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OBJECTIVES: This project aimed to promote evidence-based practices relat. ed to the oral health of critically ill patients in an intensive care unit in Brazil. INTRODUCTION: The oral hygiene of patients on mechanical ventilation is an essential component of nursing care quality, and well-defined guidelines ensure appropriate care. Mechanical ventilation is associated with the risk of ventilator-associated pneumonia, which can increase mortality, length of stay, time on mechanical ventilation, and hospital costs. METHODS: This project was guided by the JBI Evidence Implementation Framework, which consists of seven stages: (1) identification of the area of practice to be changed, (2) involvement of change agents, (3) context assessment and readiness for change, (4) review of practices against evidence-based audit criteria, (5) implementation of practice changes, (6) reassessment of practices using a follow-up audit and (7) consideration of the sustainability of changes in practice. RESULTS: Four audit criteria were developed to evaluate compliance with best practices. In the follow-up audit, Criteria 1, 2, and 3 obtained compliance of ≥ 80%. Thus, for Criterion 1, all the patients on mechanical ventilation for more than 24 hours were evaluated by the oral medicine team, resulting in 100% compliance. For Criterion 2 on appropriate oral hygiene measures, a compliance rate of 80% was achieved. For Criterion 3, 39 professionals (90.7%) participated in educational activities related to the oral health protocol for critically ill patients, obtaining 90.7% compliance. For Criterion 4 regarding patients being evaluated before receiving any oral health care, improvement was low (only 50%), revealing the need for further improvement. CONCLUSION: This best practice project improved the professional practice of nursing staff and increased compliance with best practices for the oral health of critically ill patients. SPANISH ABSTRACT: http://links.lww.com/IJEBH/A175.
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BACKGROUND: Despite the advances in robotic surgery and its benefits for the patient and surgeon, there are difficulties and challenges in reprocessing surgical instruments, including with regard to patient safety, such as the risk of infection. The aim of this article is to evaluate the effectiveness of manual plus ultrasonic cleaning of EndoWrist devices used in robotic surgery using the adenosine triphosphate bioluminescence quantitative test. METHODS: A prospective cross-sectional study assessed the cleanliness of robotic instrumentals used in surgeries. Surgical instruments were collected immediately after the end of the surgery and sent for cleaning and disinfection following standard hospital procedures. The adenosine triphosphate test was done after visual evaluation. According to our hospital standard, instruments were classified as "approved" if the test found ≤50 relative light units. FINDINGS: We evaluated 279 EndoWrist instruments from 65 robotic surgeries. The most frequently used instruments were needle drivers (102; 39%), followed by bipolar instruments (65; 25%). Median relative light units were 49 (range = 4-13,095); 54% of instruments were classified as approved according to the hospital's threshold (relative light units ≤50) and 78% when the manufacturer's threshold (relative light units ≤150) was used. Monopolar instruments presented the best rate of approval (94% considering relative light units ≤50 and 100% with relative light units ≤150). The average relative light units did not vary with the number of reuses. There were no surgical site infections. CONCLUSION: Manual plus automated cleaning processes reduced bioburden in all situations evaluated. It seems that instruments can be safely reprocessed ≤9 times and that monopolar instruments are the easiest to clean.
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Desinfección , Procedimientos Quirúrgicos Robotizados , Adenosina Trifosfato , Humanos , Estudios Prospectivos , Estudios Transversales , Desinfección/métodos , Ultrasonido , Mediciones LuminiscentesRESUMEN
Objetivo: Analisar a ocorrência de pacientes cirúrgicos assintomáticos com teste para COVID-19 positivo, delimitar o perfil epidemiológico, identificar o tipo de cirurgia e a especialidade, bem como determinar o tempo de execução do procedimento cirúrgico após testagem positiva. Método: Trata-se de um estudo de coorte retrospectiva, em um hospital de grande porte, filantrópico, de São Paulo, realizado no período de março a setembro de 2020, baseado na análise de dados de prontuário. Resultados: Foram 4.870 procedimentos cirúrgicos, dos quais 3.688 pacientes tiveram coleta de exame PCR. A ocorrência de pacientes cirúrgicos posi-tivos e assintomáticos foi de 1,7%; no perfil epidemiológico, observa-se predominância de sexo masculino, meia-idade, com classificação de risco anestésico ASA II e em procedimentos das especialidades de ortopedia, urologia, ginecologia e gastroenterologia. A execução do teste foi de dois dias pré-procedimento e a presença de pacientes com sintomas em até 14 dias após testagem foi de 0,5%. Conclusão: A ocorrência de pacientes cirúrgicos positivos e assintomáticos foi pequena dentro do quantitativo analisado, os achados deste estudo são similares aos de estudos nacionais e internacionais em relação a especialidade, comorbidades e idade
Objective: To analyze the occurrence of asymptomatic surgical patients with a positive COVID-19 test, delimit the epidemiological profile, iden-tify the type of surgery and specialty, as well as determine the time for performing the surgical procedure after a positive test. Method: This is a retrospective cohort study, in a large, philanthropic hospital in São Paulo, carried out from March to September 2020, based on the analysis of medical records. Results:There were 4,870 surgical procedures, of which 3,688 patients underwent a PCR test. The occurrence of positive and asymptomatic surgical patients was 1.7%; in the epidemiological profile, there is a predominance of males, middle-aged, with ASA II anesthetic risk classification and in procedures of the spe-cialties of orthopedics, urology, gynecology, and gastroenterology. The test was carried out two days before the procedure and the presence of patients with symptoms within 14 days after testing was 0.5%. Conclusion: The occurrence of positive and asymptomatic surgical patients was small within the quantita-tive analyzed, the findings of this study are similar to those of national and international studies in relation to specialty, comorbidities, and age
Objetivo: Analizar la ocurrencia de pacientes quirúrgicos asintomáticos con prueba COVID-19 positiva, delimitar el perfil epidemiológico, iden-tificar el tipo de cirugía y especialidad, así como determinar el tiempo para realizar el procedimiento quirúrgico luego de una prueba positiva. Método:Este es un estudio de cohorte retrospectivo, en un gran hospital filantrópico de São Paulo, realizado de marzo a septiembre de 2020, basado en el análi-sis de registros médicos. Resultados: Se realizaron 4.870 procedimientos quirúrgicos, de los cuales se recolectó examen PCR a 3.688 pacientes. La ocur-rencia de pacientes quirúrgicos positivos y asintomáticos fue de 1,7%; en el perfil epidemiológico predomina el sexo masculino, de mediana edad, con clasificación de riesgo anestésico ASA II y en procedimientos de las especialidades de ortopedia, urología, ginecología y gastroenterología. La prueba se realizó dos días antes del procedimiento y la presencia de pacientes con síntomas dentro de los 14 días posteriores a la prueba fue del 0,5%. Conclusión:La ocurrencia de pacientes quirúrgicos positivos y asintomáticos fue pequeña dentro de lo cuantitativo analizado, los hallazgos de este estudio son simi-lares a los de estudios nacionales e internacionales en relación a especialidad, comorbilidades y edad
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Humanos , Masculino , Femenino , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Cuidados Preoperatorios/métodos , Portador Sano , Prueba de COVID-19 , COVID-19/diagnóstico , Estudios Retrospectivos , Estudios de Cohortes , Procedimientos Quirúrgicos ElectivosRESUMEN
OBJECTIVES: To describe the compliance to the practices of hand hygiene and hub disinfection before manipulation of the central venous catheter in two moments: before and after educational intervention. Adherence to hand hygiene was assessed with two methods: direct observation and video camera. METHODS: Before and after study conducted with the nursing team in an adult intensive care unit, in São Paulo, Brazil, including 180 observations using video cameras and direct observation. Hand hygiene compliance before catheter manipulation and compliance with the correct technique and the hub disinfection for five seconds were observed. RESULTS: When video cameras recording was observed, hand hygiene compliance increased from 46% to 66% and the use of the proper technique increased from 23% to 46% (p < 0.05). Regarding hub disinfection compliance, no difference was observed between the periods. Hand hygiene compliance in direct observation increased from 83% to 87% and in indirect observation, from 46% to 66% after the intervention. CONCLUSION: After the educational intervention, hand hygiene compliance before CVC manipulation and the use of the correct technique improved. When observed indirectly, the adherence to these practices was lower, reinforcing the Hawthorne effect.
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Catéteres Venosos Centrales , Infección Hospitalaria , Higiene de las Manos , Adulto , Brasil , Modificador del Efecto Epidemiológico , Adhesión a Directriz , Desinfección de las Manos , Humanos , Control de Infecciones/métodosRESUMEN
ABSTRACT Objectives: To describe the compliance to the practices of hand hygiene and hub disinfection before manipulation of the central venous catheter in two moments: before and after educational intervention. Adherence to hand hygiene was assessed with two methods: direct observation and video camera. Methods: Before and after study conducted with the nursing team in an adult intensive care unit, in São Paulo, Brazil, including 180 observations using video cameras and direct observation. Hand hygiene compliance before catheter manipulation and compliance with the correct technique and the hub disinfection for five seconds were observed. Results: When video cameras recording was observed, hand hygiene compliance increased from 46% to 66% and the use of the proper technique increased from 23% to 46% (p < 0.05). Regarding hub disinfection compliance, no difference was observed between the periods. Hand hygiene compliance in direct observation increased from 83% to 87% and in indirect observation, from 46% to 66% after the intervention. Conclusion: After the educational intervention, hand hygiene compliance before CVC manipulation and the use of the correct technique improved. When observed indirectly, the adherence to these practices was lower, reinforcing the Hawthorne effect.
RESUMO Objetivos: Descrever o cumprimento das práticas de higienização das mãos e desinfecção dos conectores antes da manipulação do cateter venoso central antes e após intervenção educativa. A adesão à higienização das mãos foi avaliada por observação direta e câmera de vídeo. Métodos: Estudo antes e depois realizado com a equipe de enfermagem em unidade de terapia intensiva para adultos, em São Paulo, Brasil, com 180 observações com câmeras de vídeo e observação direta. A adesão à higienização das mãos antes da manipulação do cateter e à técnica correta e desinfecção do conector por cinco segundos foram observadas. Resultados: Quando as câmeras de vídeo foram observadas, a adesão à higiene das mãos aumentou de 46% para 66% e o uso da técnica adequada aumentou de 23% para 46% (p < 0,05). Em relação à adesão à desinfecção do conector, não foi observada diferença entre os períodos. A adesão à higienização das mãos na observação direta aumentou de 83% para 87% e na indireta, de 46% para 66% após a intervenção. Conclusão Após a intervenção educativa, houve melhora na adesão à higienização das mãos antes da manipulação do cateter venoso central e no uso da técnica correta. Quando observada indiretamente, a adesão a essas práticas foi menor, reforçando o efeito Hawthorne.
RESUMEN Objetivo: Describir el cumplimiento de las prácticas de higiene de manos y desinfección del hub antes de la manipulación del catéter venoso central en dos momentos: antes y después de la intervención educativa. La adherencia a la higiene de manos se evaluó con dos métodos: observación directa y cámara de video. Métodos: Estudio antes-después realizado con el equipo de enfermería en una unidad de cuidados intensivos de adultos, en São Paulo, Brasil, que incluye 180 observaciones utilizando cámaras de video y observación directa. Se observaron el cumplimiento de la higiene de manos antes de la manipulación del catéter y el cumplimiento de la técnica correcta y la desinfección del hub durante cinco segundos. Resultados: Cuando se observó la grabación de cámaras de video, el cumplimiento de la higiene de manos aumentó del 46% al 66% y el uso de la técnica adecuada aumentó del 23% al 46% (p<0,05). En cuanto al cumplimiento de la desinfección de hubs, no se observó diferencia entre los períodos. El cumplimiento de la higiene de manos en observación directa aumentó del 83% al 87% y en observación indirecta del 46% al 66% tras la intervención. Conclusión: Después de la intervención educativa mejoró el cumplimiento de la higiene de manos antes de la manipulación del CVC y el uso de la técnica correcta. Cuando se observó indirectamente, la adherencia a estas prácticas fue menor, reforzando el efecto Hawthorne.
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Infecciones Relacionadas con Catéteres , Catéteres Venosos Centrales , Práctica Clínica Basada en la Evidencia , Higiene de las Manos , Grupo de EnfermeríaRESUMEN
We evaluated the seroprevalence of SARS-CoV-2 and risk factors among 1,996 oligo/asymptomatic health care workers. The seroprevalence was 5.5% and risk factors associated with being infected with SARS-CoV-2 was professional category of cleaning (adj odds ratio 2.22, 95% confidence interval: 1.12-4.44, P: .023) and male gender (adj odds ratio: 1.54, 95% confidence interval: 1.03-2.32, P: .035).Working at dedicated COVID-19 units (high-risk group) was not an independent risk factor for seropositivity.
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COVID-19 , SARS-CoV-2 , Personal de Salud , Humanos , Masculino , Factores de Riesgo , Estudios SeroepidemiológicosRESUMEN
ABSTRACT Introduction: Chronic hemodialysis (HD) patients are considered to be at high risk for infection. Here, we describe the clinical outcomes of chronic HD patients with influenza A (H1N1) infection and the strategies adopted to control an outbreak of influenza A in a dialysis unit. Methods: Among a total of 62 chronic HD patients, H1N1 infection was identified in 12 (19.4%). Of the 32 staff members, four (12.5%) were found to be infected with the H1N1 virus. Outcomes included symptoms at presentation, comorbidities, occurrence of hypoxemia, hospital admission, and clinical evaluation. Infection was confirmed by real-time reverse transcriptase polymerase chain reaction. Results: The 12 patients who had H1N1 infection did not differ significantly from the other 50 non-infected patients with respect to age, sex, dialysis vintage, dialysis modality, or proportion of comorbidities. Obesity was higher in the H1N1-infected group (41.5 vs. 4%, p<0.002). The most common symptoms were fever (92%), cough (92%), and rhinorrhea (83%). Early empirical antiviral treatment with oseltamivir was started in symptomatic patients and infection control measures, including the intensification of contact-reduction measures by the staff members, antiviral chemoprophylaxis to asymptomatic patients undergoing HD in the same shift of infected patients, and dismiss of staff members suspected of being infected, were implemented to control the spread of infection in the dialysis unit. Conclusion: The clinical course of infection with H1N1 in our patients was favorable. None of the patients developed severe disease and the strategies adopted to control the outbreak were successful.
RESUMO Introdução: Pacientes em hemodiálise (HD) crônica apresentam risco elevado para infecções. O presente estudo descreve os desfechos clínicos de pacientes em HD crônica com infecção pelo vírus influenza A (H1N1) e as estratégias adotadas para controlar um surto de influenza A numa unidade de diálise. Métodos: Doze (19,4%) de 62 pacientes em HD crônica e quatro (12,5%) de 32 funcionários desta unidade de diálise apresentaram infecção pelo vírus H1N1. Os desfechos incluíram sintomas à apresentação, comorbidades, ocorrência de hipoxemia, internação hospitalar e avaliação clínica. A presença de infecção foi confirmada por reação em cadeia da polimerase via transcriptase reversa (RT-PCR) em tempo real. Resultados: Os 12 pacientes com infecção por H1N1 não diferiram significativamente dos 50 pacientes sem infecção no tocante a idade, sexo, tempo em diálise, modalidade de diálise e percentual de comorbidades. O percentual de obesidade foi mais elevado no grupo com infecção por H1N1 (41,5% vs. 4%, p<0,002). Os sintomas mais comuns foram febre (92%), tosse (92%) e rinorreia (83%). Os pacientes foram submetidos a tratamento antiviral com oseltamivir e medidas de controle (intensificação das medidas de redução de contato pelos funcionários da clínica, quimioprofilaxia com antiviral para pacientes assintomáticos em HD na mesma sala dos pacientes com infecção e afastamento de funcionários da clínica com suspeita de infecção) para controlar a disseminação da infecção pela unidade de diálise. Conclusão: O curso clínico da infecção por H1N1 em nossos pacientes foi favorável. Nenhum evoluiu para doença grave e as estratégias adotadas foram efetivas no controle do surto.
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Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Antivirales/administración & dosificación , Vacunas contra la Influenza/administración & dosificación , Brotes de Enfermedades/prevención & control , Gripe Humana/tratamiento farmacológico , Gripe Humana/epidemiología , Subtipo H1N1 del Virus de la Influenza A/genética , Brasil/epidemiología , Comorbilidad , Estudios Retrospectivos , Diálisis Renal , Vacunación/métodos , Resultado del Tratamiento , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Gripe Humana/prevención & control , Gripe Humana/virología , Oseltamivir/administración & dosificación , Reacción en Cadena en Tiempo Real de la PolimerasaRESUMEN
INTRODUCTION: Chronic hemodialysis (HD) patients are considered to be at high risk for infection. Here, we describe the clinical outcomes of chronic HD patients with influenza A (H1N1) infection and the strategies adopted to control an outbreak of influenza A in a dialysis unit. METHODS: Among a total of 62 chronic HD patients, H1N1 infection was identified in 12 (19.4%). Of the 32 staff members, four (12.5%) were found to be infected with the H1N1 virus. Outcomes included symptoms at presentation, comorbidities, occurrence of hypoxemia, hospital admission, and clinical evaluation. Infection was confirmed by real-time reverse transcriptase polymerase chain reaction. RESULTS: The 12 patients who had H1N1 infection did not differ significantly from the other 50 non-infected patients with respect to age, sex, dialysis vintage, dialysis modality, or proportion of comorbidities. Obesity was higher in the H1N1-infected group (41.5 vs. 4%, p<0.002). The most common symptoms were fever (92%), cough (92%), and rhinorrhea (83%). Early empirical antiviral treatment with oseltamivir was started in symptomatic patients and infection control measures, including the intensification of contact-reduction measures by the staff members, antiviral chemoprophylaxis to asymptomatic patients undergoing HD in the same shift of infected patients, and dismiss of staff members suspected of being infected, were implemented to control the spread of infection in the dialysis unit. CONCLUSION: The clinical course of infection with H1N1 in our patients was favorable. None of the patients developed severe disease and the strategies adopted to control the outbreak were successful.
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Antivirales/administración & dosificación , Brotes de Enfermedades/prevención & control , Subtipo H1N1 del Virus de la Influenza A/genética , Vacunas contra la Influenza/administración & dosificación , Gripe Humana/tratamiento farmacológico , Gripe Humana/epidemiología , Oseltamivir/administración & dosificación , Diálisis Renal , Vacunación/métodos , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Comorbilidad , Femenino , Humanos , Gripe Humana/prevención & control , Gripe Humana/virología , Masculino , Persona de Mediana Edad , Reacción en Cadena en Tiempo Real de la Polimerasa , Estudios Retrospectivos , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Resultado del TratamientoRESUMEN
Objetivou-se avaliar a Qualidade de Vida Profissional por meio da análise de Satisfação por Compaixão, Burnout e Estresse Traumático Secundário em profissionais da saúde que atuam em Unidades de Terapia Intensiva, bem como verificar os fatores de risco para a ocorrência de Burnout e Estresse Traumático Secundário. O método adotado foi o estudo Survey em quatro UTIs de hospital universitário terciário da cidade de São Paulo. Foram utilizadas fichas de dados sociodemográficos e o instrumento ProQOL-BR. Verificou-se associação estatisticamente significativa entre Estresse Traumático Secundário e sexo (p = 0,03), e entre Satisfação por Compaixão, Burnout e Estresse Traumático Secundário (p < 0,01; p = 0,002). Constatou-se, ademais, que existe desequilíbrio da qualidade de vida profissional dos participantes, e que os fatores de risco para Burnout e Estresse Traumático Secundário não estão relacionados com a área de atuação profissional, idade, escolaridade, estado civil ou renda.
OBJECTIVES: To evaluate the Professional Quality of Life analizing Compassion Satisfaction, Burnout and Secondary Traumatic Stress among health professionals working in Intensive Care Units; to check the risk factors for the occurrence of Burnout and Secondary Traumatic Stress on those professionals. METHOD: Survey study conducted in four ICUs of tertiary university hospitals in São Paulo. Sociodemographic data was used along with the and ProQOL-BR tool. RESULTS: There was a statistically relevant association between Secondary Traumatic Stress and gender (p = 0.03) and between Compassion Satisfaction, Burnout and Secondary Traumatic Stress (p < 0.01; p = 0.002). CONCLUSION: It was found that there is instability in the professional quality of life of participants, and that the risk factors for Burnout and Secondary Traumatic Stress aren't related to professional area, age, education, marital status, or income.
Se objectiva evaluar la Calidad de Vida Profesional por medio del análisis de la Satisfacción por Compasión, Burnout y Estrés Traumático Secundario en el personal de la salud que trabajan en Unidades de Cuidados Intensivos y comprobar los factores de riesgo para la ocurrencia de burnout y estrés traumático secundario. El método adoptado es el estudio de encuesta en cuatro UCIs de hospital universitario terciario en Sao Paulo. Se utilizó datos sociodemográficos y ProQol-BR. Se confirmó la asociación estadísticamente significativa entre Estrés Traumático Secundario y sexo (p = 0,03) y entre Satisfacción por Compasión entre Burnout y Estrés Traumático Secundario (p < 0,01; p = 0,002). Se constató, además, que existe desequilibrio de la calidad de vida profesional de los participantes y que los factores riesgo para Burnout y Estrés Traumático Secundario no tiene relación con la práctica, edad, educación, estado civil o el ingreso profesional.
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Humanos , Masculino , Femenino , Ubicación de la Práctica Profesional , Calidad de Vida , Salud Laboral , Personal de Salud , Desgaste por Empatía , Agotamiento Psicológico , Hospitales Universitarios , Unidades de Cuidados Intensivos , Brasil , Salud Mental , Encuestas y CuestionariosRESUMEN
To describe the nationwide impact of a restrictive law on over-the-counter sales of antimicrobial drugs, implemented in Brazil in November 2010. Approximately 75% of the population receives healthcare from the public health system and receives free-of-charge medication if prescribed. Total sales in private pharmacies as compared with other channels of sales of oral antibiotics were evaluated in this observational study before and after the law (2008-2012). Defined daily dose per 1000 inhabitants per day (DDD/TID) was used as standard unit. In private pharmacies the effect of the restrictive law was statistically significant (Pâ<â0.001) with an estimated decrease in DDD/TID of 1.87 (s.e.â=â 0.18). In addition, the trend of DDD/TID before the restrictive law was greater than after the intervention (Pâ<â0.001). Before November 2010, the slope for the trend line was estimated as 0.08 (s.e.â=â0.01) whereas after the law, the estimated slope was 0.03 (s.e.â=â0.01). As for the nonprivate channels, no difference in sales was observed (Pâ=â0.643). The impact in the South and Southeast (more developed) regions was higher than in the North, Northeast, and Mid-West. The state capitals had a 19% decrease, compared with 0.8% increase in the rest of the states. Before the law, the sales of antimicrobial drugs were steadily increasing. From November 2010, with the restrictive law, there was an abrupt drop in sales followed by an increase albeit at a significantly lower rate. The impact was higher in regions with better socio-economic status.
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Antiinfecciosos/economía , Legislación de Medicamentos , Brasil , Humanos , Medicamentos sin Prescripción/economíaRESUMEN
INTRODUÇÃO: Em junho de 2009 a Organização Mundial de Saúde declarou pandemia de influenza A (H1N1)pdm09. Esse novo vírus teve grande impacto na saúde mundial, foi responsável por 90% dos casos de influenza no mundo com apresentação clínica diferente da sazonal, acometendo indivíduos jovens e causando milhares de óbitos. O Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo foi referência para atendimento de casos graves. Por se tratar de um vírus novo houve controvérsias em relação a medidas de precaução e em relação ao afastamento dos profissionais de saúde (PAS). Devido a elevada incidência de influenza A (H1N1)pdm09 também ocorreram casos entre os profissionais da área da saúde (PAS). OBJETIVOS: Geral: Avaliar os fatores de risco para aquisição de influenza A (H1N1)pdm09 entre profissionais da área da saúde. Específico: Comparar características clínicas e de exposição dos casos de influenza A (H1N1)pdm09 em comparação a outros casos sintomáticos respiratórios entre profissionais da área da saúde MÉTODOS: Estudo caso-controle no qual foram criados três grupos e divididos em: sintomático respiratório H1N1-positivo, sintomático respiratório H1N1-negativo e controle assintomático. RESULTADOS: 274 PAS foram avaliados: 52 sintomáticos respiratórios H1N1-positivo, 120 sintomáticos respiratórios H1N1-negativo e 102 controles assintomáticos. Na análise multivariada que comparou sintomático respiratório H1N1-positivo com assintomáticos, presença de comorbidades/fatores de risco (OR=16,31; IC de 95%; 4,08-65,07) e contato desprotegido durante atendimento a caso suspeito e/ou confirmado para influenza A (H1N1)pdm09 em outro Hospital (OR=12,77; IC de 95%; 1,35-121,52) foram fatores de risco independentes para aquisição de influenza A (H1N1)pdm09. Contato social ou com colega de trabalho suspeito e/ou confirmado para influenza A (H1N1)pdm09 (OR=0,11; IC de 95%; 0,04-0,28) e uso de transporte público (OR=0,19; IC de 95%; 0,07-0,50)...
INTRODUCTION: In June 2009 the World Health Organization declared influenza A (H1N1) pdm09 pnademic. This new virus had great impact on global health and accounted for 90% of cases of influenza in the world. It affected young people and caused thousands of deaths. The Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo was a reference for the treatment of severe cases. Because it was a new virus there were controversies regarding the precautions and HCW sick leave policies. OBJECTIVE: General-To evaluate risk factors for acquisition of influenza A (H1N1) pdm09 among health care workers (HCW). Specific: To compare clinical and exposure characteristics of cases of influenza A (H1N1) pdm09 with other respiratory symptomatic infections among HCW. METHODS: Case-control study with three groups: symptomatic H1N1-positive cases, symptomatic H1N1-negative cases and asymptomatic controls. RESULTS: 274 HCW were evaluated: 52 symptomatic H1N1-positive cases, 120 symptomatic H1N1-negative cases and 102 asymptomatic controls. In the multivariate analysis that compared H1N1- symptomatic H1N1-positive cases with asymptomatic controls, comorbidities/risk factors (OR=16.31; 95% CI 4.08-65.07) and unprotected contact during caring for a confirmed or suspected case of influenza A (H1N1) pdm09 in another hospital (OR=12.77, 95% CI; 1.35- 121.52) were independent risk factors for pandemic influenza infection among HCW. Social contact or contact with co-worker with confirmed or suspected case of influenza A (H1N1) pdm09 (OR=0.11; 95% CI, 0.04- 0.28) and use of public transportation (OR= 0.19; 95% CI, 0.07- 0.50) were protective. Comparing symptomatics groups, unprotected contact during caring for a confirmed or suspected case of influenza A (H1N1) pdm09 in another hospital, to be a medical doctor, contact for or a confirmed or suspected case of influenza A (H1N1) pdm09 at home, reside with child from 5 to 12 years, fever and conjunctivitis were more common...
Asunto(s)
Humanos , Masculino , Femenino , Comorbilidad , Diagnóstico , Transmisión de Enfermedad Infecciosa , Personal de Salud , Subtipo H1N1 del Virus de la Influenza A , Equipos de Seguridad , Factores de RiesgoRESUMEN
OBJECTIVE: To determine factors associated with colonization by carbapenem-resistant Pseudomonas aeruginosa and multiresistant Acinetobacter spp. METHODS: Surveillance cultures were collected from patients admitted to the intensive care unit at admission, on the third day after admission and weekly until discharge. The outcome was colonization by these pathogens. Two interventions were implemented: education and the introduction of alcohol rubs. Compliance with hand hygiene, colonization pressure, colonization at admission and risk factors for colonization were evaluated. RESULTS: The probability of becoming colonized increased during the study. The incidence density of colonization by carbapenem-resistant P. aeruginosa and multiresistant Acinetobacter spp. and colonization pressure were different between periods, increasing gradually throughout the study. The increase in colonization pressure was due to patients already colonized at admission. The APACHE II score, colonization pressure in the week before the outcome and male gender were independent risk factors for colonization. Every 1% increase in colonization pressure led to a 2% increase in the risk of being colonized. CONCLUSION: Colonization pressure is a risk factor for carbapenem-resistant P. aeruginosa and multiresistant Acinetobacter spp. colonization. When this pressure reaches critical levels, efforts primarily aimed at hand hygiene may not be sufficient to prevent transmission.
Asunto(s)
Infecciones por Acinetobacter/epidemiología , Carbapenémicos , Infección Hospitalaria/epidemiología , Farmacorresistencia Bacteriana Múltiple , Unidades de Cuidados Intensivos , Infecciones por Pseudomonas/epidemiología , Resistencia betalactámica , APACHE , Acinetobacter/efectos de los fármacos , Infecciones por Acinetobacter/microbiología , Infecciones por Acinetobacter/prevención & control , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Carga Bacteriana , Brasil/epidemiología , Niño , Preescolar , Infección Hospitalaria/microbiología , Infección Hospitalaria/prevención & control , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Infecciones por Pseudomonas/microbiología , Infecciones por Pseudomonas/prevención & control , Pseudomonas aeruginosa/efectos de los fármacos , Factores de Riesgo , Factores de Tiempo , Adulto JovenAsunto(s)
Humanos , Masculino , Femenino , Niño , Adulto , Personal de Salud , Manuales como Asunto , Infección Hospitalaria/prevención & control , EnfermeríaRESUMEN
OBJECTIVE: To determine factors associated with colonization by carbapenem-resistant Pseudomonas aeruginosa and multiresistant Acinetobacter spp. METHODS: Surveillance cultures were collected from patients admitted to the intensive care unit at admission, on the third day after admission and weekly until discharge. The outcome was colonization by these pathogens. Two interventions were implemented: education and the introduction of alcohol rubs. Compliance with hand hygiene, colonization pressure, colonization at admission and risk factors for colonization were evaluated. RESULTS: The probability of becoming colonized increased during the study. The incidence density of colonization by carbapenem-resistant P. aeruginosa and multiresistant Acinetobacter spp. and colonization pressure were different between periods, increasing gradually throughout the study. The increase in colonization pressure was due to patients already colonized at admission. The APACHE II score, colonization pressure in the week before the outcome and male gender were independent risk factors for colonization. Every 1% increase in colonization pressure led to a 2% increase in the risk of being colonized. CONCLUSION: Colonization pressure is a risk factor for carbapenem-resistant P. aeruginosa and multiresistant Acinetobacter spp. colonization. When this pressure reaches critical levels, efforts primarily aimed at hand hygiene may not be sufficient to prevent transmission. .