Desinfeksi Nebulizer yang Terkontaminasi Klebsiella Pneumoniae untuk Pencegahan Ventilator-Associated Pneumonia (VAP)
Abstract
This study aims to evaluate the effectiveness of nebulizer disinfection contaminated with Klebsiella pneumoniae using one of the materials widely used in hospitals, chlorhexidine. The research method used in vitro experiments. K. pneumoniae was isolated from hospital samples and then multiplied for 24 hours. The nebulizer jet was then intentionally contaminated with K. pneumoniae and disinfected using chlorhexidine solution at various concentrations. The effectiveness of the disinfection process was then assessed using culture and calculated based on the number of colonies formed after the disinfection process. The results showed that chlorhexidine was effective in significantly reducing the number of K. pneumoniae colonies, especially at a concentration of 2.5%. The use of chlorhexidine as a routine disinfectant in pneumatic nebulizers could be an effective strategy in the prevention of VAP, thus improving safety in critically ill patients. This study supports the use of chlorhexidine as part of a disinfection protocol to reduce the incidence of VAP caused by K. pneumoniae. In conclusion, chlorhexidine is effective in reducing the number of K. pneumoniae colonies so that it can be a disinfectant to prevent Ventilator-Associated Pneumonia (VAP).
Keywords : Disinfectant, Jet Nebulizer, Klebsiella pneumoniae, Ventilator-Associated Pneumonia
References
Alajlan, A. A., Mukhtar, L. E., Almussallam, A. S., Alnuqaydan, A. M., Albakiri, N. S., Almutari, T. F., Bin Shehail, K. M., Aldawsari, F. S., & Alajel, S. M. (2022). Assessment of Disinfectant Efficacy in Reducing Microbial Growth. PLOS ONE, 17(6), e0269850. https://doi.org/10.1371/journal.pone.0269850
Ariningpraja, R. T., Widyawati, I. Y., & Fatma, E. P. L. (2023). Apa yang Harus Dipahami Perawat Tentang Pencegahan Nosokomial Terkait Multidrug-Resistant Organisms (MDROS)? Journal of Telenursing (JOTING), 5(2), 2446–2458. https://doi.org/10.31539/joting.v5i2.7683
Arnott, A., Watson, M., & Sim, M. (2024). Nebuliser Therapy in Critical Care: The Past, Present and Future. Journal of the Intensive Care Society, 25(1), 78–88. https://doi.org/10.1177/17511437231199899
Chinese College of Emergency Physicians (CCEP). (2019). Expert Consensus on Nebulization Therapy in Pre-Hospital and in-Hospital Emergency Care. Annals of Translational Medicine, 7(18), 487–487. https://doi.org/10.21037/atm.2019.09.44
Dhand, R. (2017). How Should Aerosols Be Delivered During Invasive Mechanical Ventilation? Respiratory Care, 62(10), 1343–1367. https://doi.org/10.4187/respcare.05803
Dubovoy, V., Desai, P., Hao, Z., Cheng, C., Verma, G., Wojtas, L., Brinzari, T. V., Boyd, J. M., Ma, S., Asefa, T., & Pan, L. (2020). Synthesis, Characterization, and Antimicrobial Investigation of a Novel Chlorhexidine Cyclamate Complex. Crystal Growth & Design, 20(8), 4991–4999. https://doi.org/10.1021/acs.cgd.0c00107
Harris, J. C., Collins, M. S., Huang, P. H., Schramm, C. M., Nero, T., Yan, J., & Murray, T. S. (2022). Bacterial Surface Detachment during Nebulization with Contaminated Reusable Home Nebulizers. Microbiology Spectrum, 10(1). https://doi.org/10.1128/spectrum.02535-21
Huang, Y., Jiao, Y., Zhang, J., Xu, J., Cheng, Q., Li, Y., Liang, S., Li, H., Gong, J., Zhu, Y., Song, L., Rong, Z., Liu, B., Jie, Z., Sun, S., Li, P., Wang, G., & Qu, J. (2018). Microbial Etiology and Prognostic Factors of Ventilator-associated Pneumonia: A Multicenter Retrospective Study in Shanghai. Clinical Infectious Diseases, 67(suppl_2), S146–S152. https://doi.org/10.1093/cid/ciy686
Hutauruk, S. M., Hermani, B., & Monasari, P. (2021). Role of Chlorhexidine on Tracheostomy Cannula Decontamination in Relation to The Growth of Biofilm-Forming Bacteria Colony-A Randomized Controlled Trial Study. Annals of Medicine and Surgery, 67(June), 102491. https://doi.org/10.1016/j.amsu.2021.102491
Kharel, S., Bist, A., & Mishra, S. K. (2021). Ventilator-Associated Pneumonia Among ICU Patients in WHO Southeast Asian Region: A Systematic Review. PLOS ONE, 16(3), e0247832. https://doi.org/10.1371/journal.pone.0247832
Kohbodi, G. A., Rajasurya, V., & Noor, A. (2021). Ventilator-associated Pneumonia. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK507711/
Köhler, A. T., Rodloff, A. C., Labahn, M., Reinhardt, M., Truyen, U., & Speck, S. (2019). Evaluation of Disinfectant Efficacy Against Multidrug-Resistant Bacteria: A Comprehensive Analysis of Different Methods. American Journal of Infection Control, 47(10), 1181–1187. https://doi.org/10.1016/j.ajic.2019.04.001
Li, L., Huang, L., Liu, X., Ye, Y., Sai, F., & Huang, H. (2023). Intensive Care Unit-Acquired Pneumonia Caused by Klebsiella Pneumoniae in China: Risk Factors and Prediction Model of Mortality. Medicine, 102(12), e33269. https://doi.org/10.1097/MD.0000000000033269
Masyithah, I., Hadi, U., & Koendhori, E. B. (2021). Ventilator-Associated Pneumonia in Dr. Soetomo General Hospital Surabaya. JUXTA: Jurnal Ilmiah Mahasiswa Kedokteran Universitas Airlangga, 12(2), 57. https://doi.org/10.20473/juxta.V12I22021.57-60
Mc Carlie, S., Boucher, C. E., & Bragg, R. R. (2020). Molecular basis of bacterial disinfectant resistance. Drug Resistance Updates, 48, 100672. https://doi.org/10.1016/j.drup.2019.100672
Milani, E. S., Hasani, A., Varschochi, M., Sadeghi, J., Memar, M. Y., & Hasani, A. (2021). Biocide Resistance in Acinetobacter Baumannii: Appraising the Mechanisms. Journal of Hospital Infection, 117, 135–146. https://doi.org/10.1016/j.jhin.2021.09.010
Papazian, L., Klompas, M., & Luyt, C. E. (2020). Ventilator-Associated Pneumonia in Adults: A Narrative Review. Intensive Care Medicine, 46(5), 888–906. https://doi.org/10.1007/S00134-020-05980-0/TABLES/4
Ramadan, R. A., Bedawy, A. M., Negm, E. M., Hassan, T. H., Ibrahim, D. A., ElSheikh, S. M., & Amer, R. M. (2022). Carbapenem-Resistant Klebsiella pneumoniae Among Patients with Ventilator-Associated Pneumonia: Evaluation of Antibiotic Combinations and Susceptibility to New Antibiotics. Infection and Drug Resistance, Volume 15, 3537–3548. https://doi.org/10.2147/IDR.S371248
Rozman, U., Pušnik, M., Kmetec, S., Duh, D., & Šostar Turk, S. (2021). Reduced Susceptibility and Increased Resistance of Bacteria against Disinfectants: A Systematic Review. Microorganisms, 9(12), 2550. https://doi.org/10.3390/microorganisms9122550
Russell, N., Clements, M. N., Azmery, K. S., Bekker, A., Bielicki, J., Dramowski, A., Ellis, S., Fataar, A., Hoque, M., LeBeau, K., O’Brien, S., Schiavone, F., Skoutari, P., Islam, M. S., Saha, S. K., Walker, A. S., Whitelaw, A., & Sharland, M. (2024). Safety And Efficacy Of Whole-Body Chlorhexidine Gluconate Cleansing with or Without Emollient in Hospitalised Neonates (Neochg): A Multicentre, Randomised, Open-Label, Factorial Pilot Trial. eClinicalMedicine, 69, 102463. https://doi.org/10.1016/j.eclinm.2024.102463
Sikora, A., & Zahra, F. (2022). Nosocomial Infections. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK559312/
Spalding, M. C., Cripps, M. W., & Minshall, C. T. (2017). Ventilator-Associated Pneumonia. Critical Care Clinics, 33(2), 277–292. https://doi.org/10.1016/j.ccc.2016.12.009
Swanson, C. S., Dhand, R., Cao, L., Ferris, J., Elder, C. S., & He, Q. (2022). Microbiome Profiles of Nebulizers in Hospital Use. Journal of Aerosol Medicine and Pulmonary Drug Delivery, 35(4), 212–222. https://doi.org/10.1089/jamp.2021.0032
Tong, C., Hu, H., Chen, G., Li, Z., Li, A., & Zhang, J. (2021). Disinfectant Resistance in Bacteria: Mechanisms, Spread, and Resolution Strategies. Environmental Research, 195, 110897. https://doi.org/10.1016/j.envres.2021.110897
Torabi, S., & Zahra, F. (2022). Disinfectants. Encyclopedia of Infection and Immunity, 4, 630–639. https://doi.org/10.1016/B978-0-12-818731S-9.00206-8
Trubiano, J. A., & Padiglione, A. A. (2015). Nosocomial infections in the intensive care unit. Anaesthesia & Intensive Care Medicine, 16(12), 598–602. https://doi.org/10.1016/j.mpaic.2015.09.010
Tsioutis, C., Eichel, V. M., & Mutters, N. T. (2021). Transmission of Klebsiella Pneumoniae Carbapenemase (KPC)-producing Klebsiella Pneumoniae : the Role of Infection Control. Journal of Antimicrobial Chemotherapy, 76(Supplement_1), i4–i11. https://doi.org/10.1093/jac/dkaa492
Wei, J., He, L., Weng, F., Huang, F., & Teng, P. (2021). Effectiveness of Chlorhexidine in Preventing Infections Among Patients Undergoing Cardiac Surgeries: A Meta-Analysis and Systematic Review. Antimicrobial Resistance & Infection Control, 10(1), 140. https://doi.org/10.1186/s13756-021-01009-3
Wei, L., Wu, L., Wen, H., Feng, Y., Zhu, S., Liu, Y., Tang, L., Doughty, E., van Schaik, W., McNally, A., & Zong, Z. (2021). Spread of Carbapenem-Resistant Klebsiella pneumoniae in an Intensive Care Unit: A Whole-Genome Sequence-Based Prospective Observational Study. Microbiology Spectrum, 9(1). https://doi.org/10.1128/Spectrum.00058-21
Ariningpraja, R. T., Widyawati, I. Y., & Fatma, E. P. L. (2023). Apa yang Harus Dipahami Perawat Tentang Pencegahan Nosokomial Terkait Multidrug-Resistant Organisms (MDROS)? Journal of Telenursing (JOTING), 5(2), 2446–2458. https://doi.org/10.31539/joting.v5i2.7683
Arnott, A., Watson, M., & Sim, M. (2024). Nebuliser Therapy in Critical Care: The Past, Present and Future. Journal of the Intensive Care Society, 25(1), 78–88. https://doi.org/10.1177/17511437231199899
Chinese College of Emergency Physicians (CCEP). (2019). Expert Consensus on Nebulization Therapy in Pre-Hospital and in-Hospital Emergency Care. Annals of Translational Medicine, 7(18), 487–487. https://doi.org/10.21037/atm.2019.09.44
Dhand, R. (2017). How Should Aerosols Be Delivered During Invasive Mechanical Ventilation? Respiratory Care, 62(10), 1343–1367. https://doi.org/10.4187/respcare.05803
Dubovoy, V., Desai, P., Hao, Z., Cheng, C., Verma, G., Wojtas, L., Brinzari, T. V., Boyd, J. M., Ma, S., Asefa, T., & Pan, L. (2020). Synthesis, Characterization, and Antimicrobial Investigation of a Novel Chlorhexidine Cyclamate Complex. Crystal Growth & Design, 20(8), 4991–4999. https://doi.org/10.1021/acs.cgd.0c00107
Harris, J. C., Collins, M. S., Huang, P. H., Schramm, C. M., Nero, T., Yan, J., & Murray, T. S. (2022). Bacterial Surface Detachment during Nebulization with Contaminated Reusable Home Nebulizers. Microbiology Spectrum, 10(1). https://doi.org/10.1128/spectrum.02535-21
Huang, Y., Jiao, Y., Zhang, J., Xu, J., Cheng, Q., Li, Y., Liang, S., Li, H., Gong, J., Zhu, Y., Song, L., Rong, Z., Liu, B., Jie, Z., Sun, S., Li, P., Wang, G., & Qu, J. (2018). Microbial Etiology and Prognostic Factors of Ventilator-associated Pneumonia: A Multicenter Retrospective Study in Shanghai. Clinical Infectious Diseases, 67(suppl_2), S146–S152. https://doi.org/10.1093/cid/ciy686
Hutauruk, S. M., Hermani, B., & Monasari, P. (2021). Role of Chlorhexidine on Tracheostomy Cannula Decontamination in Relation to The Growth of Biofilm-Forming Bacteria Colony-A Randomized Controlled Trial Study. Annals of Medicine and Surgery, 67(June), 102491. https://doi.org/10.1016/j.amsu.2021.102491
Kharel, S., Bist, A., & Mishra, S. K. (2021). Ventilator-Associated Pneumonia Among ICU Patients in WHO Southeast Asian Region: A Systematic Review. PLOS ONE, 16(3), e0247832. https://doi.org/10.1371/journal.pone.0247832
Kohbodi, G. A., Rajasurya, V., & Noor, A. (2021). Ventilator-associated Pneumonia. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK507711/
Köhler, A. T., Rodloff, A. C., Labahn, M., Reinhardt, M., Truyen, U., & Speck, S. (2019). Evaluation of Disinfectant Efficacy Against Multidrug-Resistant Bacteria: A Comprehensive Analysis of Different Methods. American Journal of Infection Control, 47(10), 1181–1187. https://doi.org/10.1016/j.ajic.2019.04.001
Li, L., Huang, L., Liu, X., Ye, Y., Sai, F., & Huang, H. (2023). Intensive Care Unit-Acquired Pneumonia Caused by Klebsiella Pneumoniae in China: Risk Factors and Prediction Model of Mortality. Medicine, 102(12), e33269. https://doi.org/10.1097/MD.0000000000033269
Masyithah, I., Hadi, U., & Koendhori, E. B. (2021). Ventilator-Associated Pneumonia in Dr. Soetomo General Hospital Surabaya. JUXTA: Jurnal Ilmiah Mahasiswa Kedokteran Universitas Airlangga, 12(2), 57. https://doi.org/10.20473/juxta.V12I22021.57-60
Mc Carlie, S., Boucher, C. E., & Bragg, R. R. (2020). Molecular basis of bacterial disinfectant resistance. Drug Resistance Updates, 48, 100672. https://doi.org/10.1016/j.drup.2019.100672
Milani, E. S., Hasani, A., Varschochi, M., Sadeghi, J., Memar, M. Y., & Hasani, A. (2021). Biocide Resistance in Acinetobacter Baumannii: Appraising the Mechanisms. Journal of Hospital Infection, 117, 135–146. https://doi.org/10.1016/j.jhin.2021.09.010
Papazian, L., Klompas, M., & Luyt, C. E. (2020). Ventilator-Associated Pneumonia in Adults: A Narrative Review. Intensive Care Medicine, 46(5), 888–906. https://doi.org/10.1007/S00134-020-05980-0/TABLES/4
Ramadan, R. A., Bedawy, A. M., Negm, E. M., Hassan, T. H., Ibrahim, D. A., ElSheikh, S. M., & Amer, R. M. (2022). Carbapenem-Resistant Klebsiella pneumoniae Among Patients with Ventilator-Associated Pneumonia: Evaluation of Antibiotic Combinations and Susceptibility to New Antibiotics. Infection and Drug Resistance, Volume 15, 3537–3548. https://doi.org/10.2147/IDR.S371248
Rozman, U., Pušnik, M., Kmetec, S., Duh, D., & Šostar Turk, S. (2021). Reduced Susceptibility and Increased Resistance of Bacteria against Disinfectants: A Systematic Review. Microorganisms, 9(12), 2550. https://doi.org/10.3390/microorganisms9122550
Russell, N., Clements, M. N., Azmery, K. S., Bekker, A., Bielicki, J., Dramowski, A., Ellis, S., Fataar, A., Hoque, M., LeBeau, K., O’Brien, S., Schiavone, F., Skoutari, P., Islam, M. S., Saha, S. K., Walker, A. S., Whitelaw, A., & Sharland, M. (2024). Safety And Efficacy Of Whole-Body Chlorhexidine Gluconate Cleansing with or Without Emollient in Hospitalised Neonates (Neochg): A Multicentre, Randomised, Open-Label, Factorial Pilot Trial. eClinicalMedicine, 69, 102463. https://doi.org/10.1016/j.eclinm.2024.102463
Sikora, A., & Zahra, F. (2022). Nosocomial Infections. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK559312/
Spalding, M. C., Cripps, M. W., & Minshall, C. T. (2017). Ventilator-Associated Pneumonia. Critical Care Clinics, 33(2), 277–292. https://doi.org/10.1016/j.ccc.2016.12.009
Swanson, C. S., Dhand, R., Cao, L., Ferris, J., Elder, C. S., & He, Q. (2022). Microbiome Profiles of Nebulizers in Hospital Use. Journal of Aerosol Medicine and Pulmonary Drug Delivery, 35(4), 212–222. https://doi.org/10.1089/jamp.2021.0032
Tong, C., Hu, H., Chen, G., Li, Z., Li, A., & Zhang, J. (2021). Disinfectant Resistance in Bacteria: Mechanisms, Spread, and Resolution Strategies. Environmental Research, 195, 110897. https://doi.org/10.1016/j.envres.2021.110897
Torabi, S., & Zahra, F. (2022). Disinfectants. Encyclopedia of Infection and Immunity, 4, 630–639. https://doi.org/10.1016/B978-0-12-818731S-9.00206-8
Trubiano, J. A., & Padiglione, A. A. (2015). Nosocomial infections in the intensive care unit. Anaesthesia & Intensive Care Medicine, 16(12), 598–602. https://doi.org/10.1016/j.mpaic.2015.09.010
Tsioutis, C., Eichel, V. M., & Mutters, N. T. (2021). Transmission of Klebsiella Pneumoniae Carbapenemase (KPC)-producing Klebsiella Pneumoniae : the Role of Infection Control. Journal of Antimicrobial Chemotherapy, 76(Supplement_1), i4–i11. https://doi.org/10.1093/jac/dkaa492
Wei, J., He, L., Weng, F., Huang, F., & Teng, P. (2021). Effectiveness of Chlorhexidine in Preventing Infections Among Patients Undergoing Cardiac Surgeries: A Meta-Analysis and Systematic Review. Antimicrobial Resistance & Infection Control, 10(1), 140. https://doi.org/10.1186/s13756-021-01009-3
Wei, L., Wu, L., Wen, H., Feng, Y., Zhu, S., Liu, Y., Tang, L., Doughty, E., van Schaik, W., McNally, A., & Zong, Z. (2021). Spread of Carbapenem-Resistant Klebsiella pneumoniae in an Intensive Care Unit: A Whole-Genome Sequence-Based Prospective Observational Study. Microbiology Spectrum, 9(1). https://doi.org/10.1128/Spectrum.00058-21
Published
2024-08-30
Section
Articles
Copyright (c) 2024 Rustiana Tasya Ariningpraja, Shila Wisnasari, Retno Lestari, Wendi Genta Perkasa, Rifka Anindita Suwondo
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
