Plano de contingencia para enfrentamento do Covid19 no HDT-UFT / Contingency plan to face Covid19 at HDT-UFT

Tratado do plano de contingencia para enfrentamento do covid19 no Hospital de Doenças Tropicais-HDT-UFT. O protocolo aborda as características do coronavírus (COVID19), as definições para casos suspeitos, confirmados e descartados. Apresenta documentos como a Ficha de Notificação de Síndrome Respiratória Aguda Grave ­ SRA. Mostra critérios de acesso e classificação dos casos, as Medidas de controle de infecção. Traz parâmetros para Fluxo de Atendimento ­ Ambulatorial e Pronto Atendimento, Utilização de Sistema de Classificação de Pacientes para dimensionamento diário da equipe (Escala de Fugulin). Mostra relação de equipamentos que o HDT-UFT possui para demanda geral) e Estrutura de internação para atendimento ao COVID-19 e Dimensionamento da Equipe além da Previsão de realocação das equipes assistenciais e administrativas para o cuidado a esses pacientes. Estratégias para ampliação da capacidade instalada e operacional atual para assistência aos pacientes com COVID-19. Estimativa de insumos e equipamentos necessários para os próximos 6 meses, incluindo os valores necessários para investimento e custeio. Previsão das unidades de contra- referência, pactuadas junto aos gestores locais, para pacientes leves ou moderados, ou em condições de alta clínica. Previsão de isolamento reverso, transferência ou referenciamento de pacientes imunocomprometidos. Previsão dos fluxos e responsáveis pelo transporte dos pacientes. Medidas que visem a redução de etapas nos processos cotidianos do hospital para tomadas de decisão nos momentos de crise. Capacitação quanto aos cuidados a pacientes críticos. Suporte laboratorial. Coleta de Aspirado de Nasofaringe ou Swab Combinado Nasal/Oral ou Amostra de Secreção Respiratória Inferior. Plano de comunicação. Hotelaria. Tratamento de Resíduos. Processamento de Roupas. Higienização. Processamento de produtos para a saúde.

Contingency plan treaty for coping with covid19 at the Tropical Diseases Hospital-HDT-UFT. The protocol addresses the characteristics of the coronavirus (COVID19), the definitions for suspected, confirmed and discarded cases. It presents documents such as the Serious Acute Respiratory Syndrome Notification Form - SARS. Shows access criteria and case classification, Infection Control Measures. It brings parameters for Care Flow - Outpatient and Emergency Care, Use of Patient Classification System for daily dimensioning of the team (Fugulin Scale). It shows a list of equipment that HDT-UFT has for general demand) and Inpatient structure to attend to COVID-19 and Team Sizing, in addition to the forecast of relocation of assistance and administrative teams to care for these patients. Strategies to expand the current installed and operational capacity to assist patients with COVID-19. Estimate of inputs and equipment needed for the next 6 months, including the amounts needed for investment and funding. Forecast of counter-referral units, agreed with local managers, for light or moderate patients, or under conditions of clinical discharge. Prediction of reverse isolation, transfer or referral of immunocompromised patients. Forecast of flows and responsible for the transport of patients. Measures aimed at reducing steps in the daily processes of the hospital for decision making in times of crisis. Training in the care of critical patients. Laboratory support. Collection of Nasopharynx Aspirate or Nasal / Oral Combined Swab or Lower Respiratory Secretion Sample. Communication plan. Hospitality. Waste treatment. Clothing Processing. Sanitation. Processing of health products.

Tratado de plan de contingencia para el afrontamiento de covid19 en el Hospital de Enfermedades Tropicales-HDT-UFT. El protocolo aborda las características del coronavirus (COVID19), las definiciones de casos sospechosos, confirmados y descartados. Presenta documentos como el Formulario de notificación de síndrome respiratorio agudo grave - SARS. Muestra criterios de acceso y clasificación de casos, medidas de control de infecciones. Aporta parámetros de Flujo de atención - Atención ambulatoria y de emergencia, Uso del Sistema de clasificación de pacientes para el dimensionamiento diario del equipo (Escala de Fugulin). Muestra una lista de equipos que HDT-UFT tiene para la demanda general) y la estructura de pacientes hospitalizados para ayudar a COVID-19 y el tamaño del equipo, además del pronóstico de reubicación de los equipos de atención y administrativos para atender a estos pacientes. Estrategias para ampliar la capacidad instalada y operativa actual para ayudar a los pacientes con COVID-19. Estimación de insumos y equipos necesarios para los próximos 6 meses, incluidos los montos necesarios para inversión y financiamiento. Previsión de unidades de contrarreferencia, consensuada con gestores locales, para pacientes leves o moderados, o en condiciones de alta clínica. Predicción de aislamiento inverso, traslado o derivación de pacientes inmunodeprimidos. Previsión de flujos y responsable del transporte de pacientes. Medidas encaminadas a reducir pasos en los procesos diarios del hospital para la toma de decisiones en tiempos de crisis. Formación en la atención de pacientes críticos. Soporte de laboratorio. Recolección de aspirado nasofaríngeo o muestra combinada de torunda nasal / oral o secreción respiratoria inferior. Plan de comunicación. Hospitalidad. Tratamiento de desechos. Procesamiento de ropa. Saneamiento. Procesamiento de productos sanitarios.

Traité de plan d'urgence pour faire face au covid19 au Tropical Diseases Hospital-HDT-UFT. Le protocole aborde les caractéristiques du coronavirus (COVID19), les définitions des cas suspects, confirmés et rejetés. Il présente des documents tels que le Formulaire de notification du syndrome respiratoire aigu grave - SRAS. Affiche les critères d'accès et la classification des cas, les mesures de contrôle des infections. Il apporte des paramètres pour Care Flow - Soins ambulatoires et d'urgence, Utilisation du système de classification des patients pour le dimensionnement quotidien de l'équipe (Fugulin Scale). Il montre une liste des équipements dont HDT-UFT dispose pour la demande générale) et la structure des patients hospitalisés pour aider le COVID-19 et le dimensionnement de l'équipe, en plus des prévisions de relocalisation des équipes de soins et administratives pour soigner ces patients. Stratégies pour étendre la capacité actuelle installée et opérationnelle pour aider les patients atteints du COVID-19. Estimation des intrants et équipements nécessaires pour les 6 prochains mois, y compris les montants nécessaires pour l'investissement et le financement. Prévision des unités de contre-référence, en accord avec les responsables locaux, pour les patients légers ou modérés, ou en conditions de sortie clinique. Prédiction de l'isolement inversé, du transfert ou de la référence de patients immunodéprimés. Prévision des flux et responsable du transport des patients. Mesures visant à réduire les étapes dans les processus quotidiens de l'hôpital pour la prise de décision en temps de crise. Formation à la prise en charge des patients critiques. Support de laboratoire. Prélèvement d'un prélèvement nasopharynx par aspiration ou d'un écouvillon combiné nasal / oral ou d'un échantillon de sécrétion respiratoire inférieure. Plan de communication. Hospitalité. Traitement des déchets. Traitement des vêtements. Assainissement. Transformation des produits de santé.

Estructura de las unidades de cuidados intensivos de anestesia: recomendaciones de la Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR) / Structure of the anesthesia intensive care units: recommendations of the Intensive Care Section of the Spanish Society of Anaesthesiology

ANTECEDENTES Y OBJETIVO: Los objetivos de la Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor (SCI-SEDAR) con el presente trabajo son: establecer nuevas recomendaciones adaptando los estándares publicados por el Ministerio de Sanidad y Política Social, y alineadas con las principales guías internacionales, y desarrollar una herramienta de mejora de la calidad y la eficiencia. MATERIALES Y MÉTODO: A lo largo de 2018, 3 miembros de la SCI-SEDAR definieron la metodología, desarrollaron las recomendaciones y seleccionaron al panel de expertos. Debido a la limitada evidencia de buena parte de las recomendaciones y a la importante variabilidad estructural de las unidades de cuidados intensivos de anestesia actuales, se optó por un abordaje Delphi modificado para determinar el grado de consenso. RESULTADOS: Un total de 24 expertos de 21 instituciones constituyeron el grupo de expertos del presente trabajo. Se establecieron 175 recomendaciones sobre 8 apartados, incluyendo 129 con consenso fuerte y 46 con consenso débil. CONCLUSIONES: La SCI-SEDAR estableció las recomendaciones estructurales de las unidades de cuidados intensivos de anestesia que deberán guiar la renovación o la creación de nuevas unidades

BACKGROUND AND OBJECTIVE: In this article, the Intensive Care Section of the Spanish Society of Anesthesiology (SCI-SEDAR) establishes new recommendations based on the standards published by the Ministry of Health, Consumer Affairs and Social Welfare and aligned with the principle international guidelines, and develops a tool to improve quality and efficiency. MATERIALS AND METHOD: Over a 12-month period (2018), 3 members of the SCI-SEDAR defined the methodology, developed the recommendations and selected the panel of experts. Due to the limited evidence available for many of the recommendations and the significant structural differences between existing anesthesia intensive care units, we chose a modified Delphi approach to determine the degree of consensus. RESULTS: The panel consisted of 24 experts from 21 institutions. The group put forward 175 recommendations on 8 sections, including 129 with strong consensus and 46 with weak consensus. CONCLUSIONS: The SCI-SEDAR has established a series of structural recommendations that should be used when renovating or creating new anesthesia intensive care units

Structure of the Anesthesia Intensive Care Units: Recommendations of the Intensive Care Section of the Spanish Society of Anaesthesiology. / Estructura de las unidades de cuidados intensivos de anestesia: recomendaciones de la Sección de Cuidados Intensivos de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR).

BACKGROUND AND OBJECTIVE: In this article, the Intensive Care Section of the Spanish Society of Anesthesiology (SCI-SEDAR) establishes new recommendations based on the standards published by the Ministry of Health, Consumer Affairs and Social Welfare and aligned with the principle international guidelines, and develops a tool to improve quality and efficiency. MATERIALS AND METHOD: Over a 12-month period (2018), 3 members of the SCI-SEDAR defined the methodology, developed the recommendations and selected the panel of experts. Due to the limited evidence available for many of the recommendations and the significant structural differences between existing anesthesia intensive care units, we chose a modified Delphi approach to determine the degree of consensus. RESULTS: The panel consisted of 24 experts from 21 institutions. The group put forward 175 recommendations on 8 sections, including 129 with strong consensus and 46 with weak consensus. CONCLUSIONS: The SCI-SEDAR has established a series of structural recommendations that should be used when renovating or creating new anesthesia intensive care units.

How clean is "hygienically clean": Quantitative microbial levels from samples of clean health care textiles across the United States.

BACKGROUND: In the United States, the laundry industry has not reliably measured microbial levels on hygienically clean textiles. The aim of this study was to quantitatively measure the microbial levels found on a sample of hygienically clean textiles. METHODS: Forty-eight health care textile samples were collected from hygienically clean linen scheduled to be used on 3 different patient care units. Samples were taken at 2 separate points in time representing laundry facility processing practices and hospital linen management practices. United States Pharmacopeia 61 testing was completed using a pour plate culturing method, producing a total aerobic microbial count and a total yeast and mold count. RESULTS: Of the samples, only 27% had a total aerobic microbial count below the expected 100 colony-forming unit level (range, 9-40,000) versus 81% (range, 9-1,000) for total yeast and mold count. Median microbial counts for the 2 separate time points across the 3 different patient care units were also higher than expected. CONCLUSIONS: As far as we know, this study is a first step by the laundry industry to understand what quantitative microbial levels are currently found on hygienically clean health care textiles. These types of data can assist the industry in establishing appropriate outcome targets for process improvement initiatives.

Hospital Outbreak of Pulmonary and Cutaneous Zygomycosis due to Contaminated Linen Items From Substandard Laundry.

BACKGROUND: Healthcare laundry-related infection is rare, and pulmonary zygomycosis due to contaminated hospital linens has never been reported. METHODS: We reported an outbreak investigation of zygomycosis in a university-affiliated teaching hospital. Air samplers, sponge swabs and Replicate Organism Detection and Counting (RODAC) contact plates were used for environmental sampling. The fungal isolates from clinical and environmental samples were identified by morphology, MALDI-TOF MS, and ITS1-5.8S-ITS2 rRNA gene cluster sequencing. RESULTS: From 2 June 2015 to 18 July 2015, 6 immunosuppressed patients developed pulmonary (n = 4) and/or cutaneous (n = 3) infection by a spore-forming mold, Rhizopus microsporus, through direct inhalation and skin contact of contaminated linen items supplied by a designated laundry. Seventy (27.8%) of 252 freshly laundered clothing and 15 (3.4%) of 443 nonclothing laundered linen items (pillow case, bed sheet, draw sheet) were contaminated by R. microsporus, which was significantly higher than those from other hospital laundries (0%, n = 451; P < .001) supplying linen to hospitals with no cases of zygomycosis reported during the same period. The fungal isolates from patients and linens were phylogenetically related. In sum, 61% of environmental samples and 100% of air samples at the designated laundry were also positive for zygomycetes, suggesting heavy environmental contamination. RODAC contact plates revealed mean total viable bacteria counts of freshly laundered items (1028 ± 611 CFU/100 cm(2)) far exceeded the "hygienically clean" standard of 20 CFU/100 cm(2) set by the US healthcare textile certification requirement. CONCLUSIONS: Suboptimal conditions of washing, drying, and storage contributed to the massive linen contamination and the outbreak of zygomycosis.

Healthcare Laundry and Textiles in the United States: Review and Commentary on Contemporary Infection Prevention Issues.

Healthcare professionals have questions about the infection prevention effectiveness of contemporary laundry processes for healthcare textiles (HCTs). Current industrial laundry processes achieve microbial reductions via physical, chemical, and thermal actions, all of which result in producing hygienically clean HCTs. European researchers have demonstrated that oxidative laundry additives have sufficient potency to meet US Environmental Protection Agency benchmarks for sanitizers and disinfectants. Outbreaks of infectious diseases associated with laundered HCTs are extremely rare; only 12 such outbreaks have been reported worldwide in the past 43 years. Root cause analyses have identified inadvertent exposure of clean HCTs to environmental contamination (including but not limited to exposure to dust in storage areas) or a process failure during laundering. To date, patient-to-patient transmission of infection has not been associated with hygienically clean HCTs laundered in accordance with industry process standards. Occupationally acquired infection involved mishandling of soiled HCTs and failure to use personal protective equipment properly. Laboratory studies of antimicrobial treatments for HCTs demonstrate a wide range of activity from 1 to 7 log10 reduction of pathogens under various experimental conditions. Clinical studies are needed to evaluate potential use of these treatments for infection prevention. Microbiological testing of clean HCTs for certification purposes is now available in the United States. Key features (eg, microbial sampling strategy, numbers of textiles sampled) and justification of the testing are discussed.

Recommended standards for newborn ICU design, eighth edition.

This is the eighth edition of the Recommended Standards for Newborn ICU Design. It contains substantive changes in recommendations for patient room size and feeding preparation areas, and a number of refinements of previous Recommended Standards with respect to family space, hand hygiene, lighting and other aspects of the newborn intensive care unit (NICU) design.

Microfibre barrier laundry adds value.

London's Guy's and St Thomas' NHS Foundation Trust has installed a complete barrier laundry system from Electrolux Professional at its St Thomas' Hospital location for specialist washing of an estimated 7,000 microfibre cloths and 5,000 microfibre mops each day from both the St Thomas' and Guy's Hospital sites. Since the installation, as Electrolux Professional national account manager Kurt Fryer reports, the "cost-effective" equipment's high performance has seen laundry staff achieve a significant increase in productivity.