Proporção de casos nosocomiais de COVID-19 no Brasil: análise de seus fatores associados em 1.631.47 registros de 2020 a 2022 / Proporción de casos nosocomiales de COVID-19 en Brasil: análisis de sus factores asociados en 1.631.47 registros de 2020 a 2022 / Proportionof nosocomial cases of COVID-19 in Brazil: analysisof1.631.47 case records from 2020 to 2022

Introdução: Infecções nosocomiais, adquiridas após a internação hospitalar, são o evento adverso mais comum que ameaça a saúde dos pacientes hospitalizados, sendo a pneumonia, incluindo a causada pelo SARS-Cov-2, responsável por mais de 80% das infecções nosocomiais. A pandemia declarada pela OMS em março de 2020 reflete o rápido aumento de casos, impulsionado pela disseminação do vírus através de gotículas e aerossóis. A transmissão nosocomial do SARS-Cov-2 foi observada desde o início do surto em Wuhan, representando um desafio adicional na qualidade de vida dos pacientes. Estudos internacionais em hospitais reportam incidências de infecção nosocomial por COVID-19 entre 11% e 44%.Objetivo: Identificar a proporção de infecção nosocomial por SARS-COV-2 no Brasil entre março de 2020 até dezembro de 2022.Metodologia:Trata-se de um estudo analítico, retrospectivo, de corte transversal, sobre a proporção de infecção nosocomial por Sars-Cov-2 no Brasil, através de dados secundários oriundos do Sistema de Informação da Vigilância Epidemiológica da Gripe. No presente estudo a variável dependente analisada foi a proporção de infecção nosocomial por Sars-cov-2. Como variáveis independentes exploratórias foram utilizadas: faixa etária, sexo, comorbidades e macrorregião de residência. Resultados: O estudo identificou uma proporção de casos nosocomiais de 2,58%, sendo maior no terceiro ano da pandemia 2022 (5,5%) na região Norte (7,57%), entre os indivíduos de 18-59 anos de idade (6,93%)Conclusões: Este estudo sobre casos nosocomiais de COVID-19 no Brasil revela uma proporção de 2,58% entre 2020 e 2022, com associações identificadas em relação à região, idade e comorbidades. Diferenças em relação a estudos internacionais sugerem questões metodológicas específicas. Essa pesquisa é de importância crítica, visto ser de abrangência nacional com grande amplitude, e estabelece uma base sólida para futuros estudos epidemiológicos (AU).

Introduction: Nosocomial infections, acquired after hospital admission, are the most common adverse events threatening patient health, with pneumonia, including that caused by SARS-CoV-2, responsible for over 80% of nosocomial infections. The pandemic declared by the WHO in March 2020 reflects the rapid rise in cases driven by the virus's spread through droplets and aerosols. Nosocomial transmission of SARS-CoV-2 has been observed since the outbreak's onset in Wuhan, posing an additional challenge to patient quality of life. International hospital studies report nosocomial COVID-19 infection rates between 11% and 44%. Objective: Identifying the proportion of nosocomial SARS-CoV-2 infection in Brazil between March 2020 and December 2022.Methodology:This is an analytical, retrospective, cross-sectional study on the proportion of nosocomial SARS-CoV-2 infection in Brazil, using secondary data from the Influenza Epidemiological Surveillance Information System. In this study, the analyzed dependent variable was the proportionof nosocomial SARS-CoV-2 infection. The exploratory independent variables included: age group, gender, comorbidities, and macro-region of residence.Results:The study identified a proportion of nosocomial cases of 2.58%, with a higher proportion in the third year of the pandemic, 2022 (5.5%) in the North region (7.57%), among individuals aged 18-59 years (6.93%). Conclusions: This study on nosocomial cases of COVID-19 in Brazil reveals a proportion of 2.58% between 2020 and 2022, with associations identified regarding region, age, and comorbidities. Differences compared to international studies suggest specific methodological issues. This research is of critical importance, given its national scope and broad coverage, and establishes a solid foundation for future epidemiological studies (AU).

Introducción: Las infecciones nosocomiales, adquiridas tras la hospitalización, son el evento adverso más común que amenaza la salud de los pacientes hospitalizados, siendo la neumonía, incluida la causada por el SARS-Cov-2, la responsable de más del 80% de las infecciones. La pandemia declarada por la OMS en marzo de 2020 refleja el rápido aumento de casos, impulsado por la propagación del virus a través de gotitas y aerosoles. La transmisión nosocomial del SRAS-Cov-2 se ha observado desde el inicio del brote en Wuhan, lo que supone un reto adicional para la calidad de vida de los pacientes. Estudios internacionales realizados en hospitales informan de incidencias de infecciones nosocomiales por COVID-19 de entre el 11% y el 44%. Objetivo: Identificar la proporción de infección nosocomial por SARS-CoV-2 en Brasil entre marzo de 2020 y diciembre de 2022. Metodología: Se trata de un estudio analítico, retrospectivo y transversal sobre la proporción de infección nosocomial por SARS-CoV -2 en Brasil, utilizando datos secundarios del Sistema de Información de Vigilancia Epidemiológica de Influenza. La variable dependiente analizada fue la proporción de infección nosocomial por SARS-CoV-2. Como variables independientes exploratorias se utilizaron: grupo de edad, sexo, comorbilidades y macrorregión de residencia. Resultados:El estudio identificó una proporción de casos nosocomiales del 2,58%, siendo mayor en el tercer año de la pandemia de 2022 (5,5%) en la región Norte (7,57%), entre individuos de 18 a 59 años (6,93%). Conclusiones:Este estudio de casos de COVID-19 hospitalizados en Brasil revela una proporción de 2,58% entre 2020 y 2022, con asociaciones identificadas en relación a la región, edad y comorbilidades. Las disparidades en relación a estudios internacionales sugieren la presencia de cuestiones metodológicas específicas. Esta investigación es de extrema importancia para orientar estrategias preventivas y mejorar el control de las infecciones hospitalarias (AU).

Resistência antimicrobiana na infecção urinária em unidade de terapia intensiva / Antimicrobial resistance in urinary tract infection in the intensive care unit / Resistencia a los antimicrobianos en la infección del tracto urinario en la unidad de cuidados intensivos

A infecção do trato urinário (ITU) nada mais é do que o acometimento das vias urinárias por microrganismo. Entre as infecções hospitalares de maior incidência está a infecção do trato urinário, acometendo mais mulheres do que homens. Uma das possíveis causas dessa infecção, em pacientes na unidade de terapia intensiva (UTI), é o uso de cateter vesical. Seu tratamento inadequado pode ocasionar uma pielonefrite, podendo adentrar à circulação sanguínea, gerando uma infecção sistêmica e levar o paciente a óbito. A resistência antimicrobiana é uma das principais dificuldades encontrada em UTI sendo considerado um problema de saúde pública. O objetivo deste trabalho foi realizar um breve relato, baseado na literatura, sobre a resistência antimicrobiana na infecção urinária em unidade de terapia intensiva adulta. Em ambientes hospitalares o principal microrganismo causador de ITU é Escherichia coli, sendo 55,5% das culturas positivas estão associadas a procedimentos invasivos, como as sondas vesicais de demora, como consequência este é o microrganismo que mais apresenta resistência aos antimicrobianos utilizados como a ampicilina, trimetoprima e ciprofloxacino. O uso indiscriminado de antibióticos deixa em evidência a necessidade de análise criteriosa da real necessidade de qual antimicrobianos usar, tempo de uso e forma correta de administração. Portanto é necessária a ação dos profissionais de saúde frente a atenção ao paciente, desde a higiene das mãos, uso do cateter, quando necessário observar a real necessidade do uso do antimicrobianos e que esse seja feito após cultura e antibiograma.

Urinary tract infection (UTI) is nothing more than the involvement of the urinary tract by a microorganism. Among the hospital infections with the highest incidence is urinary tract infections, affecting more women than men. One of the possible causes of this infection in patients in the intensive care unit (ICU) is the use of a bladder catheter. Its inadequate treatment can cause pyelonephritis, which can enter the bloodstream, generating a systemic infection and leading the patient to death. Antimicrobial resistance is one of the main difficulties encountered in ICUs and is considered a public health problem. The objective of this study was to present a brief report, based on the literature, on antimicrobial resistance in urinary tract infections in an adult intensive care unit. In hospital environments, the main microorganism that causes UTI is Escherichia coli, and 55.5% of positive cultures are associated with invasive procedures, such as indwelling urinary catheters, as a consequence, this is the microorganism that is most resistant to antimicrobials used, such as ampicillin, trimethoprim and ciprofloxacin. The indiscriminate use of antibiotics highlights the need for a careful analysis of the real need for which antimicrobials to use, time of use, and correct form of administration. Therefore, it is necessary for the action of health professionals in the care of the patient, from the hygiene of the professional to, the use of the catheter, when necessary to observe the real need for the use of antimicrobials and that this is done after culture and antibiogram.

La infección del tracto urinario (ITU) no es más que la afectación de las vías urinarias por un microorganismo. Entre las infecciones hospitalarias con mayor incidencia se encuentra la infección del tracto urinario, que afecta más a mujeres que a hombres. Una de las posibles causas de esta infección en pacientes en la unidad de cuidados intensivos (UCI) es el uso de una sonda vesical. Su tratamiento inadecuado puede causar pielonefritis, la cual puede ingresar al torrente sanguíneo, generando una infección sistémica y llevando al paciente a la muerte. La resistencia a los antimicrobianos es una de las principales dificultades encontradas en las UCI y se considera un problema de salud pública. El objetivo de este estudio fue presentar un breve informe, basado en la literatura, sobre la resistencia antimicrobiana en infecciones del tracto urinario en una unidad de cuidados intensivos de adultos. En ambientes hospitalarios, el principal microorganismo causante de ITU es Escherichia coli, y el 55,5% de los cultivos positivos están asociados a procedimientos invasivos, como sondas vesicales permanentes, por lo que este es el microorganismo más resistente a los antimicrobianos utilizados, como la ampicilina. ., trimetoprima y ciprofloxacino. El uso indiscriminado de antibióticos pone de relieve la necesidad de un análisis cuidadoso de la necesidad real de qué antimicrobianos utilizar, el momento de uso y la forma correcta de administración. Por lo tanto, es necesaria la actuación de los profesionales de la salud en el cuidado del paciente, desde la higiene del profesional, uso del catéter, cuando sea necesario observar la necesidad real del uso de antimicrobianos y que este se realice previo cultivo y antibiograma.

Chapare Hemorrhagic Fever and Virus Detection in Rodents in Bolivia in 2019.

BACKGROUND: In June 2019, the Bolivian Ministry of Health reported a cluster of cases of hemorrhagic fever that started in the municipality of Caranavi and expanded to La Paz. The cause of these cases was unknown. METHODS: We obtained samples for next-generation sequencing and virus isolation. Human and rodent specimens were tested by means of virus-specific real-time quantitative reverse-transcriptase-polymerase-chain-reaction assays, next-generation sequencing, and virus isolation. RESULTS: Nine cases of hemorrhagic fever were identified; four of the patients with this illness died. The etiologic agent was identified as Mammarenavirus Chapare mammarenavirus, or Chapare virus (CHAPV), which causes Chapare hemorrhagic fever (CHHF). Probable nosocomial transmission among health care workers was identified. Some patients with CHHF had neurologic manifestations, and those who survived had a prolonged recovery period. CHAPV RNA was detected in a variety of human body fluids (including blood; urine; nasopharyngeal, oropharyngeal, and bronchoalveolar-lavage fluid; conjunctiva; and semen) and in specimens obtained from captured small-eared pygmy rice rats (Oligoryzomys microtis). In survivors of CHHF, viral RNA was detected up to 170 days after symptom onset; CHAPV was isolated from a semen sample obtained 86 days after symptom onset. CONCLUSIONS: M. Chapare mammarenavirus was identified as the etiologic agent of CHHF. Both spillover from a zoonotic reservoir and possible person-to-person transmission were identified. This virus was detected in a rodent species, O. microtis. (Funded by the Bolivian Ministry of Health and others.).

Adherence to hand hygiene in critical sectors: Can we go on like this?

AIMS AND OBJECTIVES: The rates of healthcare-associated infections are high around the world. Hand hygiene is considered the most effective measure to reduce the transmission of pathogens in the hospital environment. Our objective was to evaluate adherence to hand hygiene in critical units of a tertiary-level hospital in Central-West Brazil. DESIGN: Observational study employing cross-sectional data. Reporting rigour was demonstrated using the STROBE checklist. METHODS: Observation of hand hygiene practices of 129 professionals from the health team, including nursing staff, physicians and physical therapists. Data collection was carried out using the World Health Organization form. RESULTS: A total of 3,025 hand hygiene opportunities were observed, and the overall rate of adherence was only 46.25%. There was a greater frequency of hand hygiene after risk of exposure to bodily fluids and after contact with patients, 60.80% and 53.45%, respectively. Nurses obtained a higher rate of adherence to hand hygiene (59.80%). The neonatal ICU had a higher rate of adherence to hand hygiene when compared to other sectors. CONCLUSIONS: The physical structure for hand hygiene in the institution was poor, and no professionals reached the minimum time required for execution of hand hygiene techniques. There were low rates of adherence to hand hygiene by professionals at all five times and in all categories and sectors observed, which may have been influenced by poor infrastructure present in the institution. RELEVANCE TO CLINICAL PRACTICE: This study is of great relevance to patient safety, given the rates of healthcare-associated infections worldwide, with emphasis on underdeveloped countries. It is hoped that the results of this research can guide organisations to validly and systematically evaluate adherence to hand hygiene and achieve higher rates of adherence to hand hygiene and consequently reduce the number of infections in health environments.

Hepatitis C in Hemodialysis Units: diagnosis and therapeutic approach / Hepatite C nas Unidades de Hemodiálise: diagnóstico e abordagem terapêutica

Abstract According to data from the last census of the Brazilian Society of Nephrology (SBN), the prevalence of hepatitis C virus (HCV) in Brazilian hemodialysis units (HU) is 3.3%, about three times higher than what is reported for the Brazilian general population. Often, professionals working in HU are faced with clinical situations that require rapid HCV diagnosis in order to avoid horizontal transmission within the units. On the other hand, thanks to the development of new antiviral drugs, the cure of patients with HCV, both in the general population and in patients with chronic kidney disease and the disease eradication, appear to be very feasible objectives to be achieved in the near future . In this scenario, SBN and the Brazilian Society of Hepatology present in this review article a proposal to approach HCV within HUs.

Resumo De acordo com os dados do último censo da Sociedade Brasileira de Nefrologia (SBN), a prevalência de portadores do vírus da hepatite C (HCV) nas unidades de hemodiálise (UH) no Brasil é de 3,3%, cerca de três vezes maior do que é observado na população geral brasileira. Muitas vezes, os profissionais que trabalham nas UH deparam-se com situações clínicas que demandam rápido diagnóstico do HCV, a fim de evitar uma transmissão horizontal dentro das unidades. Por outro lado, a cura dos pacientes portadores do HCV, tanto na população geral como na portadora de doença renal crônica e a erradicação da doença, em virtude do desenvolvimento de novas drogas antivirais, parecem ser objetivos bastante factíveis, a ser alcançados em futuro próximo. Nesse cenário, a SBN e a Sociedade Brasileira de Hepatologia apresentam neste artigo de revisão uma proposta de abordagem do HCV dentro das UH.

Hepatitis C in Hemodialysis Units: diagnosis and therapeutic approach.

According to data from the last census of the Brazilian Society of Nephrology (SBN), the prevalence of hepatitis C virus (HCV) in Brazilian hemodialysis units (HU) is 3.3%, about three times higher than what is reported for the Brazilian general population. Often, professionals working in HU are faced with clinical situations that require rapid HCV diagnosis in order to avoid horizontal transmission within the units. On the other hand, thanks to the development of new antiviral drugs, the cure of patients with HCV, both in the general population and in patients with chronic kidney disease and the disease eradication, appear to be very feasible objectives to be achieved in the near future . In this scenario, SBN and the Brazilian Society of Hepatology present in this review article a proposal to approach HCV within HUs.

Diversity of metallo-b-lactamase-encoding genes found in distinct species of Acinetobacter isolated from the Brazilian Amazon Region

BACKGROUND The multidrug resistance (MDR) phenotype is frequently observed in Acinetobacter baumannii, the most clinically relevant pathogenic species of its genus; recently, other species belonging to the A. calcoaceticus-A. baumannii complex have emerged as important MDR nosocomial pathogens. OBJECTIVES The present study aimed to verify the occurrence of metallo-β-lactamase genes among distinct Acinetobacter species in a hospital located in the Brazilian Amazon Region. METHODS Antimicrobial susceptibility profiles were determined by broth microdilution. The genetic relationships among these isolates were assessed by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Pyrosequencing reads of plasmids carrying the bla NDM-1 gene were generated using the Ion Torrent™ platform sequencing. FINDINGS A total of six isolates carried bla NDM-1: A. baumannii (n = 2), A. nosocomialis (n = 3), and A. pittii (n = 1); three carried bla IMP-1: A. baumannii, A. nosocomialis, and A. bereziniae. Resistance to colistin was observed for an NDM-1-producing A. nosocomialis isolate. Diverse PFGE patterns and sequence types were found among A. nosocomialis and A. baumannii isolates. The bla NDM-1 sequence was inserted in a Tn125 transposon, while the bla IMP-1 was found as a gene cassette of the class 1 integron In86. MAIN CONCLUSIONS To the best of our knowledge, this is the first report describing the dissemination of bla NDM-1 among distinct Acinetobacter species recovered from the same hospital in South America.

Airborne fungi in an intensive care unit / Fungos anemófilos em uma unidade de terapia intensiva

The presence of airborne fungi in Intensive Care Unit (ICUs) is associated with increased nosocomial infections. The aim of this study was the isolation and identification of airborne fungi presented in an ICU from the University Hospital of Pelotas RS, with the attempt to know the places environmental microbiota. 40 Petri plates with Sabouraud Dextrose Agar were exposed to an environment of an ICU, where samples were collected in strategic places during morning and afternoon periods for ten days. Seven fungi genera were identified: Penicillium spp. (15.18%), genus with the higher frequency, followed by Aspergillus spp., Cladosporium spp., Fusarium spp., Paecelomyces spp., Curvularia spp., Alternaria spp., Zygomycetes and sterile mycelium. The most predominant fungi genus were Aspergillus spp. (13.92%) in the morning and Cladosporium spp. (13.92%) in the afternoon. Due to their involvement in different diseases, the identified fungi genera can be classified as potential pathogens of inpatients. These results reinforce the need of monitoring the environmental microorganisms with high frequency and efficiently in health institutions.(AU)

A presença de fungos anemófilos nas UTIs estão associada com o aumento de infecções nosocomiais. O objetivo deste estudo foi isolar e identificar quais os principais fungos anemófilos presentes em uma Unidade de Terapia Intensiva (UTI) de um Hospital Universitário de Pelotas RS, na tentativa de conhecer a microbiota ambiental do local. Através de 40 placas de Petri com Agar Sabouraud dextrose expostas no ambiente de UTI foram coletadas amostras por exposição em locais estratégicos durante períodos da manhã e tarde por dez dias. Sete gêneros fúngicos foram identificados: Penicillium spp. (15,18%), o gênero de maior frequência, seguido de Aspergillus spp., Cladosporium spp., Fusarium spp., Paecelomyces spp., Curvularia spp., Alternaria spp., além de Zigomicetos e micélios estéreis. Houve predomínio de Aspergillus spp. (13,92%) pela manhã e Cladosporium spp. (13,92%) a tarde. Por estarem envolvidos em diferentes enfermidades, os gêneros identificados podem ser classificados como patógenos em potencial aos pacientes internados. Estes resultados reforçam a necessidade de um monitoramento dos micro-organismos ambientais com maior freqüência e eficiência nas instituições de saúde.(AU)

Perfil epidemiológico das infecções hospitalares na unidade de terapia intensiva de um hospital terciário / Epidemiological profile of infections in the unit of therapy intensive care of a tertiary hospital

O estudo objetivou conhecer o perfil das infecções hospitalares na Unidade de Terapia Intensiva de um hospital, interior de São Paulo.Estudo retrospectivo, quantitativo, sendo os dados coletados através da CCIH. A taxa de pacientes com infecções hospitalares foi de 21,8%,o trato respiratório o sítio mais acometido (60,9%) e Acinetobacter spp e Staphylococcus aureus os patógenos mais encontrados. O óbito por infecções hospitalares foi mais frequente em mulheres (p=0,0322), idosos (p=0,0002) e em pacientes com maior dias de internação(p=0,0143). Os resultados apontam a necessidade de ações de prevenção e controle deste agravo.

This study aimed to know the profile of hospital infections (HI) in the Intensive Care Unit of a countryside hospital in São Paulo. It is a retrospective,quantitative study, with data collected through the CCIH. The rate of patients with HI was 21,8% and respiratory tract (60.9%) wasthe most affected site, and Acinetobacter spp and Staphylococcus aureus were the most found pathogens. The death for HI was found morefrequent in women (p=0.0322), in the elderly (p=0,0002) and patients with more days of admission (p=0.0143).The results show the needfor prevention and control of this disease.

El objetivo fue conocer el perfil de las infecciones hospitalarias (IH) en la unidad de terapia intensiva de un hospital en el interior de São Paulo.Estudio retrospectivo, cuantitativo y con datos recogidos a través de CCIH. La tasa de pacientes con IH fue 21,8%, el sitio más afectado eltracto respiratorio (60,9%), y Acinetobacter spp y Staphylococcus aureus los patógenos predominantes. La muerte por IH fue predominante en las mujeres (p=0,0322), ancianos (p=0,0002) y en pacientes con mayor número de días de hospitalización (p=0,0143). Son necesarias acciones de prevención y control de esto agravio.

Nosocomial Transmission and Genetic Diversity of Rhinovirus in a Neonatal Intensive Care Unit.

Rhinoviruses were detected as sole pathogens in 6 preterm infants who developed severe respiratory infections while hospitalized in a neonatal intensive care unit. We confirmed 2 nosocomial rhinovirus transmission episodes and describe the genetic diversity of rhinovirus strains that circulated simultaneously during a winter season.

Clonal spread of carbapenem-resistant Acinetobacter baumannii in a neonatal intensive care unit.

Acinetobacter baumannii has often been associated with colonization and/or infection in neonatal intensive care units (NICU). This study describes a clonal spread of carbapenem-resistant A. baumannii (CRAB) isolates in an NICU. In total, 21 CRAB isolates were collected from premature newborns. Only polymyxin B was active against such isolates. Nineteen CRAB isolates were clonally related (Cluster C, which belonged to worldwide-disseminated ST1). All newborns had peripheral access and had received ß-lactam therapy previously. The implementation of strict infection control measures was of fundamental importance to eradicate the clonal type in the study hospital.

Genome sequence of a multidrug-resistant Corynebacterium striatum isolated from bloodstream infection from a nosocomial outbreak in Rio de Janeiro, Brazil

Multidrug-resistant (MDR) Corynebacterium striatum has been cited with increased frequency as pathogen of nosocomial infections. In this study, we report the draft genome of a C. striatum isolated from a patient with bloodstream infection in a hospital of Rio de Janeiro, Brazil. The isolate presented susceptibility only to tetracycline, vancomycin and linezolid. The detection of various antibiotic resistance genes is fully consistent with previously observed multidrug-resistant pattern in Corynebacterium spp. A large part of the pTP10 plasmid of MDR C. striatum M82B is present in the genome of our isolate. A SpaDEF cluster and seven arrays of CRISPR-Cas were found.

Healthcare workers' hands as a vehicle for the transmission of virulent strains of Candida spp.: A virulence factor approach.

BACKGROUND: Although the majority of Candida infections are thought to come from endogenous sources, the healthcare workers' (HCWs) hands are being increasingly reported as vehicles for the transmission of pathogens. The aim of the present study was to evaluate the susceptibility of yeast isolated from the HCWs' hands and ICU (Intensive Care Unit) surfaces to antifungal agents and to determine the virulence potential and the genetic similarity between the same. METHODS: The susceptibility of yeasts from the HCWs' hands (n = 57) and ICU surfaces (n = 98) to conventional antifungals (fluconazole, voriconazole, amphotericin B and micafungin) was evaluated using the broth microdilution assay accordance with CLSI M27-A3. Additionally, some virulence factors such as adhesion and biofilm capacity on abiotic surfaces and on endothelial cells were evaluated, as well as germ tube formation. The similarity among yeast isolates were evaluated by the RAPD technique using the P4, OPA18 and OPE18 primers. RESULTS: Five species of Candida were found on the HCWs' hands (C. albicans, C. parapsilosis (sensu stricto), C. glabrata, C. tropicalis and C. krusei) and two on ICU surfaces (C. albicans and C. parapsilosis (sensu stricto)). The isolates from hands had higher resistance rates, with C. glabrata having the highest indices (100% FLU; 100% MFG). The similarity of C. albicans from HCWs and ICU surfaces was ≥80% according to the three primers analyzed. Candida spp. from hands had a greater potential for adhesion and biofilm formation on abiotic surfaces (p < 0.05). C. albicans from ICU surfaces had the greatest potential of adhesion on endothelial cells after 2 and 24 h, and presented high filamentation in SEM images and formed more and larger germ tubes (p < 0.05). CONCLUSION: the present study showed the significant virulence potential of yeasts transmitted in the hospital environment for the first time. Additionally, healthy people working in the ICU can carry these yeasts, which are capable of surviving in hospital surfaces, on their hands, offering a risk to patients, especially those who are immunocompromised.

A percepção dos profissionais de saúde em relação à higienização das mãos / La percepción de los profesionales de la salud en relación con la higiene de manos / Healthcare workers perception regarding hand hygiene

Objective: To verify aspects related to the perception of healthcare workers regarding hand hygiene. Methods: Cross-sectional study in a emergency care unit at a university hospital in Belo Horizonte. A structured questionnaire was applied to nursing and medical staff. The statistic program SPSS was used, descriptive and univariate analysis were made. Results: Healthcare workers attributed as high the impact of infections on clinical evolution of patients and the effectiveness of hand hygiene in controlling those infections. The rate forself-reported compliance to hand hygiene was 76.0% for the nursing staff and 72.5% for medical staff, but lower than 60.0% for coworkers. Conclusions: Healthcare workers perceive hand hygiene as an effective measure to control infection and recognize that compliance rates of hand hygiene among health teams in general are low.

Objetivo: Verificar os aspectos relacionados à percepção dos profissionais de saúde em relação à higienização das mãos. Métodos: Estudo transversal, realizado em uma unidade de pronto-atendimento de um hospital universitário de Belo Horizonte. Foi aplicado um questionário estruturado aos profissionais de enfermagem e da equipe médica. Utilizou-se o programa estatístico SPSS, realizou-se análise descritiva e univariada. Resultados: Os profissionais de saúde atribuem como alto o impacto das infecções na evolução clínica dos pacientes e a eficácia da higiene de mãos no controle destas. A taxa auto-reportada para adesão à higiene de mãos foi de 76% para a equipe de enfermagem e 72,5% para a equipe médica, porém, inferiores a 60% para os colegas de trabalho. Conclusões: Os profissionais percebem a HM como uma medida eficaz de controle de infecção e reconhecem que as taxas de adesão das equipes de saúde em geral, são baixas.

Objetivo: Verificar los aspectos relacionados con la percepción de los profesionales de salud con respecto a higiene de las manos. Métodos: Estudio transversal en un servicio de emergencia de un hospital universitario de Belo Horizonte. Un cuestionario estructurado fue aplicado para los profesionales de enfermería y médicos. Se utilizó el programa estadístico SPSS, hubo análisis descriptivo y univariante. Resultados: Los profesionales de salud atribuyen alto impacto para las infecciones en la evolución clínica de los pacientes y alta la eficacia de la higiene de manos en el control de estas infecciones. La tasa de adherencia auto-reportada a la higiene de manos fue 76,0% para el personal de enfermería y 72,5% para el personal médico, sin embargo, inferior a 60,0% para los compañeros de trabajo. Conclusiones: Los profesionales perciben la higiene de las manos como una medida efectiva para controlar la infección y reconocen que las tasas de adherencia de los equipos de salud en general son bajos.

Sphygmomanometers and thermometers as potential fomites of Staphylococcus haemolyticus: biofilm formation in the presence of antibiotics

BACKGROUND The association between Staphylococcus haemolyticus and severe nosocomial infections is increasing. However, the extent to which fomites contribute to the dissemination of this pathogen through patients and hospital wards remains unknown. OBJECTIVES In the present study, sphygmomanometers and thermometers were evaluated as potential fomites of oxacillin-resistant S. haemolyticus (ORSH). The influence of oxacillin and vancomycin on biofilm formation by ORSH strains isolated from fomites was also investigated. METHODS The presence of ORSH on swabs taken from fomite surfaces in a Brazilian hospital was assessed using standard microbiological procedures. Antibiotic susceptibility profiles were determined by the disk diffusion method, and clonal distribution was assessed in pulsed-field gel electrophoresis (PFGE) assays. Minimum inhibitory concentrations (MICs) of oxacillin and vancomycin were evaluated via the broth microdilution method. Polymerase chain reaction (PCR) assays were performed to detect the mecA and icaAD genes. ORSH strains grown in media containing 1/4 MIC of vancomycin or oxacillin were investigated for slime production and biofilm formation on glass, polystyrene and polyurethane catheter surfaces. FINDINGS ORSH strains comprising five distinct PFGE types were isolated from sphygmomanometers (n = 5) and a thermometer (n = 1) used in intensive care units and surgical wards. ORSH strains isolated from fomites showed susceptibility to only linezolid and vancomycin and were characterised as multi-drug resistant (MDR). Slime production, biofilm formation and the survival of sessile bacteria differed and were independent of the presence of the icaAD and mecA genes, PFGE type and subtype. Vancomycin and oxacillin did not inhibit biofilm formation by vancomycin-susceptible ORSH strains on abiotic surfaces, including on the catheter surface. Enhanced biofilm formation was observed in some situations. Moreover, a sub-lethal dose of vancomycin induced biofilm formation by an ORSH strain on polystyrene. MAIN CONCLUSIONS Sphygmomanometers and thermometers are fomites for the transmission of ORSH. A sub-lethal dose of vancomycin may favor biofilm formation by ORSH on fomites and catheter surfaces.

Disability Adjusted Life Year (DALY) of Central-Line Bloodstream Infection (CLABSI) in a University Hospital in a Developing Country, Brazil.

Central-line bloodstream infection (CLABSI) increases hospital mortality. A cohort study was conducted in a Brazilian hospital to estimate the disability-adjusted life year (DALY) of CLABSI using modified World Health Organization (WHO) methodology. CLABSI DALY was 20.44 per 1,000 inpatients, most were the result of premature death (20.42 per 1,000 inpatients). DALY can be useful to guide and measure the impact of healthcare infection prevention. Infect Control Hosp Epidemiol 2017;38:606-609.

Aetiology and Significance of Hospital-Acquired Infections in Mexico.

Hospital-acquired infections (HAIs) are infections that develop in the hospital environment and can be acquired by a patient or hospital staff. They are complications that combine diverse risk factors that make an individual susceptible and are frequently caused by endogenous and exogenous bacterial agents. The most commonly studied etiological agents are bacteria and fungi, with the former representing the most common etiological agents reported to the Hospital Epidemiological Surveillance Network (RHOVE) between 2007 and 2012. Among these agents were Acinetobacter baumannii, Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, coagulase-negative Staphylococci (CNS), Enterococcus spp., and Streptococcus pneumoniae. Although obligate anaerobic bacteria are also etiological agents of HAIs, clinical laboratories do not usually perform bacteriological tests to isolate and identify these bacteria. As a result, patients are at a greater risk of not surviving an infection and the epidemiology of this bacterial group is unknown. An important problem associated with HAIs is bacterial multiple drug resistance, which not only increases morbidity and mortality but also the cost of inpatient care. The aim of this review is to provide current information to healthcare professionals on the status of HAIs in Mexico with an emphasis on the etiology, diagnosis, and antimicrobial resistance.

Sphygmomanometers and thermometers as potential fomites of Staphylococcus haemolyticus: biofilm formation in the presence of antibiotics.

BACKGROUND: The association between Staphylococcus haemolyticus and severe nosocomial infections is increasing. However, the extent to which fomites contribute to the dissemination of this pathogen through patients and hospital wards remains unknown. OBJECTIVES: In the present study, sphygmomanometers and thermometers were evaluated as potential fomites of oxacillin-resistant S. haemolyticus (ORSH). The influence of oxacillin and vancomycin on biofilm formation by ORSH strains isolated from fomites was also investigated. METHODS: The presence of ORSH on swabs taken from fomite surfaces in a Brazilian hospital was assessed using standard microbiological procedures. Antibiotic susceptibility profiles were determined by the disk diffusion method, and clonal distribution was assessed in pulsed-field gel electrophoresis (PFGE) assays. Minimum inhibitory concentrations (MICs) of oxacillin and vancomycin were evaluated via the broth microdilution method. Polymerase chain reaction (PCR) assays were performed to detect the mecA and icaAD genes. ORSH strains grown in media containing 1/4 MIC of vancomycin or oxacillin were investigated for slime production and biofilm formation on glass, polystyrene and polyurethane catheter surfaces. FINDINGS: ORSH strains comprising five distinct PFGE types were isolated from sphygmomanometers (n = 5) and a thermometer (n = 1) used in intensive care units and surgical wards. ORSH strains isolated from fomites showed susceptibility to only linezolid and vancomycin and were characterised as multi-drug resistant (MDR). Slime production, biofilm formation and the survival of sessile bacteria differed and were independent of the presence of the icaAD and mecA genes, PFGE type and subtype. Vancomycin and oxacillin did not inhibit biofilm formation by vancomycin-susceptible ORSH strains on abiotic surfaces, including on the catheter surface. Enhanced biofilm formation was observed in some situations. Moreover, a sub-lethal dose of vancomycin induced biofilm formation by an ORSH strain on polystyrene. MAIN CONCLUSIONS: Sphygmomanometers and thermometers are fomites for the transmission of ORSH. A sub-lethal dose of vancomycin may favor biofilm formation by ORSH on fomites and catheter surfaces.