The impact of an effective 3-step hand hygiene technique in reducing potentially pathogenic microorganisms found on nursing professionals' hands.

INTRODUCTION: Healthcare-associated infections are concerning adverse events and hand hygiene is considered an essential preventive measure. The objective of the present study was to assess the effect of a correct 3-step hand hygiene technique on reducing of potentially pathogenic microorganisms on hands related to the WHO five moments for hand hygiene. METHODOLOGY: A cross-sectional study was performed by means of direct observation involving 60 Intensive Care Units (ICU) and clinical nursing professionals in a Brazilian hospital. Observations were performed in order to ascertain the adherence rate and the correct technique during health assistance. Additionally, microbiological analysis of material collected from the nursing professional's hands was carried out. Exploratory and inferential analyses were performed on R software and binomial analysis was carried out by using the Z-test. The study was approved by the research ethics committee and covered all the legal principles for the protection of human subjects. RESULTS: Hand hygiene adherence rate was 63.3%. However, only 13.3% of the professionals performed the correct 3-step hand hygiene technique regarding steps and time. Sixty-five microorganisms were isolated, among which 56.9% were coagulase-negative Staphylococcus, 26.2% were Gram-negative bacilli, 7.7% were Enterococcus faecalis, and 6.2% were Candida parapsilosis. There was no presence of potentially pathogenic microorganisms on the nursing professional's hands who performed the correct three-step technique. CONCLUSIONS: Overall correct hand hygiene technique was poor. The results indicated the presence of potentially pathogenic microorganisms at moments in which hand hygiene was mandatory but was not executed or was executed incorrectly. The 3-step hand hygiene technique proved to be effective when correctly performed since there were no microorganism growth. Larger studies are needed to test if these results can be replicated at a larger scale, since streamlining hand hygiene technique yielded encouraging results.

Recommendations for the diagnosis and management of persons with suspected vaccine-induced immune thrombotic thrombocytopenia (VITT) / Recomendaciones para diagnostico y manejo de personas con trombocitopenia trombotica inmune inducida por vacunas (VITT)

Abstract In recent months, rare cases of thrombosis at unusual sites associated with thrombocytopenia, occurring within a typical risk window (i.e., 4-28 days) after receiving SARS CoV2 vaccines, have been reported. Healthcare professionals should be prepared to detect these cases on time. The Expert Panel of the Knowledge Management and Transfer Network conducted a free search of the related literature. With the available information and the clinical expertise of the working group, we formulated, reviewed, and endorsed recommendations for the timely suspicion, diagnosis (case definitions, the use of initial laboratory and imaging tests, specific tests), and management of these thrombotic conditions. This document is considered a living document that will be updated as new evidence emerges, and recommendations may change over time.

Resumen En meses recientes se han reportado casos raros de trombocitopenia y trombosis en sitios inusuales, que ocurren dentro de una ventana de riesgo típica ( por ejemplo de 4 a 28 días) luego de recibir vacunas de SARS CoV 2. Los profesionales de la salud deben estar preparados para detectar estos casos a tiempo. Un panel de expertos y una red de transferencia de conocimiento realizó una búsqueda libre de literatura seleccionada. Con la información disponible y la experticia clínica del grupo de trabajo revisamos y dimos recomendaciones para la sospecha temprana, el diagnostico (definición de caso, el uso de pruebas de laboratorio especificas y de imágenes diagnósticas) para le manejo de estas condiciones tromboticas. Este documento es considerado un documento vivo que debe ser actualizado a medida que surja nueva evidencia y las recomendaciones vayan cambiando con el tiempo

Bactérias resistentes isoladas de superfícies inanimadas em um hospital público / Bacterias resistentes aisladas de superficies inanimadas en un hospital público / Isolated resistant bacteria from inanimate surfaces in a public hospital

RESUMO Objetivo: descrever o perfil de resistência a antimicrobianos de microrganismos presentes em superfícies inanimadas. Método: estudo descritivo, realizado entre fevereiro e junho de 2018. Coletou-se 40 amostras microbiológicas de superfícies da Clínica Médica e Unidade de Terapia Intensiva Adulto em um hospital de Mato Grosso, Brasil. A identificação e sensibilidade microbiana foram realizadas através do VITEK-2. A análise dos resultados de resistência foi avaliada conforme as diretrizes do Clinical Laboratory Standards Institute. Resultados: foram isolados 32 microrganismos das 22 amostras contaminadas, dentre eles 14 (43,8%) Staphylococcus coagulase negativa, sete (21,9%) Acinetobacter baumanni complex, três (9,4%) Enterobacter aerogenes. Dentre os Staphylococcus coagulase negativa, 11 (78,6%) apresentaram multirresistência a antimicrobianos e três (42,9%) dos isolados de Acinetobacter baumanni complex foram extremamente resistentes. Conclusão: evidenciou-se a necessidade de educação com ênfase na desinfecção correta e frequente de superfícies e na higienização das mãos após tocar o paciente e as superfícies próximas a ele.

RESUMEN Objetivo: describir el perfil de resistencia de microrganismos presentes en superficies inanimadas a agentes antimicrobianos. Método: estudio descriptivo realizado entre febrero y junio de 2018. Se recolectaron 40 muestras microbiológicas de superficies de la Clínica Médica y de la Unidad de Cuidados Intensivos para Adultos de un hospital de Mato Grosso, Brasil. Los procesos de identificación y sensibilidad microbiana se realizaron a través del dispositivo VITEK 2. El análisis de los resultados de resistencia se evaluó conforme a las directrices del Clinical Laboratory Standards Institute. Resultados: se aislaron 32 microrganismos de las 22 muestras contaminadas; entre ellos, hubo 14 (43,8%) Staphylococcus coagulasa negativa, siete (21,9%) Acinetobacter baumanni complex y tres (9,4%) Enterobacter aerogenes. Entre los Staphylococcus coagulasa negativa, 11 (78,6%) presentaron multi-resistencia a agentes antimicrobianos y tres (42,9%) de los aislados bacterianos de Acinetobacter baumanni complex fueron extremamente resistentes. Conclusión: se hizo evidente la necesidad de instrucción con énfasis en la correcta y frecuente desinfección de superficies y en el lavado de manos después de entrar en contacto con el paciente y con las superficies próximas al paciente.

ABSTRACT Objective: to describe the antimicrobial resistance profile of microorganisms present on inanimate surfaces. Method: a descriptive study, conducted between February and June 2018. Forty microbiological samples were collected from surfaces of the Medical Clinic and Intensive Care Unit for Adults in a hospital located in Mato Grosso, Brazil. Microbial identification and sensitivity were performed by means of VITEK 2. The analysis of the resistance results was assessed according to the Clinical Laboratory Standards Institute guidelines. Results: a total of 32 microorganisms were isolated from the 22 contaminated samples, the following among them: 14 (43.8%) Coagulase-Negative Staphylococcus, seven (21.9%) Acinetobacter baumanni complex, and three (9.4%) Enterobacter aerogenes. Of the Coagulase-Negative Staphylococcus, 11 (78.6%) presented multi-drug resistance to antimicrobial agents, and three (42.9%) of the Acinetobacter baumanni complex isolates were extremely resistant. Conclusion: this study evidenced the need for education with emphasis on proper and frequent disinfection of surfaces and on hand hygiene after touching patients and surfaces close to them.

Validación transcultural y lingüística de la escala de sedación y agitación Richmond al español / Transcultural and linguistic adaptation of the Richmond Agitation-Sedation Scale to Spanish

Introduction: Goal oriented sedation is standard in the management of critically ill patients, but its systematic evaluation is not frequent. The Richmond agitation sedation scale's efficient operative features make it a validated instrument for sedation assessment. Objectives: To translate and validate the Richmond agitation sedation scale into Spanish. Method: A cultural and linguistic adaptation study was designed. Translation into Spanish included back-translation and pilot testing. The inter-rater reliability testing was conducted in Clínica Colombia's cardiovascular and general intensive care unit, including 100 patients mechanically ventilated and sedated. Inter-rater reliability was tested using Kappa statistics and Intra-class correlation coefficient. This study was approved by Fundación Universitaria Sanitas Research and Ethics Institute and Clínica Sanitas Research Committee. Results: 300 assessments using the Spanish version of the Richmond agitation sedation scale were performed by three independent evaluators. The intra-class correlation coefficient was 0.977 (CI 95% 0.968-0.984). The kappa was 0.84 between the first and second evaluators 0.85 between the first and third evaluators and 0.86 between the second and third evaluators. Conclusion: The product of this study, the Spanish version of the Richmond agitation sedation scale, is conceptually equivalent to the original scale, being reproducible and understandable to physicians whose native language is Spanish.

Introducción: La sedación por metas es un estándar en el manejo del paciente crítico pero su evaluación sistemática no es frecuente, la escala de sedación y agitación Richmond es un instrumento con características operativas eficientes para evaluar sedación. Objetivo: Traducir y validar la escala de sedación y agitación Richmond al idioma español. Método: Se diseñó un estudio de adaptación transcultural y lingüística y validación de instrumento. La traducción al idioma español incluyó una traducción reversa y una prueba piloto. Las evaluaciones para la validación se realizaron con 100 pacientes bajo sedación, ventilados mecánicamente en dos unidades de cuidados intensivos, una polivalente y otra cardiovascular de la Clínica Universitaria Colombia. La fiabilidad entre los observadores fue probada utilizando el estadístico kappa y el coeficiente de correlación intraclase. El estudio contó con la aprobación del instituto de investigaciones y comité de ética de la Fundación Universitaria Sanitas y comité de investigaciones de Clínica Sanitas. Resultados: Se realizaron evaluaciones secuenciales e independientes por tres entrevistadores, completando 300 valoraciones con la traducción de la escala en español. El coeficiente de correlación intraclase fue de 0,977 (IC 95% 0,968 - 0,984). La concordancia cualitativa entre los evaluadores también fue alta con un kappa de 0,84 entre el primer y segundo evaluador, 0,85 entre el primer y tercer evaluador y 0,86 entre el segundo y tercero. Conclusión: La versión en español de la escala de sedación y agitación Richmond producto de este estudio, resulta conceptualmente equivalente a la original, es reproducible y comprensible para médicos de habla hispana.

Hollow-fiber solvent bar microextraction with gas chromatography and electron capture detection determination of disinfection byproducts in water samples.

A liquid-phase microextraction method that uses a hollow-fiber solvent bar microextraction technique was developed by combining gas chromatography with electron capture detection for the analysis of four trihalomethanes (chloroform, dichlorobromomethane, chlorodibromomethane, and bromoform) in drinking water. In the microextraction process, 1-octanol was used as the solvent. The technique operates in a two-phase mode with a 5 min extraction time, a 700 rpm stirring speed, a 30°C extraction temperature, and NaCl concentration of 20%. After microextraction, one edge of the membrane was cut, and 1 µL of solvent was collected from the membrane using a 10 µL syringe. The solvent sample was directly injected into the gas chromatograph. The analytical characteristics of the developed method were as follows: detection limits, 0.017-0.037 ng mL-1 ; linear working range, 10-900 ng mL-1 ; recovery, 74 ± 9-91 ± 2; relative standard deviation, 5.7-10.3; and enrichment factor, 330-455. A simple, fast, economic, selective, and efficient method with big possibilities for automation was developed with a potential use to apply with other matrices and analytes.

[Detection of polyps, adenomas, advanced adenomas and adenocarcinomas in patients between 45 and 49 years]. / Detección de pólipos, adenomas, adenomas avanzados y adenocarcinomas de colon en pacientes entre 45 y 49 años.

UNLABELLED: BACKGROUND. Colorectal cancer (CRC) can be prevented. Colonoscopy is the first-line procedure for screening in average risk population. In 2002, Imperiale evaluated people between 40 to 49 years and reported that adenomas and advanced adenomas presented in 8.5% and 3.5% of cases, respectively. Currently, no recommendations for CRC screening in this population have been made. OBJECTIVE: To estimate the prevalence ofpolyps, adenomas, advanced lesions and adenocarcinomas in the 45- to 49-year-old population. METHODS: We included consecutive adults between 45 and 49 years old who performed colonoscopy because of gastrointestinal signs or symptoms. Exclusion criteria were high risk for CRC, incomplete VCC and/or previous evidence of colonic lesions. The study was conducted in a gastroenterology center from Buenos Aires, between September 2010 and October 2011. The design was prospective and cross-sectional. Polyethylene glycol (PEG) lavage solution or phosphates were usedfor cleansing. Colonoscopies were performed under sedation with Olympus equipment. The protocol was approved by the local IRB. 95% confidence intervals (95% CI) were estimated. RESULTS: 814 patients were evaluated and 764 were included, 440 (57%) were women and the average age was 47 years. The global prevalence of polyps was 20% (160 cases, 95% CI 18%-24%). The global prevalence of adenomas was 14% (107 cases, 95% CI 11%-16%). The prevalence of advanced adenomas was 5% (39 cases, 95% CI 4%-7%) and the prevalence of adenocarcinoma was 0.1% (1 case, 95% CI 0%-0.7%). CONCLUSIONS: The prevalence of lesions in this population is lower than that in the average risk population. At the moment we do understand that there is no evidence to recommend CRC screening in 45- to 49-year-old individuals.