RESUMO
The most popular method of GBS identification in Poland currently is by culturing on enriched agar and verifying the Lancefield Group using special latex agglutination kits. However, the classical methods are time-consuming and their sensitivity is insufficient therefore it is becoming more common to try and apply molecular methods which are characterized by high sensitivity and rapid results. Moreover, molecular methods give us the possibility to carry out epidemiological investigations and gene detection, for instance for antibiotic resistance. It was confirmed that PCR and FISH procedures may be effective in rapid detection of GBS. Thanks to RAPD methods we showed that newborns born to colonized mothers were colonized by GBS strains which originated from the mother, irrespective of the way and the course of labour. Additionally, we detected GBS colonization in children who were born to mothers who were not colonized by GBS. These children were probably colonized with strains coming from hospital environment. More studies are needed to elucidate the route of transmission and the role of colonization of the medical staff. Using multiplex PCR we showed the presence of ermA, ermB and ermC genes in phenotypically confirmed MLS, GBS strains.
Assuntos
Infecção Hospitalar/microbiologia , Infecção Hospitalar/transmissão , Transmissão Vertical de Doenças Infecciosas/classificação , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/transmissão , Streptococcus agalactiae/classificação , Adulto , Resistência Microbiana a Medicamentos , Feminino , Humanos , Recém-Nascido , Transmissão de Doença Infecciosa do Profissional para o Paciente/métodos , Fenótipo , Reação em Cadeia da Polimerase , Especificidade da Espécie , Streptococcus agalactiae/genéticaRESUMO
BACKGROUND: Hand hygiene (HH) compliance by health care workers has been universally disappointing. Two major programs (Washington and Geneva) have demonstrated interventions that induce sustained improvement. The introduction of alcohol-based hand rub (AHR) together with education also has been reported to improve compliance. METHODS: These interventions were replicated concurrently for 2 years in selected wards of an 800-bed university teaching hospital, with compliance assessed only within, not between, programs. RESULTS: No significant improvement in HH compliance was observed after the introduction of AHR (incidence rate ratio [IRR] = 1.11; 95% confidence interval [CI] = 0.93 to 1.33; P = .238) or substitution of AHR for a similar product (IRR = 1.10; 95% CI = 0.91 to 1.32; P = .328) with concomitant education. The Washington program achieved a 48% (IRR = 1.48, 95% CI = 1.20 to 1.81; P < .001) improvement in compliance, sustained over 2 years. The Geneva program failed to induce a significant increase in HH compliance in 3 wards, but achieved a 56% (IRR = 1.56; 95% CI = 1.29 to 1.89; P < .001) improvement over the already high HH rate in 1 ward (infectious disease unit). CONCLUSIONS: The Washington program demonstrated effectiveness in achieving sustained improved HH compliance, whereas the effect of the Geneva program was limited in those wards without strong medical leadership. Introduction of AHR without an associated behavioral modification program proved ineffective.
Assuntos
Desinfecção das Mãos , Pessoal de Saúde/estatística & dados numéricos , Higiene , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Anti-Infecciosos Locais , Coleta de Dados , Fidelidade a Diretrizes , Desinfecção das Mãos/métodos , Hospitais com mais de 500 Leitos , Hospitais de Ensino , Humanos , Higiene/normas , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Profissional para o Paciente/métodos , Queensland , Reprodutibilidade dos TestesRESUMO
We describe the transmission of hepatitis C virus (HCV) to two patients from a thoracic surgeon who was unaware of his hepatitis C infection. By partial sequencing of the non-structural 5B gene and phylogenetic analysis, the viruses from both patients were found to be closely related to genotype 1a strain from the surgeon. Two further hepatitis C cases were found in relation to the thoracic clinic. Their HCV sequences were related to each other but were of genotype 2b and the source of infection was never revealed. To elucidate the magnitude of the problem, we conducted a prospective study for a period of 17 months in which patients who were about to undergo thoracic surgery were asked to participate. Blood samples were drawn prior to surgery and at least four months later. The postoperative samples were then screened for anti-HCV and, if positive, the initial sample was also analysed. The only two patients (0.4%) identified were confirmed anti-HCV positive before surgery, and none out of 456 evaluable cases seroconverted to anti-HCV during the observation period. Despite the retrospectively identified cases, nosocomial hepatitis C is rare in our thoracic unit. The study points out the risk of transmission of hepatitis C from infected personnel and reiterates the need for universal precautions.
Assuntos
Infecção Hospitalar/transmissão , Infecção Hospitalar/virologia , Hepatite C/transmissão , Transmissão de Doença Infecciosa do Profissional para o Paciente/métodos , Cirurgia Torácica , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Genótipo , Hepacivirus/classificação , Hepacivirus/genética , Hepacivirus/imunologia , Hepacivirus/isolamento & purificação , Anticorpos Anti-Hepatite C/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Filogenia , Estudos Prospectivos , RNA Viral , Estudos Retrospectivos , Centro Cirúrgico Hospitalar , SuéciaAssuntos
Anestesiologia , Infecção Hospitalar/transmissão , Transmissão de Doença Infecciosa do Profissional para o Paciente/métodos , Meningites Bacterianas/transmissão , Infecções Estreptocócicas/transmissão , Streptococcus/isolamento & purificação , Humanos , Controle de Infecções/métodos , Máscaras , MédicosRESUMO
Virus-infected medical personnel under certain circumstances might represent a risk for pregnant women. With regard to such nosocomial provider-to-patient transmissions, the pathogens rubella virus, herpes viruses and the hepatitis B and hepatitis C viruses are of particular concern. It will become clear from the following short communication that in this context one should strive to achieve optimal protection for the expectant mothers without restricting the professional activities of virus-infected members of the medical staff in an unjustified way. In this respect it always has to be kept in mind that the risk of provider-to-patient transmissions of viruses in obstetrics and neonatology can be significantly reduced by vaccinating all personnel working in these departments against infections by the rubella, varicella-zoster, and hepatitis B viruses, and that additional strict adherence to so-called universal hygienic precautions will add more than an incremental benefit.
Assuntos
Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/estatística & dados numéricos , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Viroses/epidemiologia , Viroses/transmissão , Feminino , Humanos , Transmissão de Doença Infecciosa do Profissional para o Paciente/métodos , Corpo Clínico Hospitalar , Gravidez , Complicações Infecciosas na Gravidez/etiologia , Viroses/prevenção & controleAssuntos
Vestuário/efeitos adversos , Infecção Hospitalar/prevenção & controle , Reservatórios de Doenças , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Recursos Humanos de Enfermagem , Infecção Hospitalar/transmissão , Reservatórios de Doenças/microbiologia , Reservatórios de Doenças/virologia , Humanos , Controle de Infecções , Transmissão de Doença Infecciosa do Profissional para o Paciente/métodos , Lavanderia , Fatores de Risco , Medicina Estatal , Reino UnidoRESUMO
OBJECTIVES: Hand hygiene promotion interventions rarely result in sustained improvement, and an assessment of their impact on individual infection risk has been lacking. We sought to measure the impact of hand hygiene promotion on health care worker compliance and health care-associated infection risk among neonates. METHODS: We conducted an intervention study with a 9-month follow-up among all of the health care workers at the neonatal unit of the Children's Hospital, University of Geneva Hospitals, between March 2001 and February 2004. A multifaceted hand hygiene education program was introduced with compliance assessed during successive observational surveys. Health care-associated infections were prospectively monitored, and genotypic relatedness of bloodstream pathogens was assessed by pulsed-field gel electrophoresis. A comparison of observed hand hygiene compliance and infection rates before, during, and after the intervention was conducted. RESULTS: A total of 5325 opportunities for hand hygiene were observed. Overall compliance improved gradually from 42% to 55% across study phases. This trend remained significant after adjustment for possible confounders and paralleled the measured increase in hand-rub consumption (from 66.6 to 89.2 L per 1000 patient-days). A 9-month follow-up survey showed sustained improvement in compliance (54%), notably with direct patient contact (49% at baseline vs 64% at follow-up). Improved compliance was independently associated with infection risk reduction among very low birth weight neonates. Bacteremia caused by clonally related pathogens markedly decreased after the intervention. CONCLUSIONS: Hand hygiene promotion, guided by health care workers' perceptions, identification of the dynamics of bacterial contamination of health care workers' hands, and performance feedback, is effective in sustaining compliance improvement and is independently associated with infection risk reduction among high-risk neonates.
Assuntos
Infecção Hospitalar/prevenção & controle , Desinfecção das Mãos , Higiene , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Infecção Hospitalar/epidemiologia , Seguimentos , Desinfecção das Mãos/métodos , Humanos , Higiene/normas , Recém-Nascido , Transmissão de Doença Infecciosa do Profissional para o Paciente/métodos , Fatores de RiscoRESUMO
Food workers are an important risk group for intestinal parasite contamination and dissemination. In the present study food workers, working in food preparation and distribution in the Adnan Menderes University Hospital, Aydin State Hospital and 82. Yil State Hospital, were screened for the presence of intestinal parasites. Out of 58 food workers 22 were females and 36 were males, and the age of workers ranged from 20 to 56. All workers included in the study answered a questionnaire concerned with their social demographic situation and hygiene habits. Stool specimens and cellophane tape specimens were taken from food workers and studied for the presence of parasites. Stool samples were studied using native Lugol, precipitation by formol ethyl acetate, trichrome and acid fast staining methods. Cellophane tape slides were examined for Enterobius vermicularis with the 10X objective. Out of 58 food workers investi-gated, 17 (29.31%) had at least one parasite; nine had Blastocystis hominis (15.51%), five had E. vermicularis (8.62%), one had Giardia intestinalis (1.72%), one had both Entamoeba histolytica/dispar and Entamoeba coli (1.72%), and one had both E. vermicularis and B. hominis (1.72%). All workers with parasites were treated and taken under surveillance. The oral-fecal route is the main source for intes-tinal parasite contamination. It should be considered that food workers may be the main source for the contamination of hospital workers as well as patients which may cause serious problems especially for the cases with immune deficiency.
Assuntos
Infecção Hospitalar/transmissão , Serviço Hospitalar de Nutrição , Transmissão de Doença Infecciosa do Profissional para o Paciente/métodos , Enteropatias Parasitárias/epidemiologia , Enteropatias Parasitárias/transmissão , Recursos Humanos em Hospital , Adulto , Canal Anal/parasitologia , Animais , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/parasitologia , Fezes/parasitologia , Feminino , Humanos , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Enteropatias Parasitárias/parasitologia , Masculino , Pessoa de Meia-Idade , Parasitos/classificação , Parasitos/isolamento & purificação , Inquéritos e Questionários , Turquia/epidemiologia , Recursos HumanosRESUMO
Studies have shown that despite infection control guidelines recommending that false fingernails, nail varnish, stoned rings and wrist watches not be worn by clinical staff, a large proportion of them continue to do so. The recently updated epic guidelines (Pratt et al, 2007) state that hand jewellery and false finger nails should be kept short, clean and free from nail polish. This article discusses the bacterial carriage, contributions to outbreaks of infection and interference with proper hand hygiene practices, thereby explaining why these recommendations are made in infection control policies and guidelines.
Assuntos
Cosméticos/efeitos adversos , Infecção Hospitalar/transmissão , Fômites/microbiologia , Pessoal de Saúde , Transmissão de Doença Infecciosa do Profissional para o Paciente , Unhas/microbiologia , Portador Sadio/microbiologia , Portador Sadio/prevenção & controle , Portador Sadio/transmissão , Infecção Hospitalar/microbiologia , Infecção Hospitalar/prevenção & controle , Surtos de Doenças/prevenção & controle , Mãos/microbiologia , Humanos , Controle de Infecções/métodos , Controle de Infecções/normas , Transmissão de Doença Infecciosa do Profissional para o Paciente/métodos , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Guias de Prática Clínica como Assunto , Fatores de RiscoRESUMO
We examined a cluster of 5 hemodialysis patients who contracted gram-negative bacteremia. A nurse who used an artificial fingernail to open a vial of heparin that was mixed to make a flush solution had a culture of an artificial fingernail specimen positive for Serratia marcescens. The typing of the S. marcescens strains isolated from the 5 patients and the nurse showed them to be identical. This finding provides strong support for policies prohibiting artificial nails for healthcare workers in all hemodialysis units.
Assuntos
Bacteriemia/transmissão , Infecção Hospitalar/transmissão , Transmissão de Doença Infecciosa do Profissional para o Paciente/métodos , Unhas/microbiologia , Diálise Renal/efeitos adversos , Infecções por Serratia/transmissão , Serratia marcescens/isolamento & purificação , Bacteriemia/microbiologia , Indústria da Beleza , Infecção Hospitalar/microbiologia , Impressões Digitais de DNA , Desinfecção das Mãos/métodos , Humanos , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Infusões Intravenosas/efeitos adversos , Recursos Humanos de Enfermagem , Infecções por Serratia/microbiologia , Infecções por Serratia/prevenção & controleRESUMO
BACKGROUND AND PURPOSE: Nosocomial infections present a widespread problem in today's healthcare environment, with a significant number of patients acquiring an infection annually. With the contemporary transition of immunocompromised and high-risk patients to community-based care, therapeutic ultrasound has the potential to be a vector of infection in the physiotherapy setting. The purpose of the present study was to determine the degree of contamination on therapeutic ultrasound transducer heads and ultrasound gel after routine clinical use, and to evaluate the efficacy of recommended infection control procedures. METHOD: The study consisted of two phases. Using a prospective cross-sectional design, microbiological cultures were obtained from 44 transducer heads and 43 gels. Subjects were drawn from a variety of physiotherapy practice settings. All samples containing more than five colony forming units per cm2 were considered contaminated. Following these measurements, a repeated-measures design was used to re-evaluate the 44 transducer heads for the amount and type of bacteria present after cleaning with a 70% alcohol wipe. RESULTS: Twenty-seven per cent of transducer heads and 28% of gels were contaminated. Transducer heads showed fairly low levels of contamination across the sample, with the majority of organisms isolated found in normal skin and environmental flora. Gels were heavily contaminated with opportunistic and potentially pathogenic organisms, including Stenotrophomonas maltophilia, Staphylococcus aureus, Acinetobacter baumannii and Rhodotorula mucilaginosa. No multi-resistant organisms were identified. Cleaning with 70% alcohol significantly reduced the level of contamination on transducer heads (p < 0.01). CONCLUSIONS: Therapeutic ultrasound equipment is a potential vector for nosocomial infection in physiotherapy patients. The risk of infection from transducer heads can be effectively removed by cleaning with 70% alcohol between patients. Further research into possible strategies to reduce the risk of infection from ultrasound gels is needed.
Assuntos
Infecções Bacterianas/transmissão , Infecção Hospitalar/etiologia , Infecção Hospitalar/transmissão , Contaminação de Equipamentos , Terapia por Ultrassom/instrumentação , Acinetobacter baumannii/patogenicidade , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/prevenção & controle , Infecção Hospitalar/microbiologia , Estudos Transversais , Desinfecção/métodos , Contaminação de Equipamentos/prevenção & controle , Géis , Humanos , Incidência , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Profissional para o Paciente/métodos , Estudos Prospectivos , Staphylococcus aureus/patogenicidade , Stenotrophomonas maltophilia/patogenicidade , Transdutores/microbiologia , Terapia por Ultrassom/efeitos adversosRESUMO
INTRODUCTION: The hospital is a favourable setting for the transmission of tubercle bacilli. The presence of susceptible subjects, often immunocompromised, increases the dangers. This risk extends to the patients' visitors and to the staff. It is therefore the responsibility of the hospital to establish preventative measures capable of reducing the risk of transmission or to reduce the effects by appropriate management of exposed subjects. BACKGROUND: The modes and vectors of transmission are well established. The standardised prevention of transmission is achieved by isolation, the indications and duration of which are based on incomplete information. The surveillance of the carers by the doctor in charge, is based on precise recommendations depending on the risk of exposure. VIEWPOINT: The objectives are a reduction diagnostic delay, a better determination of infectivity and its duration during treatment, and a more complete census of cases of hospital acquired tuberculosis. CONCLUSIONS: The management of tuberculosis in hospital requires co-ordination of all involved including those outside the institution and a deliberate policy in the institution itself.
Assuntos
Infecção Hospitalar/prevenção & controle , Transmissão de Doença Infecciosa/prevenção & controle , Instalações de Saúde , Tuberculose/prevenção & controle , Microbiologia do Ar , Poluição do Ar em Ambientes Fechados , Animais , Antituberculosos/uso terapêutico , Portador Sadio , Infecção Hospitalar/transmissão , Surtos de Doenças/prevenção & controle , Reservatórios de Doenças , Desinfecção/métodos , Contaminação de Equipamentos , Cobaias , Infecções por HIV/complicações , Humanos , Higiene , Hospedeiro Imunocomprometido , Transmissão de Doença Infecciosa do Paciente para o Profissional/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/métodos , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Máscaras , Resíduos de Serviços de Saúde , Mycobacterium tuberculosis/isolamento & purificação , Isolamento de Pacientes , Vigilância da População , Risco , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , Tuberculose/transmissão , Tuberculose Resistente a Múltiplos Medicamentos/prevenção & controle , Tuberculose Resistente a Múltiplos Medicamentos/transmissão , Ventilação/instrumentaçãoRESUMO
A 44-year-old lady was diagnosed with acute hepatitis C virus (HCV) infection 8 weeks after hysterectomy at which the attending anesthetist was known to be hepatitis C seropositive. Comparative nucleotide sequence analysis and phylogenetic comparison proved that transmission had occurred from the anesthetist to the patient. The patient had received general anesthesia with endotracheal intubation and peripheral intravenous cannulation. No exposure-prone anesthetic procedures had been performed. This is the first case described in UK involving transmission from an anesthetist to a patient during anesthesia where no exposure prone procedures were carried out. It is the first example in which the anesthetist was known to be seropositive for hepatitis C prior to the operation.
Assuntos
Anestesia Endotraqueal/efeitos adversos , Anestesia Geral/efeitos adversos , Infecção Hospitalar/transmissão , Hepatite C/transmissão , Transmissão de Doença Infecciosa do Profissional para o Paciente/métodos , Adulto , Infecção Hospitalar/virologia , DNA Complementar/química , DNA Viral/química , Feminino , Hepacivirus/genética , Hepacivirus/isolamento & purificação , Humanos , Histerectomia , Epidemiologia Molecular , Análise de Sequência de DNA , Homologia de Sequência , Reino UnidoAssuntos
Infecção Hospitalar/transmissão , Família , Transmissão de Doença Infecciosa do Profissional para o Paciente/métodos , Resistência a Meticilina , Doenças Profissionais , Recursos Humanos em Hospital , Infecções Estafilocócicas/transmissão , Staphylococcus aureus , Portador Sadio/epidemiologia , Portador Sadio/microbiologia , Portador Sadio/transmissão , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Surtos de Doenças/estatística & dados numéricos , Eletroforese em Gel de Campo Pulsado , Humanos , Controle de Infecções , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/estatística & dados numéricos , Programas de Rastreamento , Países Baixos/epidemiologia , Doenças Profissionais/epidemiologia , Doenças Profissionais/microbiologia , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/microbiologiaRESUMO
This study evaluated personal digital assistant (PDA) microbial colonization before and after cleaning with alcohol. Samples from 75 PDAs were processed. Before cleaning, 96% of the samples were culture positive. After cleaning, 75% became culture negative. PDAs cleaned with an alcohol swab demonstrated significant reduction in colonization.
Assuntos
Computadores de Mão/estatística & dados numéricos , Contaminação de Equipamentos/estatística & dados numéricos , Equipamentos e Provisões Hospitalares/microbiologia , Equipamentos e Provisões Hospitalares/estatística & dados numéricos , Bactérias/isolamento & purificação , Contagem de Colônia Microbiana , Infecção Hospitalar/transmissão , Estudos Transversais , Contaminação de Equipamentos/prevenção & controle , Fungos/isolamento & purificação , Humanos , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Profissional para o Paciente/métodos , New York , Estudos ProspectivosAssuntos
Hepatite B/epidemiologia , Hepatite B/transmissão , Hepatite C/epidemiologia , Hepatite C/transmissão , França/epidemiologia , Hepatite B/prevenção & controle , Hepatite C/prevenção & controle , Humanos , Controle de Infecções/métodos , Controle de Infecções/normas , Transmissão de Doença Infecciosa do Profissional para o Paciente/métodos , Transmissão de Doença Infecciosa do Profissional para o Paciente/estatística & dados numéricos , Saúde Ocupacional , Fatores de Risco , Reino Unido/epidemiologia , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Patients receiving hemodialysis are generally considered to be at increased risk of developing tuberculosis (TB). We evaluated a 13-station chronic outpatient hemodialysis unit associated with a community hospital in northern California. Within 6 months, there were 2 incident source cases in the unit of active smear positive pulmonary tuberculosis; the first in a health care worker (HCW), diagnosed April 3, 1998, and the second in a patient undergoing dialysis treatment in October 1998. We describe the cases; the evaluation of exposures; and the institution of an intentional prospective TB control plan, designed specifically for the unique hemodialysis setting. METHODS: We evaluated 23 HCWs twice and 89 patients undergoing hemodialysis treatment who were exposed to case 1 and 38 patients who were exposed to case 2. All 23 HCWs had documented prior negative Sierbert purified protein derivative of tuberculin (PPD) status and were retested at 12 weeks after exposure. None of the patients had documentation of PPD status. All of the patients were skin-tested initially with use of the 2-step method, and those with positive test results were offered isoniazid (INH). RESULTS: One of the 23 HCWs' negative baseline PPD skin test status converted after exposure to case 1, and none of the remaining 22 converted after exposure to case 2. Twelve of 89 exposed patients with no prior skin test record had positive results for PPD after initial testing with the 2-step method. Three of the 12 (25%) patients were treated with INH at the discretion of their attending nephrologist. The 77 patients with negative results for PPD still had negative test results when retested at 3 months. None of 38 patients who underwent dialysis on the same schedule as source case 2 had a converted PPD test. Restriction fragment length polymorphism on TB isolates from both source cases ultimately showed them to be unrelated strains. CONCLUSION: Our experience with these exposures suggests that TB screening of patient populations undergoing renal dialysis-though they have intrinsic high anergy rates-is advisable with a designed prospective plan before any inadvertent and/or repetitive exposure of that population to active TB. A planned intentional TB control program increases HCW awareness of TB, establishes baselines for evaluation, decreases "panic" in the event of subsequent exposures, and emphasizes the rationale for preventive therapy.