Enterobacteriaceae isolates from the oral cavity of workers in a Brazilian oncology hospital.

The evaluation of workers as potential reservoirs and disseminators of pathogenic bacteria has been described as a strategy for the prevention and control of healthcare-associated infections (HAIs). The aim of this study was to evaluate the presence of Enterobacteriaceae in the oral cavity of workers at an oncology hospital in the Midwest region of Brazil, as well as to characterize the phenotypic profile of the isolates. Saliva samples of 294 workers from the hospital's healthcare and support teams were collected. Microbiological procedures were performed according to standard techniques. Among the participants, 55 (18.7%) were colonized by Enterobacteriaceae in the oral cavity. A total of 64 bacteria were isolated, including potentially pathogenic species. The most prevalent species was Enterobacter gergoviae (17.2%). The highest rates of resistance were observed for ß-lactams, and 48.4% of the isolates were considered multiresistant. Regarding the enterobacteria isolated, the production of ESBL and KPC was negative. Nevertheless, among the 43 isolates of the CESP group, 51.2% were considered AmpC ß-lactamase producers by induction, and 48.8% were hyper-producing mutants. The significant prevalence of carriers of Enterobacteriaceae and the phenotypic profile of the isolates represents a concern, especially due to the multiresistance and production of AmpC ß-lactamases.

Enterobacteriaceae ISOLATES FROM THE ORAL CAVITY OF WORKERS IN A BRAZILIAN ONCOLOGY HOSPITAL / Enterobacteriaceae isoladas da cavidade bucal de trabalhadores de hospital oncológico do Centro-Oeste brasileiro

The evaluation of workers as potential reservoirs and disseminators of pathogenic bacteria has been described as a strategy for the prevention and control of healthcare-associated infections (HAIs). The aim of this study was to evaluate the presence of Enterobacteriaceae in the oral cavity of workers at an oncology hospital in the Midwest region of Brazil, as well as to characterize the phenotypic profile of the isolates. Saliva samples of 294 workers from the hospital’s healthcare and support teams were collected. Microbiological procedures were performed according to standard techniques. Among the participants, 55 (18.7%) were colonized by Enterobacteriaceae in the oral cavity. A total of 64 bacteria were isolated, including potentially pathogenic species. The most prevalent species was Enterobacter gergoviae (17.2%). The highest rates of resistance were observed for β-lactams, and 48.4% of the isolates were considered multiresistant. Regarding the enterobacteria isolated, the production of ESBL and KPC was negative. Nevertheless, among the 43 isolates of the CESP group, 51.2% were considered AmpC β-lactamase producers by induction, and 48.8% were hyper-producing mutants. The significant prevalence of carriers of Enterobacteriaceae and the phenotypic profile of the isolates represents a concern, especially due to the multiresistance and production of AmpC β-lactamases.

A investigação de trabalhadores dos serviços de saúde como reservatório e disseminadores de bactérias patogênicas tem sido referida como estratégia de prevenção e controle das infecções relacionadas à assistência à saúde. Este estudo buscou avaliar a presença de Enterobacteriaceae na cavidade bucal de trabalhadores de hospital oncológico do Centro-Oeste brasileiro, bem como caracterizar o perfil fenotípico dos isolados. Foi coletada amostra de saliva de 294 trabalhadores pertencentes às equipes de saúde e de apoio. Procedimentos microbiológicos foram realizados segundo técnicas referendadas. Dentre os participantes, 55 (18,7%) estavam colonizados por Enterobacteriaceae na cavidade bucal. Foram isoladas 64 bactérias, incluindo espécies potencialmente patogênicas. A espécie mais prevalente foi Enterobacter gergoviae (17,2%). As maiores taxas de resistências foram observadas para os β-lactâmicos e 48,4% dos isolados foram considerados multirresistentes. Para as enterobactérias pesquisadas, a produção de ESBL e KPC foi negativa. Porém, dentre os 43 isolados do grupo CESP, 51,2% foram considerados produtores de β-lactamase AmpC por indução e 48,8% mutantes hiperprodutores. Considera-se a prevalência de portadores de Enterobacteriaceae significativa e o perfil fenotípico dos isolados preocupante, especialmente pela multirresistência e produção de β-lactamases AmpC.

Pseudomonas spp. ISOLATED FROM THE ORAL CAVITY OF HEALTHCARE WORKERS FROM AN ONCOLOGY HOSPITAL IN MIDWESTERN BRAZIL.

This cross-sectional study, performed in an oncology hospital in Goiania, aimed to characterize the prevalence of oral colonization and antimicrobial susceptibility of Pseudomonas spp. isolated from the saliva of healthcare workers. Microorganisms were subjected to biochemical tests, susceptibility profile, and phenotypic detection. Of 76 participants colonized with Gram negative bacilli, 12 (15.8%) harbored Pseudomonas spp. Of all isolates, P. aeruginosa (75.0%), P. stutzeri (16.7%), and P. fluorescens (8.3%), were resistant to cefoxitin, and therefore likely to be AmpC producers. The results are clinically relevant and emphasize the importance of surveillance to minimize bacterial dissemination and multiresistance.

Methicillin-resistant Staphylococcus sp. colonizing health care workers of a cancer hospital.

The aim of the study was to analyze epidemiological and microbiological aspects of oral colonization by methicillin-resistant Staphylococcus of health care workers in a cancer hospital. Interview and saliva sampling were performed with 149 health care workers. Antimicrobial resistance was determined by disk diffusion and minimum inhibitory concentration. Polymerase Chain Reaction, Internal Transcribed Spacer-Polymerase Chain Reaction and Pulsed Field Gel Electrophoresis were performed for genotypic characterization of methicillin-resistant Staphylococcus. Risk factors were determined by logistic regression. Methicillin-resistant Staphylococcus colonization prevalence was 19.5%, denture wearing (p = 0.03), habit of nail biting (p = 0.04) and preparation and administration of antimicrobial (p = 0.04) were risk factors identified. All methicillin-resistant Staphylococcus were S. epidermidis, 94.4% of them had mecA gene. Closely related and indistinguishable methicillin-resistant S. epidermidis were detected. These results highlight that HCWs which have contact with patient at high risk for developing infections were identified as colonized by MRSE in the oral cavity, reinforcing this cavity as a reservoir of these bacteria and the risk to themselves and patients safety, because these microorganisms may be spread by coughing and talking.

Methicillin-resistant Staphylococcus sp. colonizing health care workers of a cancer hospital

The aim of the study was to analyze epidemiological and microbiological aspects of oral colonization by methicillin-resistant Staphylococcus of health care workers in a cancer hospital. Interview and saliva sampling were performed with 149 health care workers. Antimicrobial resistance was determined by disk diffusion and minimum inhibitory concentration. Polymerase Chain Reaction, Internal Transcribed Spacer-Polymerase Chain Reaction and Pulsed Field Gel Electrophoresis were performed for genotypic characterization of methicillin-resistant Staphylococcus. Risk factors were determined by logistic regression. Methicillin-resistant Staphylococcus colonization prevalence was 19.5%, denture wearing (p = 0.03), habit of nail biting (p = 0.04) and preparation and administration of antimicrobial (p = 0.04) were risk factors identified. All methicillin-resistant Staphylococcus were S. epidermidis, 94.4% of them had mecA gene. Closely related and indistinguishable methicillin-resistant S. epidermidis were detected. These results highlight that HCWs which have contact with patient at high risk for developing infections were identified as colonized by MRSE in the oral cavity, reinforcing this cavity as a reservoir of these bacteria and the risk to themselves and patients safety, because these microorganisms may be spread by coughing and talking.

Tricotomía preoperatoria: aspectos relacionados con la seguridad del paciente / Tricotomía pré-operatória: aspectos relacionados à segurança do paciente / Trichotomy preoperative: aspects related to patient safety

El objetivo del estudio fue analizar los indicadores del proceso de Rasurado en cirugías limpias, en un hospital universitario del Centro-Oeste brasileño. Se trata de un estudio retrospectivo, de corte transversal, analítico. Se analizaron 700 historias clínicas de pacientes sometidos a cirugía limpia, de 2008 a 2010. Evidenció que, 27% (189) los pacientes fueron rasurados y 15,9% desarrolló infección del sitio quirúrgico, dato mayor que el encontrado en la literatura, se asume una tasa de entre 1 y 5%. Entre los indicadores de proceso relacionados al rasurado, 82,5% se realizaron hasta 2 horas antes de la incisión de la piel, 16,9% usaron una cuchilla de afeitar, el método estándar que se utiliza en el servicio y 83,1% de los registros, no había constancia del método utilizado para este procedimento. Se concluyó que el método de eliminación del vello mostró desacuerdo con los principios de funcionamiento seguro, siendo este un fuerte predictor de la tasa de infección encontrada en el estudio (AU)

The study is aimed at analyzing the indicators of the process of Trichotomy in clean surgeries in a teaching hospital in Central Brazil. This is a cross-sectional retrospective study, of analytical nature.700 medical records of patients submitted to clean surgeries from 2008 to 2010 were analyzed. It was shown that 27% (189) of the patients were trichotomized and 15.9% developed surgical site infection, given higher than that found in the literature, which admits a rate between 1 and 5%. Among the indicators of the process related to tricotomy, it became evident that 82,5% performed it until 2 hours before the skin incision, 16.9% used the razor blade, the standard method used in the service and 83.1% of the records, there was no reported the method used for this procedure. It was concluded that the method of hair removal disagreed with the principles of safe surgery, being a strong predictor of the rate of infection found in this study (AU)

O estudo objetivou analisar o indicador de processo Tricotomia em cirurgias limpas em um hospital de ensino do Centro-Oeste brasileiro. Trata-se de estudo retrospectivo do tipo transversal, de natureza analítica. Analisou-se 700 prontuários de pacientes submetidos à cirurgia limpa, de 2008 a 2010. Evidenciou-se que, 27% (189) dos pacientes foram tricotomizados e 15,9% desenvolveram infecção do sítio cirúrgico, dado superior ao encontrado na literatura, que se admite uma taxa entre 1 e 5%. Dentre os indicadores de processo relacionados à tricotomia, 82,5% foi realizada até 2 horas antes da incisão da pele, 16,9% usaram a lâmina de barbear, método padrão empregado no serviço e 83,1% dos prontuários, não havia o registro do método utilizado para esse procedimento. Concluiu-se que, o método da tricotomia, demonstrou inconformidade com os princípios da cirurgia segura, sendo este, forte preditor da taxa de infecção encontrada no estudo

Trabajadores del área de salud de un hospital oncológico colonizados por microorganismos multidroga resistentes / Trabalhadores da área de saúde de um hospital oncológico colonizados por micro-organismos multi-droga-resistentes / Oncology hospital health workers colonized by multi-drug resistant microorganisms

Estudio transversal con trabajadores de salud en un Hospital de referencia en oncología de 02/2009 a 12/2010. Se objetivó caracterizar el perfil de los profesionales colonizados por microorganismos multirresistentes y verificar su adhesión a Higiene de las Manos y utilización de Equipamientos de Protección Individual (EPI). Para identificarlos, se utilizó entrevista, recolección de saliva y análisis microbiológicos. Datos tratados con SPSS(R) 19.0. Se observaron aspectos éticos (protocolo 040/08). Se encontraron 148 profesionales colonizados, 29,7% por microorganismos multirresistentes. El 75% trabajaba 40 horas semanales o más. Sin relación entre categoría profesional y estar colonizado, ni entre estar colonizado y vínculos laborales. Todos refirieron higienizar sus manos, la mayoría con frecuencia (97,8%). Respecto al EPI, 91% informó su utilización. Teniendo en cuenta la población atendida, se verifica la necesidad de reforzar medidas preventivas y de control de infecciones en la institución, entre ellas, implantar vigilancia microbiológica activa de los profesionales (AU)

Estudo transversal com trabalhadores da saúde em um Hospital referência em oncologia de 02/2009 a 12/2010. Objetivou-se caracterizar o perfil dos profissionais colonizados por micro-organismos multirresistentes e verificar a adesão desses a Higienização das Mãos e ao uso dos Equipamentos de Proteção Individual (EPI). Para a identificação destes utilizou-se de entrevista, coleta de saliva e análises microbiológicas. Tratamento dos dados no Software SPSS(R)/19.0. Observou-se os aspectos éticos (protocolo-040/08). Colonizados 148 profissionais sendo por micro-organismos multirresistentes 29,7%. Trabalhavam 40 horas semanais ou mais 75%. Não houve relação entre a categoria profissional e estar colonizado, nem estar colonizado e vínculos de trabalho. Todos referiram higienizar as mãos e realizá-la com frequência (97,8%). Quanto ao EPI verificou-se que 91% relataram a sua utilização. Tendo em vista a população assistida verifica-se que é necessário reforçar as medidas de prevenção e controle de infecções da instituição estando dentre essas a vigilância microbiológica ativa dos profissionais

Cross-sectional study conducted with health workers of an Oncology Hospital between 02/2009 and 12/2010. The objective was to characterize the profile of workers colonized by multi-drug resistant microorganisms and identity their adherence to Hand Washing and Personal Protective Equipment (PPE). The subjects were interviewed, a sample of saliva was collected and microbiological analyses were performed. Data were treated using SPSS(R)/19.0. All ethical aspects were considered (protocol-040/08). A total of 148 workers were colonized, 29.7% by multi-drug resistant microorganisms. Most (75%) worked 40 weekly hours or more. It wasn’t found any relationship between the professional category and being colonized, or between being colonized and types of work contracts. All subjects reported washing hands; 97.8% frequently. Regarding PPE, 91% reported adherence. Infection control and prevention measures at the studied institution must be improved, which includes an active microbiological surveillance of workers (AU)

Perfil dos trabalhadores de um hospital oncológico colonizados na cavidade bucal / Profile of workers in an oncology hospital colonized in the oral cavity by Enterobacteriaceae

O objetivo deste estudo foi caracterizar o perfil dos trabalhadores de um hospital oncológico colonizados na cavidade bucal por Enterobacteriaceae. Foram investigadas as variáveis sociodemográficas, profissionais, comportamentais, de doença/infecção e colonização bacteriana. A coleta de saliva e as análises microbiológicas foram realizadas por técnicas padronizadas; a coleta de dados, por meio da aplicação de formulário. Dentre os 55 trabalhadores colonizados por Enterobacteriaceae, 56,4 por cento (31/55) também albergavam na cavidade bucal Staphylococcus e/ou Pseudomonas. A categoria profissional mais comumente colonizada foi a de técnico de enfermagem. Quadros frequentes de doença/infecção foram relatados entre os portadores. Os dados apresentados revelaram uma realidade preocupante para o contexto da assistência à saúde. Considera-se que estes resultados contribuem com subsídios importantes para os programas de prevenção e controle de infecção, visto que o conhecimento do estado de portador reduz os riscos de transmissão de micro-organismos.

Profile of workers in an oncology hospital colonized in the oral cavity by Enterobacteriaceae. The aim of this study was to characterize the profile of workers of the oncology hospital colonized by Enterobacteriaceae in the oral cavity. Along with bacterial colonization, socio-demographic,professional, disease/ infection and behavioral variables were investigated. The collection of saliva and microbiological analyses were performed using standard techniques. Data collection was conducted through a questionnaire. Among the 55 professionals colonized by Enterobacteriaceae, 56.4 percent (31/55) also harbored Staphylococcus and/or Pseudomonas in the oral cavity. The mostcommonly infected professionals were nursing technicians. Episodes of disease/infection were reported among carriers. The data revealed a worrying situation in the context of healthcare. It is hoped that these results will contribute to the prevention and control of this infection, as knowledge of carrier status reduces the risk of microorganism transmission.

Prevalência de bastonetes gram-negativos isolados da saliva de trabalhadores da saúde / Prevalence of gram-negative bacilli isolated from saliva of health workers / Prevalencia de las bacterias gram-negativas aisladas en la saliva de los trabajadores de la salud

O estudo objetivou determinar a prevalência de bastonetes Gram-negativos (BGN) isolados da saliva de trabalhadores de saúde de um hospital universitário em Goiânia-Goiás e caracterizar o perfil dos colonizados. De agosto⁄2005 a julho⁄2006, participaram do estudo 278 trabalhadores de saúde responsáveis pelos cuidados assistenciais aos clientes atendidos na instituição. A taxa de portadores foi de 69,4%, destes 44% foram considerados portadores persistentes e 49,2% multicolonizados. Foram isolados 319 BGN, sendo 208 (65,2%) enterobactérias e 111 (34,8%) não-fermentadores. As principais espécies identificadas foram: Enterobacter aerogenes (17,9%), Klebsiella pneumoniae (16,3%), Enterobacter agglomerans (8,8%). No grupo dos BGN não-fermentadores, foram isoladas 25 (7,8%) Pseudomonas aeruginosa. Elevada prevalência de trabalhadores colonizados por BGN foi observada. Os resultados obtidos neste estudo são de grande relevância, pois BGN assumem fundamental importância na etiologia e patogênese de infecções relacionadas à assistência à saúde de pacientes críticos, submetidos a procedimentos invasivos e com permanência prolongada no ambiente nosocomial.

The aim of this study was to determine the prevalence of Gram-negative (GNB) isolated from the saliva of health workers in a school hospital in Goiânia-Goiás, and to characterize the profile of the colonized individuals. From August/2005 to July/2006, 278 health care workers participated of the study. The GNB carrier rate was 69.4%, being 44% of them persistent carriers, and 49.2% multicolonized carriers. 319 BGN were isolated, of which 208 (65.2%) were Enterobacteriaceae and 111 (34.8%) non-fermenters. The main species identified were Enterobacter aerogenes (17.9%), Klebsiella pneumoniae (16.3%), and Enterobacter agglomerans (8.8%). In the group of non-fermenting GNB were isolated 25 (7.8%) Pseudomonas aeruginosa. High prevalence of colonization by GNB was observed. The results of this study are of great importance because BGN are important in the etiology and pathogenesis of infections associated with health care of critically ill patients, undergoing invasive procedures and prolonged stay in the nosocomial environment.

El objetivo del estudio fue determinar la prevalencia de bacterias Gram-negativas (BGN) aislado de la saliva de trabajadores de salud en un hospital universitario en Goiânia-Goiás y caracterizar el perfil de los colonizados. Participaron del estudio realizado entre Agosto/2005 a Julio/2006, 278 profesionales 278 responsables por asistencia sanitaria a los clientes. La tasa de portadores fue 69,4%, siendo de estos 44% persistente y 49,2% multicolónias. 319 BGN fueron aislados, 208 (65,2%) enterobacterias y 111 (34,8%) no fermentadores. Principales especies identificadas fueron Enterobacter aerogenes (17,9%), Klebsiella pneumoniae (16,3%), Enterobacter agglomerans (8,8%). En el grupo de los no fermentadores fueron aisladas 25 (7,8%) Pseudomonas aeruginosa. Alta prevalencia de colonización por los trabajadores GNB se observó. Los resultados de este estudio son de gran pertinencia, porque BGN son de fundamental importancia en la etiología y patogénesis de las infecciones relacionadas con el cuidado de salud de los pacientes enfermos, sometidos a procedimientos invasivos y estancia prolongada en ambiente hospitalario.