Criteria for the Use, Processing, and Disposal of Flexible Endoscope Cleaning Brushes.

Objectives: To ensure effectiveness in the endoscope channel cleaning process, using functional brushes that are in good condition is necessary. This study sought to identify the criteria for acquiring, using, and disposing of cleaning brushes at endoscopy facilities in Brazil. We further sought to evaluate the conditions of the cleaning brushes in use in the facilities. Methods: This cross-sectional study was conducted between July 2021 and January 2022. Personnel responsible for processing endoscopes were interviewed regarding the use, processing, and disposal of flexible endoscope cleaning brushes. In addition, the brushes used to clean the equipment were inspected. Results: All participants interviewed reported the practice of brushing endoscope channels. Of them, 60% noted the use of disposable brushes, with 40% using reusable brushes. None of the facilities interviewed reported discarding disposable brushes after use. The protocols for disposal of brushes included disposing due to bristle wear (70%), disposal at the end of the day (20%), and an absence of disposal protocols (10%). In addition, 30% of facilities did not clean the bristles before reintroducing them into the channel/lumen, and no facility had an established routine for cleaning brushes between uses. Inspection of brushes revealed that only 20% of facilities had new brushes with no signs of wear or damage. Conclusion: The use of inappropriate brushes/sponges for cleaning endoscope channels and the lack of criteria for the reuse and disposal of brushes increases the risk of cross-contamination, internal damage to channels, and biofilm formation.

Avaliação da adesáo ao checklist cirúrgico

RESUMO Objetivo: Verificar a adesão ao checklist cirúrgico obtida por meio de diferentes ferramentas: completude, auditoria de processo e a avaliação da taxa de complicações e mortalidade, em um hospital universitário. Material e Método: Tratou-se de um estudo transversal realizado em um centro cirúrgico de um hospital universitário de Belo Horizonte, Brasil. A coleta de dados se deu em dois momentos: primeiro, auditoria da aplicação verbal do checklist e comparação com o preenchimento do formulário; e o segundo, de forma paralela, por revisão de prontuários de pacientes de cirurgias colorretais para avaliação da completude, taxas de infecção do sítio cirúrgico, reoperação, reinternação e óbito. Foi realizada análise descritiva dos dados, estatística inferencial e teste qui-quadrado. Resultados: No primeiro momento, 100 procedimentos aleatórios foram acompanhados para auditoria da aplicação verbal e nenhum deles foi totalmente seguido pela equipe cirúrgica, porém os formulários de 65% foram completamente preenchidos. No segundo momento, dos 353 prontuários analisados, 63,7% dos checklists estavam completos, a taxa de infecção do sítio cirúrgico foi maior naqueles incompletos e não foram observados impactos da sua completude nos demais desfechos. Conclusão: A completude do checklist não retratou a adesão ao mesmo, devendo ser usada com cautela como indicador, associando-a ferramentas complementares como a auditoria periódica e o monitoramento dos desfechos clínicos.

ABSTRACT Objective: To verify surgical checklist compliance obtained through different tools: checklist completion, process auditing and evaluation of complication and mortality rates in a university hospital. Materials and Methods: Cross-sectional study carried out in a surgical center of a university hospital in Belo Horizonte, Brazil. Data collection occurred in two stages: firstly, by auditing the oral application of the checklist and comparing it with the checklist completion level; and secondly, by reviewing medical records of colorectal surgery patients to evaluate compliance, surgical site infection, reoperation, readmission and mortality rates. Descriptive data analysis, inferential statistics and chi-square test were performed. Results: In the first stage, 100 random procedures were monitored for oral application auditing and none of them were totally applied by the surgical team, however, 65% of the checklists were fully completed. In the second stage, from 353 analyzed records, 63.7% of the checklists were complete, surgical site infection rate was higher in cases with incomplete checklists and no impact of their compliance level on the other outcomes was observed. Conclusion: Checklist completion does not portray its compliance level and should be used with caution as an indicator, associating it with complementary tools such as regular auditing and monitoring of clinical outcomes.

RESUMEN Objetivo: Verificar el cumplimiento de la lista de verificación quirúrgica obtenida por diferentes herramientas en un hospital universitario: completación, auditoría de procesos y evaluación de la tasa de complicaciones y mortalidad. Material y Método: Se realizó un estudio transversal en un centro quirúrgico en un hospital universitario en Belo Horizonte, Brasil. La recolección de datos se realizó en dos momentos: primero, la auditoría de la aplicación oral de la lista de verificación y la comparación con el formulario de la lista de verificación; y segundo, en paralelo, mediante la revisión de los registros médicos de pacientes sometidos a cirugías colorrectales para la evaluación del cumplimiento, tasas de infección del sitio quirúrgico, reoperación, readmisión y mortalidad. Se realizó un análisis descriptivo de los datos, estadística inferencial y prueba de chi-cuadrado. Resultados: En el primer momento se siguieron 100 procedimientos aleatorios para la auditoría de la aplicación oral de la lista y ninguno de ellos fue totalmente aplicado por el equipo quirúrgico, sin embargo, 65% de los formularios estaban completamente llenos. En el segundo momento, de los 353 registros analizados, 63,7% de las listas de verificación estaban completas, la tasa de infección del sitio quirúrgico fue mayor en las listas incompletas y no hubo impactos de su cumplimiento en los otros resultados. Conclusión: La completación de la lista de verificación no fue un retrato de su adhesión y debe usarse con precaución como un indicador, asociándolo con herramientas complementarias, como la auditoría periódica y el seguimiento de los resultados clínicos.

Impact of Surgical Checklist on Mortality, Reoperation, and Readmission Rates in Brazil, a Developing Country, and Canada, a Developed Country.

PURPOSE: To compare the mortality, reoperation, and readmission rates before and after the implementation of a surgical checklist in Brazil and Canada. DESIGN: An epidemiological, retrospective study was conducted. METHODS: Preimplementation and postimplementation data were collected via patient chart reviews to determine mortality, reoperation, and readmission rates. FINDINGS: In Brazil, a decrease in readmission rate from 2.9% to 1.7% (P = .518) was observed after the implementation of the checklist. In Canada, reoperation rate decreased from 5.6% to 4.8% (P = .649) and mortality from 1.7% to 0.9% (P = .407) after implementation. In the Brazilian institution, patients with incomplete checklists had increased rates of readmission, from 1.4% to 2.4% (P = .671), and reoperation, from 6.8% to 10.4% (P = .232). CONCLUSIONS: The use of surgical checklist did not translate into improvements in the outcomes studied after its implementation in any of the scenarios evaluated. This result is possibly justified by the socioeconomic structure of each of these settings.

O que usar no preparo cirúrgico da pele: povidona-iodo ou clorexidina? / What to use in preoperative skin preparation: povidone-iodine or chlorhexidine? / ¿Qué usar en la preparación quirúrgica de la piel: povidona-iodo o clorhexidina?

Objetivo: Discorrer sobre a eficácia do gluconato de clorexidina e do povidona-iodo em soluções aquosas ou alcoólicas na redução de infecções do sítio cirúrgico e na contagem bacteriana da pele, no preparo pré-operatório do paciente. Método: Estudo de reflexão acerca do melhor antisséptico a ser usado no preparo cirúrgico da pele. Resultados: Verificou-se que tanto a clorexidina quanto o povidona-iodo são igualmente seguros e efetivos e que os manuais de boas práticas internacionais têm recomendado a sua utilização em soluções alcoólicas. Observou-se uma tendência na indicação da clorexidina alcoólica e a emergência de estudos que têm avaliado o uso sequencial ou concomitante da clorexidina e do povidona-iodo com resultados favoráveis a essa prática. Conclusão: Há uma tendência mundial mais favorável ao uso da clorexidina alcoólica em detrimento ao povidona-iodo. Contudo, a decisão pelo melhor agente antisséptico deve considerar cada caso clínico, (contra) indicações e situação

Objective: To discuss the efficacy of chlorhexidine gluconate and povidone-iodine in aqueous or alcoholic solutions in reducing surgical site infections and skin bacterial counts in the preoperative preparation of the patient. Method: Reflective study about the best antiseptic to use in preoperative skin preparation. Results: We found that chlorhexidine and povidone-iodine are equally safe and effective and that international guidelines for good practices have recommended their use in alcoholic solutions. We observed a trend in recommending alcoholic chlorhexidine and an emergence of studies that have evaluated the sequential or concurrent use of chlorhexidine and povidone-iodine with favorable results for this practice. Conclusion: There is a global trend that favors the use of alcoholic chlorhexidine over povidone-iodine. However, the decision about the best antiseptic agent to useshould be based on each clinical case, (contra)indications, and situation

Objetivo: Discutir sobre la eficacia del gluconato de clorhexidina y del povidona-yodo en soluciones acuosas o alcohólicas en la reducción de infecciones del sitio quirúrgico y en el recuento bacteriano de la piel en la preparación preoperatoria del paciente. Método: Estudio de reflexión acerca del mejor antiséptico a utilizarse en la preparación quirúrgica de la piel. Resultados: Se ha comprobado que tanto la clorhexidina como el povidona yodo son igualmente seguros y efectivos y que los manuales de buenas prácticas internacionales han recomendado su utilización en soluciones alcohólicas. Se observó una tendencia en la indicación de la clorhexidina alcohólica y la emergencia de estudios que han evaluado el uso secuencial o concomitante de la clorhexidina y del povidona-yodo con resultados favorables a esa práctica. Conclusión: Hay una tendencia mundial más favorable al uso de la clorhexidina alcohólica en detrimento del povidona-yodo. Sin embargo, la decisión por el mejor agente antiséptico debe considerar cada caso clínico, (contra) indicaciones y situación.

Indicações e limitações dos diferentes detergentes utilizados no processamento de produtos para a saúde / Indications and limitations of different detergents used in the processing of health products / Indicaciones y limitaciones de los detergentes diferentes utilizados en el procesamiento para la salud

Objetivo: Identificar estudos que abordem indicações e limitações dos diferentes detergentes utilizados no processamento de produtos para a saúde. Método: Revisão integrativa que incluiu publicações presentes nas bases de dados Scientific Eletronic Library Online, Science Direct, Scopus, Web of Science e PubMed, no período de 2000 a 2016, nos idiomas inglês e português. Resultados: Foram identificados nove estudos. Os detergentes alcalinos apresentam boa remoção de sujidades, são indicados para uso em equipamento automatizado, adequados em processos que utilizem água dura e compatíveis com instrumentais cirúrgicos de aço inoxidável. Podem danificar o produto para a saúde e reagir com alumínio, zinco, metais não ferrosos, borracha e látex. Detergentes enzimáticos são compatíveis com diversos materiais e, devido à presença de enzimas, removem diferentes sujidades do instrumental. Conclusão: Embora os detergentes alcalino e enzimático possuam similaridades, a escolha do produto exige o conhecimento da sua ação, observando as características de uso, compatibilidade com o produto para a saúde e qualidade da água.

Objective: To identify studies that address indications and limitations of different detergents used in the processing of medical devices. Method: Integrative review that included publications in Scientific Electronic Library Online, Science Direct, Scopus, Web of Science and PubMed, from 2000 to 2016, in English and in Portuguese. Results: Nine studies were identified. Alkaline detergents remove dirt well, its use is indicated for automated equipment, and they are suitable in processes that use hard water, compatible with surgical stainless steel instruments. They may damage the medical device and react with aluminum, zinc, non-ferrous metals, rubber and latex. Enzymatic detergents are compatible with various materials and, due to the presence of enzymes, remove different types of dirt from the instrument. Conclusion: Although alkaline and enzymatic detergents present similarities, the choice of the product requires knowledge of its action, observing the characteristics of use, compatibility with the medical device and water quality.

Objetivo: Identificar los estudios que abordan indicaciones y limitaciones de diferentes detergentes utilizados en el procesamiento de productos de salud. Método: Revisión integrada que incluye publicaciones presentes en las bases de datos Scientific Electronic Library Online, Science Direct, Scopus, Web of Science y PubMed, de 2000 a 2016, en los idiomas Inglés y Portugués. Resultados: Se identificaron nueve estudios. Los detergentes alcalinos tienen buena eliminación de impurezas, están indicados para su uso en equipos automatizados, los procedimientos adecuados utilizando agua dura compatibles e instrumental acero inoxidable quirúrgico. Pueden dañar la salud del producto, y reaccionar con aluminio, zinc, metales no ferrosos, caucho y látex. Detergentes enzimáticos son compatible con diversos materiales y, debido a la presencia de enzimas, eliminan diferentes suciedades de los instrumentales. Conclusión: Aunque detergentes alcalinos y enzimáticos presenten similitudes, la elección del producto requiere el conocimiento de su acción, observando las características de uso, compatibilidad con el producto para la salud y la calidad del agua.

Surgical site infection prevention: An analysis of compliance with good practice in a teaching hospital.

BACKGROUND: Surgical teams play a critical role in reducing surgery-related risks during preoperative and intraoperative phases. AIM: To analyse the preoperative and intraoperative practices adopted by surgical teams in surgical site infections prevention. METHODS: This was a cross-sectional study conducted during April-September 2013 in a large university hospital in Belo Horizonte, Minas Gerais, Brazil. It was conducted through observation of the surgical practice during preoperative and intraoperative phases of procedures used by a gastroenterological, cardiovascular and paediatric surgical team. RESULTS: A total of 100 surgeries were monitored. Hair removal was performed for 20% of the patients inside the operating room by professionals using clippers in 65% of operations. The antimicrobial agent of choice was appropriate/satisfactory in 62% of the operations and administered up to 60 min before surgical incision in 90.3% of the cases. The operating room door was kept closed in 4% of these procedures. DISCUSSION: Some preoperative measures for surgical site infection prevention were not adhered to by the professionals who were monitored in this study. It is recommended that surgical teams undergo professional surveillance and training to highlight the necessity and importance of implementing measures to improve the quality of care provided to surgical patients.

Custos com antimicrobianos no tratamento de pacientes com infecção / Costs of antimicrobial treatment in patients with infection

Introdução: Os custos relacionados ao tratamento antimicrobiano de pacientes com infecções da corrente sanguínea causadas por microrganismos resistentes têm sido pouco explorados. Objetivo: Comparar os custos diretos do tratamento antimicrobiano de pacientes com infecção da corrente sanguínea causada por Staphylococcus aureus resistente e sensível à oxacilina (MRSA e MSSA, respectivamente). Metodologia: Tratou-se de uma coorte histórica, realizada em uma unidade de terapia intensiva. Foram incluídos pacientes com infecção da corrente sanguínea por Staphylococcus aureus, entre março de 2007 e março de 2011. Utilizaram-se os registros dos prontuários, da comissão de controle de infecção hospitalar e do sistema de finanças do hospital, sendo realizada análise univariada. Resultados: Fizeram parte do estudo 31 pacientes tanto no grupo infectado por MRSA, quanto naquele infectado por MSSA. De acordo com a análise univariada, o direcionamento do tratamento reduziu o espectro de ação dos antibióticos utilizados e os custos (p < 0,001) e a resistência bacteriana esteve relacionada a um maior gasto com o tratamento antimicrobiano empírico (p = 0,05), não sendo encontrada associação para tratamentos direcionado e total. Conclusão: A resistência bacteriana pode influenciar os custos com tratamento antimicrobiano, sendo necessários mais estudos sobre o tema, avaliando especificamente tratamento antimicrobiano.

Introducción: Los costos relacionados con el tratamiento antimicrobiano de los pacientes con infecciones del torrente sanguíneo causados por microorganismos resistentes han sido poco explorados. Objetivo: Comparar los costos directos del tratamiento antimicrobiano de los pacientes con infección del torrente sanguíneo causada por Staphylococcus aureus resistente y sensible a la oxacilina (MSSA y MRSA, respectivamente). Metodología: Se realizó un estudio de cohorte histórico en una Unidad de Cuidados Intensivos. Se incluyeron los pacientes con infección del torrente sanguíneo por Staphylococcus aureus, entre marzo del 2007 y marzo del 2011. Se utilizó la historia clínica, la comisión de control de la infección hospitalaria, las finanzas del sistema de hospital y se realizó un análisis univariado. Resultados: El estudio investigó 31 pacientes en ambos grupos (MRSA y MSSA). Según el análisis univariado, el direccionamiento del tratamiento redujo el espectro de acción de los antibióticos y los costos (p < 0,001), la resistencia bacteriana se relacionó con un mayor gasto en el tratamiento antimicrobiano empírico (p = 0,05) y no se encontró ninguna asociación para tratamientos en total o direccionados. Conclusión: La resistencia bacteriana puede influir en el costo del tratamiento antimicrobiano, por lo que se necesita más investigación sobre el tema, específicamente, en la evaluación del tratamiento antimicrobiano.

Introduction: Costs related to antimicrobial treatment of patients with bloodstream infections caused by resistant microorganisms have been little explored. Objective: Compare the cost of treatment in patients with oxacillin-resistant Staphylococcus aureus (MRSA) and oxacillin-susceptible Staphylococcus aureus (MSSA) bloodstream infection (BSI). Methodology: It is a historic cohort study performed in an intensive care unit with patients with Staphylococcus aureus bsi between March/2007 and March/2011. Patients’ medical records, records of the hospital infection control committee and of the hospital financial system were used. Univariate analysis were performed. Results: 31 patients with MRSA and MSSA infection took part in the study. According to the univariate analysis, directed therapy lowered the spectrum of antibiotics activity and the costs (p = 0,000), bacterial resistance was linked to a bigger expenditure in empiric antimicrobial therapy (p = 0,013), not being found any association for directed or total therapy. Conclusion: Bacterial resistance may influence the costs of antimicrobial therapy. More studies are needed, specifically, evaluating antibacterial therapy.

Analysis of microbial load on surgical instruments after clinical use and following manual and automated cleaning.

BACKGROUND: We aimed to monitor the microbial load and identify the microorganisms recovered from surgical instruments after clinical use and following manual and automated cleaning. METHODS: This experimental study was carried out in the Laboratory of Oral Microbiology and Anaerobes at the Federal University of Minas Gerais in Brazil. Microbial samples were taken from 125 surgical instruments used in 25 types of gastrointestinal surgeries. RESULTS: The average microbial load was 93.1 CFU/100 mL after clinical use and 41 CFU/100 mL and 8.24 CFU/100 mL on instruments following 2 sequential steps of manual cleaning, respectively, and 75 CFU/100 mL and 16.1 CFU/100 mL on instruments after automated cleaning. Surgical wound classification significantly affected the microbial load recovered on instruments. Coagulase-negative Staphylococcus, Escherichia coli, Pseudomonas spp, Stenotrophomonas maltophilia, and Acinetobacter baumannii complex were recovered. CONCLUSIONS: The average microbial load observed after the cleaning steps decreased, and the decrease in microbial load was more pronounced using the manual method compared with that observed using the automated method.

Adherence and knowledge about the use of personal protective equipment among manicurists.

OBJECTIVE: This study aimed to assess adherence and knowledge of manicures/pedicures on the use of Personal Protective Equipment (PPE). METHODS: It was a survey with 235 manicures/pedicures in salons, Belo Horizonte/Brazil. Data were analyzed with the software Statistical package for the social sciences (17.0), using descriptive statistics, chi-square and logistic regression. RESULTS: The adherence and the knowledge of the professional were evaluated using the median of the results, obtaining 52% and 63% respectively. The professionals younger than 31 were more likely (2.54 times) to adhere to PPE and those who claimed to have done biosafety course and to use uniform during work, had better chance of understanding (2.86 and 3.12 times, respectively). The majority (83.4 %) stated that the use of PPE should occur for all procedures, meanwhile 71.5 % cited not use them. CONCLUSIONS: The results indicate the poor adherence to PPE, strengthen occupational biological risk and need for training of these professionals.

Community-acquired methicillin-resistant Staphylococcus aureus: a global problem.

OBJECTIVE: To describe the epidemiology of CA-MRSA cases in Brazil order to understand its occurrence, risk factors and forms of management in the country compared with the worldwide situation. METHOD: Literature review and for articles selection considering the databases: Scopus, Science Direct, Isi Web of Knowledge, PubMed and BVS. RESULTS: Ten national articles describing 21 cases of CA-MRSA were identified, mostly in children, adolescents and adults with skin and soft tissue infection progressing to severe infections related to Oceania Southwest Pacific Clone (OSPC) leading to hospitalization. Conclusión: Although CA-MRSA is considered a global important microorganism we found a lack of published data about its epidemiology in Brazil, which hinder the design of the reality of the country against CA-MRSA.

Evaluation of surgical glove integrity during surgery in a Brazilian teaching hospital.

BACKGROUND: A cross-sectional study was conducted in a large university hospital in Belo Horizonte, Minas Gerais, Brazil to evaluate surgical glove integrity after use during surgery. METHODS: This 6-month study was conducted by a gastroenterological, cardiovascular, and pediatric surgical team consisting of surgeons (main surgeon and first and second assistants), medical students, and scrub nurses. The gloves used during surgery were examined postsurgery for microperforations using the watertight test as described in European Norm EN 455-1. RESULTS: A total of 116 medical professionals conducted the 100 surgeries monitored. Of the 1090 gloves analyzed, 131 (12%) had a perforation detected postsurgery, 39 of which (37.5%) were recognized by users at the time of occurrence. The highest incidence of perforations occurred among surgeons (P = .033) in the index finger, followed by the thumb of the nondominant hand; in outer gloves (76.9%) when double-gloving was used (P = .014); in open surgery (P = .019); and in surgeries lasting ≥ 150 minutes (P < .05). CONCLUSION: These findings reaffirm the importance of double-gloving, using a perforation indicator system, and changing gloves in surgeries of ≥ 150 minutes duration, especially in procedures involving open incisions.

Adherence to and knowledge of best practices and occupational biohazards among manicurists/pedicurists.

BACKGROUND: Unsafe behaviors of the professionals working at health and beauty centers are arousing concern among researchers, especially because of the risk of infections related to occupational health. METHODS: This study involved a survey of 153 manicurists/pedicurists working in beauty salons in Belo Horizonte, Brazil between June 2012 and March 2013. The data were analyzed through descriptive statistics, χ(2) tests, and logistic regression. Participants' knowledge of and adherence to best practices were evaluated based on the median results, and serologic markers for hepatitis B and C were identified. RESULTS: Associations (P < .05) were observed between adherence and workload, biosafety training, and hepatitis B surface antibody (anti-HBs) serology, as well as between knowledge and courses in the area and accidents with sharp instruments. Manicurists who participated in a course on biosafety (63.6%) and were positive for anti-HBs reagents (56.8%) achieved better results on issues of adherence. Those who reported taking a specific course on this topic had good scores on issues of knowledge (60%). Reactivity to hepatitis C antibody was identified in 1.3%, and reactivity to anti-HBs was detected in 53%. CONCLUSIONS: Overall, the participants demonstrated poor knowledge of and adherence to good safety practices and exposure to occupational biohazards, such as contact with blood by accidents with sharp instruments and minimal vaccine protection.

Analysis of occupational accidents with biological material among professionals in pre-hospital services.

OBJECTIVE: To estimate the prevalence of accidents due to biological material exposure, the characteristics and post-accident conduct among professionals of pre-hospital services of the four municipalities of Minas Gerais, Brazil. METHOD: A cross-sectional study, using a structured questionnaire that was developed to enable the calculation of prevalence, descriptive analysis and analytical analysis using logistic regression. The study included 228 professionals; the prevalence of accidents due to biological material exposure was 29.4%, with 49.2% percutaneous, 10.4% mucousal, 6.0% non-intact skin, and 34.4% intact skin. RESULTS: Among the professionals injured, those that stood out were nursing technicians (41.9%) and drivers (28.3%). CONCLUSION: Notification of the occurrence of the accident occurred in 29.8% of the cases. Percutaneous exposure was associated with time of work in the organization (OR=2.51, 95% CI: 1.18 to 5.35, p<0.017). Notification about accidents with biological material should be encouraged, along with professional evaluation/monitoring.

Effectiveness of flexible gastrointestinal endoscope reprocessing.

The practice of reprocessing endoscopes and its effectiveness was evaluated in 37 services. Contamination of at least 1 endoscope could be identified in 34 (91.6%) of 37 services. Bacteria, fungi, and/or mycobacteria were isolated from 84.6% (33/39) of the colonoscopes (110-32,000 colony-forming units [CFUs]/mL) and from 80.6% (50/62) of the gastroscopes (100-33,000 CFUs/mL). Not all services followed recommended guidelines. Therefore, patients who underwent gastrointestinal endoscopies were exposed to diverse pathogens.

Analysis of the air/water channels of gastrointestinal endoscopies as a risk factor for the transmission of microorganisms among patients.

BACKGROUND: For the effective reprocessing of gastrointestinal endoscopes, contaminants must be removed from the entire surface. However, these devices have long and narrow channels that can make this process difficult. METHODS: In this cross-sectional study, the staff assigned to reprocess gastroscopes and colonoscopes in 37 services located throughout Brazil completed a questionnaire regarding reprocessing practices geared toward the channels in these devices. In addition, samples from these air/water channels were collected for microbiological analysis. RESULTS: Contamination was detected in 71.8% (28/39) of the samples obtained from the air/water channels of colonoscopes, and in 70% (42/60) of the samples from the air/water channels of gastroscopes. The median microbial load was 1,800 colony-forming units (CFU)/mL in the colonoscopes and 750 CFU/mL in the gastroscopes. The main microorganisms isolated from the air/water channels of gastroscopes were Pseudomonas aeruginosa (26.4%), Escherichia coli (18.9%), and Acinetobacter baumannii (9.4%), and those isolated from the colonoscopes included P aeruginosa (46.4%), A baumannii (14.3%), and Klebsiella pneumoniae (10.7%), among others. The possible causes of the contamination of these devices included the failure to fill these channels with cleaning solution, lack of friction during cleansing, and inadequate rinsing. CONCLUSION: The contamination of the air/water channels did in fact represent a risk for the transmission of microorganisms during gastrointestinal endoscopy exams, possibly related to the inadequate reprocessing of these channels.

Epidemiologic characteristics of resistant microorganisms present in reserves from an intensive care unit.

In this study, significant contamination in the intensive care unit environment was observed (P < .004). Sampling of inanimate surfaces and equipment found vancomycin-resistant Enterococcus faecalis, ciprofloxacin-resistant Staphylococcus aureus and S epidermidis, and multiresistant Acinetobacter baumannii with similarities (60%-80%) to blood culture isolates.

[Knowledge and attitudes of workers from a public emergency service about the adoption of standard precautions]. / Conhecimento e atitudes de trabalhadores de um serviço público de emergência sobre adoção de precauções padrão.

The aims of the study were to evaluate the adoption of the precaution measures, assessing knowledge and attitude of multiprofessional team. This is a transversal study, accomplished in an Emergency Medical Service of Minas Gerais. Univariate and multivariate analysis were used. The results showed that nurses and drivers had the highest and lowest level of knowledge regarding the standard precautions, respectively. The possibility of non-adoption of the precautionary measures was 3.76 (95% CI: 1.48 to 9.53) times higher among professionals aged over 31 years and 6.7 (95% CI: 1.81 to 24,75) times greater among workers in crowded unit of basic support. The conclusion is that is essential to implement strategies in order to improve the professional's knowledge related to infection control and safety recommendations.

Nosocomial infection in an intensive care unit in a Brazilian university hospital.

This prospective study aimed to determine the nosocomial infection (NI) incidence in an Intensive Care Unit (ICU), its association with clinical characteristics and occurrence sites. It was carried out among 1.886 patients admitted in an ICU of a University Hospital, from August 2005 to January 2008. Data analysis was done using Fishers test and Relative Risk (RR). There were 383 NIs (20.3%). The infections were in the urinary tract (n=144; 37.6%), pneumonia (n=98; 25.6%), sepsis (n=58; 15.1%), surgical site (n=54; 14.1%) and others (n=29; 7.7%). Hospitalization average was 19.3 days for patients with NI and 20.2 days for those with colonization by resistant microorganisms. The mortality was 39.5% among patients with NI (RR: 4.4; 3.4-5.6). The NI was associated with patients originated from other units of the institution/emergency unit, more than 4 days of hospitalization, community infection, colonized by resistant microorganisms, using invasive procedures and deaths resulting from NI.

[Reprocessing validation of angiographic cardiac catheters: an evaluation of the functionality and integrity]. / Validação do reprocessamento de cateteres cardíacos angiográficos: uma avaliação da funcionalidade e da integridade.

The objective of this study was to validate the reprocessing of angiographic cardiac catheters regarding their characteristics of mechanical functionality and the molecular and micro-structural integrity of the polymeric chain.This is an experimental, applied, comparative and controlled study. A simulation set was built for a left coronary angiography in order to simulate mechanical and biological stress in the catheters. Traction tests were performed for the functionality and the integrity was tested through Infrared Spectrometry and Scanning Electronic Microscopy. The study evidenced a tendency to an increase in rigidity at every increment of the reprocessing number (p < 0.05). The changes in the mechanical properties and molecular structures of the polymers were more evident as of the fifth reprocessing. Micrographies revealed an increase in rugosity as of the forth reprocessing. The results of this study may contribute to the elaboration of reprocessing protocols and a systematic surveillance of the reutilization of single use materials, not only due to their economical relevance, but especially from the ethical, legal, biological, functional and care point of view.

[Surfaces of the hospital environment as possible deposits of resistant bacteria: a review]. / Superfícies do ambiente hospitalar como possíveis reservatórios de bactérias resistentes: uma revisão.

The main objective of this study is to identify, in the literature, articles about the occurrence of contamination from inanimate surfaces and a possible dissemination of resistant bacteria in the hospital environment. A bibliographic survey was performed with articles published in the databases LILACS, MEDLINE, Science Direct, SCOPUS and ISI Web of Knowledge, between 2000 and 2008. Twenty-one articles were selected and analyzed. The analyzed studies highlighted the presence of bacteria on monitors, bed grids, tables, faucets, telephones, keyboards and other objects. There was a prevalence of Staphylococcus aureus resistant to methicillin, Clostridium difficile, Acinetobacter baumannii and Enterococcus resistant to vancomycin, being the predictive factor the previous occupation of patients colonized by these microorganisms. There was a similarity observed among the isolated strains of colonized and/or infected patients and the strains of the environment by molecular typification. These evidences reinforce the need for knowledge and control of the sources of pathogens in the hospital environment.