Adapting the Nominal Group Technique to a virtual version: an experience report.

OBJECTIVE: To report on the adaptations made to the original Nominal Group Technique (NGT), allowing it to be applied to the virtual format, preserving all its key elements. METHOD: An experience report on the adaptations and adjustments made to the original NGT to the virtual format using Information and Communication Technologies (ICT), using digital tools that are available free of charge or are low cost and easy to use. RESULTS: The NGT was carried out entirely virtually and underwent adaptations in each of its four stages through the incorporation of specific digital resources. It was possible to present the most voted ideas and obtain final approval from the participants. The participants had no difficulty in using the virtual resources provided and, based on the reaction evaluation, they were satisfied with the tools provided. CONCLUSION: The adapted NGT proved to be an effective method when used in a virtual setting, capable of producing a significant number of ideas and developing consensus. The adapted tool can be used by other researchers in countries with similar resources or dimensions to Brazil.

Adapting the Nominal Group Technique to a virtual version: an experience report / Adaptación de la Técnica del Grupo Nominal a una versión virtual: informe de una experiencia / Adaptação da Técnica de Grupo Nominal para versão virtual: relato de experiência

ABSTRACT Objective: To report on the adaptations made to the original Nominal Group Technique (NGT), allowing it to be applied to the virtual format, preserving all its key elements. Method: An experience report on the adaptations and adjustments made to the original NGT to the virtual format using Information and Communication Technologies (ICT), using digital tools that are available free of charge or are low cost and easy to use. Results: The NGT was carried out entirely virtually and underwent adaptations in each of its four stages through the incorporation of specific digital resources. It was possible to present the most voted ideas and obtain final approval from the participants. The participants had no difficulty in using the virtual resources provided and, based on the reaction evaluation, they were satisfied with the tools provided. Conclusion: The adapted NGT proved to be an effective method when used in a virtual setting, capable of producing a significant number of ideas and developing consensus. The adapted tool can be used by other researchers in countries with similar resources or dimensions to Brazil.

RESUMEN Objetivo: Informar sobre las adaptaciones realizadas a la Técnica de Grupo Nominal (TGN) original, permitiendo su aplicación al formato virtual, preservando todos sus elementos clave. Método: Se trata de un informe de experiencia sobre las adaptaciones y ajustes realizados a la TGN original para el formato virtual mediante el uso de las Tecnologías de la Información y la Comunicación (TIC), utilizando herramientas digitales disponibles de forma gratuita o de bajo coste y fácil uso. Resultados: El TGN se realizó íntegramente de manera virtual y sufrió adaptaciones en cada una de sus cuatro etapas mediante la incorporación de recursos digitales específicos. Fue posible presentar las ideas más votadas y obtener la aprobación final de los participantes. Los participantes no tuvieron dificultades para utilizar los recursos virtuales proporcionados y, según los comentarios recibidos, se mostraron satisfechos con las herramientas facilitadas. Conclusión: El TGN adaptado demostró ser un método eficaz cuando se utiliza en un entorno virtual, capaz de producir un número significativo de ideas y desarrollar el consenso. La herramienta adaptada puede ser utilizada por otros investigadores en países con recursos o dimensiones similares a las de Brasil.

RESUMO Objetivo: Relatar as adaptações realizadas na Técnica de Grupo Nominal (TGN) original, permitindo sua aplicação ao formato virtual, preservando todos os seus elementos-chave. Método: Relato de experiência sobre as adaptações e adequações realizadas na TGN original ao formato virtual aplicando as Tecnologias da Informação e Comunicação (TIC), por meio de ferramentas digitais disponibilizadas gratuitamente ou de baixo custo e de fácil manejo. Resultados: A TGN foi realizada integralmente de forma virtual e sofreu adaptações em cada uma das suas quatro etapas através da incorporação de recursos digitais específicos. Foi possível apresentar as ideias mais votadas e obter a aprovação final dos participantes. Os participantes não apresentaram dificuldade para utilizar os recursos virtuais disponibilizados, e, partir da avaliação de reação, mostram-se satisfeitos com as ferramentas disponibilizadas. Conclusão: A TGN adaptada mostrou-se um método efetivo quando utilizada em cenário virtual, sendo capaz de produzir um significativo número de ideias e desenvolver consenso. A ferramenta adaptada pode ser usada por outros pesquisadores em países com recursos ou dimensões semelhantes ao Brasil.

A Study on the Epidemiological-Molecular Role of Staphylococcus aureus Strains in the Development of Ventilator-Associated Pneumonia in a Tertiary Hospital in Brazil.

This study aimed to explore the molecular epidemiology of Staphylococcus aureus isolated from patients on mechanical ventilation and the participation of virulence factors in the development of ventilator-associated pneumonia (VAP). A prospective cohort study was conducted on patients under mechanical ventilation, with periodic visits for the collection of tracheal aspirates and clinical data. The S. aureus isolates were analyzed regarding resistance profile, virulence, expression of protein A and alpha-toxin using Western blot, clonal profile using PFGE, sequence type using MLST, and characterization and quantification of phenol-soluble modulins. Among the 270 patients in the study, 51 S. aureus strains were isolated from 47 patients. The incidence density of S. aureus and MRSA VAP was 2.35/1000 and 1.96/1000 ventilator days, respectively; of these, 45% (n = 5) were resistant to oxacillin, with 100% (n = 5) harboring SCCmec types II and IV. The most frequent among the tested virulence factors were icaA, hla, and hld. The clonal profile showed a predominance of sequence types originating from the community. Risk factors for VAP were the presence of solid tumors and the sea gene. In conclusion, patient-related risk factors, together with microbiological factors, are involved in the development of S. aureus VAP, which is caused by the patient's own strains.

Staphylococcus aureus and CA-MRSA Carriage among Brazilian Indians Living in Peri-Urban Areas and Remote Communities.

The emergence of Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections among indigenous populations has been reported. Usually, indigenous communities live in extreme poverty and are at risk of acquiring infections. In Brazil, healthcare inequality is observed in this population. To date, there are no reports of CA-MRSA infections, and no active search for asymptomatic S. aureus carriage has been conducted among Brazilian Indians. The aim of this study was to investigate the prevalence of colonization with S. aureus and CA-MRSA among Brazilian Indians. We screened 400 Indians (from near urban areas and remote hamlets) for S. aureus and CA-MRSA colonization. The isolates were submitted to clonal profiling by pulsed-field gel electrophoresis (PFGE), and selected isolates were submitted to multilocus sequence typing (MLST). Among 931 specimens (nasal and oral) from different indigenous individuals in remote hamlets, S. aureus was cultured in 190 (47.6%). Furthermore, CA-MRSA was found in three isolates (0.7%), all SCCmec type IV. PFGE analysis identified 21 clusters among the S. aureus isolates, and MLST analysis showed a predominance of sequence type 5 among these isolates. Our study revealed a higher prevalence of S. aureus carriage among Shanenawa ethnicity individuals (41.1%). Therefore, ethnicity appears to be associated with the prevalence of S. aureus in these populations.

Infection prevention and control program assessment tools: A comparative study.

BACKGROUND: Infection prevention and control program (IPCP) assessment tools help to identify the improvement needs. This study aimed to identify fit-for-purpose of 3 IPCP assessment tools. METHODS: An exploratory mixed-method study was performed from 2018-2019 in Brazil, using a convenience sample of IPC professionals with various levels of experience to evaluate the IPCP tools: (1) the WHO Infection Prevention and Control Assessment Framework at the Facility Level (IPCAF), (2) the University of Sao Paulo IPCP tool (OGIPCP), and (3) the Infection Prevention and Control Programme Evaluation (IPCPE) tool. A quantitative survey followed by a semi-structured interview accessed the participants' perceptions about these tools. Quantitative data analysis were descriptive and qualitative data were thematical. RESULTS: IPCPE was considered more complete, better for effectiveness, easy to apply, and with easily interpreted indicators. IPCAF was the best regarding to purpose, easy reporting, and interpretation; however, requires professional experience. OGIPCP have the fastest application, easy to understand, and easily calculated indicators, requiring less experience. Qualitative data endorsed the quantitative results and showed IPCPE and IPCAF tools as the most accepted. CONCLUSIONS: The 3 assessment tools for IPCP have similar potential for use to support improvements in the IPCP. The IPCPE and IPCAF were considered advantageous on the effectiveness and fit-for-purpose compared to OGIPCP, despite the higher familiarity of participants with this tool.

Coagulase-Negative Staphylococci Clones Are Widely Distributed in the Hospital and Community.

Coagulase-negative staphylococci (CoNS) may be considered contaminants when isolated from clinical specimens but may also be a cause of true infection. This study aimed to compare the clonality and SCCmec type of a collection of CoNS isolated from blood cultures of inpatients, nasal swabs of healthy individuals, and patients with chronic wounds, all from the same community, using SCCmec typing, pulsed-field gel electrophoresis (PFGE), and MLST. Staphylococcus epidermidis, exhibited high clonal diversity, but hospital and community clusters were observed. Nosocomial S. epidermidis clones belonged to sequence types ST2, ST6, and ST23. Some Staphylococcus haemolyticus clones were found to circulate in the hospital and community, while Staphylococcus saprophyticus exhibited very high clonal diversity. Staphylococcus lugdunensis, Staphylococcus warneri, and Staphylococcus capitis revealed several isolates belonging to the same clone in the hospital and community. The detection of different SCCmec types within the same cluster indicated high diversity. S. epidermidis was associated with SCCmec I and III, S. haemolyticus with I and II, S. capitis with type V, Staphylococcus hominis with mec complex type A and ccr1, and S. warneri and S. saprophyticus with SCCmec I. The generation of elements and new combinations of cassette genes were highly associated with CoNS isolates, suggesting that SCCmec may not be a good marker of clonality in these bacteria.

Molecular epidemiology of methicillin-resistant Staphylococcus aureus in the Brazilian primary health care system.

OBJECTIVE: To evaluate the molecular epidemiology and to georeference Staphylococcus aureus isolated from wounds and nares of patients seen at Basic Health Units (BHUs) of a Brazilian city. METHODS: Observational, cross-sectional study conducted from 2010 to 2013. A total of 119 S. aureus strains isolated from the wounds and nares of 88 patients were studied. The isolates were characterised by identifying virulence genes encoding enterotoxins A-E, haemolysins α, ß and δ, exfoliatins A, B and D, biofilm production, Panton-Valentine Leukocidin and toxic shock syndrome toxin 1, and by pulsed-field gel electrophoresis (PFGE), multilocus sequence and spa typing. RESULTS: Eighteen methicillin-resistant Staphylococcus aureus (MRSA) (6 SCCmec type II and 12 SCCmec type IV) and 101 (85%) MSSA were identified. PFGE typing resulted in the formation of eight clusters, with STs 1, 5, 8, 30, 188, 1176 and 1635 and spa type t002 being the predominant types among MSSA. The 18 MRSA belonged to STs 5, 8 and 1176 and spa types t002 and t062. CONCLUSION: The results demonstrate widespread dissemination of MSSA and MRSA clones carrying haemolysin, biofilm and toxin genes. Kernel density estimation revealed the highest density of S. aureus in the 4, 5 and 8 BHUs.

OBJECTIF: Evaluer l'épidémiologie moléculaire et géoréférencer le Staphylococcus aureus isolé de plaies et de narines de patients vus dans les unités sanitaires de base (BHU) d'une ville brésilienne. MÉTHODES: Etude observationnelle transversale réalisée de 2010 à 2013. Au total, 119 souches de S. aureus isolées de plaies et de narines de 88 patients ont été étudiées. Les isolats ont été caractérisés par l'identification de gènes de virulence codant pour les entérotoxines AE, les hémolysines α, ß et δ, les exfoliatines A, B et D, la production de biofilm, la leucocidine de Panton-Valentine et la toxine 1 du syndrome de choc toxique, et par typage par électrophorèse sur gel en champ pulsé (PFGE), séquence multilocus et spa. RÉSULTATS: Dix-huit SARM (6 de type II SCCmec et 12 de type IV SCCmec) et 101 (85%) SASM ont été identifiés. Le typage PFGE a résulté à l'obtention de huit grappes, dont STs 1, 5, 8, 30, 188, 1176 et 1635 et le type spa t002 étant les types prédominants parmi les SASM. Les 18 SARM appartenaient aux STs 5, 8 et 1176 et aux types de spa t002 et t062. CONCLUSION: Les résultats démontrent une dissémination étendue des clones de SASM et de SARM portant les gènes de l'hémolysine, de biofilm et de toxine. L'estimation de la densité par noyau a révélé la densité la plus élevée de S. aureus dans les 4, 5 et 8 BHU.

Nasal carriage of Staphylococcus aureus in Botucatu, Brazil: a population-based survey.

Recent increases in the incidence and severity of staphylococcal infections renewed interest in studies that assess the burden of asymptomatic carriage of Staphylococcus aureus in the community setting. We conducted a population-based survey in the city of Botucatu, Brazil (122,000 inhabitants), in order to identify the prevalence of nasal carriage of Staphylococcus aureus (including methicillin-resistant strains). Nasal swabs were obtained from 686 persons over one year of age. Resistance to methicillin was assessed through phenotypic methods, identification of the mecA gene and typing of the Staphylococcal Chromosome Cassette mec (SCCmec). Methicillin-resistant S. aureus (MRSA) isolates were characterized using Pulsed-Field Gel Electrophoresis (PFGE), Multilocus Sequence Typing (MLST) and spa typing. Polymerase chain reaction was applied to identify genes coding for Panton-Valentine Leukocidin (PVL) in isolates. The prevalence of overall S. aureus carriage was 32.7% (95%CI, 29.2%-36.2%). Carriers were significantly younger (mean age, 28.1 versus 36.3 for non-carriers; OR for age, 0.98; 95%CI, 0.97-0.99) and likely to report recent skin infection (OR, 1.85; 95%CI, 1.03-3.34). Carriage of methicillin-resistant S. aureus (MRSA) was found in 0.9% of study subjects (95%CI, 0.4%-1.8%). All MRSA isolates harbored SCCmec type IV, and belonged to spa types t002 or t021, but none among them harbored genes coding for PLV. In MLST, most isolates belonged to clones ST5 or ST1776. However, we found one subject who carried a novel clone, ST2594. Two out of six MRSA carriers had household contacts colonized with isolates similar to theirs. Our study pointed to dissemination of community-associated MRSA among the Brazilian population.

Detecção dos genes de virulência e identificação do perfil clonal de isolados de Staphylococcus aureus colonizantes de nasofaringe obtidos em estudo de base populacional / Detection of virulence genes and profile identification clonal isolates of Staphylococcus aureus colonizing the nasopharynx obtained in population-base study

Estudos recentes apontam para elevação da incidência e da gravidade das infecções por Staphylococcus aureus. Esse fato é agravado pela ampla disseminação de isolados de Staphylococcus aureus resistentes à meticilina (MRSA) nos hospitais, além de sua recente introdução na comunidade. A colonização nasal de indivíduos assintomáticos é o principal fator responsável pela persistência e disseminação de S. aureus nas populações humanas. Assim sendo, inquéritos de carreamento nasal são importantes para estimar a “carga” (burden) de S. aureus como um todo e de MRSA na comunidade. Além disso, a compreensão da relação bactéria-hospedeiro e dos fatores de virulência envolvidos se faz necessária para o combate às infecções que colocam em risco a vida da população em geral. O presente trabalho teve como objetivo investigar a distribuição de clones de Staphylococcus aureus e MRSA na população da área urbana de Botucatu, SP, identificando a prevalência dos determinantes de virulência junto aos fatores de risco associados em isolados obtidos da nasofaringe de indivíduos hígidos do município. Um total de 223 amostras de S. aureus isoladas de secreções nasais foi submetido a testes de susceptibilidade antimicrobiana à oxacilina e cefoxitina através da técnica de discodifusão. O método de E-test foi empregado para determinar a Concentração Inibitória Miníma (CIM) em amostras resistentes. Em seguida, foram realizadas reações de PCR para a detecção dos genes mecA, genes codificadores de fatores de virulência das enterotoxinas (sea, seb e sec) e toxina associada à síndrome do choque tóxico (tst); toxinas esfoliativas A e B (eta, etb), leucocidina de Panton-Valentine (lukS-PV e lukF-PV), hemolisinas alfa e delta (hla e hld); e biofilme (icaA e icaD)...

Recent findings show an increase on the incidence and severity of Staphylococcus aureus infection. This fact is worsened by the wide dissemination of the methicillin-resistant S. aureus (MRSA) isolates in hospitals and its recent introduction in the community settings. The nasal colonization in asymptomatic individuals remains the main factor responsible for the persistence and dissemination of S. aureus in the human population. Thereby, nasal carriage surveys are an important tool in order to estimate the total S. aureus burden and the MRSA in the community. Besides, understanding the bacterial-host relationship and the virulence factors involved is necessary in order to manage the infections that jeopardize the population’s health. The present study aims at investigating the clonal distribution of S. aureus and MRSA strains in an urban population area in Botucatu, SP, identifying both the prevalence of the virulence determinants together to the associated risk factors in samples obtained from the nasopharynx of healthy individuals from Botucatu. A total of 223 S. aureus samples isolated from nasal secretions were submitted to the antimicrobial susceptibility tests through the disk-difusion method with oxacillin and cefoxitin disks. The E-test method with oxacillin was applied in order to obtain the Minimum Inhibitory Concentration (MIC) among oxacillin disk resistant samples. Afterwards, PCR (Polimerase Chain Reaction) was carried out for the detection of the mecA gene and of the following virulence genes: enterotoxins (sea, seb and sec), toxic shock syndrome toxin (tst), exfoliative toxin A and B (eta, etb), Panton-Valentine Leukocidin (lukS-PV and lukF-PV), alphaand delta-hemolysins (hla and hld), and biofilms (icaA and icaD). The PFGE molecular typing was employed in order to determine the prevalent clusters...