RESUMO
INTRODUCTION: Bacteremia associated to vascular catheters is the most frequent nosocomial infection in Neonatal Intensive Care Units and increases cost and mortality. OBJECTIVE: To know the risk of bacteremia related to vascular devices in hospitalized newborns, stratified by birth weight. METHOD: A surveillance system was established considering birth weight and type of catheters in order to detect bacteremia and look for the risks associated to type of catheters and birth weight in the period 2005 to 2011, according to Chilean Ministry of Health's surveillance. RESULTS: We registered bacteremia associated to vascular devices in newborns considering birth weight between less than 1,000 g to more than 2,500 g from years 2005 and 2011. In the period, 4,704 patients were surveyed with 25,130 catheter days and 70 bacteremia were detected. The rates of bacteremia were 0.9 per 1,000 catheter days in peripheral catheters, 3.0 per 1000 catheter days in peripheral inserted central catheters and 9.6 per 1,000 catheter days in umbilical catheters (UC). On the other side the risk of bacteremia was 6.4% in newborns with birth weight less 1,000 g and 1.5% in newborns with birth weight over 2,500 g. Coagulase negative Staphylococcus was the most frequent isolate agents. CONCLUSIONS: The risk of developing bacteremia is associated with lower birth weight and the use of UC independent of weight.
Assuntos
Bacteriemia/epidemiologia , Infecções Relacionadas a Cateter/epidemiologia , Infecção Hospitalar/epidemiologia , Recém-Nascido de Baixo Peso , Dispositivos de Acesso Vascular/efeitos adversos , Infecções Relacionadas a Cateter/microbiologia , Criança , Chile/epidemiologia , Feminino , Seguimentos , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Dispositivos de Acesso Vascular/microbiologiaRESUMO
UNLABELLED: We conducted a clinical trial to determine the impact of coating surfaces with copper in reducing hospital-acquired infections, mortality associated with nosocomial infections and antimicrobial costs in the UCI. The study took place at Carlos Van Buren Hospital, Valparaíso, Chile. No differences in the frequency of nosocomial infections were found. Not in rates of ventilator-associated pneumonia (p = 0.9), nor in catheter- associated urinary tract infection (p = 0.9) or in central venous catheter associated bacteremia (p = 0.3). There were no differences in infection-free survival (p = 0.9). There were less costs of antimicrobials in patients in which copper was used. The fact that the sample size was not completed could explain that no significant differences in infections were found. CONCLUSION: The use of copper as a surface in the ICU showed no statistically significant differences in rates of nosocomial infections during the study period, however, these results could be related to the sample size.
Assuntos
Cobre , Infecção Hospitalar , Controle de Infecções/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/economia , Bacteriemia/mortalidade , Bacteriemia/prevenção & controle , Cateterismo Venoso Central/efeitos adversos , Chile/epidemiologia , Infecção Hospitalar/economia , Infecção Hospitalar/mortalidade , Infecção Hospitalar/prevenção & controle , Feminino , Fômites/microbiologia , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Pneumonia Associada à Ventilação Mecânica/economia , Pneumonia Associada à Ventilação Mecânica/mortalidade , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Estudos Prospectivos , Cateterismo Urinário/efeitos adversos , Infecções Urinárias/economia , Infecções Urinárias/mortalidade , Infecções Urinárias/prevenção & controle , Adulto JovemRESUMO
BACKGROUND: Reporting on the International Nosocomial Infection Control Consortium study results from 2015 to 2020, conducted in 630 intensive care units across 123 cities in 45 countries spanning Africa, Asia, Eastern Europe, Latin America, and the Middle East. METHODS: Prospective intensive care unit patient data collected via International Nosocomial Infection Control Consortium Surveillance Online System. Centers for Disease Control and Prevention/National Health Care Safety Network definitions applied for device-associated health care-associated infections (DA-HAI). RESULTS: We gathered data from 204,770 patients, 1,480,620 patient days, 936,976 central line (CL)-days, 637,850 mechanical ventilators (MV)-days, and 1,005,589 urinary catheter (UC)-days. Our results showed 4,270 CL-associated bloodstream infections, 7,635 ventilator-associated pneumonia, and 3,005 UC-associated urinary tract infections. The combined rates of DA-HAIs were 7.28%, and 10.07 DA-HAIs per 1,000 patient days. CL-associated bloodstream infections occurred at 4.55 per 1,000 CL-days, ventilator-associated pneumonias at 11.96 per 1,000 MV-days, and UC-associated urinary tract infections at 2.91 per 1,000 UC days. In terms of resistance, Pseudomonas aeruginosa showed 50.73% resistance to imipenem, 44.99% to ceftazidime, 37.95% to ciprofloxacin, and 34.05% to amikacin. Meanwhile, Klebsiella spp had resistance rates of 48.29% to imipenem, 72.03% to ceftazidime, 61.78% to ciprofloxacin, and 40.32% to amikacin. Coagulase-negative Staphylococci and Staphylococcus aureus displayed oxacillin resistance in 81.33% and 53.83% of cases, respectively. CONCLUSIONS: The high rates of DA-HAI and bacterial resistance emphasize the ongoing need for continued efforts to control them.
Assuntos
Infecções Relacionadas a Cateter , Infecção Hospitalar , Humanos , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/microbiologia , Estudos Prospectivos , Unidades de Terapia Intensiva , Adulto , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Pneumonia Associada à Ventilação Mecânica/microbiologia , Masculino , Criança , Feminino , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologia , Pessoa de Meia-Idade , Controle de Infecções/métodos , Lactente , Pré-Escolar , Ásia/epidemiologiaRESUMO
Introduction: Bacteremia associated to vascular catheters is the most frequent nosocomial infection in Neonatal Intensive Care Units and increases cost and mortality. Objective : To know the risk of bacteremia related to vascular devices in hospitalized newborns, stratified by birth weight. Method: A surveillance system was established considering birth weight and type of catheters in order to detect bacteremia and look for the risks associated to type of catheters and birth weight in the period 2005 to 2011, according to Chilean Ministry of Health’s surveillance. Results: We registered bacteremia associated to vascular devices in newborns considering birth weight between less than 1,000 g to more than 2,500 g from years 2005 and 2011. In the period, 4,704 patients were surveyed with 25,130 catheter days and 70 bacteremia were detected. The rates of bacteremia were 0.9 per 1,000 catheter days in peripheral catheters, 3.0 per 1000 catheter days in peripheral inserted central catheters and 9.6 per 1,000 catheter days in umbilical catheters (UC). On the other side the risk of bacteremia was 6.4% in newborns with birth weight less 1,000 g and 1.5% in newborns with birth weight over 2,500 g. Coagulase negative Staphylococcus was the most frequent isolate agents. Conclusions: The risk of developing bacteremia is associated with lower birth weight and the use of UC independent of weight.
Introducción: La bacteriemia asociada al uso de dispositivos intravasculares constituye la infección nosocomial más frecuente en las unidades de cuidado intensivo neonatal, asociándose a mayores costos y letalidad. Objetivo: Conocer el riesgo de bacteriemias relacionadas al uso de dispositivos intravasculares en recién nacidos hospitalizados, de acuerdo a su peso de nacimiento. Material y Métodos: Vigilancia epidemiológica de baeteriemia en neonatos con catéteres vasculares para asociarlos con los tipos de catéteres y el peso de nacimiento, durante el período 2005 a 2011, utilizando el sistema de vigilancia vigente en el país. Resultados: Se registraron las bacteriemias asociadas a dispositivos vasculares en neonatos considerando peso de nacimiento entre menos a 1.000 g a más de 2.500 g entre los años 2005 y 2011. Se vigilaron 4.704 pacientes con 25.130 días de uso de catéter y se detectaron 70 bacteriemias. La mayor utilización de la vía venosa fue por catéteres venosos periféricos. Las tasas de bacteriemias fueron de 0,9 por mil días catéter en venoso periférico, 3,0 en catéter central por vía percutánea y 9,6 en catéter umbilical (CU). El riesgo de bacteriemia fue de 6,4% en los neonatos de peso < 1.000 g y 1,5% en > 2.500 g. Staphylococcus coagulasa negativa fue el agente más frecuentemente aislado. Conclusiones: El riesgo de desarrollar bacteriemia se asoció a menor peso de nacimiento y a la utilización de CU en forma, independiente del peso.
Assuntos
Criança , Feminino , Humanos , Recém-Nascido , Masculino , Bacteriemia/epidemiologia , Infecções Relacionadas a Cateter/epidemiologia , Infecção Hospitalar/epidemiologia , Recém-Nascido de Baixo Peso , Dispositivos de Acesso Vascular/efeitos adversos , Infecções Relacionadas a Cateter/microbiologia , Chile/epidemiologia , Seguimentos , Unidades de Terapia Intensiva Neonatal , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Dispositivos de Acesso Vascular/microbiologiaRESUMO
We conducted a clinical trial to determine the impact of coating surfaces with copper in reducing hospital-acquired infections, mortality associated with nosocomial infections and antimicrobial costs in the UCI. The study took place at Carlos Van Buren Hospital, Valparaíso, Chile. No differences in the frequency of nosocomial infections were found. Not in rates of ventilator-associated pneumonia (p = 0.9), nor in catheter- associated urinary tract infection (p = 0.9) or in central venous catheter associated bacteremia (p = 0.3). There were no differences in infection-free survival (p = 0.9). There were less costs of antimicrobials in patients in which copper was used. The fact that the sample size was not completed could explain that no significant differences in infections were found. Conclusion: The use of copper as a surface in the ICU showed no statistically significant differences in rates of nosocomial infections during the study period, however, these results could be related to the sample size.
Introducción: Las infecciones nosocomiales incrementan la mortalidad y costos en las instituciones de salud. El revestimiento con cobre, de superficies de alto contacto en la unidad clínica en torno a los pacientes, reduce la colonización bacteriana de las mismas. Objetivo: Determinar el impacto del revestimiento de las superficies con cobre en la disminución de las infecciones intrahospitalarias, la mortalidad asociada a las infecciones intrahospitalarias y los costos en antimicrobianos en pacientes hospitalizados en UCI adultos en el Hospital Carlos Van Buren. Pacientes y Métodos: Estudio prospectivo, comparativo, mayo de 2011-mayo de 2012. Asignación aleatoria de pacientes adultos ingresados en UCI, que permanecieran al menos por 24 h en dicha unidad, a unidades de aislamiento recubiertas (n: 7) o no recubiertas con cobre (n: 7). Resultados: Ingresaron al estudio 440 pacientes, 217 pacientes (49,3%) en el grupo sin cobre y 223 en el grupo con cobre (50,7%). No se encontraron diferencias en la frecuencia de infecciones intrahospitalarias en ambos grupos. Tampoco se encontraron diferencias significativas en las tasas de neumonía asociada a ventilación mecánica (p = 0,9), infección urinaria asociada a catéter urinario (p = 0,9) y bacteremias asociada a catéter venoso central (p = 0,3). Tampoco se encontraron diferencias en la sobrevida libre de infección (p = 0,9). Se encontró un gasto menor de antimicrobianos en pacientes atendidos en unidades revestidas con cobre. Durante el período del estudio no se completó el tamaño de muestra y las diferencias no significativas podrían deberse a este hecho. Conclusión: El uso del cobre como revestimiento de las superficies hospitalarias en UCI, mostró diferencia en la tasa de bacteriemia asociada a dispositivos venosos, aunque no significativa, y no mostró diferencia en neumonías e infecciones urinarias. Las diferencias no significativas pueden deberse a que no se completó el tamaño de la muestra. Se observó un mayor gasto de antimicrobianos en pacientes de unidades no cobrizadas, lo que plantea una nueva área de investigación.
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Cobre , Infecção Hospitalar , Controle de Infecções/métodos , Bacteriemia/economia , Bacteriemia/mortalidade , Bacteriemia/prevenção & controle , Cateterismo Venoso Central/efeitos adversos , Chile/epidemiologia , Infecção Hospitalar/economia , Infecção Hospitalar/mortalidade , Infecção Hospitalar/prevenção & controle , Fômites/microbiologia , Unidades de Terapia Intensiva , Estudos Prospectivos , Pneumonia Associada à Ventilação Mecânica/economia , Pneumonia Associada à Ventilação Mecânica/mortalidade , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Cateterismo Urinário/efeitos adversos , Infecções Urinárias/economia , Infecções Urinárias/mortalidade , Infecções Urinárias/prevenção & controleRESUMO
We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from 2002 through 2007 in 98 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study, using Centers for Disease Control and Prevention (CDC) National Nosocomial Infections Surveillance System (NNIS) definitions for device-associated health care-associated infection, we collected prospective data from 43,114 patients hospitalized in the Consortium's hospital ICUs for an aggregate of 272,279 days. Although device utilization in the INICC ICUs was remarkably similar to that reported from US ICUs in the CDC's National Healthcare Safety Network, rates of device-associated nosocomial infection were markedly higher in the ICUs of the INICC hospitals: the pooled rate of central line-associated bloodstream infections (CLABs) in the INICC ICUs, 9.2 per 1000 CL-days, is nearly 3-fold higher than the 2.4-5.3 per 1000 CL-days reported from comparable US ICUs, and the overall rate of ventilator-associated pneumonia was also far higher, 19.5 vs 1.1-3.6 per 1000 ventilator-days, as was the rate of catheter-associated urinary tract infection, 6.5 versus 3.4-5.2 per 1000 catheter-days. Most strikingly, the frequencies of resistance of Staphylococcus aureus isolates to methicillin (MRSA) (80.8% vs 48.1%), Enterobacter species to ceftriaxone (50.8% vs 17.8%), and Pseudomonas aeruginosa to fluoroquinolones (52.4% vs 29.1%) were also far higher in the Consortium's ICUs, and the crude unadjusted excess mortalities of device-related infections ranged from 14.3% (CLABs) to 27.5% (ventilator-associated pneumonia).
Assuntos
Infecção Hospitalar/epidemiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Positivas/microbiologia , África/epidemiologia , Ásia/epidemiologia , Infecção Hospitalar/microbiologia , Infecção Hospitalar/mortalidade , Farmacorresistência Bacteriana , Europa (Continente)/epidemiologia , Infecções por Bactérias Gram-Negativas/mortalidade , Infecções por Bactérias Gram-Positivas/mortalidade , Humanos , Unidades de Terapia Intensiva , Cooperação Internacional , América Latina/epidemiologia , Organizações , PrevalênciaRESUMO
Es necesario capacital personal de salud en control de prevención de infecciones hospitalarias para la conformación y funcionamiento adecuado de comisiones de control de infecciones y lograr disminuir las IAAS. Evaluación diagnóstica de la capacitación de profesionale durante dos años del proyecto CINELA (Combatiendo las Infecciones Nosocomiales en Latinoamerica) en Venezuela. CINELA, iniciado en 2009, persigue capacitar al trabajador de salud en prevención y control de IAAS. Consta de 40 horas académicas con conferencias. discusiones y talleres. Fue discutido y validado por profesionales latinoamericanos de control de infecciones; acreditado por la Universidad de Valparaíso, Chile y avalado por organizaciones internacionales y sociedades científicas. Estudio descriptivo, transversal de los registros del tipo de participante, institución del programa por los cursantes en Venezuela. Resultados mostrados en tablas y expresados en números absolutos y porcentajes. Participantes: 84; 54,8% de instituciones privadas; 34,5% públicas; 9,5% de ambas. Enfermeros 78,6%, 19% médicos, 7 (9,5%) involucrados en control de infecciones. Un tercio provenían de servicios médicos; 12% quirúrgicos; 9,5% unidades pediátricas. Más de 95% desconocía normativas de su centro y 100% negaron supervisión estructurada para control de IAAS; < 90% de profesionales de instituciones públicas y 60% de privados informó uso inadecuado de desinfectantes, métodos de esterilización o antisépticos. El 44% aprobó el curso. Existen carencias en el funcionamiento de las comisiones de control de infecciones en Venezuela; es importante la capacitación de los profesionales de salud en IAAS.
It is necessary to train health personnel in prevention and control of hospital infections for the establishment and operation of appropriate infection control committees. This approach will reduce Health-Associated Infections (HALs). Diagnostic evaluation of professional training during the first two years of the project CINELA (Fighiting nosocomial infections in Latin America) in Venezuela. CINELA, initiated in 2009, aims to train health workers in prevention and control of HAIs. It consists of 40 academic hours with lectures, discussions and workshops. It was discussed and validated by professional workers in infection control from Latin America, accredited by the University of Valparaiso, Chile and supported by international organizations and scientific societies. This is descriptive, cross-type study with revision of participant records, institutions represented, approval rating and evaluation of the program by the students in Venezuela. Results are shown in tables and expressed in absolute numbers and percentages.There were a total of 84 participants, 54.8% from private institutions, 34.5% public, 9.5% both. More than 78% were nurses, 19% medical doctors, 7 (9.5%) involved in infection control . One third of the participants worked in medical, 12% surgical, and 9.5% in pediatric units. Over 95% were unaware of their center regulations and 100% stated that structured supervision to control HAIs was not done; more than 90% of professionals from public, and 60% from private institutions reported improper use of disinfectants, antiseptics and sterilization methods. Forty four percent of students successfully completed the course. There are important gaps in the functioning of the infection control committees in Venezuela; training of health personnel is of utmost importance to prevent occurrence of HAIs.
Assuntos
Humanos , Masculino , Feminino , Controle de Infecções/métodos , Infecção Hospitalar/prevenção & controle , Pessoal de Saúde/educação , Serviços de Saúde do Trabalhador/métodosRESUMO
La elevada morbilidad de la fiebre tifoidea en Chile, junto a los datos demostrativos de que existe una correlación entre el estado portador de S. typhi y las colecistopatías encontradas en otros lugares, condujo a analizar 1.000 muestras de bilis de pacientes con colecistopatía. Los resultados indican que la prevalencia excepcionalmente elevada de colecistopatías en Chile constituye un factor importante en la transmisión de la fiebre tifoidea (AU)
Assuntos
Febre Tifoide/transmissão , Colecistectomia/tendências , Chile/epidemiologiaRESUMO
La elevada morbilidad de la fiebre tifoidea en Chile, junto a los datos demostrativos de que existe una correlacion entre el estado de portador de S. typhi y las colecistopatias encontradas en otros lugares, condujo a analizar 1000 muestras de bilis de pacientes con colecistopatia. Los resultados indican que la prevalencia excepcionalmente elevada de colecistopatias en Chile constituye un factor importante en la transmision de la fiebre tifoidea