Manual resuscitators in successive use in the same patient: reservoir of multi- and extensively resistant bacteria

Area of Science:

• Infectious Diseases
• Microbiology
• Critical Care Medicine

Background:

• Manual resuscitators (MRs) are critical for ventilation in intensive care units (ICUs).
• The potential for bacterial contamination of MRs poses a risk to patient health.
• Standard decontamination protocols may not be sufficient to eliminate microbial load.

Purpose of the Study:

• To quantify bacterial load on manual resuscitators (MRs) during use in an ICU.
• To identify predominant bacterial species and assess their antimicrobial resistance.
• To inform recommendations for MR handling and patient safety.

Main Methods:

• Swab samples collected from MR connectors of 20 devices at 0, 24, and 48 hours of use in the same patient.
• Bacterial isolation and identification using standard microbiological techniques.
• Antimicrobial susceptibility testing to determine multidrug resistance patterns.

Main Results:

• A total of 54 bacterial isolates were recovered from 20 MRs.
• Bacterial load increased significantly over time: 6 isolates at 0h, 17 at 24h, and 31 at 48h.
• Predominant isolates included Staphylococcus aureus, Acinetobacter baumannii, Serratia marcescens, and Pseudomonas aeruginosa, with widespread multidrug resistance.

Conclusions:

• Manual resuscitators accumulate significant bacterial contamination during patient use.
• Multidrug-resistant bacteria commonly colonize MRs, increasing infection risk.
• Enhanced decontamination and more frequent MR replacement are recommended to mitigate patient (re)colonization and infection risk.