Análise microbiológica de terminais de computadores de um hospital de ensino do sul do Brasil / Microbiological analysis of computer terminals in a teaching hospital of southern Brazil

Objetivo ­ As infecções relacionadas à assistência à saúde são um problema mundial. A contaminação de pacientes através de mãos e objetos constitui-se na principal causa de infecção. O objetivo deste foi avaliar a contaminação bacteriana de terminais de computadores utilizados em diferentes setores do Hospital da Cidade de Passo Fundo-RS (HCPF), analisando o possível papel dos mesmos como fômites de infecção hospitalar. Métodos ­ Ao todo foram coletadas amostras de 221 terminais de computadores situados em setores críticos, semicríticos e não críticos. A coleta foi realizada com swab umedecido em solução salina, por fricção, sendo o material semeado em placas de Petri contendo ágar sangue e ágar MacConkey. As placas foram incubadas a 35-37ºC por 24 horas e as colônias presentes nos meios de cultura foram identificadas por técnicas convencionais. Resultados ­ Em 87,5% das amostras houve crescimento de micro-organismos, sendo identificados 11 tipos de bactérias. Cocos Gram-positivos foram os mais frequentes, com predominância de Staphylococcus coagulase-negativos (44,3%). As bactérias Gram-negativas foram responsáveis por apenas 4,2% dos casos. Não houve diferença significativa entre os três setores, embora Staphylococcus aureus tenha ocorrido com maior frequência nos setores críticos. Conclusão ­ Elevados níveis de contaminação foram observados nos terminais de computadores dos três setores, reforçando a importância da higienização desses equipamentos para evitar a transmissão cruzada de micro-organismos para os pacientes.

Objective ­ Infections related to health care is a global problem. Contamination of patients through hands and objects constitutes the main cause of infection. The objective of this study was to evaluate the bacterial contamination on computer terminals of different sectors of the Hospital da Cidade de Passo Fundo-RS (HCPF), to determine their possible role as sources of hospital infections. Methods ­ Samples were collected from 221 computer terminals located in critical, semi-critical, and non-critical sectors. The collection was made by rubbing the terminals with saline solution moistened swabs, then applying to blood and MacConkey agars in Petri dishes. After incubation at 35ºC to 37ºC for 24 hours, any resulting colonies in the medium were identified by conventional methods. Results ­ There was micro-organism growth in 87.5% of the samples, identified as 11 types of bacteria. Gram-positive cocci were the most frequent, predominantly Staphylococcus coagulase-negative. Gram-negative bacteria accounted for only 4.2% of the cases. There was no significant difference among the three sectors, although critical sectors had a higher frequency of Staphylococcus aureus. Conclusion ­ High levels of contamination were observed on computer terminals of all three sectors, re-enforcing the importance of equipment sanitation to prevent micro-organism cross transmission to patients.

Sepse na unidade de terapia intensiva: etiologias, fatores prognósticos e mortalidade / Sepsis in the intensive care unit: etiologies, prognostic factors and mortality

JUSTIFICATIVA E OBJETIVOS: Sepse é a principal causa de morte em pacientes tratados em unidade de terapia intensiva (UTI). O objetivo deste estudo foi avaliar etiologia, fatores prognósticos e mortalidade de pacientes sépticos tratados nas UTI de Passo Fundo, Brasil. MÉTODO: Foram avaliados 971 pacientes consecutivos prospectivamente, entre agosto de 2005 e fevereiro de 2006, 560 foram selecionados pela presença de síndrome da resposta inflamatória sistêmica (SIRS) e acompanhados por 28 dias ou até a alta ou óbito. Os pacientes foram classificados de acordo com a etiologia da SIRS e adicionalmente classificados como tendo SIRS, sepse, sepse grave e choque séptico. O prognóstico foi avaliado por meio dos escores APACHE II e SOFA. A mortalidade foi comparada em diferentes etiologias de sepse e parâmetros APACHE II e SOFA. RESULTADOS: Dos 971 pacientes admitidos nas UTI, 560 desenvolveram SIRS (58 por cento). A causa mais freqüente de internação foi doença neurológica (28,9 por cento), o mais freqüente local de infecção foi o trato respiratório (71,6 por cento), e os germes mais prevalentes foram os bacilos gram-negativos (53,2 por cento). O escore APACHE II médio foi 18 ± 9 e o escore SOFA médio foi 5 ± 4. O tempo médio de permanência foi 6 (3-11) dias e a taxa de mortalidade foi 31,1 por cento: 6,1 por cento para SIRS não infecciosa, 10,1 por cento para sepse, 22,6 por cento para sepse grave e 64,8 por cento para choque séptico. CONCLUSÕES: Sepse é um importante problema de saúde que leva a uma taxa extremamente alta de mortalidade nas UTI de Passo Fundo, Brasil.

BACKGROUND AND OBJECTIVES: Sepsis is the main cause of death in patients treated in intensive care units (ICU). The aim of this study was to evaluate etiology, prognostic factors and mortality of septic patients treated in ICU of Passo Fundo, Brazil. METHODS: Out of 971 consecutive patients prospectively evaluated from August 2005 to February 2006, 560 were selected due to presence of systemic inflammatory response syndrome (SIRS) and followed for 28 days or until discharge or death. Patients were categorized according with the etiology of SIRS and further classified as having SIRS, sepsis, severe sepsis and septic shock. Prognosis was assessed by means of Apache II and SOFA. Mortality was compared in different etiologies of sepsis, APACHE II and SOFA scores, parameters. RESULTS: Of the 971 patients admitted to the ICU, 560 developed SIRS (58 percent). The most frequent cause of internation was neurological disease (28.9 percent), the most frequent site of infection was the respiratory tract (71.6 percent), and the most prevalent pathogens were gram-negative bacilli (53.2 percent). Mean APACHE II score was 18 ± 9, and mean SOFA score was 5 ± 4. Median ICU stay was 6 (3-11) days and overall mortality rate was 31.1 percent: 6.1 percent for non-infectious SIRS, 10.1 percent for sepsis, 22.6 percent for severe sepsis, and 64.8 percent for septic shock. CONCLUSIONS: Sepsis is an important health problem that leads to an extremely high mortality rate in the ICU of Passo Fundo, Brazil.

Sepsis in the intensive care unit: etiologies, prognostic factors and mortality. / Sepse na unidade de terapia intensiva: etiologias, fatores prognósticos e mortalidade.

BACKGROUND AND OBJECTIVES: Sepsis is the main cause of death in patients treated in intensive care units (ICU). The aim of this study was to evaluate etiology, prognostic factors and mortality of septic patients treated in ICU of Passo Fundo, Brazil. METHODS: Out of 971 consecutive patients prospectively evaluated from August 2005 to February 2006, 560 were selected due to presence of systemic inflammatory response syndrome (SIRS) and followed for 28 days or until discharge or death. Patients were categorized according with the etiology of SIRS and further classified as having SIRS, sepsis, severe sepsis and septic shock. Prognosis was assessed by means of Apache II and SOFA. Mortality was compared in different etiologies of sepsis, APACHE II and SOFA scores, parameters. RESULTS: Of the 971 patients admitted to the ICU, 560 developed SIRS (58%). The most frequent cause of internation was neurological disease (28.9%), the most frequent site of infection was the respiratory tract (71.6%), and the most prevalent pathogens were gram-negative bacilli (53.2%). Mean APACHE II score was 18 ± 9, and mean SOFA score was 5 ± 4. Median ICU stay was 6 (3-11) days and overall mortality rate was 31.1%: 6.1% for non-infectious SIRS, 10.1% for sepsis, 22.6% for severe sepsis, and 64.8% for septic shock. CONCLUSIONS: Sepsis is an important health problem that leads to an extremely high mortality rate in the ICU of Passo Fundo, Brazil.

Efficacy of two different doses of antilonomic serum in the resolution of hemorrhagic syndrome resulting from envenoming by Lonomia obliqua caterpillars: a randomized controlled trial.

The hemorrhagic syndrome caused by contact with Lonomia obliqua caterpillars has reached epidemic proportions in southern Brazil. This study aimed at assessing the efficacy of two different dosages of an antilonomic serum (SALon) in the treatment of patients who had accidental contact with L. obliqua caterpillars. A randomized, prospective controlled trial was conducted at São Vicente de Paulo Hospital, a tertiary hospital in Passo Fundo, Brazil. From January 2000 to April 2002, 44 patients with grade I or II hemorrhagic syndrome were randomly assigned to either group A: 22 patients treated with 10.5 mg total dose (three vials of SALon) or group B: 22 patients treated with 17.5 mg total dose (five vials of SALon). Treatment efficacy was assessed according to time necessary for blood coagulation to go back to normal, incidence of adverse reactions, and hospitalization time. There were no differences in clinical picture and laboratory findings between the two groups. Mean time for coagulation to go back to normal was 15.3+/-6.6 and 19.1+/-8 h in groups A and B, respectively. Adverse reactions and hospitalization time were similar in both groups. SALon was effective and well tolerated. This study demonstrated that three vials are as effective as five vials of SALon for the treatment of envenoming by Lonomia caterpillars.