Otopsi salonu solunum havasında bulunan patojenlerin mikrobiyolojik yöntemler ile saptanması
Determination of pathogens existed in respiration air of autopsy room by microbiological methods
Yazar: ERSEL SÖNMEZ
Danışman: DOÇ.DR. M. HAKAN ÖZDEMİR
Dokuz Eylül Üniversitesi / Tıp Fakültesi / Aile Hekimliği Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2006
Konu: Adli Tıp = Forensic Medicine

Özet:
ÖZETÇürümenin çe itli evrelerindeki cesetlerle ve bu cesetlerin vücut s v lar ve yumu akdokular ile direkt temasta olan otopsi salonunda çal an sa l k personeli, di er sa l kçal anlar na oranla daha fazla risk alt ndad r. Üstelik otopsi salonu çal anlar otopsi yap lancesedin geçmi hastal k öykülerini, ya am biçimlerini, madde ba ml s olup olmad klar nbilemediklerinden bula c enfeksiyonlar n tehlikesi daha da artmaktad r. Otopsi s ras ndaçal an sa l k personeline enfeksiyon bula , direkt kutanöz inokulasyonla yada aerosollerinve damlac klar n solunmas yoluyla gerçekle mektedir. Ülkemizde otopsi salonlar n nhavas nda var olan mikroorganizmalar n varl n ve yo unlu unu gösteren bir çal mabulunmamaktad r.Bu çal man n amac ; mesleksel riskin boyutlar n n ortaya koymak, otopsi salonusolunum havas nda gram negatif ve gram pozitif bakteriler ile mantarlar n otopsi öncesi,otopsi s ras ve otopsi sonras nda varl n ve koloni say lar n saptamak, bakteri vemantarlar n varl na ve koloni say lar na etkili olan faktörleri incelemek, otopsi salonusolunum havas n n çal ma ortam aç s ndan uygunlu unu de erlendirmektir.%lkbahar ve yaz mevsimlerinde %zmir Adli T p Kurumu Morg %htisas Dairesi OtopsiSalonu havas ndan ondokuzar gün, plak açma ve hava örnekleme cihaz ile otopsi öncesinde,otopsi s ras nda ve tüm otopsiler bitirilip salon temizlendikten sonra örnekleme yap ld .Havada bulunan bakterilerin izole edilmesi amac yla kanl agar, maya ve küf mantarlar n nsoyutlanmas amac yla Sabouraud Dekstroz Agar kullan ld . Örneklerin de erlendirilmea amas Dokuz Eylül Üniversitesi T p Fakültesi Mikrobiyoloji ve Klinik MikrobiyolojiAnabilim Dal laboratuvarlar nda gerçekle tirildi.Çal mam zda mevsimin, otopsi salonunun s cakl n n, nemin, klima ve havaland rmasisteminin, içerideki ki i say s n n, yap lan otopsi say s n n, otopsi salonunda kullan lan masasay s n n, koku mu cesetlere yap lan otopsinin bakteri ve mantar koloni say lar na etkisigösterildi. Otopsi salonu solunum havas nda, 14 tür bakteri ve 26 tür mantar üredi. Otopsisalonu solunum havas nda en s k üreyen gram pozitif bakteriler aras nda Koagülaz negatifstafilokok , Micrococcus spp, Bacillus spp., Difteroid basil, en s k üreyen gram negatifbakteriler aras nda Acinetobacter spp., Proteus mirabilis, Eschericia coli, en s k üreyenmantarlar aras nda ise Penicillium spp., Alternaria spp., Aspergillus flavus bulunmaktayd .Çal mam zda kullan lan her iki yöntem ile belirlenen koloni say lar aç s ndan, bakteriler içinotopsi öncesi bir günde, otopsi s ras nda dört günde, otopsi sonras iki günde; mantarlar içinise otopsi öncesi bir günde, otopsi s ras 18 günde, otopsi sonras dört günde otopsi salonusolunum havas n n kirli oldu u saptand .Ülkemizde kullan lan otopsi salonlar n n solunum havas nda mikrobiyal say myönünden resmi sa l k kurumlar nca belirlenen ulusal bir standart ya da yönetmelik yoktur.Biz bu çal mayla ulusal düzeyde otopsi salonu solunum havas n n temizlik standard nolu turmaya ve uygun havaland rma sistemlerinin kullan lmas gerekti ine katk olabilecekbir ad m att k. Bu çal malar n de i ik merkezlerde yap lmas ile ulusal bir standartolu turulmas na yard mc olunacak, asgari hava temizli ine ili kin kabul edilebilir mikrobiyalsay m standartlar olu acakt r.Anahtar Kelimeler: Otopsi salonu, otopsi personeli, hava yoluyla bula an enfeksiyonlar,mesleksel hastal klar, bakteri, mantar

Abstract:
SUMMARYThe forensic medicine personnel assisting to conduct an autopsy who come in directcontact with body fluids, soft tissues of the dead and skeletal remains in different stages ofdecomposition, are at continuous risk of acquiring various kinds of infectious. Dead bodies invarious conditions often brought for postmortem examination are of unknown back round, therisk of infection from these bodies are also unknown. The transmission of these deadlydisease via blood or any other means, their capacity to represent a source of infection withoutnecessarily being any indication of their presence, their prevalence in individuals such as drugabusers, prostitutes etc, who are liable to meet violent unexplained deaths and the existence ofsocial and ethical pressures which restrict the availability of information, all combine to createsignificant risk for forensic medicine expert and postmortem examination room worker.Autopsy-transmitted infections may occur after direct cutaneus inoculation, contact withdroplets, and aerosol exposure. This research is the first time study indicating the presenceand intensity of microorganisms determined from autopsy rooms in our country.Bearing this in mind, our study aimed to show not only the extent of occupationalhazard and determine the presence and number of colonies of gram positive and gramnegative bacteria and fungi in breathing-respiration air of autopsy room prior, during and afterperforming an autopsy but also examine the agents effecting the presence and colony numbersof bacteria and fungi. Also we have targeted to evaluate whether the respiration air of autopsyroom was appropriate for occupational environment.Samples were taken by settle plate method and air sampler method prior autopsy,during autopsy and after whole autopsies performed and the room was cleaned in the periodof 19 days in spring and summer seasons at autopsy room of Council of Forensic MedicineMortuary in (zmir. Sabouraud Dextroz Agar was used for isolation of the fungus and mould,blood agar was used for isolation of bacteria from air. The evaluation stages of samples wereperformed at laboratories of Microbiology and Clinical Microbiology Department of DokuzEylül University School of Medicine.In our study, we have showed whether there were any differences in the number ofbacteria and fungi colonies by the effects of season, moisture, air conditioning system,temperature in autopsy room, number of staff and desks in autopsy room, number of autopsiesperformed and number of decomposed bodies. 14 types of bacteria and 26 types of fungi werereproduced in respiration air at autopsy room. Mostly reproduced bacteria presented amonggram positive ones in autopsy room respiration air were coagulase negative staphylococcus,Micrococcus spp, Bacillus spp., Diphteroid bacil, among gram negative ones wereAcinetobacter spp., Proteus mirabilis, Eschericia coli, among fungi ones were Penicilliumspp., Alternaria spp., Aspergillus flavus. With respect to number of colonies determined byboth methods in our study, respiration air of autopsy room was found contaminated one dayprior to autopsy, four days during autopsy, two days after autopsy for bacteria and one dayprior to autopsy, 18 days during autopsy, 4 days after autopsy for fungi.There has been neither a national standard procedure nor a legislation designated byofficial health foundations with regard to microbiological enumeration of respiration air inautopsy rooms of our country. Our study has taken a step contributed to the necessity of usingappropriate conditioning systems and establishing national safety-cleanliness standardspreventing transmitted infections. In conclusion, performing further studies in differentcenters could help establishing a national standard and acceptable standardizedmicrobiological enumerations concerning minimum air cleaning.Keywords: Autopsy room, autopsy staff, air transmitted infections, occupational disease,bacteria, fungi.