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">Potentially pathogenic bacteria were isolated from 6 ventilators &#40;15&#37;&#41; and the nasal swabs of 10 patients &#40;25&#37;&#41;&#46; <span class="elsevierStyleItalic">Staphylococcus aureus</span> was the most frequently isolated one &#40;in 5 ventilators and 6 patients&#8212;contamination coinciding with colonization in 3 cases&#41;&#46; Other potentially pathogenic bacteria isolated were <span class="elsevierStyleItalic">Proteus</span> species &#40;from the nostrils of 2 patients&#41; and an unidentified gram-negative bacillus from the ventilator&#46; On analysis by underlying disease&#44; 60&#37; of the patients with obesity had been colonized&#46; No other findings of note were obtained for other diseases&#46; Contamination and colonization correlated with attention to cleanliness and maintenance of the ventilator but not with type of ventilator&#44; time on the ventilation program&#44; or use of a humidifier&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Home mechanical ventilators are a potential source of nasal colonization&#46; The most frequently encountered microorganism was <span class="elsevierStyleItalic">S&#46; aureus&#46;</span> The degree of ventilator cleaning and disinfection seems to affect contamination&#59; thus it is necessary to impress on patients the need for adequate maintenance of their ventilators&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">Conocer la prevalencia de contaminaci&#243;n bacteriana de los ventiladores utilizados en la ventilaci&#243;n mec&#225;nica no invasiva domiciliaria&#44; la colonizaci&#243;n en los pacientes&#44; los microorganismos implicados y los factores favorecedores&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><p class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un estudio descriptivo transversal en 40 pacientes en programa de ventilaci&#243;n mec&#225;nica no invasiva domiciliaria &#40;edad media&#58; 63&#44;1 &#177; 12 a&#241;os&#59; tiempo en ventilaci&#243;n&#58; 30&#44;7 &#177; 25 meses&#59; utilizaci&#243;n diaria&#58; 8&#44;1 &#177; 2 h&#41;&#46; Se tomaron muestras microbiol&#243;gicas mediante escobi-llado del equipo de ventilaci&#243;n &#40;mascarilla y tubuladuras&#41; y de las fosas nasales para realizar cultivos semicuantitativos&#44; y se complet&#243; un cuestionario que inclu&#237;a enfermedad de base&#44; tiempo en programa de ventilaci&#243;n&#44; tipo de ventilador&#44; existen-cia de humidificador y h&#225;bitos y grado de limpieza&#46; Definimos como &#8220;colonizaci&#243;n&#8221; la presencia de microorganismos en las fosas nasales sin evidencia de respuesta org&#225;nica por parte del hu&#233;sped&#44; y &#8220;contaminaci&#243;n&#8221; como la presencia de microorganismos en una superficie &#40;tubuladura y mascarilla nasal&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Se aislaron microorganismos potencialmen-te pat&#243;genos en las conexiones de 6 equipos &#40;15&#37;&#41; y en el frotis nasal de 10 pacientes &#40;25&#37;&#41;&#46; <span class="elsevierStyleItalic">Staphylococcus aureus</span> fue el aislado con mayor frecuencia &#40;5 equipos y 6 pacientes&#59; fue coincidente en 3 casos&#41;&#46; Otros g&#233;rmenes aislados fueron <span class="elsevierStyleItalic">Proteus</span> spp&#46; &#40;2 casos en fosas nasales&#41;&#44; <span class="elsevierStyleItalic">Streptococcus pneu-moniae</span> &#40;2 casos en fosas nasales&#41; y un bacilo gramnegativo no tipificable en las conexiones&#46; Por patolog&#237;as&#44; el &#250;nico dato destacable fue que en el 60&#37; de los pacientes con obesidad exist&#237;a colonizaci&#243;n&#44; sin que hubiera datos significativos en el resto de enfermedades&#46; Existe correlaci&#243;n positiva entre el grado de limpieza macrosc&#243;pico y los aislamientos&#44; pero no entre la contaminaci&#243;n&#44; la colonizaci&#243;n y factores como tipo de ventilador&#44; tiempo en ventilaci&#243;n o uso de humidificador&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Los equipos de ventilaci&#243;n mec&#225;nica do-miciliario pueden representar una fuente potencial de colonizaci&#243;n nasal&#46; El microorganismo m&#225;s representativo en-contrado fue <span class="elsevierStyleItalic">S&#46; aureus&#46;</span> El grado de limpieza de los equipos parece influir en la contaminaci&#243;n&#44; por lo que es necesario insistir en el adecuado mantenimiento de estos equipos&#46;</p>"
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Vol. 40. Issue 9.
Pages 392-396 (September 2004)
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Vol. 40. Issue 9.
Pages 392-396 (September 2004)
Original Articles
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Bacterial Colonization and Home Mechanical Ventilation: Prevalence and Risk Factors
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J.M. Rodríguez González-Moroa, G. Andrade Viverob, J. de Miguel Díeza, S. López Martína, C. Sánchezc, J.L. Izquierdo Alonsod, P. de Lucas Ramosa,
Corresponding author
pdr01m@saludalia.com

Correspondence: Dra. P. de Lucas Ramos. Servicio de Neumología. Hospital General Universitario Gregorio Marañón. C/ Dr. Esquerdo, 46. 28007 Madrid. España
a Sección de Soporte Ventilatorio y Trastornos del Sueño, Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
b Servicio de Cuidados Intensivos, Hospital General Universitario Gregorio Marañón, Madrid, Spain
c Servicio de Microbiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
d Sección de Neumología, Hospital Universitario de Guadalajara, Guadalajara, Spain
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Objective

TO investigate the prevalence of bacterial contamination of ventilators and colonization of patients, the bacteria implicated, and predisposing factors in noninvasive home ventilation.

Material and methods

Forty patients on a home noninvasive ventilation program (mean [SD] age: 63.1 [12] years; time on ventilation: 30.7 [25] months; daily use: 8.1 [2] hours) were enrolled in this descriptive cross-sectional study. Microbiological samples for semiquantitative cultures were swabbed from the ventilator (mask and tubing) and the nostrils. A questionnaire was completed on the underlying disease, time on the ventilation program, type of ventilator, presence of a humidifier, and attention to ventilator cleanliness and maintenance. We defined “colonization” as the presence of microorganisms in the nostrils without evidence of a host immune response, and “contamination” as the presence of surface microorganisms (on tubing or the nasal mask).

Results

Potentially pathogenic bacteria were isolated from 6 ventilators (15%) and the nasal swabs of 10 patients (25%). Staphylococcus aureus was the most frequently isolated one (in 5 ventilators and 6 patients—contamination coinciding with colonization in 3 cases). Other potentially pathogenic bacteria isolated were Proteus species (from the nostrils of 2 patients) and an unidentified gram-negative bacillus from the ventilator. On analysis by underlying disease, 60% of the patients with obesity had been colonized. No other findings of note were obtained for other diseases. Contamination and colonization correlated with attention to cleanliness and maintenance of the ventilator but not with type of ventilator, time on the ventilation program, or use of a humidifier.

Conclusions

Home mechanical ventilators are a potential source of nasal colonization. The most frequently encountered microorganism was S. aureus. The degree of ventilator cleaning and disinfection seems to affect contamination; thus it is necessary to impress on patients the need for adequate maintenance of their ventilators.

Key Words:
Colonization
Contamination
Home mechanical ventilation
Objetivo

Conocer la prevalencia de contaminación bacteriana de los ventiladores utilizados en la ventilación mecánica no invasiva domiciliaria, la colonización en los pacientes, los microorganismos implicados y los factores favorecedores.

Material y métodos

Se realizó un estudio descriptivo transversal en 40 pacientes en programa de ventilación mecánica no invasiva domiciliaria (edad media: 63,1 ± 12 años; tiempo en ventilación: 30,7 ± 25 meses; utilización diaria: 8,1 ± 2 h). Se tomaron muestras microbiológicas mediante escobi-llado del equipo de ventilación (mascarilla y tubuladuras) y de las fosas nasales para realizar cultivos semicuantitativos, y se completó un cuestionario que incluía enfermedad de base, tiempo en programa de ventilación, tipo de ventilador, existen-cia de humidificador y hábitos y grado de limpieza. Definimos como “colonización” la presencia de microorganismos en las fosas nasales sin evidencia de respuesta orgánica por parte del huésped, y “contaminación” como la presencia de microorganismos en una superficie (tubuladura y mascarilla nasal).

Resultados

Se aislaron microorganismos potencialmen-te patógenos en las conexiones de 6 equipos (15%) y en el frotis nasal de 10 pacientes (25%). Staphylococcus aureus fue el aislado con mayor frecuencia (5 equipos y 6 pacientes; fue coincidente en 3 casos). Otros gérmenes aislados fueron Proteus spp. (2 casos en fosas nasales), Streptococcus pneu-moniae (2 casos en fosas nasales) y un bacilo gramnegativo no tipificable en las conexiones. Por patologías, el único dato destacable fue que en el 60% de los pacientes con obesidad existía colonización, sin que hubiera datos significativos en el resto de enfermedades. Existe correlación positiva entre el grado de limpieza macroscópico y los aislamientos, pero no entre la contaminación, la colonización y factores como tipo de ventilador, tiempo en ventilación o uso de humidificador.

Conclusiones

Los equipos de ventilación mecánica do-miciliario pueden representar una fuente potencial de colonización nasal. El microorganismo más representativo en-contrado fue S. aureus. El grado de limpieza de los equipos parece influir en la contaminación, por lo que es necesario insistir en el adecuado mantenimiento de estos equipos.

Palabras clave:
Colonización
Contaminación
Ventilación mecánica domiciliaria
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