Preparing schools for future pandemics: Insights on water, sanitation and hygiene solutions from the Brazilian school reopening policies.

Post-COVID-19, schools urgently need to enhance infection control and prevention (IPC) measures, including water, sanitation, and hygiene (WASH), to prepare for future outbreaks and pandemics. Particularly in Brazil, that is of particular concern, as students are still recovering from the 20th longest school closure in the world. Hence, the current study had two goals: (i) to describe WASH solutions outlined in policies released at the federal, state, and capital city levels in Brazil during the COVID-19 pandemic for the safe reopening of schools and (ii) to discuss their potential to enhance school's capacity to remain operational during a new pandemic or outbreak. With a qualitative exploratory approach, we performed content analysis to discuss the direction (what, where, how and for whom?) of 66 public policies by integrating four frameworks. Solutions were discussed in the light of the principles of human rights and the human rights to water and sanitation, international guidelines for WASH and IPC in schools and the Sphere minimum standards for humanitarian aid. One hundred and fifty-nine solutions, spanning five thematic areas and five population groups, including software and hardware interventions, were compiled for potential use in Brazil and beyond. While suggested solutions have the potential to provide a cleaner and safer learning environment, it is essential to exercise caution when implementing these measures and adapt them to the specific circumstances of each school.

Comparing surgeons' skin tolerance and acceptability to alcohol-based surgical hand preparation vs traditional surgical scrub: A matched quasi-experimental study.

BACKGROUND: We aimed to compare the tolerance and acceptability of alcohol-based surgical hand preparation versus handscrubbing with antimicrobial soap and water by surgeons. METHODS: Matched quasi-experimental trial in an academic quaternary care hospital in Ribeirão Preto, Brazil, from April 1 to October, 31, 2017. Participants were cardiac and orthopedics surgeons from the study facility. In the first study phase, they performed handscrubbing with either 2% chlorhexidine (CHG) or 10% iodopovidone (PVP-I) and, in the second phase, they performed handrubbing with alcohol-based handrub (ABHR). Surgeons' skin tolerance and acceptability were evaluated using WHO-validated tools. Data were analyzed using the MacNemar's test within STATA. RESULTS: A total of 33 surgeons participated to the "per protocol" population; the majority were male (94%); mean age of 35 years (SD, 8.5). On product tolerance, there was a minimal variation in redness, scaliness, fissures, and visual evaluation of the skin when handrubbing with ABHR was compared to handscrubbing with either PVP-I or CHX. Regarding acceptability, participants rated better handrubbing with ABHR than handscrubbing with PVP-I when assessing product smell (66.6% vs 0%, p=0.002), color (73.3% vs 0%, p=0.001), product texture (60% vs 0%, p=0.004), skin dryness (60% vs 0%, p=0.004), ease of application (66.6% vs 0%, p=0.002) and overall satisfaction (66.6% vs 6.7% p=0.011). Participants rated similarly handrubbing with ABHR and handscrubbing with CHX, except for product texture, where handrubbing rated better (71,4% vs. 0%, p=0.002). Handrubbing with ABHR was preferred by 73.3%. CONCLUSION: Although handrubbing and handscrubbing were equally well tolerated by surgeons, alcohol-based surgical hand preparation fell into the personal preference for most of them. TRIAL REGISTRATION: Brazilian Clinical Trials Registry (ReBEC), RBR-8ym9yj.

Hospital-Acquired SARS-CoV-2 infection among patients admitted to a university hospital.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a public health emergency, as it is a highly contagious disease, health services had to adapt to the high demand for hospitalizations in order to contain hospital outbreaks. We aimed to identify the impact of nosocomial transmission of severe acute respiratory coronavirus virus 2 among inpatients at a university hospital in São Paulo, Brazil. Among 455 inpatients diagnosed with coronavirus disease 2019 in March-May, 2020, nosocomial infection was implicated in 42 (9.2%), of whom 23 (54.7%) died. becoming routine, especially when community transmission occur with high levels of incidence. It was possible to observe with this study that the nosocomial transmission by SARS-CoV-2 was present even with these measures instituted, and some of the damages caused by these infections are intangible.

Dissemination interventions to improve healthcare workers' adherence with infection prevention and control guidelines: a systematic review and meta-analysis.

BACKGROUND: The COVID-19 pandemic has challenged health systems worldwide since 2020. At the frontline of the pandemic, healthcare workers are at high risk of exposure. Compliance with infection prevention and control (IPC) should be encouraged at the frontline. This systematic review aimed to assess the effects of dissemination interventions to improve healthcare workers' adherence with IPC guidelines for respiratory infectious diseases in the workplace. METHODS: We searched CENTRAL, MEDLINE, Embase, and the Cochrane COVID-19 Study Register. We included randomized controlled trials (RCTs) and cluster RCTs that assessed the effect of any dissemination strategy in any healthcare settings. Certainty of evidence was assessed using the GRADE approach. We synthesized data using random-effects model meta-analysis in Stata 14.2. RESULTS: We identified 14 RCTs conducted from 2004 to 2020 with over 65,370 healthcare workers. Adherence to IPC guidelines was assessed by influenza vaccination uptake, hand hygiene compliance, and knowledge on IPC. The most assessed intervention was educational material in combined strategies (plus educational meetings, local opinion leaders, audit and feedback, reminders, tailored interventions, monitoring the performance of the delivery of health care, educational games, and/or patient-mediated interventions). Combined dissemination strategies compared to usual routine improve vaccination uptake (risk ratio [RR] 1.59, 95% confidence interval [CI] 1.54 to 1.81, moderate-certainty evidence), and may improve hand hygiene compliance (RR 1.70; 95% CI 1.03 to 2.83, moderate-certainty). When compared to single strategies, combined dissemination strategies probably had no effect on vaccination uptake (RR 1.01, 95% CI 0.95 to 1.07, low-certainty), and hand hygiene compliance (RR 1.16, 95% CI 0.99 to 1.36, low-certainty). Knowledge of healthcare workers on IPC improved when combined dissemination strategies were compared with usual activities, and the effect was uncertain in comparison to single strategy (very low-certainty evidence). CONCLUSIONS: Combined dissemination strategies increased workers' vaccination uptake, hand hygiene compliance, and knowledge on IPC in comparison to usual activities. The effect was negligible when compared to single dissemination strategies. The adoption of dissemination strategies in a planned and targeted way for healthcare workers may increase adherence to IPC guidelines and thus prevent dissemination of infectious disease in the workplace. TRIAL REGISTRATION: Protocol available at http://osf.io/aqxnp .

Impact of In-Hospital infection with SARS-CoV-2 among Inpatients at a university hospital.

OBJECTIVE: The objective of this study was to evaluate the incidence of nosocomial infection and the impact of cross-transmission of SARS-CoV-2 among inpatients at a tertiary care teaching hospital. METHODS: This was a retrospective cohort study involving inpatients admitted to a tertiary university hospital in the city of São Paulo, Brazil, between March 2020 and February 2021. Cases were identified on the basis of a positive reverse-transcription polymerase chain reaction result for SARS-CoV-2 and the review of electronic medical records. Nosocomial transmission was defined by applying the criteria established by the Brazilian National Health Regulatory Agency. RESULTS: We identified 2146 cases of SARS-CoV-2 infection, 185 (8.6%) of which were considered cases of nosocomial transmission. The mean age was 58.3 years. The incidence density was 1.78 cases per 1,000 patient-days on the general wards, being highest on the cardiac surgery ward, and only 0.16 per 1,000 patient-days on the COVID-19 wards. Of the 185 patients evaluated, 115 (62.2%) were men, 150 (81.1%) cases had at least one comorbidity, and 104 (56.2%) evolved to death. CONCLUSIONS: Despite the preventive measures taken, nosocomial transmission of SARS-CoV-2 occurred throughout our hospital. Such measures should be intensified when the incidence of community transmission peaks.

Train-the-Trainers in hand hygiene: a standardized approach to guide education in infection prevention and control.

BACKGROUND: Harmonization in hand hygiene training for infection prevention and control (IPC) professionals is lacking. We describe a standardized approach to training, using a "Train-the-Trainers" (TTT) concept for IPC professionals and assess its impact on hand hygiene knowledge in six countries. METHODS: We developed a three-day simulation-based TTT course based on the World Health Organization (WHO) Multimodal Hand Hygiene Improvement Strategy. To evaluate its impact, we have performed a pre-and post-course knowledge questionnaire. The Wilcoxon signed-rank test was used to compare the results before and after training. RESULTS: Between June 2016 and January 2018 we conducted seven TTT courses in six countries: Iran, Malaysia, Mexico, South Africa, Spain and Thailand. A total of 305 IPC professionals completed the programme. Participants included nurses (n = 196; 64.2%), physicians (n = 53; 17.3%) and other health professionals (n = 56; 18.3%). In total, participants from more than 20 countries were trained. A significant (p < 0.05) improvement in knowledge between the pre- and post-TTT training phases was observed in all countries. Puebla (Mexico) had the highest improvement (22.3%; p < 0.001), followed by Malaysia (21.2%; p < 0.001), Jalisco (Mexico; 20.2%; p < 0.001), Thailand (18.8%; p < 0.001), South Africa (18.3%; p < 0.001), Iran (17.5%; p < 0.001) and Spain (9.7%; p = 0.047). Spain had the highest overall test scores, while Thailand had the lowest pre- and post-scores. Positive aspects reported included: unique learning environment, sharing experiences, hands-on practices on a secure environment and networking among IPC professionals. Sustainability was assessed through follow-up evaluations conducted in three original TTT course sites in Mexico (Jalisco and Puebla) and in Spain: improvement was sustained in the last follow-up phase when assessed 5 months, 1 year and 2 years after the first TTT course, respectively. CONCLUSIONS: The TTT in hand hygiene model proved to be effective in enhancing participant's knowledge, sharing experiences and networking. IPC professionals can use this reference training method worldwide to further disseminate knowledge to other health care workers.

Public policies on healthcare associated infections: A case study of three countries.

Healthcare-associated infections (HAIs) are a global concern due to the impact on healthcare safety. Consequently, they demand the implementation of effective public policies for their prevention and control. The objective of this study was to analyze and compare the implementation of national programs for the prevention and control of HAIs in Brazil, Chile, and Israel. The triangle of health policy analysis was used to compare the context, process, and content of national HAI prevention and control programs. Common elements identified among the three countries led to the proposal of an explanatory theoretical model constituted of two nuclei: formation, and development & sustainability.This model may favor to understand the factors that can influence the progress of a national HAI program, providing insights into the elements for establishing programsin countries where they are still inceptive.

Adherence to precautions for preventing the transmission of microorganisms in primary health care: a qualitative study.

BACKGROUND: Health care associated infections (HAIs) are a source of concern worldwide. No health service in any country can be considered HAI risk-free. However, there is scarcity of data on the risks to which both patients and health workers are subject in non-hospital settings. The aim of this study was to identify issues that determine the adherence of professionals to precautions for preventing transmission of microorganisms in primary health care. METHOD: This was a qualitative study, using focus groups of primary health care staff, in two Brazilian municipalities. The data were analysed using content analysis. RESULTS: Four focus groups were conducted with 20 professionals (11 community health workers, 5 nursing assistants and 4 nurses), and the analysed content was organized into four thematic categories. These categories are: low risk perception, weaknesses in knowledge, insufficient in-service training and infrastructure limitations. Participants expressed their weaknesses in knowledge of standard and transmission based precautions, mainly for hand hygiene and tuberculosis. A lack of appropriate resources and standardization in sharps disposal management was also highlighted by the participants. CONCLUSION: The study points out the need to provide in-service training for professionals on the transmission of microorganisms in primary health care to ensure adequate level of risk perception and knowledge. Further recommendations include investment to improve infrastructure to facilitate adherence to precautions and to minimize the risk of disease transmission for both patients and health care workers.

Uso de Simuladores para Treinamento de Prevenção de Infecções Relacionadas à Assistência à Saúde / Simulation Training for Prevention of Healthcare Associated-Infections

Descrevem-se os resultados de treinamentos de estudantes de graduação e profissionais da saúde em prevenção de infecções relacionadas à assistência à saúde com uso de simuladores. O treinamento foi realizado em cinco módulos: higienização de mãos, prevenção de infecções de corrente sanguínea, prevenção de pneumonia associada a dispositivos respiratórios, prevenção de infecção urinária e biossegurança. Os treinamentos simulados foram aplicados a pequenos grupos de alunos de diferentes períodos da graduação e diversos cursos. Entre maio de 2012 e abril de 2013, 61 estudantes fizeram pelo menos um módulo do curso. O desempenho dos estudantes foi medido por um pré-teste e pós-teste aplicado antes e após cada módulo. O aproveitamento positivo nos módulos de I a V foi de 34,2%, 34%, 40,4%, 28,2% e 42,2%, respectivamente. Não houve diferença estatística significativa, em relação ao aproveitamento positivo, nos cinco módulos, quando analisados os estudantes dos diferentes cursos. Concluiu-se que treinamentos simulados em prevenção de infecções relacionadas à assistência à saúde foram efetivos para aumentar o conhecimento de alunos de graduação em saúde de diferentes cursos e períodos.

This article describes the results of training undergraduate students and health professionals about preventing healthcare-associated infections, with the use of simulators. The training consisted of five modules: hand washing, prevention of bloodstream infections, prevention of pneumonia associated to respiratory devices, prevention of urinary infection and biosecurity. The simulation training was performed with small groups of students at different stages of their degrees and from various courses. The course was taken from May 2012 to April 2013 by 61 students, each following at least one module of the course, and student performance was measured by tests applied before and after each module. The positive improvement rates reported in modules 1 to 5 were: 34.2%, 34%, 40.4%, 28.2% and 42.2% respectively. No statistical difference was found in relation to the positive improvement achieved in all five modules when analyzed in terms of students from different undergraduate programs. In conclusion, the simulation training proved effective in increasing the undergraduate students’ understanding of prevention of healthcare associated-infections.

Suplemento de oxígeno peri-operatorio e infección del sitio operatorio: meta-análisis de ensayos clínicos controlados / Perioperatory oxygen supplement and surgical wound infection: a metanalysis of randomized controlled trial

Objetivo: revisar sistemáticamente la evidencia acerca de la eficacia del suplemento de dosis altas de oxígeno perioperatorio y el riesgo de infección del sitio operatorio. Fuentes de datos: Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, LILACS, CINAHL, contacto con investigadores, libros. Selección estudios: ensayos clínicos aleatorios o cuasialeatorios que evaluaran suplemento con oxígeno a dosis altas FIO2 " 80% durante el transoperatorio y al menos dos horas postoperatorias con dosis estándares de oxígeno FIO2 #35% y evaluaranla infección del sitio operatorio superficial al menos a los 15 días postoperatorio. Extracción datos: los autores extrajeron los datos en forma independiente y evaluaron la calidad de los estudios con la escala de Jadad.Síntesis datos: Se incluyeron cuatro estudios con 989 participantes. La infección del sitio operatorio con la administración de FIO2 alta tuvo un OR 0,79 IC 95% (0,34, 1,84) valor p = 0,58 y con evidencia de heterogeneidad X2 11,77 gl 3, p = 0.008, I2 74,5%.Sobre la mortalidad el OR 0,17 IC 95% (0,03, 0,98) Valor p = 0,05 y sin evidencia de heterogeneidad X2 0,01 gl 1, p = 0,94, I2 0%. La duración de la hospitalización tuvo una WMD 0,75 IC 95% (0,05, 1,45)) Valor p = 0,03 y sin evidencia de heterogeneidad X2 2,74 gl 2, p = 0,25, I2 26,9%...

Objective: To systematically asses the evidence about high perioperatory oxygen doses efficacy and the surgical wound infection risk. Data Sources: The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, LILACS, CINAHL, investigators contacts, books.Selection Criteria: Randomized Controlled Trials which asses the oxygen high doses FIO2 " 80% supplement during the transoperatory and at least two hours postoperatory with standard oxygen doses FIO2 # 35% and evaluate the superficialsurgical site infection at least fifteen days after surgery. Data Collection and Analysis: The authors extracted the data in an independent way and evaluated the trials quality with the Jadad scale.Main Results: Four trial involving 989 participants were included in this review. The administration of high FIO2 demonstrated no statistically significant reduction in the...

Conhecimento da enfermagem na prevenção de infecção hospitalar / Knowledge of the nursing in the prevention of hospital infection

Introdução - A finalidade deste estudo teve como base analisar o conhecimento dos enfermeiros, técnicos e auxiliares de enfermagem com relação aos conhecimentos acerca dos métodos de prevenção contra infecção hospitalar em uma Unidade de Terapia Intensiva. Diante dessa problemática a maior preocupação foi saber ou delimitar se a Instituição de Saúde em estudo investe em programas de prevenção da infecção hospitalar, quais as estratégias de aperfeiçoamento e sua periodicidade. Material e Método - Foi realizado um estudo do tipo quantitativo, exploratório e descritivo com coleta de dados primários por meio da aplicação de questionário que procurou compreender a realidade estudada. A população do estudo foi constituída pela totalidade de profissionais de enfermagem que atuam no setor nas 24 horas, tendo como amostra o número máximo de sujeitos que respondeu ao questionário. Resultados - Por meio da análise de dados foi constatado que os sujeitos possuem conhecimentos sobre equipamentos de proteção individual, classificação das precauções, mas, contudo, na aplicabilidade durante o planejamento de suas ações junto ao isolamento respiratório por aerossóis a maioria (84%) desconhece, esse resultado causou surpresa, visto que são atuantes no setor de UTI entre cinco a dez anos.Conclusões - Conclui-se ser primordial que a equipe de saúde atuante na área hospitalar desenvolva ações educativas voltadas para a prevenção das infecções.

Introduction - The purpose of this study had as base to analyze the knowledge of the nurses, technician and nurse aid with relation to the knowledge concerning the methods of prevention against hospital infection in a Unit of Intensive Therapy. Ahead of this problematic a bigger concern was to know or to delimit if the Institution of Health in study invests in programs of prevention of the hospital infection, which the strategies of perfectioning and its regularity. Material and Method - A study of the quantitative, exploratory and descriptive type was carried through with collection of primary data by means of the questionnaire application that it looked to understand the studied reality. The population of the study was constituted by the totality of nursing professionals who act in the sector in the 24 hours, having as it shows the maximum number of citizens that answered to the questionnaire. Results - By means of the analysis of data it was evidenced that the citizens possess knowledge on Epis, classification of the precautions, but, however, in the applicability during the planning of its together action to the respiratory isolation for aerosols the majority (84%) is unaware of, this result in them caused surprise, since the ten years are operating in the sector of UTI between five. Conclusions - We conclude that it is primordial that the health teams that act in the hospital area develop educative actions directed toward the prevention of the infections.

Higiene das mãos: conhecimento dos profissionais de Saúde em um hospital universitário / Hand hygiene: healthcare workers knowledge in a university hospital

Introdução - As mãos dos Profissionais da Área da Saúde (PAS), quando não higienizadas adequadamente, podem carrear grande quantidade de microrganismos entre pacientes, paraequipamentos médico-cirúrgicos ou ainda para medicamentos e alimentos, proporcionando condições favoráveis à infecção hospitalar. Recentemente, há um interesse dos PAS a respeito deste tema, tal fato é observado através da diversidade de publicações e pesquisas: revisão do assunto, barreiras que influenciam na freqüência da higiene das mãos (HM), eficácia e impacto dos produtos existentes, ênfase na utilização do álcool para HM, métodos para avaliar a adesão a HM e relatos de métodos de educação continuada utilizadas para incentivar e educar o PAS a higienizar suas mãos. O objetivo é avaliar o conhecimento, e a adesão da HM dos PAS, dentro de um hospital universitário, terciário que atende a pacientes do Sistema Único de Saúde. Material e Métodos - Trata-se de um estudo unicêntrico, quantitativo, de natureza exploratória, onde se elaborou um questionário com doze questões objetivas. Incluiu-se neste trabalho todos os profissionais da área de Enfermagem dos três turnos. Resultados - Os resultados mostraram que os PAS sabem sobre a técnica correta da HM, no entanto possuem dúvidas em relação aos produtos, as indicações e os procedimentos. Quanto à adesão apenas 39% dos entrevistados apontaram seu setor como efetivo na HM. Conclusão - Concluí-se que os PAS da instituição possuem conhecimento a respeito das normas e técnicas sobre HM preconizadas. Porém treinamento e programa de incentivos periódicos são necessários para reforçar a adesão às medidas propostas, visando a melhoria e qualidade na assistência de Enfermagem.

Introduction - By improper hand hygiene healthcare workers´ (HCWs) hands can carry great amount of microorganisms from one patient to another, contaminate equipment by touching or even contaminate medicines and foods. This provides proper conditions for hospital infections. Recently HCWs are interested in this thema. This fact is observed by means of a diversity of researches and publications: subject review, barries that influence on hand hygiene frequency, effectiveness and impact of the existing products, emphasis in the use of the alcohol for hand hygiene, methods to evaluate the adhesion to hand hygiene and reports about methods of continued education used to stimulate and to educate HCWs for hand hygiene. The objective is to evaluate the knowledge and the adhesion of HCWs to hand hygiene methods in a university hospital that takes care of patients of the SUS (Sistema Único de Saúde). Material and Methods - One is about a unicentral, quantitative and exploratory nature study. A questionnaire with twelve objective questions was elaborated. All the professionals of nursing area of the three turns were envolved. Results - The results reveal that although HCWs know the correct hand hygiene techniques, they have doubts concerning products, indications and procedures. Regarding adhesion, only 39% of the interviewed workers had pointed its sector as effective in the hand hygiene. Conclusion - We concluded that the HCWs have knowledge about norms and techniques of handy hygiene. However, training and periodic incentives program are necessary to strengthen the adhesion to the proposed methods for improvement and quality of nursing assistance.

Das práticas de isolamento às práticas de controle de infecção: uma (re) evolução histórica / From the isolation practices to the infection control practices: a historical (re) evolution

Este trabalho busca relacionar a evolução histórica do conceito de transmissão de doenças e as práticas de isolamento, à gênese e orientação das comissões de controle de infecções, intra e extra-hospitalar. A escolha deste tema surgiu como consequência de questões que vem sendo analisadas e discutidas e que culminaram com a ocorrência da epidemia da síndrome da imunodeficiência humana (AIDS), perpassando pela criação das comissões de controle de infecção hospitalar. A escolha deste tema surgiu como consequência de questões que vem sendo analisadas e discutidas e que culminaram com a ocorrência da epidemia da síndrome da imunodeficiência humana (AIDS), perpassando pela criação das comissões de controle de infecção hospitalar. Constata-se que, a partir da percepção de que situações sociais ou ocorrências relacionadas a epidemias de uma doença, nova ou não, vão sendo construídas verdades e definições que norteiam todo um pensar e agir da sociedade e principalmente dos profissionais da área da saúde, em especial da enfermagem, quanto às práticas de controle das doenças transmissíveis. As mudanças sociais e comportamentais foram se sucedendo ao lingo da história, visando controlar a disseminação das doenças transmissíveis, minimizar riscos, proteger e promover a saúde das populações. Porém, a letalidade da doença e a sua ação discriminatória são fatores que mais tem influenciado o pensar e o fazer no cuidado como o outro, levando os profissionais da saúde a adesão às precauções de isolamento na assistência. Identifica os condicionantes da adoção das práticas de isolamento, desvelando o que é mito e o que é fato nas práticas de isolamento. Ainda são abordadas as incertezas e as dificuldades para o milênio no tocante às práticas de controle de infecção, destacando-se as recomendações aos profissionais da saúde para adesão às práticas de controle de infecções que se refere tanto a proteção pessoal, mas principalmente a proteção do ecossistema.

This work aims at correlating the background of the concept og disease transmission and the isolation practices to the basic and guidance of the Hospital Infection Control Committee inside and outside hospitals. The chice of this subject stemmed from the questions that have been analyzed and discussed into the nursing education at graduate level. This subject is intrinsically related to both the outbreak of the Acquired Immunodeficiency Syndrome (AIDS) and the hospital infection control committees and takes into account the fact that the perception that social developments related to outbreaks of new or already known deseases gives rise to true facts that rule the entire behavior of the saciety, especially the health practitioners, particularly those acting on the nursing field, thaking care of transmissible diseases. Changes in social attitudes and behavior have been made to control the widespread occurence of transmissible diseases, minimize risk, protect and uphold the health of the populations. However, the criticality of the disease and its discriminatory action are the aspects that most affect the thoughts and the procedure in taking care of the human geing and that stand for the decision of adopting or disregarding the isolation precautions by health professional. The identification of the usage of isolation practices reveals what is myth and fact in this practice. In addition, there is still the issue of uncertainty and difficulty in the millennium regarding the practice of infection control. The emphasis is on the recommendation to the healthcare providers to practice infection control not only for personal safety but mainly to the protection of the eco-system.

Infecções hospitalares: repensando a importância da higienização das mãos no contexto da multirresistência / Hospital infections: rethinking the importance of handwashing in context of multi-resistance / Infecciones intra-hospitalarias: la importancia de la higienización de las manos en el contexto de la multirresistencia

Mais de um século após a descoberta de Semmelweis sobre a importância da lavagem das mãos, ainda existe uma grande dificuldade de implementá-la. Acredita-se que os microrganismos mais associados à ocorrência das infeccções são pertencentes à flora transitória, podendo ser facilmente eliminados pela higienização das mãos. Outra antiga preocupação vem ganhando enorme repercussão mundial no contexto das infecções hospitalares: a emergência de microrganismos multirresistentes. Este artigo de revisão discute as atitudes dos profissionais e a importância das ações do Programa de Controle de Infecção Hospitalar, como medida para reduzir a transmissão de microrganismos multirresistentes e aumentar a adesão à higienização

More than a century after Semmelweis' discovery of the importance of handwashing, it is still difficult to implement. It is believed that the microorganisms most associated with infections belong to the transitory flora that could be eliminated easily by handwashing. However, another concern has gained enormous attention around the world in the context of hospital infections: the emergence of multiresistant microorganisms. This article discusses the professional attitudes and the importance of the actions of the Hospital Infection Control Program, as a measure to reduce the transmission of multi-resistant microorganisms and to increase compliance to handwashing

A pesar de haber transcurrido más de un siglo desde que Semmelweis descubrió la importancia del acto de lavarse las manos, todavía hoy hay problemas para que, efectivamente, se lleve a cabo. Se sabe que los microorganismos más asociados a las infecciones pertenecen a la flora transitoria, motivo por el cual podrían ser eliminados fácilmente con la higiene de las manos. Otra antigua preocupación que está adquiriendo enorme repercusión mundial en el contexto de las infecciones hospitalarias es el resurgimiento de los microorganismos multirresistentes. Este artículo de revisión discute las actitudes de los profesionales y la importancia de las acciones del Programa de Control de Infecciones intrahospitalarias, como medidas que permitan reducir la transmisión de los microorganismos multirresistentes y aumentar la adherencia a la higiene de las manos