Influenza complications: Reporting cardiac events through a hospital surveillance system.

BACKGROUND AND AIMS: The aim of this study was to determine the complications of influenza in all adults hospitalized with this disease and, specifically, to analyze the characteristics of post-infection cardiovascular events. METHODS: This work is observational descriptive study of adults hospitalized with influenza during the 2017-2018 and 2018-2019 seasons using the specific registry of a tertiary hospital. The complications analyzed were pneumonia, multiple organ dysfunction syndrome, septic shock, acute respiratory distress syndrome, and cardiac events. RESULTS: A total of 928 adults with influenza required hospitalization and 303 (32.7%) presented with one or more complications. A post-influenza cardiac event occurred in 2.5% of patients; they had a higher probability of ICU admission and higher mortality. Influenza vaccination was a protective factor for cardiac events (OR 0.32; 95%CI 0.13-0.83). CONCLUSIONS: Influenza can lead to important complications in hospitalized patients. The high mortality rate associated with post-infection cardiac events means that preventive measures, including annual influenza vaccination, need to be emphasized.

[Ethical aspects of specific precautions programs in patients infected or colonised by multidrug-resistant microorganisms in a hospital setting]. / Aspectos éticos de los programas de precauciones específicas de contacto en pacientes infectados o colonizados por microorganismos multirresistentes en el ámbito hospitalario.

The approach to public health, patient safety and quality of care has led to analysing health situations or problems from a population perspective, in a wide way and giving priority to factors that can normally be left in the background from a clinical point of view. For years, the problem of the use and abuse of antimicrobials, the increase and diffusion of microorganisms resistant to them, cross-transmission, and healthcare related infections have been prioritised both nationally and internationally. To combat these problems, various strategies are being developed and put into practice, from the policies of rational use and optimization of antimicrobials, surveillance, and control of infections related to health care, to training information and awareness strategies. One of the pillars of surveillance and control is the correct application of standard and specific precautions, which within the framework of these comprehensive programs aim to control the transmission of microorganisms of special microbiological and/or epidemiological interest through a series of measures. In hospitals, the application of these precautions (single room, barrier measures, restrictions on access to rooms, waste management…) in patients infected or colonised by these microorganisms can have different repercussions, both for patients and the professionals that attend them, and it is considered pertinent that the protocols and/or programs of specific precautions explicitly include the analysis of the ethical aspects in their preparation, implementation, and monitoring.

[GEMICOMED/GEIRAS-SEIMC recommendations for the management of Candida auris infection and colonization]. / Recomendaciones GEMICOMED/GEIRAS-SEIMC para el manejo de las infecciones y colonizaciones por Candida auris.

Candida auris is a new species of Candida that causes nosocomial outbreaks in several countries around the world, including Spain. C.auris is resistant to fluconazole and multi- and pan-resistant strains have been described. It is highly transmissible and can survive long term in the hospital environment, causing long-lasting outbreaks that are difficult to detect in early stages, and making it difficult to control and eradicate. It is currently an emerging threat to global health. This document provides a set of guidelines, developed by a multidisciplinary team, to limit the impact and facilitate the control of C.auris infection based on the experiences gathered in the Spanish and English outbreaks. The implementation of early and strict surveillance and control measures is essential to prevent the spread of the outbreak, which can spread over time, posing a significant risk to complex, critical and immunocompromised surgical patients. Immediate notification of C.auris isolation to clinical and infection control teams, as well as to health authorities and institutions, is essential to implement infection control measures at all levels in a timely manner, to prevent internal and inter-centre transmission, and to ensure a proper surveillance and prevention to patients who are already colonized and can develop an infection.

Impact of removing sinks from an intensive care unit on isolations by gram-negative non-fermenting bacilli in patients with invasive mechanical ventilation. / Impacto de la retirada de los lavabos en una unidad de cuidados intensivos sobre los aislamientos por bacilos gramnegativos no fermentadores en pacientes con ventilación mecánica invasiva.

INTRODUCTION AND OBJECTIVE: Contamination of sinks, even due to their underuse, is associated with the transmission of non-fermenting gram-negative bacilli (NFGNB) to patients in Augmented Care Units. After previous monitoring with environmental and patient samples, we now explore the impact of removing sinks from ICU cubicles on incidental isolations related to health care in bronchoaspirate samples of patients with invasive mechanical ventilation (IMV). MATERIAL AND METHODS: Quasi-experimental study, before-and-after, pre-intervention annuities April 2014-2016 and post-intervention April 2016-2017. Incidence densities per 1,000 days of IMV were studied, comparing by the exact method based on the binomial distribution and estimating the incidence density ratio. RESULTS: The incidence densities per 1,000 days of IMV of isolations by NFGNB in bronchoaspirate samples of the pre and post-intervention periods were 11.28 and 1.9, respectively. This implies a post-intervention incidence density 5.90 times lower than before (95% CI: 1.49-51.05, P=.003). CONCLUSIONS: Despite of the limitations of the design, the removal of sinks showed a reduction of the isolations.

[Rates of surgical wound infection in hip arthroplasty (2007-2015)]. / Tasas de infección de herida quirúrgica en artroplastia de cadera (2007-2015).

OBJECTIVE: To estimate the incidence of surgical site infection in the hip replacement procedure during nine years of follow-up in a local public hospital. MATERIAL AND METHODS: A prospective study conducted between 2007 and 2015, using the Clinical Indicators of Continuous Quality Improvement (INCLIMECC) tool. All primary hip prostheses and revisions were studied. The definitions, criteria and categories for surgical site infection were those estimated for the risk index of the National Nosocomial Infections Surveillance of Centres for Disease Control and Prevention. Crude and adjusted rates were calculated by risk index. RESULTS: A total of 999 interventions were included. The overall infection rate was 1.5% (95%CI: 0.75-2.25). Surgical prophylaxis was prescribed in 98.3% of the cases, and was adequate in 70.7%, with the main cause of inadequacy being its prolonged duration in 71.3%. The infection rate was 53%, being better than the rates published for Spanish hospitals INCLIMECC in the period 1997-2012. But they were 19% higher than those published for the USA according to the National Healthcare Safety Network, and 50% higher than expected according to data published for Europe by the European Centre for Disease Prevention and Control. DISCUSSION: The infection rate in the present study is better than those described in the Spanish literature, but it is higher than those published for Europe and North America. Strategies for surveillance and control of infections associated with health care allow the evaluation of trends and the impact of prevention measures.

[Management of odontogenic infections in Primary Care: Antibiotic?] / Manejo de las infecciones odontogénicas en las consultas de atención primaria: ¿antibiótico?

Our aim is to contribute to the rational use of antibiotics prescribed by family doctors when a patient consults for a dental problem. Nowadays we should not ask which antibiotic to give. The question has to be if we need to prescribe antibiotics in front of the most common odontogenic infections seen in our practice. We review the main dental infections, which should be their appropriate management and the role of prevention. We need to know the complexity of the oral microbiome because it?ll depend on the appropriateness of the antibiotherapy, the evolution towards cure or progression of some odontogenic infections. The bacterial plaque, formed by the biofilm, behaves as a barrier to the action of antimicrobials. It?s in the prevention of its development as well as in it mechanical elimination once shaped, in what the family doctor should insist. We must transmit antibiotics don?t heal dental pain.

Quantifying the risk of nosocomial infection within Ebola Holding Units: a retrospective cohort study of negative patients discharged from five Ebola Holding Units in Western Area, Sierra Leone.

OBJECTIVES: A central pillar in the response to the 2014 Ebola virus disease (EVD) epidemic in Sierra Leone was the role of Ebola Holding Units (EHUs). These units isolated patients meeting a suspect case definition, tested them for EVD, initiated appropriate early treatment and discharged negative patients to onward inpatient care or home. Positive patients were referred to Ebola Treatment Centres. We aimed to estimate the risk of nosocomial transmission within these EHUs. METHODS: We followed up a cohort of 543 patients discharged with a negative EVD test from five EHUs in the Western Area, Sierra Leone, and examined all line-listed subsequent EVD tests from any facility in the Western Area to see whether the patient was retested within 30 days, matching by name, age and address. We defined possible readmissions as having the same name and age but uncertain address, and confirmed readmissions where name, age and address matched. RESULTS: We found a positive readmission rate of 3.3% (18 cases), which included 1.5% confirmed readmissions (8 cases) and 1.8% possible readmissions (10 cases). This is lower than rates previously reported. We cannot ascertain whether EVD was acquired within the EHUs or from re-exposure in the community. No demographic or clinical variables were identified as risk factors for positive readmission, likely due to our small sample size. CONCLUSIONS: These findings support the EHU model as a safe method for isolation of suspect EVD patients and their role in limiting the spread of EVD.

Método Delphi como referencial metodológico para a pesquisa em Enfermagem / Método Delphi como referencial metodológico para la investigación en Enfermería / The Delphi method as a methodological framework for research in Nursing

RESUMO Objetivo: descrever o processo de coleta e análise dos dados a partir do uso do método Delphi e da articulação de procedimentos qualitativos e quantitativos para a construção de uma proposta de inovação curricular na área de controle de infecções para os cursos de graduação em enfermagem. Método: foi utilizado o método Delphi com 39 participantes, sendo 31 enfermeiros e oito médicos, com expertise na área de controle de infecções. A coleta de dados transcorreu em um período de sete meses, com a realização de quatro rodadas. Para a análise de dados qualitativos foi empregada à análise de conteúdo e para os quantitativos à análise descritiva. Resultados: foram realizadas quatro rodadas interativas e sequenciais, a primeira rodada foi composta por um instrumento com perguntas abertas, a partir destas respostas (39 respondentes) foi elaborado o instrumento da segunda rodada que foi constituído de itens para avaliação dos participantes. Após a segunda rodada (35 respondentes), os itens que não obtiveram consenso foram reapresentados aos participantes no instrumento da terceira rodada (30 respondentes), contendo a problematização do item para que fosse reavaliado com a justificativa do participante. Na quarta rodada foi realizada a devolutiva dos dados à todos os participantes. O desenvolvimento de rodadas, promovendo feedbacks controlados para que os participantes possam rever suas opiniões, é uma característica marcante desse método. Conclusão: o método Delphi comprovou seu potencial como possibilidade de articulação das abordagens qualitativas e quantitativas, somando essas características para tratar de um problema complexo de pesquisa na área da enfermagem e saúde.

RESUMEN Objetivo: describir el proceso de recolección y análisis de los datos a partir del uso del método Delphi y de la articulación de procedimientos cualitativos y cuantitativos para la construcción de una propuesta de innovación curricular en el área de control de infecciones para los cursos de graduación en enfermería. Método: se utilizó el método Delphi con 39 participantes, siendo 31 enfermeros y ocho médicos, con experiencia en el área de control de infecciones. La recolección de datos transcurrió en un período de siete meses, con la realización de cuatro rondas. Para el análisis de datos cualitativos se empleó el análisis de contenido y los cuantitativos al análisis descriptivo. Resultados: se realizaron cuatro rondas interactivas y secuenciales, la primera ronda fue compuesta por un instrumento con preguntas abiertas, a partir de estas respuestas (39 respondedores) fue elaborado el instrumento de la segunda ronda que fue constituido de ítems para evaluación de los participantes. Después de la segunda ronda (35 respondedores), los ítems que no obtuvieron consenso fueron presentados a los participantes en el instrumento de la tercera ronda (30 contendientes), conteniendo la problematización del ítem para que fuera reevaluado con la justificación del participante. En la cuarta ronda se realizó la devolución de los datos a todos los participantes. El desarrollo de rondas, promoviendo feedbacks controlados para que los participantes puedan revisar sus opiniones, es una característica resaltante de ese método. Conclusión: el método Delphi comprobó su potencial como posibilidad de articulación de los abordajes cualitativos y cuantitativos, sumando esas características para tratar de un problema complejo de investigación en el área de la enfermería y salud.

ABSTRACT Objective: to describe the process of collecting and analyzing data based on the use of the Delphi method, and the process of articulating qualitative and quantitative procedures for constructing a proposal for curricular innovation in the area of infection control in undergraduate courses in nursing. Method: the Delphi method was used with 39 participants, of whom 31 were nurses and eight were physicians, all experts in the area of infection control. Data collection took place over a period of seven months, being undertaken in four rounds. Content analysis was used for analyzing the qualitative data, and descriptive analysis for the quantitative data. Results: a total of four interactive and sequential rounds was undertaken. The first was an instrument with open questions. The instrument for the second round was elaborated based on the responses to these (39 respondents), and was made up of items to be evaluated by the participants. After the second round (35 respondents), the items for which consensus was not obtained were re-presented to the participants in the instrument of the third round (30 respondents), which contained the problematization of the item so that each participant could reevaluate it and provide their rationale. In the fourth round, all the data gathered was returned to all the participants. The undertaking of rounds, promoting controlled feedback so that all participants can review their opinions is a striking characteristic of this method. Conclusion: the Delphi method evidenced its strength as a possibility for articulating qualitative and quantitative approaches, bringing these characteristics together to respond to a complex research issue in the area of nursing and health.

A importância da higienização das mãos no controle das infecções em serviços de saúde / The importance of hand hygiene in the control of infections in health services / La importancia de la higiene de las manos en el control de infecciones en servicios de salud

Objetivo: identificar a quantidade de unidades formadoras de colônias das mãos de componentes da equipede enfermagem antes e após de lavá-las com água e sabão e antisséptico. Método: estudo descritivo,transversal de abordagem quantitativa, realizado a partir da coleta de swabs esterilizados das mãos deenfermeiros e acadêmicos de enfermagem, antes de lavá-las, ao lavá-las com água e sabão e após utilizaçãode antisséptico. O material foi coletado, as placas incubadas a 37°C e após 24 horas analisadas. O projeto depesquisa teve a aprovação do Comitê de Ética em Pesquisa, protocolo 646/07. Resultados: a utilização deágua e sabão pode reduzir a população microbiana presente nas mãos em até 88,7% e a aplicação de produtosantissépticos, em especial de agentes com base alcoólica, pode intensificar a redução microbiana em até 97%.Conclusão: A higienização das mãos é de suma importância na prevenção e controle das infecções em serviçosde saúde.(AU)

Objective: to identify the number of colony forming units in the hands of members of the nursing team before and after washing them with soap and water and antiseptic. Method: descriptive, cross-sectional study, with quantitative approach, carried out from the collection of sterile swabs from the hands of nurses and nursing students, before washing them with soap and water and after the use of antiseptic. The material was collected, the plates incubated at 37°C and, after 24 hours, analyzed. The Research Ethics Committee approved the research project, protocol 646/07. Results: using soap and water can reduce the microbial population present in the hands by up to 88.7% and applying antiseptic products, especially alcohol based agents, can intensify the microbial reduction in up to 97%. Conclusion: Hand hygiene is of paramount importance to prevent and control infections in health services.(AU)

Objetivo: identificar el número de unidades formadoras de colonias de las manos de los miembros del personal de enfermería antes y después de lavarlas con agua y jabón y antiséptico. Método: estudio descriptivo, transversal, con un enfoque cuantitativo, realizado a partir de la recogida de los hisopos esterilizados de las manos de los enfermeros y estudiantes de enfermería antes de lavarlas con agua y jabón y después de usar un antiséptico. El material fue recogido, las placas, incubadas a 37°C y, después de 24 horas, analizadas. El proyecto de investigación fue aprobado por el Comité Ético de Investigación, protocolo 646/07. Resultados: el uso de agua y jabón puede reducir la población microbiana presente en las manos a 88,7% y la aplicación de producto antiséptico, en particular agente basado en alcohol, puede aumentar la reducción microbiana de hasta 97%. Conclusión: La higiene de manos es de suma importancia en la prevención y control de infecciones en los servicios de salud.(AU)

[Perioperative considerations for performing a brain biopsy on a patient with subtype VV2 sporadic Creutzfeldt-Jakob disease]. / Consideraciones perioperatorias para la realización de una biopsia cerebral en un paciente con enfermedad de Creutzfeldt-Jakob esporádica subtipo VV2.

Creutzfeldt-Jakob disease (CJD) is the most common transmissible spongiform encephalopathy. It is an infectious, progressive, degenerative neurological disorder, with a presumably long incubation period, but a rapid fatal course. CJD is transmitted by a proteinaceous infectious agent, or «prion¼. Because the prions are difficult to eradicate and are resistant to the currently used sterilization methods, special precautions must be taken with all surgical instruments. It is recommended the single-use equipment, destruction of contaminated equipment, decontamination of reusable instruments, use of protective clothing, and storing and quarantining surgical instruments. The single-use equipment and some tissues and body fluids from the patient with CJD are highly infectious and must be incinerated. We report a case of a patient who had undergone brain biopsy for suspected of CJD, being confirmed to have sporadic CJD. Specific preventive measures were taken to reduce the risk of transmission to healthcare workers.

Control strategies for carbapenemase-producing Enterobacteriaceae at different levels of the healthcare system.

There has been a rapid increase in recent years in the incidence of infection and colonization by carbapenemase-producing Enterobacteriaceae (CPE). A number of clusters and outbreaks have been reported, some of which have been contained, providing evidence that these clusters and outbreaks can be managed effectively when the appropriate control measures are implemented. This review outlines strategies recommended to control CPE dissemination both at the healthcare facility level (acute and long-term care) and from the public health point of view. A dedicated prepared plan should be required to prevent the spread of CPE at the hospital level. At the front line, activities should include management of patients at admission and new cases, active surveillance culturing and definition of high-risk groups. High compliance with standard precautions for all patients and full or modified contact precautions for defined categories of patients should be implemented. Long-term care facilities are areas where dissemination can also take place but more importantly they can become a reservoir as patients are admitted and released to other Health care facilities. From the public health point of view, surveillance must be tailored to identify regional spread and interfacility transmission to prevent further dissemination. Finally, a comprehensive set of activities at various levels is necessary to prevent further spread of these bacteria in the community.

[Nosocomial infections in long-term health care facilities]. / Infección nosocomial en centros sanitarios de cuidados prolongados.

The long-term care facilities (LTCF) are the health care level that integrates medical assistance and social services according to the requirements of its beneficiaries. There is a great variability depending on the users profile, the professional staff and accessibility to technical resources for diagnosis, treatment or rehabilitation. In LTCF different factors are shaping a challenge in the infection control. These factors are high prevalence of infection and colonization by multiresistant microorganisms (MROs), a high rate of, often inadequate, antibiotic prescriptions, the high transfer of hospital patients, and the lack of diagnostic resources. In infection studies in LTCF, one of the main problems is the lack of standard, and well defined, infection criteria. The special features of infections in the elderly population, together with the limited resources, make it necessary to establish standard and worldwide validated criteria in order achieve appropriate monitoring and control of infection. The most common infection is the respiratory, followed by the urinary, skin and soft tissue, gastro-intestinal tract, and eyes. The problematic microorganisms most frequently identified in LTCF are enterobacteriaceae extended spectrum beta lactamase, Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA). A successful infection control mainly depends on two actions. First, a high compliance of standard precautions and second, patient organization according to the risk of transmission of a particular MROs infection, especially MRSA. This risk classification may be a way to rationalize application measures, and the incorporation of ethical and legal issues. The level of stratification is established mainly according to the condition of being colonized or infected, the MROs anatomical location, and the degree of behavioral disorders suffered by the patient. Implementation of extensive screening programs or complex monitoring programs, as in acute care hospitals are not indicated. The epidemiological surveillance must adapt to clinical guidelines, with the registering of colonized and infected patients being mandatory, along with the coordination between health and social systems by applying global control programs.

Prevalencia y determinantes biomédicos asociados a infecciones post-extracción dental en dos instituciones escuela de estomatología / Prevalence and biomedical determinants associated with post-dental extraction infections in two stomatology school institutions

La presente investigación tuvo como objetivo establecer la prevalencia y los determinantes biomédicos asociados a infecciones post-extracción dental en dos instituciones escuelas de estomatología (Hospital Nacional Rosales y Facultad de Odontología de la Universidad de El Salvador) con los expedientes de pacientes adultos mayores de 18 años de edad a los que se les realizó tratamientos de extracción dental durante el año 2012. Se evaluaron los determinantes biomédicos: edad, el sexo, el estado sistémico y bucal, así como a las indicaciones post-quirúrgicas brindadas a los pacientes y condición de la zona quirúrgica. La población evaluada fue de 729 expedientes clínicos donde de forma aleatoria se seleccionaron 125 para cada institución obteniendo una muestra de 250 unidades de análisis de pacientes adultos mayores de 18 años. Durante la recolección de los datos se fueron revisando los expedientes con una guía de observación diseñada como lista de cotejo para obtener los determinantes biomédicos asociados a infecciones post-extracción dental. Una vez obtenidos los datos se tabularon para realizar las respectivas tablas y gráficas. Posteriormente se realizó la comprobación de hipótesis mediante el Tes-t estadístico Chi-Cuadrado, además se calcularon medidas de asociación y sus intervalos de confianza correspondientes. De acuerdo a los resultados, de la población total atendida el 26% presentó infección de los cuales el 8% presentó una infección establecida, además el sexo femenino es el más numeroso con un 65% (163) y el grupo etáreo más frecuente de 20-29 años, siendo también este grupo el que presentó 31 casos de infección post-extracción dental. De los pacientes sanos el 25.2% presentó signos de infección y de los que presentaron alguna condición sistémicamente solamente el 0.8% presentó signos y síntomas de infección. De 125 pacientes que recibieron antibiótico 36 presentaron infección, y de los 43 que se les dieron técnicas de higiene oral 7 presentaron infección. Según la presencia de infección preoperatoria, no se encontró ningún paciente 100% sano.

To establish the prevalence and bio medical determinants associated to the development of infection post dental extraction in two institutions of School of Dentristryis the objective of the present study. The record of adult patients over 18 year of age, who underwent dental extractions during 2012 were reviewed. The bio medical determinants evaluated were; ago, sex, systemic an oral condition, site of extraction as well as post surgical indications given to patients. The evaluation of 729 clinical records were the total population, from this universe: 125 records from each institution were ramdomly selected, with a 250 analysis units (records), representing adult patient over 18 year old. During the dataq collection, the records were reviewed whitha observation guide, designed as a check list that includes the before mentioned biomedical determinants, associated whit post dental extraction infection. Once the data was collected, the results were tabulated in the respective tables and graphs. Subsequently, hypothesis testings were performed using T-test, Chi-Square. And association measures and their corresponding confidence intervals were alculated. According to obtained data: 26% of attended population had infection (pre or post op?); besides, the female is the most attended population, whit 65%, (163), and the most frecuent age category group was 20-29 years old. This group presented 31 cases of post extraction infection in the surgical site. 25.2% presented infection in the group of patients without systemical compromise and in the group whit systemical compromise only the 0.8% presented without infection. From 125 patients that received antibiotics, (pre or post treatment?): 36 presented infection and from 43 patientes that received oral hygiene techniques: 7 presented infection. The evaluated records reveals that any patient was 100% healthy in their oral condition.

[Significant increase in the colonisation of Staphylococcus aureus among medical students during their hospital practices]. / Aumento significativo de la colonización por Staphylococcus aureus entre los estudiantes de medicina durante la realización de las prácticas en el hospital.

INTRODUCTION: Staphylococcus aureus is a pathogen of major concern. The emergence of methicillin-resistant S. aureus (MRSA) has increasingly complicated the therapeutic approach of hospital-acquired infections. Surveillance of MRSA and control measures must be implemented in different healthcare settings, including screening programs for carriers. Our first aim was to determine the prevalence of methicillin-susceptible S. aureus (MSSA) and MRSA nasal carriage in medical students from the Clínico San Carlos Hospital (Madrid). As the MRSA carrier rate in healthcare workers is higher than in the general population, we hypothesised that carrier rate could be increased during their clinical practice in their last three years. METHODS: We performed an epidemiologic al study of the prevalence of S. aureus colonisation among a group of medical students, who were sampled in 2008 in their third-year, and in 2012 when this class was in its sixth year. RESULTS: We have found a significant increase in MSSA carriage, from 27% to 46%. There were no MRSA colonisations in the third-year, but one was found in the sixth-year group. The large majority of strains (89%) of strains were resistant to penicillin, and 27% to erythromycin and clindamycin. As 19 coagulase-negative Staphylococcus MR were also identified, a horizontal transfer of genes, such as mecA gene to S. aureus, could have occurred. CONCLUSIONS: Medical students are both, at risk for acquiring, and a potential source of nosocomial pathogens, mainly MSSA. Therefore, they should take special care for hygienic precautions, such as frequent and proper hand washing, while working in the hospital.

Contaminación microbiana en las líneas de agua de las unidades odontológicas / Microbial contamination in the water lines of dental inits

Los microorganismos son responsables de múltiples patologías e infecciones. De esta manera, es fundamental controlar la microbiota que se encuentra en el agua que sale de la jeringa triple y que es usada para la irrigación en diferentes procedimientos odontológicos como en cirugía, periodoncia, endodoncia, entre otros, para producir el éxito a largo plazo. El objetivo de éste estudio fue identificar las especies microbianas (bacterianas y micóticas) cultivables, presentes en las líneas de agua de las unidades odontológicas en una clínica privada en la ciudad de Medellín, Colombia. Se evaluaron por conveniencia y al azar 11 unidades odontológicas de 89, de cada una se recolectó una muestra de agua de 500 ml expulsada por la jeringa triple. El análisis consistió en búsqueda de coliformes totales y recuento de microorganismos cultivables como también recuento de hongos filamentosos y levaduras. El recuento de microorganismos mesófilos osciló entre 40 UFC y más de 200 UFC. Se aislaron microorganismos como Aeromona Salmonicida, Actinobacilus sp y Speudomona maltophil. No se encontraron coliformes totales ni fecales. La alta contaminación indica formación de una biopelícula madura, pero la ausencia de coliformes totales y fecales señala que el agua está bien tratada, pero en algún sitio de la línea de agua hay formación de biopelículas.

Microorganisms are responsible for multiple infections and pathologies; this is why it is important to control microbes that can be found in the triple syringe used for irrigation in different dental procedures. The aim of this study was to identify cultivable species of microbes (fungus and bacteria) found in some dental units water lines of a private dental clinic from Medellín, Colombia. Random samples were taken from 11 chairs from a total of 89; a sample of water of 500ml was collected from the triple syringe of each selected chair. The study aim to search for the presence of total coliforms, filamentous fungi and leavened. The average presence of microorganisms was between 40CFU and more of 200 CFU. Microorganisms such as Aeromona salmonicida, Actinobacilus sp and Pseudomona maltophil were isolated. No total coliforms neither fecal coliforms were found. The high levels of contamination suggest that there is a mature biofilm in somewhere of the dental unit water line, but the absence of total and fecalis coliforms suggest that the water had been treated.

Descrição das práticas de prevenção da infecção Hospitalar por anestesiologistas em um hospital universitário / Description of nosocomial infection prevention practices by anesthesiologists in a university hospital

JUSTIFICATIVA E OBJETIVOS: Os anestesiologistas desempenham importante papel na prevenção de infecções hospitalares. Na prática anestésica, rotineiramente são ultrapassadas as barreiras fisiológicas, possibilitando a contaminação do paciente por micro-organismos e o desenvolvimento de infecção. A não adesão às práticas recomendadas pode facilitar a transmissão de micro-organismos. É importante descrever as práticas de profilaxia da infecção hospitalar relacionadas ao ato anestésico executadas por médicos anestesiologistas. MÉTODO: Foram distribuídos questionários estruturados, preenchidos pelo próprio anestesiologista de forma voluntária e anônima. RESULTADOS: Dentre os 112 anestesiologistas, 75 por cento responderam ao questionário. A máscara cirúrgica é usada por 95,2 por cento, 96,3 por cento usam luvas frequentemente, 98,8 por cento usam luva estéril para bloqueio do neuroeixo, 91,3 por cento adotam a técnica estéril para punção venosa central, 95,1 por cento lavam as mãos entre os casos, 91,6 por cento procuram manter estéril a cânula de intubação orotraqueal, 96,3 por cento descartam o propofol em seringa ao final de cada anestesia, 30 por cento limpam os frascos para uso no neuroeixo e 19,8 por cento para uso endovenoso. CONCLUSÕES: As práticas de profilaxia de infecção hospitalar apresentaram boa adesão e, para melhorá-las, é necessário realizar campanhas educacionais multidisciplinares.

BACKGROUND AND OBJECTIVES: Anesthesiologists play an important role in the prevention of nosocomial infections. In anesthetic practice, physiologic barriers are routinely breached, allowing patient contamination with microorganisms and the consequent development of infection. The lack of adhesion to recommended practices can facilitate transmission of microorganisms. It is important to describe prophylactic practices of anesthesiarelated nosocomial infections performed by anesthesiologists. METHODS: Structured questionnaires were distributed to be answered voluntarily and anonymously by anesthesiologists. RESULTS: Among 112 anesthesiologists, 75 percent answered the questionnaire. Surgical mask is used by 95.2 percent of anesthesiologists, 96.3 percent wear gloves frequently, 98.9 percent wear sterile gloves for neuraxial block, 91.3 percent use sterile technique for central venous puncture, 95.1 percent wash their hands between cases, 91.6 percent try to maintain the endotracheal tube sterile, 96.3 percent discard the prefilled propofol syringe at the end of each anesthesia, 30 percent clean the vials before using it in the neuraxial blocks, and 19.8 percent clean the vials before intravenous use. CONCLUSIONS: Respondents showed good adhesion to practices of nosocomial infection prophylaxis and to improve them educational multidisciplinary campaigns are necessary.

JUSTIFICATIVA Y OBJETIVOS: Los anestesiólogos desempeñan un importante papel en la prevención de las infecciones hospitalarias. En la práctica anestésica, y de forma rutinaria, se rebasan las barreras fisiológicas, posibilitando la contaminación del paciente por microorganismos y el desarrollo de las infecciones. Si no se respetan las prácticas recomendadas, se puede facilitar la transmisión de los microorganismos. Es importante describir las prácticas de profilaxis de la infección hospitalaria que se relacionan con el acto anestésico y que son hechas por los médicos anestesiólogos. MÉTODO: Se distribuyeron cuestionarios estructurados, rellenados por el propio anestesiólogo de forma voluntaria y anónima. RESULTADOS: Entre los 112 anestesiólogos, 75 por ciento de ellos respondieron al cuestionario. La máscara quirúrgica la usa un 95,2 por ciento, y el 96,3 por ciento usan guantes con frecuencia. Un 98,8 por ciento usan guantes estériles para el bloqueo del neuro eje, un 91,3 por ciento adoptan la técnica estéril para punción venosa central, un 95,1 por ciento se lavan las manos entre los casos, un 91,6 por ciento intentan mantener estéril la cánula de intubación orotraqueal, el 96,3 por ciento descartan el propofol en la jeringuilla al final de cada anestesia, el 30 por ciento limpian los frascos para el uso en el neuro eje, y el 19,8 por ciento queda para uso endovenoso. CONCLUSIONES: Las prácticas de profilaxis de infección hospitalaria presentaron una buena adhesión y para mejorarlas, es necesario realizar campañas educativas multidisciplinarias.