Health care-associated infections in hematology-oncology patients with neutropenia: a method of surveillance.

We present a prospective method of surveillance of health care-associated infection in hematology-oncology inpatients with neutropenia. Incidence rates were calculated on the basis of the number of hospitalized patients, the duration of hospital stay (in days), the number of days of neutropenia, and (in cases of central line-associated blood stream infection) the number of central line-days. We detected 11.4 and 66.4 episodes of febrile neutropenia per 1,000 hospital-days and per 1,000 days of neutropenia, respectively. The incidence of central line-associated blood stream infection was 2.6 per 1,000 central line-days. Gram-negative bacteria were the most prevalent pathogens. Efforts should be made to monitor infection rates on hematology-oncology wards.

Demographic characteristics and prevalence of serologic markers among blood donors who use confidential unit exclusion (CUE) in São Paulo, Brazil: implications for modification of CUE policies in Brazil.

BACKGROUND: This study evaluated demographic profiles and prevalence of serologic markers among donors who used confidential unit exclusion (CUE) to assess the effectiveness of CUE and guide public policies regarding the use of CUE for enhancing safety versus jeopardizing the blood supply by dropping CUE. STUDY DESIGN AND METHODS: We conducted a cross-sectional analysis of whole blood donations at a large public blood center in São Paulo from July 2007 through June 2009, compared demographic data, and confirmed serologic results among donors who used and who have never used CUE (CUE never). RESULTS: There were 265,550 whole blood units collected from 181,418 donors from July 2007 through June 2009. A total of 9658 (3.6%) units were discarded, 2973 (1.1%) because CUE was used at the current donation (CUE now) and 6685 (2.5%) because CUE was used in the past (CUE past). The CUE rate was highest among donors with less than 8 years of education (odds ratio [OR], 2.78; 95% confidence interval [CI], 2.51-3.08). CUE now donations were associated with higher positive infectious disease marker rates than CUE never donations (OR, 1.41; CI, 1.13-1.77), whereas CUE past donations were not (OR, 1.04; CI, 0.75-1.45). CONCLUSION: The CUE process results in a high rate of unit discard. CUE use on an individual donation appears predictive of a high-risk marker-positive donation and, thus, appears to contribute modestly to blood safety. The policy of discarding units from donors who have previously CUE-positive donations does not improve safety and should be discontinued.

Alcoholic intake predisposes to more interface hepatitis in chronic hepatitis C.

Progression of liver disease in chronic hepatitis C depends on several factors related to the host, virus and the environment which deserves further investigations. 120 candidates for blood donation with hepatitis C virus were divided into three groups according to alcohol intake: abstainers, light drinkers and heavy drinkers. Liver histopathology alterations, namely architectural staging, periportal and lobular inflammation as well as portal inflammatory infiltrate were graded from 0 to 4 and afterwards divided into light (0 to 2) and severe (3 to 4). There were more drinkers among men (83.5%) than among women (41.5%). Regarding the three groups, mild periportal inflammation was significantly related with abstainers and light drinkers groups whereas severe periportal inflammation was more predominant in heavy drinkers (p = 0.033). When we compared mild with severe histopathological alterations older age was significantly (p = 0.004) associated with severe fibrosis, periportal inflammation and portal inflammatory infiltrate. In relation to enzyme levels a significant difference in fibrosis and lobular activity was found for ALT, AST and GGT. Only AST was a marker of greater portal inflammatory infiltrate. Additionally, platelets were significantly lower in severe fibrosis and in periportal inflammation. Logistic regression analysis identified AST and platelets as independent predictors for severe fibrosis. In conclusion, a correlation was found between alcohol consumption and periportal inflammation. Fibrosis correlated with age, high enzymes levels and low platelets. AST and platelets were the best predictors for severe fibrosis.