Evaluating repeated utilization of Suction Catheters

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In the hospital setting, different instruments are used to promote wellness to the patients. One example of those instruments is the suction catheter. The suction catheter is used for critically ill or injured patient who requires a breathing tube or tracheostomy tube that needs occasional suctioning to remove the secretions from the airway. According to Kaye Rolls, author of "Suction Catheters - Version 2", Suctioning can be distressing for the patient however removal of these secretions is vitally important for the recovery of the patient.

The aim of suction catheter is to clear secretions, thereby maintaining a patent airway and improving ventilation and oxygenation. Removal of such secretions also minimizes the risk of atelectasis. The procedure of airway suctioning is a common practice in the treatment of children with a variety of pathologies. Most frequently undertaken to remove excessive or retained secretions from a child's respiratory tract, it may also be necessary to obtain specimens for laboratory examination.  It may be performed as a single procedure by nursing and medical staff (or occasionally by parents), or it may be incorporated into a chest physiotherapy regime.

Suction catheter has different types. And each type has a specific purpose. Suction catheter may be either open tipped or whistle tipped. The whistle tipped catheter is less irritating to respiratory tissues, although the open-tipped catheter may be more effective for removing thick mucus plugs. An oral suction tube, or Yankauer device, is used to suction the oral cavity. Most suction catheter has a thumb port on the side to control the suction. The

catheter is connected to suction tubing, which in turn is connected to a collection chamber and suction control gauge.

Most public hospitals use suction catheter more than once because of the lack of affordability to purchase a new one. Because of this there will be a possibility for the microorganisms to harbor and proliferate due to frequent utilization of used suction catheter. And with this, the researchers think that it will be risky for the patient to utilize a suction catheter that was used more than once.

The researchers chose this topic as the subject of their study to validate the reliability of the data gathered during the course of the study.

Statement of the Problem

The study aims to assess the presence of microorganisms to the frequently used Suction Catheter of "Tarlac Provincial Hospital."

What are the types of microorganism that can be seen on the suction catheter via culture media the span of :

1.1 One Day

1.2 Two Days

1.3 Three Days

What are the most common of microorganisms which may be present on the catheter in the span of:

2.1 One Day

2.2 Two Days

2.3 Three Days

Scope and Limitation

The study will determine the presence, type and number of microorganisms in suction catheter used more than twice. The researchers will gather information on confined patients who are using suction catheter at Tarlac Provincial Hospital. The information will be gathered through culture of the suction catheter. The researcher will gather information in the span of one day, two days and three days. The result of the culture of suction catheter will be discussed and analyzed. The study is only limited to the suction catheter used at a time frame of one day, two days and three days.

Significance of the Study

This study focuses on the suction catheter uses two or more times. The findings of the study aims to promote a sense of awareness to the nursing department the extent  of using aseptic technique practice of the nurse, so they can impose measures; policies and regulations about the strict compliance of aseptic technique in a suction catheter.

Student. The study hopes to benefit the student in developing a sense of responsibility to improve their knowledge from classroom discussion and clinical experience. . Thus, improving their skills in protecting one self and their patient from potential health hazards. They will be able to recognize the importance of strict adherence to aseptic technique in the delivery of total nursing care, so they will become effective and efficient student nurses. The study will provide students further knowledge. The research will serve as an inspiration to the student to explore more and uncover the capabilities of other useful living organisms to prevent the growth of disease causing microorganisms.

Institution. The positive result of the study may help them to understand the experiment about a suction catheter uses in two or more times. On the other hand, they will learn on the responses of the respondents so that they could teach in a different approach to further enhance the learning of their students.

Future researchers. The research will also contribute to other researchers' knowledge in their search to understand the microorganisms in the suction catheter.

Nursing profession. This study will be significant in nursing profession in q way that this will help in the social and intellectual life of people concerned in the study. If the outcome will yield

positive result toward the effects of group study it would aid in choosing an approach in a particular concept.

Community. This study will benefit the community in a way that this will help the community to know how the used suction catheters dispose in a proper way and to know the specimen in it. This study may serve as a reference for those who want to further conduct a research about this topic. Likewise, this study hopes to inspire future researchers to go deeper into the subject matter, and find more ways and methods in uplifting the practice of aseptic technique as part of holistic care.

CHAPTER 2

REVIEW OF RELATED LITERATURE AND STUDIES

Review of Related Literature and Studies

Foreign Studies

Tracheostomy suctioning procedure is performed with considerable variation and, frequently, with questionable regard for sterile technique. Obviously, the practice of discarding the suction catheter after a single use would be ideal. However, this practice may not always be economically feasible, or it may be logistically insupportable at times, such as during mass casualty situations.

As a step toward identifying safe, practical tracheostomy suctioning procedures, this exploratory study was conducted to compare bacterial colony counts of tracheostomized patients for whom one-catheter and two-catheter procedures were used. In the two-catheter procedure, one catheter was used exclusively for the trachea and another one for the nose and/or mouth; in the one-catheter procedure one catheter was used for all these areas.

The objectives of the study were to develop a research design for studying colony counts of tracheal secretions of tracheostomized patients for whom various types of suctioning procedures are used, and to investigate the use of bacterial colony counts as a basis for altering these nursing procedures.

Background

Infection has been, and continues to be, one of the main complications of tracheostomy. Tracheostomy bypasses the natural filtering and warming functions of the nose, increases the drying effects of air on the tracheobronchial mucous blanket, and increases the amount of

inspired, foreign, particulate matter, including bacteria. In addition, drying of mucous inhibits ciliary activity. Thus, the mucociliary apparatus which normally protects the respiratory system becomes less effective. Tracheobronchial tissue damage due to the presence of the tracheostomy tube and to suctioning have been demonstrated both in laboratory animals and on postmortem examination of humans.

A review of medical literature concerned with tracheostomy revealed 23 articles in which the authors mention the necessity for using aseptic technique for a tracheostomy suctioning procedure, but only six in which the necessity for using separate nasal and tracheal catheters is mentioned. Of twelve clinical nursing textbooks published in past ten years, only three states that separate catheters should be available for use for the trachea and for the nose or mouth. In a programmed instruction for respiratory tract aspiration appearing in the American Journal of Nursing in 1966, a patient two weeks post thyroidectomy is not considered a candidate for sterile tracheostomy suctioning technique. Only one study which attempted to evaluate a tracheostomy suctioning technique was found - a short report of undergraduate student's study in which a two-catheter procedure was used, and in which no definite conclusions were reached.

Methodology

This study was conducted on a 34 bed, male neurosurgical ward of a large military general hospital. One reason for the selection of this site was that both one-catheter and two-catheter procedures were used depending on a nurse's judgment of the area(s) that would require suctioning.

A maximum of ten patients were to be admitted to the study during a two week period. Patients already on the ward were acceptable, provided extubation was not expected before culture collection was completed. Written permission for patients' participation in the study was obtained from responsible individuals.

The head nurse assigned already tracheostomized patients to the one-catheter (Group I) or two catheter group (Group II), Upon entrance to the study, these patients were to continue with the procedure in use, unless the head nurse made an independent judgment, at that time, that a change was indicated. After assignment to a group, patients continued with that procedure throughout the study. After initial assignments were made, ward nurses assigned subsequent subjects in such a manner as to equalize the number of patients in each group.

Prior to the study, pertinent instructions were given to professional and nonprofessional ward personnel by the investigator or the head nurse. A written copy of these instructions and other informations were available for reference on the ward. During the study, each subject's bed was clearly marked with a card identifying the suctioning procedure to be used. A copy of the appropriate suctioning procedure was kept at the bedside with the suction equipment and the daily suction record.

In addition to obtaining each patient's history, the investigator made daily observations, such as state of consciousness, antibiotic therapy, rectal temperature range and any treatment of factor which might have an effect on the study.

For both catheter procedures, disposable #14 French polyethylene suction catheters with attached vacuum control piece were employed. Between suctionings, these catheters were stored in a 1:750 solution of benzalkonium chloride. Sterile normal saline was used to flush the catheters before and during use. Separate bottles of the benzalkonium solution and

normal saline, clearly marked nasal and tracheal were used in two-catheter procedure. Individually packaged sterile 4x4 gauze compresses and sterile gloves were available at the bedside. Solution bottles were capped, or covered with sterile sponges. The investigator changed equipment and benzalkonium solutions every 24 hours. Ward personnel changed the normal saline solution every six hours, in compliance with the findings of Marchetta et al. Since tracheostomy tubes were routinely changed every day, cleansing of the inner cannula was rarely required on this ward. Both wall suction, mounted about six feet above the floor, and electrical suction machines on movable stands were used.

Tracheal and posterior oropharyngeal (throat) specimens were collected every two days for eight times for each patient, at approximately the same hour (7:30 AM), but on alternate days, for the two groups to permit early processing of samples.

The apparatus developed and utilized for the collection of specimens during the suctioning process was a standard 15 ml. tapered centrifuge tube modified for use as a mucus trap. From 0.1 to 2.5 ml. of tracheal secretions were collected for each sample. Serial dilutions were made of these secretions, using both the Lindsey streaking method and the standard method. Four ten-fold dilutions were placed on blood agar, mannitol salt agar, and MacConkey's agar. Blood agar plates were incubated both aerobically and anaerobically. The same media were used for the throat cultures following 24 hours aerobic and anaerobic incubation of samples. Identification of organisms was done by standard laboratory procedures, such as gram-staining and biochemical differentiation.

Sample

Five patients entered the study, but one was dropped after the first collection because of extubation. Of the four patients comprising the sample, two were 21 years of age, one 19 years, and one 46 years. Two had tracheostomies following injury in Vietnam; the other two required tracheostomy for indications of respiratory insufficiency following neurosurgery. Three patients had indwelling nasogastric tube, via one gastrostomy tube.

Prior to the study, cultures of body areas other than the trachea or throat were positive for bacterial growth in three patients, but only one patient had such cultures during the study, this being from the urine and the scalp. All patients receive antibiotics of some type both before and during the study. Only one patient was afebrile throughout the study.

One patient was on a Foster frame throughout the study, and two were on a frame part of this period. Wall suction was used for three patients; table mounted suction equipment for one. Incision and drainage of a brain abscess caused the absence of one patient from the ward for 18 hours. One patient received intermittent positive pressure breathing (IPPB) treatments four times a day, and another received humidified oxygen via tracheostomy cup for five days.

Findings

Bacterial concentrations are presented in Table 1. Variation occurred between successive cultures of each individual in numerous instances. No similarity in the patterns of change in colony counts of patients in Group I (patients #3 and #5) as compared with those of

patients in Group II (patients #2 and #4) was apparent. Thus, there was no apparent relationship of colony counts to type of suctioning procedures used for these patients.

Although frequency of suctioning and colony count showed some direct proportionality in patients #3 and #4 (who were not in the same group), no such relationship existed for patients #2 and #5. There was no relationship between bacterial concentrations and rectal temperature measurements. Since most secretions were thick, no relationship between character of secretions and colony counts could be determined. The amount of secretions did not appear to have much influence on bacterial concentration, except for the need to adjust serial dilutions to get countable plates, which may have resulted in diluting out of some organisms. There was no specific time of day when secretions were greater in amount than at any other time, as reflected by frequency of suctioning.

Colony counts of each genera of organism in the same individual also varied between cultures; however, for each patient, one or two organisms, appearing in the majority of cultures of that patient, were less variable than the other isolated organisms. Less variable organisms were: Aerobacter aerogenes, Pseudomonas species, Staphylococcus epidermidis, and Klebsiella.

In no instance was the colony count less than 103 cells per ml. Seventy-five percent of the counts were 104 through 107 cells/ml. The highest count was 1010 cells/ml., which occurred once.

Frequency of isolation and differentiation of microorganisms isolated from the 29 tracheal and throat cultures are presented in Tables 2 and 3. Predominant organisms, defined as those appearing in more than 50 percent of the cultures, are also indicated. With the

exception of Diplococcus species, the predominant organisms of the trachea and throat were different. Gram-negative organisms outnumbered gram-positive organism nearly to one.

At least one organism was found simultaneously in both the trachea and the throat in every specimen. Organisms ranged from one to seven per culture, with a mean of three per culture. Whereas tracheal cultures yielded from one to ten genera of organisms per culture, with a mean of six, throat cultures yielded from three to ten, also with a mean of six per culture. No relationship was apparent between the number of genera of tracheal organisms and the colony counts of these patients.

Discussion

Although bacterial colony count is commonly used clinically for determining degree of urinary infection, the investigator could find no evidence of its use as an indicator of degree of infection. Nevertheless, the possible use of this procedure as a measurement of change in degree of tracheal infection was questioned. If periodic colony counts of tracheal secretions of tracheostomized patients showed a steady increase or decrease, it was hypothesized that this change might be a function of the type of suctioning procedure used. Because there are several possible sources of tracheal infection once a tracheostomy is performed, and because other factor, such as antibiotic therapy, might effect a change in degree of infection, no causal relationship might be shown between the type of suctioning procedure used and the degree of infection. However, if patients, for whom one type of suctioning procedure was used, consistently had a general increase in degree of infection, and patients, for whom another type of suctioning procedure was used, consistently had an opposite or irregular change in degree

of infection, the inference might be made that the type of suctioning procedure used had an influence on the degree of infection, therefore, that one type of suctioning procedure was preferable to the other.

The findings of this study did not support this hypothesis. On the whole, bacterial concentration varied from culture to culture for each patient, and between patients. There was no similarity in the patterns of change in colony counts of patients for whom the one-catheter procedure was used, as compared with patients for whom the two-catheter procedure was used.

One might, expect changes in rectal temperature measurements to be correlated with changes in colony counts, but no such correlation was seen in this study.

Similarity, other parameters which were observed, such as frequency of suctioning character and amount of secretions, and time of day of suctioning showed neither interrelationship to colony count, with the exception of the two patients whose colony counts varied directly with frequency of suctioning. For patient on foster frames, secretions drained freely and patients required less suctioning while in the prone position.

Although no relationship between colony counts and type of suctioning procedure used could be seen, a longer period of study for each patient may have revealed a greater similarity. The collection of cultures every two days seems justified, since it yielded data which might be significant in a study with a larger sample.

Since all four patients had tracheal infection upon entrance to the study and had their tracheostomies for varying lengths of time, better control of variables could have been

obtained by using subjects who were newly tracheostomized and initially free from infection. Time prevented such selection of subjects for this study.

Although the trachea is considered "sterile" under "normal" conditions and reportedly assumes the flora of the general environment after tracheostomy, the investigator could find no indication of a numerical value above which colonization was considered a disease process. However, organisms found in one culture often were not found in the next culture(s), only to show up in subsequent cultures, suggesting that there may have been a concentration below which they still existed in the trachea, but not in numbers sufficiently large to permit their isolation by the method employed. This possibility is strengthened by the fact that the lowest count made was 103 cells/ml., even though serial dilution of 10 -2 were used for approximately one-third of the plantings. Persistence of certain organism may have been a reflection of virulence or competitive ability of these organisms.

Determination of colony counts was problematic. With tracheal secretions containing up to ten genera of organisms per culture, not only was competition for colonization great, but the possibility of missing an organism also increased. Due to difficulty of homogenizing mucoid secretions, organisms embedded in unhomogenized particles may also have been missed. Mucolytic agents were not employed, because they might have affected the organisms, resulting in additional counting error.

The Lindsey streaking method, while being a practical method of estimating bacterial concentration does not, as used in this study, measure concentrations greater than 107.5 cells/ml., and counts of 108 and 109 cells/ml. are not uncommon. In addition, accurate estimates of different genera were difficult due to large number of genera per plate.

Furthermore, making colony counts of specific organisms, as was done, compared with making a single colony count per plate seems unnecessary, given the purpose of measuring change in total degree of infection rather than in degree of infection of individual organisms. This method of counting should be decreased by eliminating the need for several types of media.

The sample size precluded making valid conclusions concerning the superiority of one procedure over the other, as well as the efficacy of using bacterial colony counts as a basis for altering these procedures. Therefore, to resolve these questions, a study of sufficient size to permit forming of valid conclusions should be conducted with an improved design. Such a design should include selection of newly tracheostomized patients, free of respiratory infection, as subject; a more satisfactory method of preparing mucous secretions for serial dilution; use of the standard serial dilution method alone; and initial counting of total colonies rather than counting of colonies of specific organisms.

The types of organisms found in this study, as well as certain other observations, warrant discussion. As seen in table 3, nearly two-thirds of the genera of isolated organisms were gram-negative. This is consistent with the increase in gram-negative infections seen in hospitalized patients. The greater incidence in this study of pseudomonas species in the trachea, as compared with S. aureus also reflects the findings of vic-dupont's studies.

The high percentage of gram-negative organisms in three patients with indwelling nasogastric feeding tubes raises the question of such a tube being a possible source of tracheal infection. Two of these patients had a greater number of different organisms in the tracheal than in the throat cultures, and the same trend was observed in a third patient,

however, he expired after five collections. This suggested possibility raises several questions. Do enteric microorganisms ascend the feeding tube into the pharynx, then pass through a relaxed larynx into the trachea? More than 50 percent of the different organisms isolated in this study normally inhabit the gastrointestinal tract, and the majority of these are potential pathogens. Do patients with indwelling nasogastric tubes regurgitate small amounts of gastric contents, containing microorganisms, which can then pass through the larynx? Does such a tube produce pharyngitis epiglottitis, or esophagitis, resulting in these areas being susceptible to colonization of organism?

Another factor affecting tracheal infection may be physical location of tracheostomized patients. Patients #3 and #4, sharing a small room, had S. aureus in varying numbers of tracheal and throat cultures. Patients #2 and #5, next to each other in a seven-bed unit, also had S. aureus in various.

Table 1. Bacterial Concentration in Cells/ml. of Specimens from Four Tracheostomized Patients, Showing Relationships Between Cultures of the Same Patient and Between Patients.

CULTURE

GROUP I*

GROUP II**

PATIENTS

PATIENTS

#3

#5±

#2

#4

1

2

3

4

5

6

7

8

1.00 X 108

2.32 X 108

1.60 X 105

1.38 X 106

1.99 X 107

9.00 X 104

5.90 X 105

4.42 X 107

8.00 X 108

1.61 X 1010

8.79 X 1010

1.97 X 1010

1.19 X 1010

2.00 X 109

1.74 X 108

7.64 X 107

2.05 X 108

1.89 X 108

2.12 X 106

3.73 X 105

2.71 X 109

6.50 X 106

7.18 X 105

3.86 X 107

1.62 X 107

4.10 X 107

1.21 X 106

3.01 X 105

2.40 X 105

Table 2. Frequency of Isolation of Microorganism from Twenty-nine Tracheal and Throat Cultures of four Tracheostomized Patients

Organisms

Site from which isolated

Trachea

Throat

Trachea and Throat simultaneously

Number of Cultures

Percentage of culture

Number of Cultures

Percentage of culture

Number of Cultures

Percentage of culture

S. epidermidis

Diplococcus specles

Alpha hemol. Stereptococcus

Pseudomonas species

Bacillus species

Proteus species

S. aureus

Aerobacter aerogenes

Klebsiella

E. coli

Citrobacter

Serratia

Arizona group

Yeast

Alcaligenes species

Moraxella species

Providence

Beta hemol. Stereptococcus

Edwardsiella

Herreleae species

23

19

16

16

15

13

12

12

11

7

7

5

3

2

2

1

1

1

0

0

79*

65*

55*

55*

52*

45

41

41

38

24

24

17

10

7

7

3

3

3

0

0

7

16

10

12

12

19

16

16

21

12

10

0

6

7

1

0

1

0

2

1

24

34*

34

41

41

65*

55*

55*

72*

41

34

0

20

24

3

0

3

0

7

3

6

10

5

10

6

12

7

9

9

5

4

0

1

4

0

0

0

0

0

0

20

34

17

34

20

41

24

31

31

17

14

0

3

14

0

0

0

0

0

0

Total Number of Different Genera Isolated

18

17

13

Table 3. Differentiation of Microorganism Found in Twenty-nine Tracheal and Throat Cultures of four Tracheostomized Patients

Gram-Negative Organisms

Gram-positive Organism

Aerobacter aerogenes

Alcaligenes species

Arizona group

Citrobacter

E. coli

*Edwardsiella

*Herreleae species

Klebsiella

Proteus species

Providence

Pseudomonas species

*Serratia

Alpha hemol. Stereptococcus

Bacillus species

*Beta hemol. Stereptococcus

Diplococcus specles

S. aureus

S. epidermidis

Yeast

Source of Culture

Total Gram-neg. Genera Isolated

Percentage of all Genera Isolated

Source of Culture

Total Gram-neg. Genera Isolated

Percentage of all Genera Isolated

Trachea

Throat

11

11

61

65

Trachea

Throat

7

6

39

35

Local Studies

The study is for mechanically ventilated patients who are at risk for developing ventilator-associated pneumonia which increases mortality in the intensive care unit. Bacterial infection may be introduced through respiratory equipments i.e. suction catheters that could become a fomite for infection. Proper aseptic techniques should be used to prevent bacterial colonization. The study aims to determine the presence and degree of bacterial growth on suction catheter tips used in intubated patients after being used for one and eight hour/s and to compare the in-vitro effect of 0.1% hexetidine, 1% and 0.5% acetic acid and sterile NSS in inhibiting bacterial growth.

This is a prospective double blinded experimental study determining the presence and degree of bacterial growth on suction tips used after 1-hour and 8-hours. Afterwhich, the in-vitro effect, defined by the zone of inhibition, produced by 0.1% hexetidine, 1% acetic acid, 0.5% acetic acid, and sterile NSS on the bacterial growth were measured. Suction catheter tips were collected from patients aged 18 years old and above, orally intubated or on tracheostomy tube that required ventilatory support for at least 24 hours, admitted at the intensive care units of the University of Santo Tomas Hospital from August 2009 - October 2009.

The result is ninety-one percent of suction tips used for eight hours were positive for bacterial growth as compared to 54.5% of suction tips used for one-hour. In the 8-hour group, none of the solutions was comparable to the inhibitory effect of hexetidine. At one hour, 1% acetic acid was comparable with hexetidine in its capacity to inhibit growth of bacteria. Hexetidine is effective in inhibiting bacterial growth in suction catheters even after 8-hour use.

One percent acetic acid is comparable to hexetidine in its efficacy in inhibiting bacterial growth on suction tips at one hour of use

Research Paradigm

Determine the types and presence of microorganism on the suction catheter.

The information will be gathered through culture media of the used suction catheter validated by a licensed medical technologist and pathologist.

Measure the types and presence of microorganism on the suction catheter that will be used on the 1st day, 2nd day and 3rd day

Conceptual Framewor

The input of the study is measuring the types and presence of microorganism on the suction catheter. This can be gathered through culture media of the used suction catheter. Hence after, determination of the presence and types of microorganism on the suction catheter will be observed.

Definition of Terms

Agar is a gelatinous material from red algae that serves as a base for bacterial culture media.

Atelectasis is the failure of a part of the lung to expand.

Bacteria are a large group of single-celled microorganisms that doesn't have a nucleus.

Culture media is used in determining the microorganism present in a certain object.

Medical Technologist

Microorganism is an organism that is too small to be visible to the naked eye.

Mucus is the viscous slippery secretions of mucous membrane.

Open-tipped catheter is a type of catheter that may be more effective for removing thick mucus plugs.

Pathology is the study of disease processes with the aim of understanding their nature and causes.

Petri dish is a flat dish that has a cover. It is made of plastic or glass that is used mostly to cultivate bacteria.

Physiotherapy is the branch of treatment that employs physical methods to promote healing, including the use of light, infrared and ultraviolet rays, heat, electric current, ultrasound, massage, manipulation, hydrotherapy and remedial exercise.

Proliferate is an act of growing by multiplication of cells, parts, or microorganisms.

Secretion is a substance produced by a gland.

Specimen is an individual animal, plant, object, etc. used as an example of its species or type for scientific study or display

Suction Catheter an instrument used for critically ill or injured patient who requires a breathing tube or tracheostomy tube that needs occasional suctioning to remove the secretions from the airway.

Suctioning is an act of removing secretions from the airway.

Swab is a small piece of cotton that is used in obtaining a specimen.

Tracheostomy is a surgical operation that creates an opening into the trachea.

Ventilation is the passage of air into and out of the respiratory tract.

Wellness is a dynamic state of health in which an individual progresses toward a higher level of functioning, achieving an optimum balance between internal and external environments

Whistle tipped catheter is a type of catheter that is less irritating to respiratory tissues.

Yankauer device is used to suction the oral cavity.

Theoretical Framework

Researchers come up with the "Spontaneous Generation Theory". Spontaneous generation is the idea that, in modern times, living things can arise from non-living things (a violation of basic cell theory). Of course what was really being observed was the appearance of visible organisms or populations of organisms which were initially microscopic contaminants. According to the theory, "As long as individuals believed that microorganisms could arise from nonliving substances, scientists saw no purpose in considering how diseases were transmitted or how they could be controlled."

The spontaneous generation is the single most important contribution by the science of microbiology to the general welfare of the world's people, perhaps the single most important contribution of any modern scientific discipline.

The researchers relate this theory to their study for it proves that microorganisms, which are a living thing, can arise from non-living things just like the suction catheter; the subject of this study. Researchers believe that there are microorganisms present in the suction catheter that are being used by the patients.

CHAPTER 3

METHODOLOGY

Research Design

The researchers used Quantitative method as the research design of the study. According to Salustiano, Quantitative research can be define as the traditional "scientific method", which uses a general set of orderly, disciplined procedures to acquire information and moves in an orderly and systematic fashion. The researchers have chosen the Quantitative method because the study will use procedures particularly culture media to collect information; moreover this will be under conditions of control. In addition, the information will be through numeric form and statistical procedure will be utilized to analyze it.

Under Quantitative method, Descriptive method will be used. Descriptive research answers specific questions by describing and elaborating the nature of a certain phenomenon. Researchers used this method to describe the number and type of microorganisms present on the suction catheter.

Locale and Population of the Study

The researchers will conduct the study at Tarlac Provincial Hospital, particularly at the intensive care unit (ICU). The researchers will choose 3 suction catheters that will be used in three consecutive days, so there will be a total of 9 suction catheters that will be utilized.

Description of the Subject

The subject of the study will be the suction catheter that will be used on three consecutive days by the patients at Tarlac Provincial Hospital, particularly from the intensive care unit (ICU). The suction catheter will be tested for the presence of microorganisms.

Data Gathering, Instrumentation and Procedures

The researchers will first send a letter to Tarlac Provincial Hospital and ask for their approval to conduct a study on the said hospital. Once the letter is approved the researchers will ask for the assistance of the medical technologist so as to aid the researchers throughout the study. The researchers will gather the data with the help of the two medical technologists namely Gloria Lenon de Leon and Elizabeth J. Catacutan and one pathologist namely Dr. Michelle G. Tanglao. The first thing to be done is the preparation of the needed materials to be used for the culture media. These materials include agar, cooking thermometer, small cooking pot, petri dish, sterile cotton swabs, and warm dark cupboard. The medical technologists will first mix the agar according to the instruction of the manufacturer. Since the agar is like a Jell-

O, the ingredients will be heated at a precise temperature. Then they will make sure that they have a clean cooking thermometer to prevent contamination that might lead to a wrong result. After that, the medical technologists will open the petri dish and will pour enough agar to it so that the bottom will be covered completely. They will set the lid back and will place the petri dish aside until the agar hardens. Once the agar is firm, the medical technologists can now put the petri dish on the refrigerator. They will put the petri dish upside down to prevent it from acquiring airborne bacteria. The medical technologists will only remove the petri dish from the refrigerator when they are about to use it. They will open a sterile cotton swab package and will rub it on the suction catheter. Then, they will open the petri dish and will rub the swab mildly on the surface of the agar, making an "S" pattern. Then they will close the lid on the petri dish. The petri dish will be put in a warm dark cupboard for three to four days. After the fourth day, the petri dish will be removed from the cupboard. Opening the petri dish is not necessary this time because the bacteria colonies can be observe at the top of the petri dish. The color, shape and anything that can be distinguished will be recorded. The bacteria can be identified by looking at some illustrations from a bacteria book or from the internet that matches the bacteria that the medical technologists have cultured. Once the bacteria have been identified, the cultured bacteria must be destroyed by pouring 1 tbsp. of bleach into the petri dish and then seal it with a packing tape. It will be put in a baggie, and will be disposed.

After all the procedure for culture media has been done, the medical technologists together with the pathologist, will explain the results of the study to the researchers and will tell the possible effect if certain microorganisms progress in patient's body.

Statistical Treatment

In this study, the bacteria will be ranked from the most common bacteria that are present to the suction catheter to the least common bacteria.

The study will be subjected to statistical tool.

ANALYSIS OF VARIANCE (ANOVA)

ANOVA is designed specifically to test if two or more population has the same mean through examining the variances of the sample used.

This statistical tool will test the significant difference for the number of microorganisms present on the suction catheter used at a different time frame.

THE ONE WAY ANOVA

Sources of variations

Sum of squares

Degree of freedom

Mean square

Computed F-ratio

Treatments

SSC

k-1

s12=SSC

k-1

F=s12

s22

Error

SSE

k (n-1)

s22=SSE

k(n-1)

F=s12

s22

Total

SST

nk-1

Computational Formula

Total Sum of Squares

n

SST=Σx2-(Σx) 2

i=1 nk

Sum of Squares for Column Means

SSC=Σ(Txc)2-( Σx)2

n nk

Error of Sum of Squares

SSE= SST-SSC

THE NAKED TRUTH: MAGNIFYING THE MICROBES OF THE USED SUCTION CATHETER

BY:

Casanova, Leopoldo F.

Colaler, Eda Mae M.

Espina, Jelyn V.

Fernando, Frytxzky F.

Juco, Rose-Lynn Q.

Melicio, Ellaine Joyce G.

Ocampo, Kimberly

Sandoval, Darwin T.

Quillano, Jessa Vel S.

Tambis, Irish Joy G.

OUR LADY OF FATIMA UNIVERSITY

120 Mc Arthur Highway, Valenzuela City

Dr. Ricardo Ramos

Provincial Health Officer

Tarlac Provincial Hospital, San Vicente Tarlac, Tarlac

Dear Ma'am:

Greetings

We the Bachelor of Science in Nursing of Our Lady of Fatima University in the process of conducting a nursing research entitled: "THE NAKED TRUTH: MAGNIFYING THE MICROBES OF THE USED SUCTION CATHETER."

In this regard the undersigned would like to request permission from your good office to conduct the study to your institution. The researcher's intended subjects are catheter which has been used by the respondents for several times. The purpose of this study is to know or understand the possible presence of microorganism in suction catheter used several times. Thus, the results of this research will give a good implication to nursing practice. Rest assured that any possible result will be kept confidential.

Thank you very much.

Respectfully Yours,

Casanova, Leopoldo F

Colaler, Eda Mae M.

Espina, Jelyn V.

Fernando, Frytxzky F.

Juco, Rose-Lynn Q.

Melicio, Ellaine Joyce G.

Ocampo, Kimberly

Sandoval, Darwin T.

Quillano, Jessa Vel S.

Tambis, Irish Joy G.

NOTED BY:

Christopher Ponce T. Nuqui R.N

Researcher's Adviser

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