Avaliação de programas de controle de infecções relacionadas à assistência à saúde: perspectiva crítica da RDC N°48/2000 da ANVISA / Assessment of healthcare-associated infection control programs: a critical perspective of ANVISA's RDC Nº 48/2000 / Evaluación de los programas de control de las infecciones asociadas a la atención de salud: perspectiva crítica del RDC Nº 48/2000 de la ANVISA

Objetivo: avaliar criticamente Programas de Controle de Infecções Relacionadas à Assistência à Saúde (PCIRAS) em hospitais de médio-extra portes, quanto ao cumprimento dos critérios sanitários nacionais. Métodos: estudo transversal realizado em 18 hospitais com Comissões de Controle de Infecções Relacionadas à Assistência à Saúde (CCIRAS) dos estados de Goiás e São Paulo, Brasil. Para coleta de dados aplicou-se formulário online fundamentado nos itens de avaliação preconizados pela Resolução de Diretoria Colegiada (RDC) Nº 48/2000 - ANVISA. Para análise estatística utilizou-se exame da frequência e distribuição das variáveis (média e desvio padrão - DP). Resultados: as CCIRAS atenderam 100% dos itens imprescindíveis, 93,0% (DP = 5,8) dos necessários e 64,8% (DP = 32,5) dos recomendados. Os Serviços de Controle de IRAS atenderam 90,2% (DP = 16,1) dos itens necessários, e 77,8% (DP = 19,2) dos recomendáveis. Conclusão: itens imprescindíveis foram cumpridos, porém os necessários e recomendados apresentam diferentes graus de inconformidades, podendo comprometer a prevenção e controle de IRAS. A aplicação de roteiro baseado na RDC N° 48/2000 contribui para conhecer a realidade dos PCIRAS dos hospitais, contudo, essa normativa não estabelece percentual mínimo de conformidade, dificultando a interpretação dos resultados. Há necessidade de atualizá-la para instrumentalizar os órgãos fiscalizadores.

Objective: to critically evaluate Healthcare-Associated Infection Control Programs (HAICP) in medium to extra-large hospitals, as to compliance with national health criteria. Methods: cross-sectional study conducted in 18 hospitals with Healthcare-Associated Infection Control Committees (HAICC) in the states of Goiás and São Paulo, Brazil. Data were collected using online form based on the evaluation items from Directors' Collegiate Resolution (RDC) Nº 48/2000 ­ ANVISA. For statistical analysis, frequency, and distribution of variables (mean; standard deviation - SD) were examined. Results:HAICC met 100% of the indispensable items, 93.0% (SD = 5.8) of the required, and 64.8% (SD = 32.5) of the recommended. Healthcare-Associated Infection Control Services complied with 90.2% (SD = 16.1) of the necessary items, and 77.8% (SD = 19.2) of those recommended. Conclusion: indispensable items were met, but the necessary and recommended ones present different degrees of noncompliance, which may compromise the prevention and control of healthcare-associated infections. The application of a script based on the RDC Nº 48/2000 contributes to identify the reality of the hospitals' HAICP, however, this normative does not establish a minimum percentage of compliance, making it difficult to interpret the results. It is necessary to update it in order to provide tools to surveillance agencies.

Objetivo: evaluar críticamente los Programas de Control de Infecciones Relacionadas con la Atención de Salud (PCIRAA) en hospitales medianos y grandes para determinar si cumplen con los criterios nacionales de salud. Métodos: estudio transversal realizado en 18 hospitales con Comisiones de Control de las Infecciones Asociadas a la Atención de Salud (CCIAAS) en los estados de Goiás y São Paulo, Brasil. Para la recolección de datos se aplicó un formulario online, desarrollado con base en los ítems de evaluación recomendados por la Resolución Directiva Colegiada (RDC) Nº 48/2000 de la ANVISA. Para el análisis estadístico, se utilizó el examen de la frecuencia y distribución de las variables (media y desvío estándar - DE). Resultados:las CCIAAS cumplieron en promedio el 100% de los ítems indispensables, el 93,0% (DE = 5,8) de los necesarios y el 64,8% (DE = 32,5) de los recomendados. Los Servicios de Control de las Infecciones Asociadas a la Atención de Salud cumplieron en promedio el 90,2% (DE = 16,1) de los ítems necesarios y el 77,8% (DE = 19,2) de los recomendados. Conclusión: se cumplieron los ítems imprescindibles, pero los necesarios y los recomendados presentan diferentes grados de disconformidad, que pueden comprometer la prevención y el control de las infecciones asociadas a la atención de salud. La aplicación de la rutina basada en la RDC Nº 48/2000 contribuyó a conocer la realidad de los PCIRAA en los hospitales, pero esta normativa no establece un porcentaje mínimo de conformidad, lo que dificulta la interpretación de los resultados. Se hace necesario actualizarla para dotar de herramientas a los organismos supervisores

Mortality Risk Factors for Coronavirus Infection in Hospitalized Adults in Brazil: A Retrospective Cohort Study.

BACKGROUND: The COVID-19 pandemic has presented high morbidity and mortality, with associated high socioeconomic costs. Brazil ranks third in the number of COVID-19 cases, behind only India and the United States. OBJECTIVE: To analyze risk factors for mortality in adults hospitalized with COVID-19 in Brazil. METHODS: Observational retrospective cohort study including data from all Brazilian states and regions. The study included information from 468,226 in-hospital patients from all regions of Brazil from 1 January 2021 to 31 July 2021. Data from the influenza epidemiological surveillance system were used. The participants were adults hospitalized with COVID-19. A Cox regression model was used to analyze factors associated with mortality in adults with COVID-19. RESULTS: The in-hospital mortality lethality was 37.5%. The risk factors associated with COVID-19 mortality were older age, with a linear increase with increments in age, male sex, black or mixed race, low education level, comorbidities, use of ventilatory support, and living in the southeast, north, or northeast regions of the country. CONCLUSIONS: Our results illustrate the severity of the COVID-19 pandemic in Brazil and reinforce that policies and practices to deal with this disease should focus on groups and regions with higher risk, whereas public policies should promote nonpharmacological measures and vaccination in the Brazilian population.

Viral hepatitis in female sex workers using the Respondent-Driven Sampling.

OBJECTIVE: To estimate the prevalence of hepatitis B virus and C virus infections and their genotypes and analyze the risk factors for the markers of exposure to hepatitis B virus in female sex workers in a region of intense sex trade. METHODS: This is a cross-sectional study performed with four hundred and two female sex workers in Goiânia, Brazil. Data have been collected using the Respondent-Driven Sampling. The women have been interviewed and tested for markers of hepatitis B and C viruses. Positive samples have been genotyped. The data have been analyzed using the Respondent-Driven Sampling Analysis Tool, version 5.3, and Stata 11.0. RESULTS: The adjusted prevalence for hepatitis B virus and C virus were 17.1% (95%CI 11.6-23.4) and 0.7% (95%CI 0.1-1.5), respectively. Only 28% (95%CI 21.1-36.4) of the participants had serological evidence of vaccination against hepatitis B virus. Being older (> 40 years), being single, having a history of blood transfusion and use of cocaine, and ignoring the symptoms of sexually transmitted infections were associated with positivity for hepatitis B virus (p < 0.05). We have detected the subgenotype A1 of hepatitis B virus (n = 3) and the subtypes of hepatitis C virus 1a (n = 3) and 1b (n = 1). CONCLUSIONS: We can observe a low prevalence of infection of hepatitis B and C viruses in the studied population. However, the findings of the analysis of the risk factors show the need for more investment in prevention programs for sexual and drug-related behavior, as well as more efforts to vaccinate this population against hepatitis B. The genotypes of the hepatitis B virus and C virus identified are consistent with those circulating in Brazil.

Viral hepatitis in female sex workers using the Respondent-Driven Sampling

ABSTRACT OBJECTIVE To estimate the prevalence of hepatitis B virus and C virus infections and their genotypes and analyze the risk factors for the markers of exposure to hepatitis B virus in female sex workers in a region of intense sex trade. METHODS This is a cross-sectional study performed with four hundred and two female sex workers in Goiânia, Brazil. Data have been collected using the Respondent-Driven Sampling. The women have been interviewed and tested for markers of hepatitis B and C viruses. Positive samples have been genotyped. The data have been analyzed using the Respondent-Driven Sampling Analysis Tool, version 5.3, and Stata 11.0. RESULTS The adjusted prevalence for hepatitis B virus and C virus were 17.1% (95%CI 11.6-23.4) and 0.7% (95%CI 0.1-1.5), respectively. Only 28% (95%CI 21.1-36.4) of the participants had serological evidence of vaccination against hepatitis B virus. Being older (> 40 years), being single, having a history of blood transfusion and use of cocaine, and ignoring the symptoms of sexually transmitted infections were associated with positivity for hepatitis B virus (p < 0.05). We have detected the subgenotype A1 of hepatitis B virus (n = 3) and the subtypes of hepatitis C virus 1a (n = 3) and 1b (n = 1). CONCLUSIONS We can observe a low prevalence of infection of hepatitis B and C viruses in the studied population. However, the findings of the analysis of the risk factors show the need for more investment in prevention programs for sexual and drug-related behavior, as well as more efforts to vaccinate this population against hepatitis B. The genotypes of the hepatitis B virus and C virus identified are consistent with those circulating in Brazil.

INTERMEDIATE ENDEMICITY OF HEPATITIS A VIRUS INFECTION IN RURAL SETTLEMENT PROJECTS OF SOUTHWEST GOIÁS, BRAZIL.

BACKGROUND: Rural populations present an elevated risk of exposure to hepatitis A virus. OBJECTIVE: The objective of this study was to estimate the prevalence and risk factors associated with hepatitis A virus infection among residents of rural settlement projects of southwest Goiás, Central Brazil. METHODS: A total of 466 residents were interviewed and tested for the detection of anti- hepatitis A virus antibodies by ELISA. RESULTS: The global prevalence of anti- hepatitis A virus was 82.2%. In individuals aged 5-9 years and 10-19 years, the prevalence was 15% and 58.8%, respectively. Persons in the 10-19 age group, with a history of life in encampments, with more than five people per residence consuming well water, were predictors for exposure to hepatitis A virus. CONCLUSION: Our results suggest that the hepatitis A virus endemicity in rural settlements in southwest Goiás similar to that found in the urban population of the Midwest Region, confirming the implementation of universal hepatitis A vaccination in children.

INTERMEDIATE ENDEMICITY OF HEPATITIS A VIRUS INFECTION IN RURAL SETTLEMENT PROJECTS OF SOUTHWEST GOIÁS, BRAZIL / Endemicidade intermediária da infecção pelo vírus da hepatite A em projetos de assentamentos rurais do Sudoeste de Goiás, Brasil

BackgroundRural populations present an elevated risk of exposure to hepatitis A virus.ObjectiveThe objective of this study was to estimate the prevalence and risk factors associated with hepatitis A virus infection among residents of rural settlement projects of southwest Goiás, Central Brazil.MethodsA total of 466 residents were interviewed and tested for the detection of anti- hepatitis A virus antibodies by ELISA.ResultsThe global prevalence of anti- hepatitis A virus was 82.2%. In individuals aged 5-9 years and 10-19 years, the prevalence was 15% and 58.8%, respectively. Persons in the 10-19 age group, with a history of life in encampments, with more than five people per residence consuming well water, were predictors for exposure to hepatitis A virus.ConclusionOur results suggest that the hepatitis A virus endemicity in rural settlements in southwest Goiás similar to that found in the urban population of the Midwest Region, confirming the implementation of universal hepatitis A vaccination in children.

ContextoPopulações rurais apresentam um risco elevado de exposição ao vírus da hepatite A.ObjetivoO objetivo deste estudo foi estimar a prevalência e fatores de risco associados à infecção pelo vírus da hepatite A em assentados da região Sudoeste de Goiás, Brasil Central.MétodosUm total de 466 assentados foi entrevistado e testado para detecção de anticorpos anti vírus da hepatite A por ELISA.ResultadosA prevalência global de anti vírus da hepatite A foi de 82,2%. Em indivíduos de 5-9 anos e 10-19 anos, a prevalência foi de 15% e 58,8%, respectivamente. Faixa etária de 10-19 anos, antecedentes de vida em acampamento, mais de cinco pessoas por domicílio e consumir água de poços foram preditores de exposição ao vírus da hepatite.ConclusãoNossos resultados sugerem que a endemicidade do vírus da hepatite em assentamentos rurais do Sudoeste de Goiás é semelhante a encontrada na população urbana da Região Centro-Oeste, ratificando a implementação da vacinação universal contra hepatite A em crianças.