Colonização nasal em profi ssionais de enfermagem de unidades especializadas em HIV / aids Nasal colonization in nursing professionals from units specialized in HIV / AIDS

Objective: to investigate the presence of microorganisms in the nostrils of the nursing professionals of a Brazilian teaching hospital. Method: cross-sectional study in two inpatient units specialized in HIV/AIDS. Nasal secretion samples of nursing professionals were collected in one month. The samples were processed at the microbiology laboratory of the institution and analyzed using the Statistical Package for the Social Sciences (SPSS) software, version 19.0. Ethical aspects were abided. Results: from the 73 members of the nursing staff, samples of nasal secretions were collected from 61 (80.2%). Six types of microorganisms were isolated in 22 (41.0%) positive cultures. It is noteworthy that Staphylococcus aureus accounted for 22.9%, four of them oxacillin-resistant (MRSA). Conclusion: Staphylococcus aureus microorganism accounted for the largest prevalence in individuals of this study. Descriptors: AIDS Serodiagnosis; Nursing Staff; Staphylococcus Aureus; Bacteria. RESUMEN Objetivo: investigar la presencia de microorganismos en las fosas nasales del personal de enfermería de un hospital universitario brasileño. Método: estudio transversal en dos unidades de hospitalización especializados en VIH/SIDA. Muestras de secreción nasal de enfermeras fueron recolectados durante un mes. Las muestras fueron procesadas en el laboratorio de microbiología de la institución y se analizaron con el paquete estadístico para el software de Ciencias Sociales (SPSS) versión 19.0. Los aspectos éticos fueron cubiertos. Resultados: 73 de los profesionales de enfermería, se recogieron muestras de las secreciones nasales de 61 (80,2%). Se aislaron seis tipos de microorganismos en 22 (41,0%) cultivos positivos. Es de destacar que el Staphylococcus aureus representó el 22,9%, cuatro oxacilina-resistente (MRSA). Conclusión: Staphylococcus aureus fue la prevalencia más microorganismo en los individuos de este estudio. Palabras clave: Serodiagnóstico del SIDA; Personal de Enfermería; Staphylococcus Aureus; Bacterias. Colonização nasal em profi ssionais de enfermagem de unidades especializadas em HIV/aids Nasal colonization in nursing professionals from units specialized in HIV/AIDS Colonización nasal en unidades de enfermeras especializadas en el VIH/SIDA Elucir Gir E-mail: egir@eerp.usp.br AUTOR CORRESPONDENTE Colonização nasal em profissionais de enfermagem de unidades especializadas em HIV/aids 321 Rev Bras Enferm. 2015 mar-abr;68(2):320-4. INTRODUÇÃO A resistência aos antimicrobianos é considerada um problema de saúde pública mundial. Dois principais fatores têm contribuído para o acentuado aumento desta resistência: o uso indevido de antibióticos e a disseminação de micro-organismos resistentes(1). Segundo os Centros de Prevenção e Controle de Doenças (CDC), micro-organismos resistentes são aqueles resistentes a uma ou mais classes de antimicrobianos; além disso, merecem atenção especial nas unidades de saúde(2). Um grupo de patógenos responsáveis pela maioria das infecções relacionadas a assistência à saúde, é conhecido como ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa e a espécie Enterobacter)(3). A ocorrência dessas infecções torna-se cada vez mais presente nos serviços de saúde(4). Maior compreensão da virulência, resistência, transmissão e a patogenicidade destes micro-organismos podem direcionar estratégias inovadoras para o desenvolvimento de novas opções terapêuticas(1). As principais medidas de controle de micro-organismos multirresistentes consistem na identificação precoce de pacientes colonizados ou infectados, identificação do isolamento dos pacientes com placas ilustrativas e adesão às medidas de precauções de contato recomendadas pelos Serviços de Controle de Infecção Hospitalar(5). Os profissionais de saúde, sobretudo a equipe de enfermagem por ocasião do contato direto com pacientes, objetos e superfícies ambientais, constitui uma classe susceptível à colonização por patógenos resistentes(6). As mãos desses profissionais são consideradas o principal veículo de transmissão das bactérias entre os pacientes(7-8). Portanto, torna-se imprescindível a adesão às medidas de controle e prevenção. As precauções-padrão (PP) constituem um conjunto de medidas imprescindíveis para minimizar a disseminação de micro-organismos, principalmente a higienização das mãos(9-10). A microbiota nasofaríngea representa o sítio primário de colonização por micro-organismos de importância clínica, como o Staphylococcus aureus(11). Sendo assim, é o sítio mais indicado para a coleta de espécimes com o propósito de triagem(12).


INTRODUCTION
Antimicrobial resistance is considered a problem in global public health.Two main factors have contributed to the sharp increase of this resistance: the inappropriate use of antibiotics and the spread of resistant microorganisms (1) .
According to the Centers for Disease Prevention and Control (CDC), resistant microorganisms are those resistant to one or more classes of antimicrobials.Special attention must be paid to these microorganisms in health units (2) .
A group of pathogens responsible for most infections related to health care is known as ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and the Enterobacter species) (3) .These infections are increasingly present in health services (4) .A better understanding of virulence, resistance, transmission and pathogenicity of these microorganisms can drive innovative strategies for the development of new therapeutic options (1) .
The main control measures for multi-resistant microorganisms involve the early identification of colonized or infected patients, identification of patients isolation with illustrative plates and compliance with contact precautions recommended by the Hospital Infection Control Services (5) .
Health professionals, especially the nursing staff due to direct contact with patients, objects and environmental surfaces, are susceptible to colonization by resistant pathogens (6) .The hands of these professionals are considered as the main means for the transmission of bacteria among patients (7)(8) .
Therefore, it is essential to adopt control and prevention measures.Standard precautions (SP) are a set of essential measures to minimize the spread of microorganisms, especially hands hygiene (9)(10) .
The nasopharyngeal microbiota is the primary site of colonization by microorganisms of clinical importance, such as Staphylococcus aureus (11) .Therefore, it is the most suitable site for the collection of specimens for screening (12) .

OBJECTIVE
Considering the relevance of this topic, the aim of this study was to investigate the presence of microorganisms in the nostrils of the nursing professionals of a Brazilian teaching hospital, as this survey can provide support for the implementation of measures for microorganisms control and improve clinical practice in care for individuals, in this case the population with HIV/AIDS.

METHOD
This is a cross-sectional study with a quantitative approach.The population studied involved nursing professionals (nurses, nursing technicians and nursing assistants) working in the care of patients with HIV/AIDS in two specialized care units, situated in a Brazilian teaching hospital.
The list of professionals and their functions was obtained from the Human Resources Department of the hospital.It was possible to identify 73 professionals (16 nurses, 55 nursing assistants and 2 nursing technicians) working in the specialized care units and providing care services.All professionals were invited to participate in the research.Professionals performing administrative functions and on sick leave during the data collection period were excluded.
The project was evaluated and approved by the Research Ethics Committee of the institution in compliance with ethical aspects (Case number 1304/2011).
All nursing professionals, after being invited to participate in the research, were asked to read the information contained in the Informed Consent Form and to state their approval by signing it.Complete anonymity and confidentiality of identity and information provided were guaranteed to participants.
For data collection, an instrument with sociodemographic variables was used.Then the collection of nasal secretion using a Stuart Swab was performed.Data were collected between January and February 2012.
Samples of nasal secretions collected were processed at the microbiology laboratory of the institution.The material was seeded in culture media as blood agar, mannitol, MacConkey agar.For identification of microorganisms, Vitek 2 (Biomerieux) automated system was used by means of Vitek 2 GP Test Kit cards for gram-positive bacteria, and Vitek 2 GN Test Kit for gram-negative bacteria.AST-P585 cards were used to assess MRSA sensitivity to antibiotics (AST -antibiotic sensitivity testing), and AST-N105 cards for analysis of sensitivity to antibiotics of gram-negative bacteria.
It is noteworthy that the positive results for multi-resistant microorganisms identified were communicated directly to the nursing professional by the head researcher and, by agreement, reported to the Hospital Infection Control Committee of the institution for action.
Data were organized in a Microsoft Excel ® 2007 spreadsheet and analyzed using the Statistical Package for the Social Sciences (SPSS) software, version 19.0.
Of the 61 samples of nasal secretion processed, 41 (67.2%) were negative.Twenty (22.8%) samples of nasal secretion had positive cultures for some microorganisms.Staphylococcus aureus was the most common bacteria and represented 23.0% (14/61).From the amount of 14 Staphylococcus aureus, four (28.6%) were resistant to oxacillin (MRSA), which represents a prevalence of 6.6%, or 4/61.Enterobacter aerogenes was present in two (3.3%) of the samples of nasal secretion.Klebsiella pneumoniae, Proteus mirabilis, Staphylococcus lugdunensis and Pseudomomas aeruginosa were found in four different samples (6.6%) of nasal secretion from nursing professionals.
It is noteworthy that two nurses had positive nasal culture for two microorganisms, Staphylococcus aureus and Enterobacter aerogenes.

DISCUSSION
Prolonged hospitalization, prolonged or inappropriate use of antimicrobials, and the presence of invasive procedures are factors that contribute to human colonization by microorganisms in hospitals (13) .
Research performed in a unit specialized in HIV/AIDS found that immunosuppression and prolonged use of antimicrobials, associated with prolonged hospitalization could facilitate colonization by multiresistant bacteria in individuals with HIV/AIDS (14) .Consequently, nursing professionals providing direct care to these patients are more susceptible to contamination and colonization by resistant pathogens.
A study indicates that nursing professionals represent a more vulnerable group to colonization by microorganisms because they are in constant contact with potentially colonized patients and contaminated hospital materials (6) .
The preference of staphylococci in colonizing the nasal vestibule was demonstrated in this study because it was the microorganism most frequently isolated in samples of nasal secretion.The prevalence rate of Staphylococcus aureus was 22.9%.This sustains an investigation in Pernambuco, which identified a colonization rate of 25.8% among nursing professionals.In the same study, 48.8% of the biological samples from the 39 colonized individuals were isolated from the nasal cavity (6) .
Research made in a public hospital in the state of São Paulo, Brazil, indicated an MRSA colonization rate of 4.1% in healthcare professionals (17) .In this study, the MRSA colonization rate found was 6.6%.
Although healthcare professionals recognize hands hygiene as a simple procedure, studies have shown that this measure is not totally adopted (18)(19) .Despite the awareness about the effectiveness of hands hygiene, low compliance with this procedure by health professionals was identified (20) .
Research performed in an institution with endemic levels of MRSA among patients implemented a strategy that reduced such levels from 1.8 to 0.68 cases per thousand days of hospitalization in a period of five years (21) .Named as multimodal strategy, one of its implementations established the universal application of SP by professionals, especially emphasizing the five stages of hands hygiene.
Actions towards professionals, especially the use of precautions, are among the main measures to reduce the transmission of these microorganisms.
Notwithstanding the importance of the subject addressed, few studies have been published on the colonization by resistant microorganisms of nursing professionals working in specific units for care of patients with HIV/AIDS.
A limitation of this study was the participation of specific professionals from a health institution, which did not allow data generalization.But it is noteworthy that this fact does not diminish its importance, since this event provides subsidies to answer some questions about the colonization of nursing professionals, allowing an approach to the subject, in addition to the promotion of new broader research on the theme, covering a multiprofessional team.

CONCLUSION
The category of nursing professionals with the largest representation in this study was nursing assistants, totaling 75.4%, with the same proportion of women.
The most prevalent microorganism in this study was Staphylococcus aureus, representing 23.0% of the bacteria identified measures during care provision in order to interrupt transmission and reduce the potential for dissemination of these microorganisms.It is also noteworthy that the institution must maintain constant surveillance in order to identify factors that could contribute to potential infections. in nasal cavity.It is worth emphasizing the concerning presence of 6.6% of MRSA.
Considering that nursing professionals are more susceptible to colonization by microorganisms in their work activities, there must be awareness about the adoption of preventive

Table 1 -
Distribution of microorganisms present in sam-