Relato de caso clínico de infecção odontogênica resultando em complicação cervicofacial / Reporte de caso clínico de infección odontogênica com resultado de complicación cervicofacial / Clinical case reportof odontogenic infectionresulting cervicofacial complication

Introdução: A saúde bucal é um aspecto que não deve ser subestimado pelos pacientes, principalmente se considerar que as infecções odontogênicas podem levar a quadros graves, incluindo complicações cervicotorácicas, como Mediastinite e cervicofaciais, como Angina de Ludwig. Para tanto, é imprescindível que os profissionais da odontologia saibam reconhecer os principais sinais e sintomas dessas infecções, sua evolução, conhecer as complicações associadas e qual o manejo adequado. Objetivo: Assim, é objetivo deste trabalho, relatar, discutir um caso clínico de uma infecção odontogênica grave que acarretou em complicação cervical, com trajeto em direção ao mediastino, necessitando manejo multidisciplinar, e explorar os principais aspectos desse quadro e a conduta necessária, que exige, no mínimo, intervenção cirúrgica, antibioticoterapia e manutenção das vias aéreas. Relato de caso: O caso trata de um paciente com infecção odontogênica, iniciada como uma pericoronarite do dente 38 semieruptado, que evoluiu para a área cervical, demandando imediata drenagem nesta região pois encaminhava-se para uma mediastinite. Após a drenagem cervical e antibioticoterapia e, assim que houve redução do trismo, foi removido o dente 38, evoluindo para a cura.Conclusões:As infecções odontogênicas, principalmente as que acometem os espaços fasciais e cervicais profundos, são potencialmente graves e devem ter suas principais manifestações clínicas entre os domínios de conhecimento dos profissionais Bucomaxilofaciais, pois necessitam de diagnóstico preciso, manejo rápido e tratamento adequado e precoce, considerando a velocidade com que podem evoluir (AU).

Introduction: Oral healthis an aspect that should not be underestimated by patients, especially considering that dental infections can lead to serious symptoms, including cervicothoracic complications, such as Mediastinitis and cervicofacial complications, such as Ludwig's Angina. Therefore, it is essential that dental professionals know how to recognize the main signs and symptoms of these infections, their evolution, know the associated complications and appropriate management.Objective: Thus, this work aims to report and discuss a clinical case of a serious odontogenic infection that resulted in a cervical complication, with a path towards the mediastinum, requiring multidisciplinary management, and to explore the main aspects of this condition and the necessary conduct, which requires, at least, surgical intervention, antibiotic therapy and airway maintenance.Case report: The case concerns a patient with odontogenic infection, which began as pericoronitis of semi-erupted tooth 38, which progressed to the cervical area, requiring immediate drainage in this region as it was heading towards mediastinitis. After cervical drainage and antibiotic therapy and, as soon as the trismus was reduced, tooth 38 was removed, progressing towards healing.Conclusions: Odontogenic infections, especially those that affect the fascial and deep cervical spaces, are potentially serious and should have their main clinical manifestations among the domains of knowledge ofOral and Maxillofacial professionals, as they require accurate diagnosis, rapid management and adequate and early treatment, considering the speed at which they can evolve (AU).

Introducción: La salud bucal es un aspecto que los pacientes no deben subestimar, especialmente considerando que las infecciones odontógenas pueden derivar en afecciones graves, incluidas complicaciones cervicotorácicas, como la mediastinitis, y complicaciones cervicofaciales, como la angina de Ludwig.Para ello, es fundamental que los profesionales odontológicos sepan reconocer las principales señalesy síntomas de estas infecciones, su evolución, conocer las complicaciones asociadas y el manejo adecuado.Objetivo: Así,el objetivo de este trabajo es reportar y discutir un caso clínico de infección odontogénica grave que resultó en una complicación cervical, con trayecto hacia el mediastino, que requirió manejo multidisciplinario, y explorar los principales aspectos de esta condicióny las medidas necesarias, que requiere, como mínimo, intervención quirúrgica, terapia con antibióticos y mantenimiento de las vías respiratorias.Reporte de caso: El caso se trata de un paciente con una infección odontogénica, que comenzó como pericoronaritis del diente 38 semi-erupcionado, la cual progresó hacia la zona cervical, requiriendo drenaje inmediato en esta región ya que se encaminaba para una mediastinitis.Después del drenaje cervical y la terapia antibiótica y, una vez reducido el trismo, se extrajo el diente 38, evolucijjonando hacia la cura.Conclusiones: Las infecciones odontogénicas, especialmente aquellas que afectan los espacios fasciales y cervicales profundos, son potencialmente graves y deben tener sus principales manifestaciones clínicas entre los dominios del conocimiento de los profesionales Orales y Maxilofaciales, pues requieren de un diagnóstico certero, un manejo rápido y un tratamiento adecuado y temprano, considerando la velocidad a la que pueden evolucionar (AU).

Frequency of hand contact with hospital surfaces in hospitalized pediatric patients.

BACKGROUND: Hand hygiene (HH) is an important strategy for preventing health-care-associated infections (HAIs). Few programs focus on HH for family members and primary caregivers but fewer for patients. This study aimed to estimate the frequency with which hospitalized pediatric patients have hand contact with hospital surfaces. METHODS: We conducted a cross-sectional descriptive observational study consisting of three phases: the first was the creation of an observation and data collection tool, the second was the training of the monitors, and the third was the observational study of hand contact and HH opportunities in hospitalized pediatric patients. RESULTS: Over 3600 minutes of observation, 2032 HH opportunities were detected, averaging 33.8/h (SD 4.7) as determined by hand contact with hospital surfaces of hospitalized pediatric patients. In our study, infants and preschool children had the highest frequency of hand contact. CONCLUSION: The high frequency of hand contact of hospital surfaces by children suggests that hourly hand disinfection of patients and caregivers, objects and surfaces around the patients may be prevention measures that could be incorporated to reduce HAIs in pediatric hospitals.

INTRODUCCIÓN: La higiene de manos es una estrategia importante para la prevención de infecciones asociadas a la atención sanitaria. Existen pocos programas centrados en la higiene de manos para los familiares y cuidadores primarios, y aún menos para el paciente. El objetivo de este estudio fue cuantificar la frecuencia con la que los pacientes pediátricos hospitalizados tienen contacto manual con superficies hospitalarias. MÉTODOS: Se llevó a cabo un estudio observacional descriptivo transversal que constó de tres fases: la primera fue la creación de una herramienta de observación y registro de datos; la segunda fue la capacitación de los monitores y la tercera fue el estudio observacional del contacto manual y de las oportunidades de higiene de manos en pacientes pediátricos hospitalizados. RESULTADOS: Durante los 3600 minutos de observación, se detectaron 2032 oportunidades, con una media de 33.8 (DE 4.7) por hora de oportunidades de higiene de manos establecidas por contacto manual con superficies de pacientes pediátricos hospitalizados. Los lactantes y los niños en edad preescolar presentaron la mayor frecuencia de contacto manual. CONCLUSIONES: La alta frecuencia de contacto manual por parte del niño indica que medidas como la desinfección de las manos cada hora del paciente y del cuidador, así como de los objetos y superficies alrededor del paciente, podrían ser medidas útiles que deberían incluirse para prevenir las infecciones asociadas a la atención de la salud en los hospitales pediátricos.

High-risk clones of ESBL-producing Klebsiella pneumoniae colonizing ICU patients in Natal, northeastern Brazil / Clones de alto risco de Klebsiella pneumoniae produtores de ESBL colonizando pacientes de UTI em Natal, Nordeste do Brasil / Clones de alto riesgo de Klebsiella pneumoniae productores de BLEE que colonizan pacientes de UCI en Natal, noreste de Brasil

Background and objectives: colonization by extended-spectrum ß-lactamase (ESBL)-producing Klebsiella pneumoniae in Intensive Care Unit (ICU) patients is considered a risk factor for infections, and poses as a source of spreading these strains in hospital facilities. This study aimed to perform the genetic characterization of ESBL-producing K. pneumoniae isolates recovered from surveillance swabs in an ICU in northeastern Brazil. Methods: the isolates were recovered between 2018-2019 from the nasal, axillary, and rectal sites of 24 patients admitted to the ICU. Bacterial identification was performed by traditional biochemical tests. Antimicrobial susceptibility was assessed by disk diffusion, and ESBL phenotype was detected by double-disc synergy test. Polymerase chain reaction (PCR) for blaCTX-M, blaSHV, and blaTEM genes, PFGE, and MLST were carried out in representative isolates. Results: a total of 27 isolates were recovered from 18 patients (75%). The ESBL production was detected in 85% of isolates. Resistance to ciprofloxacin, sulfamethoxazole/trimethoprim and most of the ß-lactams tested was recurrent, except for carbapenems. The blaSHV, blaTEM, and blaCTX-M genes were found in high frequency, and the CTX-M-(1, 2 and 9) groups were identified. Seven sequence types (ST11, ST14, ST17, ST395, ST709, ST855, and ST3827) were described, most of them considered high-risk. Conclusion: these findings emphasize the potential threat of well-established high-risk clones in an ICU, and highlight the importance of monitoring these clones to prevent infections.(AU)

Justificativa e objetivos: a colonização por Klebsiella pneumoniae produtora de ß-lactamase de espectro estendido (ESBL) em pacientes de Unidade de Terapia Intensiva (UTI) é considerada um fator de risco para infecções, e representa uma fonte de disseminação dessas cepas em instalações hospitalares. Este estudo objetivou realizar a caracterização genética de isolados de K. pneumoniae produtores de ESBL recuperados de swabs de vigilância em uma UTI no Nordeste do Brasil. Métodos: os isolados foram recuperados entre 2018-2019 dos sítios nasal, axilar e retal de 24 pacientes internados na UTI. A identificação bacteriana foi realizada por testes bioquímicos tradicionais. A suscetibilidade antimicrobiana foi avaliada por disco-difusão, e o fenótipo ESBL foi detectado pelo teste de sinergia de duplo-disco. Polymerase chain reaction (PCR) para os genes blaCTX-M, blaSHV e blaTEM, PFGE e MLST foram realizados em isolados representativos. Resultados: foram recuperados 27 isolados de 18 pacientes (75%). A produção de ESBL foi detectada em 85% dos isolados. A resistência à ciprofloxacina, sulfametoxazol/trimetoprima e à maioria dos ß-lactâmicos testados foi recorrente, exceto para os carbapenêmicos. Os genes blaSHV, blaTEM e blaCTX-M foram encontrados em alta frequência, e os grupos CTX-M-(1, 2 e 9) foram identificados. Sete sequence types (ST11, ST14, ST17, ST395, ST709, ST855 e ST3827) foram descritos, a maioria deles considerados de alto risco. Conclusão: esses achados enfatizam a ameaça potencial de clones de alto risco bem estabelecidos em uma UTI, e destacam a importância do monitoramento desses clones para prevenir infecções.(AU)

Justificación y objetivos: la colonización por Klebsiella pneumoniae productora de ß-lactamasas de espectro extendido (BLEE) en pacientes de Unidades de Cuidados Intensivos (UCI) se considera un factor de riesgo para infecciones, y se presenta como una fuente de propagación de estas cepas en instalaciones hospitalarias. Este estudio tuvo como objetivo realizar la caracterización genética de aislamientos de K. pneumoniae productores de BLEE recuperados de hisopos de vigilancia en una UCI en el noreste de Brasil. Métodos: los aislamientos se recuperaron entre 2018-2019 de sitios nasales, axilares y rectales de 24 pacientes ingresados en la UCI. La identificación bacteriana se realizó mediante pruebas bioquímicas tradicionales. La susceptibilidad antimicrobiana se evaluó mediante difusión en disco, y el fenotipo BLEE se detectó mediante la prueba de sinergia de doble-disco. La polymerase chain reaction (PCR) para los genes blaCTX-M, blaSHV y blaTEM, PFGE y MLST se llevaron a cabo en aislamientos representativos. Resultados: se recuperaron 27 aislamientos de 18 pacientes (75%). La producción de ESBL se detectó en 85% de los aislamientos. La resistencia a ciprofloxacino, sulfametoxazol/trimetoprima y a la mayoría de los ß-lactámicos evaluados fue recurrente, excepto a los carbapenémicos. Los genes blaSHV, blaTEM y blaCTX-M se encontraron en alta frecuencia, y se identificaron los grupos CTX-M-(1, 2 y 9). Se describieron siete sequence types (ST11, ST14, ST17, ST395, ST709, ST855 y ST3827), la mayoría consideradas de alto riesgo. Conclusión: estos hallazgos enfatizan la amenaza potencial de los clones de alto riesgo bien establecidos en una UCI, y resaltan la importancia de monitorear estos clones para prevenir infecciones.(AU)

Infecção do sítio cirúrgico em pacientes submetidos a cirurgias neurológicas e ortopédicas / Infección del sitio quirúrgico en pacientes sometidos a cirugía neurológica y ortopédica / Surgical site infection in patients submitted to neurological and orthopedic surgeries abstract

RESUMO Objetivo: analisar a incidência das infecções de sítio cirúrgico (ISC) em pacientes submetidos a cirurgias neurológicas e ortopédicas e seus determinantes em um hospital público. Método: estudo de coorte retrospectivo, conduzido entre pacientes submetidos a cirurgias neurológicas e ortopédicas, de janeiro de 2015 a dezembro de 2020. Resultados: dos 3.029 procedimentos cirúrgicos realizados, 1.327 (43,8%) foram neurocirúrgicos; e 1.702 (56,2%), ortopédicos. A incidência da ISC foi 6,7% (89) em neurocirurgias e 3,3% (56) em ortopedias. A taxa global e de óbitos foi 4,8% e 12,4%, respectivamente. Na análise univariada, os fatores de risco associados às ISC em neurocirurgiasenvolveram tempo cirúrgico (>231 minutos), pontuação da American Society of Anesthesiologistsmaior que doise cirurgias emergenciais; para os procedimentos ortopédicos: cirurgias emergenciais, tempo de internação pré-operatório (>quatro dias) e cirúrgico (>149 minutos). Na análise multivariada, permaneceram cirurgias emergenciais e maior tempo cirúrgico como fatores de risco de ISC para ambas as especialidades;e, para as cirurgias ortopédicas e neurológicas, tempo de internação pré-operatório e classificação ASA, respectivamente. Conclusão: a taxa de incidência das ISC e de mortalidade bem como os fatores de risco identificados neste estudo devem ser considerados para elaborar estratégias destinadas a prevenir e controlar essas infecções.

RESUMEN Objetivo: analizar la incidencia de las infecciones de sitio quirúrgico (ISC) en pacientes sometidos a cirugías neurológicas y ortopédicas y sus determinantes en un hospital público. Método: estudio de cohorte retrospectivo, realizado entre pacientes sometidos a cirugías neurológicas y ortopédicas, de enero de 2015 a diciembre de 2020. Resultados: de los 3.029 procedimientos quirúrgicos realizados, 1.327 (43,8%) fueron neuroquirúrgicos; y 1.702 (56,2%), ortopédicos. La incidencia de la ISC fue 6,7% (89) en neurocirugía y 3,3% (56) en ortopedias. La tasa global y de muertes fue 4,8% y 12,4%, respectivamente. En el análisis univariado, los factores de riesgo asociados a las ISC en neurocirugía involucraron tiempo quirúrgico (>231 minutos), puntuación de la American Society of Anesthesiologists (ASA) mayor que dos y cirugías de emergencia; para los procedimientos ortopédicos: cirugías de emergencia, tiempo de internación preoperatorio (> cuatro días) y quirúrgico (>149 minutos). En el análisis multivariado, permanecieron cirugías de emergencia y mayor tiempo quirúrgico como factores de riesgo de ISC para ambas especialidades; y, para las cirugías ortopédicas y neurológicas, tiempo de internación preoperatorio y clasificación ASA, respectivamente. Conclusión: la tasa de incidencia de las ISC y de mortalidad, así como los factores de riesgo identificados en este estudio, debenser consideradosa la hora de elaborar estrategias para prevenir y controlar estas infecciones.

ABSTRACT Objective: to analyze the incidence of surgical site infections (SSI) in patients submitted to neurological and orthopedic surgeries and their determinants in a public hospital. Method: retrospective cohort study, conducted between patients submitted to neurological and orthopedic surgeries, from January 2015 to December 2020. Results: of the 3,029 surgical procedures performed, 1,327 (43.8%) were neurosurgical; and 1,702 (56.2%) were orthopedic. The incidence of SSI was 6.7% (89) in neurosurgeries and 3.3% (56) in orthopedic surgery. The overall rate and death rates were 4.8% and 12.4%, respectively. In the univariate analysis, the risk factors associated with SSI in neurosurgeries involved surgical time (>231 minutes), an American Society of Anesthesiologists score greater than two and emergency surgeries; the risk factors for orthopedic procedures were emergency surgeries, preoperative hospitalization time (> four days), and surgical procedures (>149 minutes). In the multivariate analysis, emergency surgeries and longer surgical time remained as risk factors for SSI for both specialties; the SSI risk factors for orthopedic and neurological surgeries were preoperative hospitalization time and ASA classification, respectively. Conclusion: the incidence rate of SSI and mortality, as well as the risk factors identified in this study, should be considered in order to develop strategies aimed at preventing and controlling these infections.

COVID-19 nosocomial. Estudio prospectivo en un hospital de referencia / Nosocomial COVID-19. Prospective study in a referral hospital

Antecedentes y ObjetivoEl objetivo fue describir las características clínicas y el pronóstico de los pacientes con infección nosocomial por SARS-CoV-2.MétodosSe realizó un estudio observacional y prospectivo en un hospital de referencia. Se incluyeron todos los pacientes adultos diagnosticados de infección por SARS-CoV-2 nosocomial en octubre de 2020, definida como una PCR para SARS-CoV-2 negativa al ingreso y positiva a partir de los siete días de hospitalización.ResultadosSe diagnosticaron 66 casos de infección por SARS-CoV-2 nosocomial: 39 (59%) hombres, edad mediana al diagnóstico de 74,5 años (RIC 56,8-83,1) y mediana del índice de comorbilidad de Charlson de 3 puntos (RIC 1-5). Veintisiete (41%) presentaron neumonía y 13 (20%) fallecieron durante el ingreso. La mortalidad a los 28 días fue del 33% (22 pacientes). La mortalidad a los 28 días en los 242 pacientes con infección por SARS-CoV-2 adquirida en la comunidad y hospitalizados durante el mismo periodo fue del 10%.ConclusionesSe deben extremar las medidas de prevención y detección precoz de brotes nosocomiales de COVID-19 para minimizar el impacto negativo de esta infección. (AU)

Background and objectiveThe objective was to describe the clinical characteristics and prognosis of patients with nosocomial SARS-CoV-2 infection.MethodsAn observational and prospective study was performed in a referral hospital. We included all adult patients diagnosed with nosocomial SARS-CoV-2 infection in October 2020. Nosocomial infection was defined as a negative PCR for SARS-CoV-2 on admission and a positive PCR after 7 days of hospitalization.ResultsWe included 66 cases of nosocomial SARS-CoV-2 infection: 39 (59%) men, median age at diagnosis was 74.5 years (IQR 56.8–83.1) and median Charlson comorbidity index was 3 points (IQR 1–5). Twenty-seven (41%) developed pneumonia and 13 (20%) died during admission. Mortality at 28 days was 33% (22 patients). Mortality at 28 days in the 242 patients with community-acquired SARS-CoV-2 infection who were hospitalized during the same period was 10%.ConclusionsPreventive measures and early detection of nosocomial outbreaks of COVID-19 should be prioritized to minimize the negative impact of this infection. (AU)

Nosocomial COVID-19. Prospective study in a referral hospital. / COVID-19 nosocomial. Estudio prospectivo en un hospital de referencia.

BACKGROUND AND OBJECTIVE: The objective was to describe the clinical characteristics and prognosis of patients with nosocomial SARS-CoV-2 infection. METHODS: An observational and prospective study was performed in a referral hospital. We included all adult patients diagnosed with nosocomial SARS-CoV-2 infection in October 2020. Nosocomial infection was defined as a negative PCR for SARS-CoV-2 on admission and a positive PCR after 7 days of hospitalization. RESULTS: We included 66 cases of nosocomial SARS-CoV-2 infection: 39 (59%) men, median age at diagnosis was 74.5 years (IQR 56.8-83.1) and median Charlson comorbidity index was 3 points (IQR 1-5). Twenty-seven (41%) developed pneumonia and 13 (20%) died during admission. Mortality at 28 days was 33% (22 patients). Mortality at 28 days in the 242 patients with community-acquired SARS-CoV-2 infection who were hospitalized during the same period was 10%. CONCLUSIONS: Preventive measures and early detection of nosocomial outbreaks of COVID-19 should be prioritized to minimize the negative impact of this infection.

Identificación de las caracteristicas más relevantes para la predicción de infecciones de sitio quirúrgico en pacientes intervenidos de artroplastia de cadera / Feature selection for the prediction of surgical site infections in patients undergoing hip arthroplasty

Objetivo: Seleccionar las características más relevantes a la hora de predecir una infección de sitio quirúrgico en un paciente sometido a intervención de artroplastia de cadera. Método: Se ha utilizado un método de selección de características basado en Información Mutua (IM) para determinar las variables que mejor predicen la infección de sitio quirúrgico (ISQ) en una cohorte prospectiva de pacientes operados de artroplastia de cadera en el Hospital Universitario Ramón y Cajal entre los años 2010 y 2020. Resultados: La característica más importante para la predicción fue el tiempo postoperatorio (0,98 valor de IM). Todas las ISQ ocurrieron tras el primer ingreso. Conclusiones: Los resultados obtenidos ponen en valor las técnicas de aprendizaje automático para tomar medidas organizativas que reduzcan los días de estancia, y así prevenir la aparición de ISQ, disminuir los costes del proceso clínico y aumentar la seguridad del paciente.(AU)

Objective: Select the most relevant characteristics to predict a surgical site infection in a patient undergoing hip arthroplasty. Methods: Mutual information (MI) method is used to select the characteristics that better predict Surgical Site Infection (SSI) in a prospective cohort of patients who underwent hip arthroplasty between 2010 and 2020 at the Ramón y Cajal University Hospital. Results: The most important characteristic to predict SSI was postoperative time (0.98 MI score). All SSIs occurred after the first admission. Conclusion: The results obtained highlight the value of machine learning techniques to take organizational measures that reduce the days of stay, and thus prevent the appearance of SSIs, reduce the costs of the clinical process and increase patient safety.(AU)

Utilização do cloreto de dialquil carbamoil na prevenção e tratamento de biofilme em feridas / Uso de cloruro de dialquil carbamoil en la prevención y tratamiento de biofilm en heridas / Use of dialkyl carbamoyl chloride in the prevention and treatment of biofilm in wounds

Objetivos:Objetivou-se identificar os benefícios na utilização do Cloreto de Dialquil Carbamoil para tratamento de biofilmes em feridas. Métodos:Trata-se de uma revisão integrativa de literatura que visou responder à questão norteadora: "Quais os benefícios do uso de Cloreto de Dialquil Carbamoil na cicatrização de lesões de pele?". As etapas de seleção dos artigos resultaram em 13 artigos inclusos. Resultados: Os artigos selecionados foram agrupados em dois grupos, a saber: prevenção e tratamento de infecção em feridas e prevenção de infecção de sítio cirúrgico, sendo nove produções no primeiro grupo e quatro no segundo. Os estudos demonstraram que o Cloreto de Dialquil Carbamoil atenua os sintomas de colonização, como odor, queixas álgicas e exsudação, além disso, auxilia no gerenciamento profilático do biofilme da ferida. As evidências apontam que coberturas com Cloreto de Dialquil Carbamoil não possuem efeitos adversos, tornando-se opções viáveis e seguras para lesões crônicas, agudas e, principalmente, infectadas. Conclusão: Identificou-se que o Cloreto de Dialquil Carbamoil foi capaz de promover ações benéficas ao tratamento de feridas, especialmente as de maior complexidade. A escolha adequada das coberturas e dos curativos pode contribuir com a utilização racional das tecnologias existentes e dos antimicrobianos, culminando em redução de custos e promoção de qualidade de vida aos indivíduos com feridas crônicas.

Objectives:The aim was to identify the benefits of using Dialkyl Carbamoyl Chloride for the treatment of biofilms in wounds. Methods: This is an integrative literature review that aimed to answer the guiding question: "What are the benefits of using Dialkyl Carbamoyl Chloride in the healing of skin lesions?". The article selection stages resulted in 13 articles included. Results:The selected articles were grouped into two groups, namely: prevention and treatment of infection in wounds and prevention of surgical site infection, with nine productions in the first group and four in the second. Studies have shown that Dialkyl Carbamoyl Chloride attenuates colonization symptoms, such as odor, pain complaints and oozing, in addition to aiding in the prophylactic management of wound biofilm. Evidence indicates that dressings with Dialkyl Carbamoyl Chloride have no adverse effects, making them viable and safe options for chronic, acute and, mainly, infected injuries. Conclusion: It was identified that Dialkyl Carbamoyl Chloride was able to promote beneficial actions in the treatment of wounds, especially those of greater complexity. The proper choice of dressings and coverings can contribute to the rational use of existing technologies and antimicrobials, culminating in cost reduction and promotion of quality of life for individuals with chronic wounds.

Objetivos:El objetivo fue identificar los beneficios del uso de Cloruro de dialquil carbamoil para tratar biopelículas en heridas. Métodos: Se trata de una revisión integradora de la literatura, cuyo objetivo es responder a la siguiente pregunta orientadora: "¿Cuáles son los beneficios del uso de Cloruro de dialquil carbamoil en la cura de lesiones cutáneas?". Los pasos para seleccionar los artículos dieron como resultado 13 artículos incluidos. Resultados: Los artículos seleccionados se agruparon en dos grupos, a saber: Prevención y tratamiento de la infección en heridas y Prevención de la infección del sitio quirúrgico, con 9 producciones en el primer grupo y 4 en el segundo. Los estudios demostraron que Cloruro de dialquil carbamoil atenúa los síntomas de la colonización, como el olor, el dolor y la exudación, además, ayuda en el manejo profiláctico de la biopelícula de la herida. La evidencia apunta a que la cobertura Cloruro de dialquil carbamoil no tiene efectos adversos, lo que la convierte en opciones viables y seguras para lesiones crónicas, agudas y principalmente infectadas. Conclusión: Se identificó que la Cloruro de dialquil carbamoil fue capaz de promover acciones beneficiosas para el tratamiento de heridas, especialmente las de mayor complejidad. La elección adecuada de cubiertas y apósitos puede contribuir al uso racional de las tecnologías y los antimicrobianos existentes, culminando en la reducción de costos y la promoción de la calidad de vida de las personas con heridas crónicas

La COVID-19 desde una mirada odontológica

RESUMEN Se realizó una revisión bibliográfica para profundizar en las medidas preventivas para la atención odontológica en tiempos de COVID-19 basado en la información obtenida de textos y revistas consultadas en centros de referencias y a través de localizadores electrónicos. La preparación del personal del área clínica puede disminuir el riesgo de exposición a sí mismo y a los pacientes, pues diversas investigaciones apuntan a la saliva como el medio de transferencia más efectivo de la enfermedad. Se precisó que el interrogatorio, en busca de síntomas característicos de la enfermedad, constituye la primera línea de trabajo. Se corroboró que la implementación de medidas extraprotectoras, la higiene y el lavado de manos, tanto de profesionales como de pacientes, y la solución de urgencias odontológicas sin el empleo de instrumentos rotatorios son aspectos importantes para combatir y frenar desde la odontología, la propagación del virus.

ABSTRACT A bibliographic review was carried out to deepen preventive measures for dental care in times of COVID-19 based on the information obtained from texts and journals consulted in reference centers and through electronic locators. The preparation of personnel in the clinical area can reduce the risk of exposure to themselves and to patients, since various studies point to saliva as the most effective means of transfer of the disease. It was specified that the questioning, in search of characteristic symptoms of the disease, constitutes the first line of work. It was confirmed that the implementation of extra-protective measures, hygiene and hand washing, both for professionals and patients, and the solution of dental emergencies without the use of rotary instruments are important aspects to combat and stop from dentistry, the spread of the virus.

12 pasos para reducir la incidencia de carbapenemasas / 12 steps to mitigate the incidence of carbapenemases

La resistencia a los antimicrobianos es un grave problema para la salud mundial. Es aún más crítico en los hospitales debido a la aparición de bacterias Gram negativas resistentes a múltiples fármacos, asociadas a una alta mortalidad. Las opciones de tratamiento en estos casos son escasas, en general de alto costo. La alta densidad de consumo de antibióticos y la transmisión cruzada en este entorno amplifican este problema.Hay más evidencia del impacto de las medidas de control de infecciones que de las intervenciones de comités de antimicrobianos para mitigarlo. Además, pocos países cuentan con programas sólidos de control de infecciones para enfrentar este problema. En la presente revisión se propone una serie de 12 pasos a adoptar para mitigar la prevalencia de resistencia antimicrobiana y reducir la incidencia de carbapenemasas en las instituciones de salud. Estas recomendaciones deben interpretase como un ̈bundle ̈o paquete de medidas, en el cual todas son importantes. Aquellas que involucran la prevención de infecciones y/o colonizaciones y su diseminación son las de mayor impacto demostrado hasta ahora. Es esencial que los programas de optimización de uso de antimicrobianos cuenten con el empoderamiento de la conducción de las instituciones donde se lleven a cabo, así como también que estén constituidos por un equipo multidisciplinario eficiente, sólidamente entrenado, con metas y métricas objetivas y auditorias periódicas. También es recomendable que se incluyan recomendaciones para los tratamientos en pacientes en cuidados de fin de vida.

Antimicrobial resistance is a serious global health problem. It is even more critical in hospitals due to the emergence of multi-drug resistant Gram negative bacteria, associated with high mortality. The treatment options in these cases are scarce, generally high cost. The high density of antibiotic consumption and cross-transmission in this environment amplifies this problem.There is more evidence of the impact of Infection Control measures than of Antimicrobial Committee interventions to mitigate it. Furthermore, few countries have solid Infection Control programs to deal with this problem.This review proposes a series of 12 steps to adopt to mitigate the prevalence of antimicrobial resistance and reduce the incidence of carbapenemases in health institutions. These recommendations should be interpreted as a ̈Bundle ̈ or package of measures, in which all are important. Those that involve the prevention of infections and / or colonizations and their dissemination are the ones with the greatest impact demonstrated so far. It is essential that antimicrobial use optimization programs have the empowerment of the leadership of the institutions where they are carried out, as well as that they are constituted by an efficient multidisciplinary team, solidly trained, with objective goals and metrics and periodic audits. It is also recommended that recommendations be included for treatments in patients in end-of-life care.

Proteínas importantes para la invasión de Babesia bovis a las células huésped / Important Proteins for Babesia bovis Invasion to Host Cells / Proteínas importantes para a invasão das células hospedeiras por Babesia bovis

Introducción: La babesiosis bovina es causada por parásitos Apicomplexa del género Babesia, siendo la Babesia bovis la especie asociada con cuadros clínicos más graves de la enfermedad. La invasión de B. bovis a los eritro-citos bovinos implica la interacción entre moléculas de los merozoítos del parásito con receptores de las células huésped. Por ende, conocer las proteínas involucradas en este proceso supone un importante paso para entender la biología del parásito. Objetivo: Describir las principales moléculas implicadas en el proceso de invasión de B. bovis a eritrocitos bovinos. Metodología: Se realizó una búsqueda en NCBI, Medline, LILACS y SciELO usando los términos: "Babesia bovis AND invasion process", "MSA-1", "RON2", "AMA-1", "moving junction", "B. bovis AND Vaccine candidates". Con corte en mayo de 2020, había 61 publicaciones disponibles en inglés que describen el estudio de las anteriores proteínas y su participación en la invasión.Resultados: Por ser clave el proceso de invasión a eritrocitos bovinos para la patogénesis de la babesiosis bovina, la revisión encontró 3 proteínas de B. bovis que participan en el reconocimiento e invasión a las células diana: MSA-1, AMA-1 y RON2. Sin embargo, los detalles a nivel molecular para las interacciones inter e intramoleculares aún no se han dilucidado por completo. Conclusiones: Conocer las moléculas involucradas en las interacciones parásito-hospedero permitirá entender cómo ocurre el proceso de invasión de B. bovis a los eritrocitos y, así, evaluar su futura utilidad como componente de una estrategia de control efectiva contra esta parasitosis

Introduction: Bovine babesiosis is caused by Apicomplexas parasites of the genus Babesia, Babesia bovis being the species associated with the most serious clinical conditions of the disease. B. bovisinvasion into the bovine erythrocytes involves the interaction between the parasites merozoites mo-lecules with host cell receptors. Therefore, knowing the proteins involved in the invasion process will enable understanding the parasite biology. Objective: To describe the important molecules involved in the B. bovis invasion process to bovine erythrocytes.Methodology: A search was made on NCBI, Medline, LILACS and SciELO databases using keywords as "Babesia bovis AND invasion process", "MSA-1", "RON2", "AMA-1", "moving junction", "B. bovis AND Vaccine candidates". 61 studies written in English describing the study for proteins that take place during invasion process which have been published until mayo were completely revised. Results: Given that the bovine erythrocyte invasion process is key for the pathogenesis of bovine babesiosis, a review was made where 3 proteins were found to be associated to the recognition and invasion processes of target cells: MSA-1, AMA-1 and RON2. However, the details at molecular level for the inter an intramolecular interaction have not yet been fully elucidated. Conclusions: Study the molecules involved in host-parasite interactions will allow understanding how the B. bovis invasion process to erythrocytes occurs and evaluating their future utility as a component of an effective control strategy for this parasitosis

Introdução: A babesiose bovina é causada por parasitas Apicomplexa do gênero Babesia, sendo a Babesia bovis a espécie associada com os sinais clínicos mais graves da doença. A invasão de B. bovis em eritrócitos bovinos envolve a interação entre moléculas dos merozoítos parasitas com receptores nas células hospedeiras. Por conseguinte, o conhecimento das proteínas envolvidas neste processo é um passo importante para a compreensão da biologia do parasita. Objetivo: Descrever as principais moléculas envolvidas no processo de invasão de B. bovis em eritró-citos bovinos. Metodologia: Foi realizada uma pesquisa no NCBI, Medline, LILACS e SciELO utilizando os termos: "Babesia bovis AND invasion process", "MSA-1", "RON2", "AMA-1", "moving junction", "B. bovis AND Vaccine candidates". Até maio de 2020 estavam disponíveis 61 publicações em inglês, que descreviam o estudo das proteínas acima referidas e o seu envolvimento na invasão. Resultados: Como o processo de invasão de eritrócitos bovinos é fundamental para á patogênese da babesiose bovina, a revisão encontrou 3 proteínas de B. bovis envolvidas no reconhecimento e invasão de células alvo: MSA-1, AMA-1 e RON2. No entanto, os detalhes a nível molecular para as interações Inter e intramoleculares ainda não foram completamente elucidados. Conclusões: A compreensão das moléculas envolvidas nas interações parasita-hospedeiro permitirá entender como ocorre o processo da invasão de B. bovis em eritrócitos e, assim, avaliar sua utilidade futura como componente de uma estratégia efetiva de controle contra esta parasitose

Clinical Consensus Recommendations Regarding Non-Invasive Respiratory Support in the Adult Patient with Acute Respiratory Failure Secondary to SARS-CoV-2 infection. / Recomendaciones de consenso respecto al soporte respiratorio no invasivo en el paciente adulto con insuficiencia respiratoria aguda secundaria a infección por SARS-CoV-2.

Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by a newly emergent coronavirus, that was first recognized in Wuhan, China, in December 2019. Currently, the World Health Organization (WHO) has defined the infection as a global pandemic and there is a health and social emergency for the management of this new infection. While most people with COVID-19 develop only mild or uncomplicated illness, approximately 14% develop severe disease that requires hospitalization and oxygen support, and 5% require admission to an intensive care unit. In severe cases, COVID-19 can be complicated by the acute respiratory distress syndrome (ARDS), sepsis and septic shock, and multiorgan failure. This consensus document has been prepared on evidence-informed guidelines developed by a multidisciplinary panel of health care providers from four Spanish scientific societies (Spanish Society of Intensive Care Medicine [SEMICYUC], Spanish Society of Pulmonologists [SEPAR], Spanish Society of Emergency [SEMES], Spanish Society of Anesthesiology, Reanimation, and Pain [SEDAR]) with experience in the clinical management of patients with COVID-19 and other viral infections, including SARS, as well as sepsis and ARDS. The document provides clinical recommendations for the noninvasive respiratory support (noninvasive ventilation, high flow oxygen therapy with nasal cannula) in any patient with suspected or confirmed presentation of COVID-19 with acute respiratory failure. This consensus guidance should serve as a foundation for optimized supportive care to ensure the best possible chance for survival and to allow for reliable comparison of investigational therapeutic interventions as part of randomized controlled trials.

[Clinical consensus recommendations regarding non-invasive respiratory support in the adult patient with acute respiratory failure secondary to SARS-CoV-2 infection]. / Recomendaciones de consenso respecto al soporte respiratorio no invasivo en el paciente adulto con insuficiencia respiratoria aguda secundaria a infección por SARS-CoV-2.

Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by a newly emergent coronavirus, that was first recognized in Wuhan, China, in December 2019. Currently, the World Health Organization (WHO) has defined the infection as a global pandemic and there is a health and social emergency for the management of this new infection. While most people with COVID-19 develop only mild or uncomplicated illness, approximately 14% develop severe disease that requires hospitalization and oxygen support, and 5% require admission to an intensive care unit. In severe cases, COVID-19 can be complicated by the acute respiratory distress syndrome (ARDS), sepsis and septic shock, and multiorgan failure. This consensus document has been prepared on evidence-informed guidelines developed by a multidisciplinary panel of health care providers from four Spanish scientific societies (Spanish Society of Intensive Care Medicine [SEMICYUC], Spanish Society of Pulmonologists [SEPAR], Spanish Society of Emergency [SEMES], Spanish Society of Anesthesiology, Reanimation, and Pain [SEDAR]) with experience in the clinical management of patients with COVID-19 and other viral infections, including SARS, as well as sepsis and ARDS. The document provides clinical recommendations for the noninvasive respiratory support (noninvasive ventilation, high flow oxygen therapy with nasal cannula) in any patient with suspected or confirmed presentation of COVID-19 with acute respiratory failure. This consensus guidance should serve as a foundation for optimized supportive care to ensure the best possible chance for survival and to allow for reliable comparison of investigational therapeutic interventions as part of randomized controlled trials.

Coronavirus (SARS-CoV-2) y el entorno odontológico / Coronavirus (SARS-CoV-2) and the dental environment

El coronavirus (SARS-CoV-2) es un virus que afecta las vías respiratorias del huésped infectado, provocando daños no solamente a ese nivel, sino una disfunción multiorgánica que provoca la muerte de la persona infectada. Factores como la edad (adultos mayores), comorbilidades (obesidad, diabetes, hipertensión, etcétera) favorecen que la afectación por este virus sea más letal. Esta pandemia que inició en China y se ha expandido en una gran cantidad de países en todo el mundo ha obligado a los servicios de salud no solamente a atender la pandemia, sino a desarrollar protocolos para la atención de los pacientes y la protección del personal de salud (AU)

The coronavirus (SARS-CoV-2) is a virus that affects the airways of the infected host, causing damage not only at that level, but also multiorgan dysfunction that causes its death. Factors such as age (older adults), comorbidities (obesity, diabetes, hypertension, etc.) favor that the affectation by this virus is more lethal. This pandemic that started in China and has spread in many countries around the world has forced health services not only to attend to the pandemic but also to develop protocols for the care of patients for their protection and the personnel of health (AU)

Pandemia do novo Coronavírus (SARS-CoV-2): o protagonismo da enfermagem ­ uma relação do passado com o presente e perspectivas para o futuro / New Coronavirus pandemic (SARS-CoV-2): nursing protagonism ­ a relation of the past with the present and perspectives for the future / Nueva pandemia de Coronavirus (SARS-CoV-2): protagonismo de enfermería: una relación del pasado con el presente y las perspectivas para el futuro

Objetivos: Realizar uma reflexão sobre a pandemia global do novo coronavírus SARS-CoV-2 e o protagonismo da enfermagem neste contexto, relacionando o presente com o passado e perspectivas para o futuro. Metodologia: Estudo de reflexão teórica e descritiva em um contexto social-econômico-político. Resultados: Descreve o SARS-CoV-2 que causa a doença COVID-19; pontua também as estratégias globais para minimizar sua rápida disseminação. Relata o protagonismo da enfermagem neste contexto, por serem os profissionais que estão na linha de frente nos cuidados de controle da infecção de uma doença sem tratamento específico e por estarem do lado dos pacientes 24 horas/dia, desde os cuidados básicos aos intensivos. Acrescentem-se a estes fatores o trabalho realizado com a escassez, a ausência ou falta de qualidade e segurança dos equipamentos de proteção individual, a carência de recursos humanos, profissionais afastados do trabalho devido à COVID-19, óbitos e uma falta de visibilidade social do passado que se faz presente nesta pandemia. Conclusão: A enfermagem nesta pandemia ganhou visibilidade e protagonismo no mundo. As perspectivas para o futuro da enfermagem e a importância de se concretizarem ações políticas devem visar, portanto, ao suprimento das demandas identificadas para que se evitem os problemas do passado, abundantemente evidenciados nesta pandemia.(AU)

Objectives: Carry out a reflection on the global pandemic of the new coronavirus SARS-CoV-2 and the role of nursing in this context, relating the present with the past and perspectives for the future. Methodology: Study of theoretical and descriptive reflection in a social-economic-political context. Results: Describes the SARS-CoV-2 that causes COVID-19 disease; it also points out the global strategies to minimize its rapid spread. She reports the role of nursing in this context, as they are the professionals who are at the forefront of infection control of a disease without specific treatment and for being on the side of patients 24 hours a day, from basic to intensive care. Add to these factors the work done with the scarcity, the absence or lack of quality and safety of personal protective equipment, the lack of human resources, professionals away from work due to COVID-19, deaths and a lack of social visibility from the past that is present in this pandemic. Conclusion: Nursing in this pandemic has gained visibility and prominence in the world. The perspectives for the future of nursing and the importance of carrying out political actions must therefore aim at meeting the identified demands to avoid the problems of the past, abundantly evidenced in this pandemic.(AU)

Objetivos: Realizar una reflexión sobre la pandemia global del nuevo coronavirus SARS-CoV-2 y el papel de la enfermería en este contexto, relacionando el presente con el pasado y las perspectivas para el futuro. Metodología: Estudio de la reflexión teórica y descriptiva en un contexto socio-económico-político. Resultados: describe el SARS-CoV-2 que causa la enfermedad COVID-19; También señala las estrategias globales para minimizar su rápida propagación. Ella informa sobre el papel de la enfermería en este contexto, ya que son los profesionales que están a la vanguardia del control de infecciones de una enfermedad sin un tratamiento específico y por estar del lado de los pacientes las 24 horas del día, desde cuidados básicos hasta cuidados intensivos. Agregue a estos factores el trabajo realizado con la escasez, la ausencia de falta de calidad y seguridad del equipo de protección personal, la falta de recursos humanos, profesionales fuera del trabajo debido a COVID-19, muertes y falta de visibilidad social. del pasado presente en esta pandemia. Conclusión: La enfermería en esta pandemia ha ganado visibilidad y prominencia en el mundo. Por lo tanto, las perspectivas para el futuro de la enfermería y la importancia de llevar a cabo acciones políticas deben apuntar a satisfacer las demandas identificadas para evitar los problemas del pasado, ampliamente evidenciados en esta pandemia.(AU)

Infecciones odontogénicas y complicaciones del embarazo / Odontogenic infections and pregnancy complications

Las complicaciones gestacionales que se asocian con insuficiencia placentaria y defectos en la remodelación vascular, como la preeclampsia y la restricción del crecimiento intrauterino, se cuentan entre las condiciones que contribuyen en mayor medida a la morbimortalidad materna y neonatal. El objetivo del estudio fue establecer la asociación entre infecciones odontogénicas y complicaciones del embarazo, en particular patologías asociadas a defectos en la placentación. En un estudio clínico en pacientes embarazadas, durante las semanas 20-35, se realizó una evaluación clínica odontológica. Posteriormente, se realizó un seguimiento para registrar los casos con complicaciones perinatales. Las variables independientes fueron; presencia de biofilm (placa bacteriana visible), profundidad al sondaje, nivel de inserción clínica y sangrado al sondaje. Las variables dependientes fueron las complicaciones embarazo. El 89,58% de las pacientes presentaban por lo menos 3 sitios con periodontitis. El 25% de las mujeres evaluadas presentaban más del 20% de los sitios con periodontitis. Ninguna de las mujeres que fueron evaluadas registraron la presencia de complicaciones durante el presente embarazo. En nuestro estudio, no fue posible establecer esa asociación debido a que la baja prevalencia de complicaciones asociadas al embarazo constituyo una dificultad para el tamaño muestral utilizado

Characterization and rapid control of a vancomycin-resistant Enterococcus faecium (VREF) outbreak in a renal transplant unit in Spain: The environment matters.

OBJECTIVE: To describe a clonal outbreak due to vancomycin-resistant Enterococcus faecium (VREF) in the nephrology and renal transplant unit of a tertiary teaching hospital in Barcelona, Spain, and to highlight how active patient and environment surveillance cultures, as well as prompt and directed intervention strategies, mainly environmental, helped to successfully bring it under control. PATIENTS AND METHODS: A study was conducted on patients admitted to the nephrology ward with any culture positive for VREF over a 6-month period (August 2012-January 2013). Based on the identification of a clonal link between the isolates, weekly rectal screening using swabs was implemented for all patients, as well as environmental cultures and cleaning of medical equipment and the ward. VREF isolates were identified by MicroScan and confirmed by Etest. Bacterial identification was confirmed by MALDI-TOF MS. The presence of van genes, and esp and hyl virulence genes was determined using PCR. The clonal relationship between the isolates was studied first with DiversiLab (bioMérieux), and then by PFGE-Smal and MLST. A two-tier sequence of infection control measures was implemented. RESULTS: During the study period, VREF was isolated from 13 patients. All cases were colonized with no criteria for infection. VREF isolates were also extensively recovered from the environment and medical equipment. Isolates carried the vanA gene, and were multidrug-resistant, including high-level resistance (MIC >16mg/L) to vancomycin and teicoplanin. Molecular analysis showed that all VREF isolates belonged to sequence type 17 (ST17) carrying hyl virulence genes. After implementing infection control measures in a two-tier sequence, and reinforcing particularly environmental and medical equipment cleaning, no further cases were detected in the follow-up year. CONCLUSION: A clonal outbreak of VREF-ST17 involving only colonization is reported. The prompt implementation of aggressive infection control measures in patients and the environment was effective in controlling the outbreak and avoided the potential emergence of infection among patients.

Ações no controle das infecções do sítio cirúrgico em neurocirurgia: revisão integrativa / Relevant actions in the control of surgical site infections in neurosurgery: an integrative review / Acciones para controlar infecciones del sitio quirúrgico en neurocirugía: revisión integrativa

OBJETIVO: identificar o conhecimento produzido e publicado quanto às ações de maior relevância no controle das infecções de sítio cirúrgico (ISC) em neurocirurgia passíveis de intervenção. MÉTODO: revisão integrativa de artigos publicados em português, inglês e espanhol, nas bases de dados MEDLINE, CINAHL, LILACS, por meio dos portais BVS, CAPES e PUBMED. Resultados: foram selecionadas e analisadas 23 produções, agrupadas em categorias com enfoque nas ações realizadas no pré, trans e pós-operatório e na vigilância cirúrgica. DISCUSSÃO: não realização de tricotomia, antibioticoprofilaxia correta, técnica asséptica rígida na cirurgia, cuidados com as derivações ventriculares, curativos no pós-operatório e vigilância cirúrgica foram considerados relevantes no controle das ISC em neurocirurgia nos estudos encontrados. CONCLUSÃO: as evidências encontradas contribuirão no direcionamento das ações da enfermeira da CCIH no controle das ISC em neurocirurgia.

AIM: to identify the knowledge produced and published regarding the most relevant actions in the control of surgical site infections (SSI) in neurosurgery amenable to intervention. METHOD: integrative review of articles published in Portuguese, English and Spanish in MEDLINE, CINAHL, LILACS, through the VHL, CAPES and PUBMED portals. RESULTS: 23 publications were selected and analyzed, grouped into categories focusing on actions taken before, during and after surgery and surgical surveillance. DISCUSSION: the non-operation of trichotomy, correct antibiotic prophylaxis, rigid aseptic technique in surgery, care with ventricular derivations, curative and postoperative surgical surveillance were considered relevant in the control of SSI in neurosurgery in the studies found. CONCLUSION: The evidence found will help to direct the actions of HICC nurses in the control of SSI in neurosurgery.

OBJETIVO: identificar el conocimiento producido y publicado sobre las acciones de mayor relevancia para controlar las infecciones del sitio quirúrgico (ISC) en neurocirugía pasibles de intervención. MÉTODO: revisión integrativa de artículos publicados en portugués, inglés y español, en las bases de datos MEDLINE, CINAHL, LILACS, por medio de los portales BVS, CAPES y PUBMED. Resultados: se seleccionaron y se analizaron 23 producciones, agrupadas en categorías con enfoque en las acciones realizadas en el pre, durante y postoperatorio y en la vigilancia quirúrgica. DISCISSIÓN: no realización de tricotomía, antibioticoprofilaxia correcta, técnica aséptica rígida en la cirugía, cuidados con las derivaciones ventriculares, curativos en el postoperatorio y vigilancia quirúrgica fueron considerados relevantes para controlar las ISC en neurocirugía en los estudios encontrados. CONCLUSIÓN: las evidencias encontradas contribuirán en el direccionamiento de las acciones de la enfermera de la CCIH para controlar las ISC en neurocirugía.

Validação de instrumento para controle e prevenção e de infecção de sítio cirúrgico em neurocirurgia / Validation of instrument for control and prevention and infection of surgical site in neurosurgery / Instrumento de validación y el control y la prevención de infección del sitio quirúrgico en neurocirugía

Objetivo: validar um instrumento para o controle e a prevenção de infecção de sítio cirúrgico emneurocirurgia destinado a direcionar as ações da Comissão de Controle de Infecção Hospitalar (CCIH). Método:estudo metodológico, com abordagem quantitativa. Após revisão integrativa, elaborou-se instrumento dechecagem subdividido em ações pré, trans e pós-operatórias. Este foi submetido à validação de conteúdo porjuízes especialistas. Utilizou-se o índice de validade de conteúdo (IVC) para calcular o grau de concordância,para análise geral do instrumento e para a validação de cada item. Resultados: das 24 questões propostas, 22foram validas e obteve-se IVC de 0,96. Conclusão: o instrumento demonstrou validade de conteúdo.(AU)

Objective: to validate an instrument for the control and prevention of surgical site infection in neurosurgery aimed at directing the actions of the Hospital Infection Control Commission (CCIH). Method: methodological study, with quantitative approach. After an integrative review, a screening tool was developed, subdivided into pre, trans and postoperative actions. This has been subject to validation of content by expert judges. The content validity index (CVI) was used to calculate the degree of agreement, for the general analysis of the instrument and for the validation of each item. Results: of the 24 questions proposed, 22 were valid and CVI was 0.96.(AU)

Objetivo: validar un instrumento para el control y la prevención de la infección del sitio quirúrgico en neurocirugía destinado a direccionar las acciones de Control de Infección Hospitalaria (CCIH). Método: estudio de metodológico, con enfoque cuantitativo. Después de revisión Integrativa, se elaboró un instrumento de verificación sub-dividido en acciones pre, trans y post-operatórias. Esto fue sometido a validación de contenido por jueces expertos. Se utilizó el índice de validez de contenido (IVC) para calcular el grado de acuerdo, para el análisis general del instrumento y para la validación de cada elemento. Resultados: de las 24 cuestiones propuestas, 22 temas eran válidos y se obtuvo IVC de 0.96. Conclusión: el instrumento demostró la validez de contenido.(AU)

[Survey of methicillin-resistant Staphylococcus aureus control measures in hospitals participating in the VINCat program]. / Encuesta de las medidas de control de Staphylococcus aureus resistente a meticilina en los hospitales que participan en el programa VINCat.

INTRODUCTION: VINCat is a nosocomial infection surveillance program in hospitals in Catalonia. The aim of the study was to determine the surveillance and control measures of methicillin-resistant Staphylococcus aureus (MRSA) in these centres. METHODS: An e-mail survey was carried out from January to March 2013 with questions related to the characteristics of the hospitals and their control measures for MRSA. RESULTS: A response was received from 53 hospitals (>500 beds: 7; 200-500 beds: 14;<200 beds: 32; had ICU: 29). Computer alert of readmissions was available in 63%. There was active surveillance of patients admitted from another hospital (46.2%) or a long-term-care centre (55.8%), both being significantly more common measures in hospitals with a rate of MRSA≤22% (global median). Compliance with hand hygiene was observed in 77.4% of the centres, and was greater than 50% in 69.7% of them. All hospitals had contact precautions, although 62.3% did not have exclusive frequently used clinical material in bedrooms. The room cleaning was performed more frequently in 54.7% of hospitals, and 67.9% of them had programs for the appropriate use of antibiotics. CONCLUSIONS: This study provides information on the implementation of measures to prevent MRSA in hospitals participating in the VINCat program. Most of the centres have an MRSA protocol, however compliance with it should be improved, especially in areas such as active detection on admission in patients at risk, hand hygiene adherence, cleaning frequency and optimising the use of antibiotics.