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1.
Medicine (Baltimore) ; 99(3): e18782, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011472

RESUMO

Hemodialysis (HD) patients had a high rate of infection transmission and mortality during the middle east respiratory syndrome coronavirus (MERS-CoV) outbreak in Saudi Arabia. A standardized guideline on isolation technique for exposed HD patients is not available. Thus, this study aimed to evaluate the effect of different isolation strategies on the prevention of secondary viral transmission and clinical outcomes among exposed HD patients.During the 2015 MERS-CoV outbreak in Korea, 116 patients in 3 HD units were incidentally exposed to individuals with confirmed MERS-CoV infection and underwent different types of isolation, which were as follows: single-room isolation (n = 54, 47%), cohort isolation (n = 46, 40%), and self-imposed quarantine (n = 16, 13%). The primary outcome was rate of secondary viral transmission. The secondary outcome measures were changes in clinical and biochemical markers during the isolation period, difference in clinical and biochemical markers according to the types of isolation practice, and effect of isolation practice on patient survival.During a mean isolation period of 15 days, no further cases of secondary transmission were detected among HD patients. Plasma hemoglobin, serum calcium, and serum albumin levels and single-pool Kt/V decreased during the isolation period but normalized thereafter. Patients who were subjected to self-imposed quarantine had higher systolic and diastolic blood pressure, lower total cholesterol level, and lower Kt/V than those who underwent single-room or cohort isolation. During the 24-month follow-up period, 12 patients died. However, none of the deaths occurred during the isolation period, and no differences were observed in patient survival rate according to different isolation strategies.Although 116 participants in 3 HD units were incidentally exposed to MERS-CoV during the 2015 outbreak in Korea, strict patient surveillance and proper isolation practice prevented secondary transmission of the virus. Thus, a renal disaster protocol, which includes proper contact surveillance and isolation practice, must be established in the future to accommodate the needs of HD patients during disasters or outbreaks.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Coronavírus da Síndrome Respiratória do Oriente Médio , Isolamento de Pacientes , Diálise Renal , Idoso , Infecções por Coronavirus/sangue , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/transmissão , Infecção Hospitalar/sangue , Infecção Hospitalar/mortalidade , Infecção Hospitalar/transmissão , Feminino , Humanos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Isolamento de Pacientes/métodos , Estudos Prospectivos , Quarentena , Resultado do Tratamento
2.
Br J Nurs ; 29(1): 8, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31917933

RESUMO

Tracy Doherty, Assistant Director of Infection Prevention & Control, Our Lady of Lourdes Hospital, Drogheda, Co Louth, discusses the maintenance of a clean healthcare environment.


Assuntos
Infecção Hospitalar/etiologia , Ambiente de Instituições de Saúde , Infecção Hospitalar/prevenção & controle , Ambiente de Instituições de Saúde/normas , Serviço Hospitalar de Limpeza/normas , Humanos , Controle de Infecções
3.
Br J Nurs ; 29(1): 10, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31917942

RESUMO

Neesha Ridley, Senior Lecturer, University of Central Lancashire, discusses the importance of hand hygiene in preventing healthcare-associated infections.


Assuntos
Infecção Hospitalar/prevenção & controle , Higiene das Mãos/normas , Gestão de Riscos/métodos , Humanos
4.
Br J Nurs ; 29(2): S24-S26, 2020 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-31972108

RESUMO

PURPOSE: Preventing CLABSI events in the dialysis inpatient population represents significant challenges. Bacteremia associated with lines or grafts are common health-associated infections that lead to adverse patient outcomes. Dialysis patients represent a much higher infection risk due to health frequency needs, more frequent hospitalizations, multiple comorbidity issues, fistula functionality, and multiple attempts for line access leading to additional complications, costs, morbidity, and mortality. METHODS: An observational study was conducted including central line device days, CLABSI events, and possible confounding variables in admitted dialysis patients. All CLABSI data were identified according to the Centers for Disease Control and Prevention's National Healthcare Safety Network's definitions for CLABSIs. The intervention involved the removal of 70% alcohol swabs and alcohol hub disinfecting caps, then replacing with swabs containing 3.15% chlorhexidine gluconate/70% alcohol for central line hub disinfection and vascular graft access skin disinfection. RESULTS: The 5-year preintervention period (2008-2012) involved 7568 central line days, 11 CLABSI events, and a 1.45 per 1000 device day rate. The 6-month trial period involved 1559 central line days and no CLABSI events. The 5-year postimplementation period (2013-2017) involved 9787 central line days, 5 CLABSI events, and a 0.51 per 1000 device day rate. The postimplementation period represented a statistically significant (P value=0.0493) reduction with 65% fewer CLABSI events compared with the preimplementation period. LIMITATIONS: A limitation was variations in scrub time and dry time during central venous catheter hub access. While we were comparing 2 products, behavioral practices using these 2 products were possible influencers and represent a possible confounding variable. CONCLUSIONS: This study found that using alcohol with chlorhexidine gluconate prior to accessing central line hubs and vascular grafts allows for reduction in CLABSI events and sustains statistically significant lower CLABSI rates in the inpatient dialysis population. HIGHLIGHTS Using alcohol with chlorhexidine gluconate (CHG) before accessing central line hubs helps reduce central line-associated bloodstream infection (CLABSI) events Using alcohol with CHG before accessing vascular grafts helps reduce CLABSI events A statistically significant reduction (65%) in CLABSI events occurred after use. Statistically significant lower CLABSI rates are sustainable with use of alcohol with CHG.


Assuntos
Bacteriemia/prevenção & controle , Infecções Relacionadas a Cateter/prevenção & controle , Infecção Hospitalar/prevenção & controle , Desinfecção/métodos , Diálise Renal/enfermagem , Álcoois/administração & dosagem , Cateterismo Venoso Central/efeitos adversos , Clorexidina/administração & dosagem , Clorexidina/análogos & derivados , Humanos , Pesquisa em Avaliação de Enfermagem
6.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1048348

RESUMO

Objetivo: elaborar um bundle de cuidados para a prevenção e o controle das infecções hospitalares em unidade de emergência, com base no conhecimento e prática dos profissionais de saúde e nas evidências científicas disponíveis na literatura. Método: pesquisa convergente assistencial, realizada em um serviço de emergência adulto de um hospital geral universitário localizado em uma capital do Sul do Brasil com aplicação de um Survey para 52 trabalhadores da equipe multiprofissional e posterior discussão em grupos "Aqui e Agora". Foi aprovado pelo CEPSH/UFSC com CAAE: 56390616.0.0000.0121. Resultados: emergiram três aspectos mais significativos que compuseram o bundle de cuidados: higienização das mãos; uso de equipamentos de proteção individual; e assepsia de materiais e equipamentos. Conclusão: a utilização do bundle permite informar, orientar, melhorar hábitos e relembrar a equipe de saúde sobre a necessidade de aderir a atitudes que tornem o cuidado realizado mais qualificado e seguro, tanto para o paciente, quanto para o profissional


Objective: develop a care bundle in order to help preventing and controlling hospital infections in emergency care units, based on the knowledge and practice of health professionals, as well as on scientific evidences available in the literature. Method: The study was carried out through the application of a survey comprising 52 health professionals working in the multi-professional team of the aforementioned hospital. The data from the survey were discussed in "Here-and-Now" groups. It was approved by CEPSH / UFSC with CAAE: 56390616.0.0000.0121. Results: the three most significant aspects composing the care bundle were selected based on data derived from the survey, from the groups and from the literature, namely: hand hygiene; use of personal protection equipment; and asepsis of materials and equipment. Conclusion: using the bundle allows inform, guide, as well as to improve habits and remind health teams about the need to adhere to measures able to make the health care practice more qualified and safer for both the patients and the professionals


Objetivo: elaborar un bundle de cuidados para la prevención y el control de las infecciones hospitalarias en unidad de emergencia, con base en el conocimiento y práctica de los profesionales de salud y en las evidencias científicas disponibles en la literatura. Método: se realizó con aplicación de un Survey de que participaron 52 trabajadores del equipo multiprofesional. Los datos de Survey fueron discutidos posteriormente en grupos "Aquí y Ahora". Fue aprobado por el CEPSH / UFSC con CAAE: 56390616.0.0.0000.0121. Resultados: en base a los datos de Survey, de los grupos y de la literatura se seleccionaron los tres aspectos más significativos que compusieron el bundle de cuidados: higienización de las manos; uso de equipos de protección individual; y asepsia de materiales y equipos. Conclusión: la utilización del bundle permite informar, orientar, mejorar hábitos y recordar el equipo de salud sobre la necesidad de adherir a actitudes que hagan del cuidado realizado más calificado y seguro, tanto para el paciente, como para el profesional


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Infecção Hospitalar/prevenção & controle , Serviços Médicos de Emergência , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos e Questionários , Grupos Focais , Segurança do Paciente , Pacotes de Assistência ao Paciente
7.
Curr Opin Ophthalmol ; 31(1): 28-32, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31770164

RESUMO

PURPOSE OF REVIEW: This article reviews the various challenges in infection control in eye clinics and successful measures taken to prevent nosocomial infections. RECENT FINDINGS: The Center for Disease Control recommends hand-washing when hands are visibly soiled, and after direct contact with patients, and inanimate objects such as medical equipment. Published studies have identified poor hygiene in clinical settings as a major cause of nosocomial outbreaks, particularly in cases of epidemic keratoconjunctivitis (EKC). Some studies of EKC outbreaks are able to support direct observation of hygiene lapses with molecular analysis that can match viral strains on particular instruments to those found in infected patients. Although most studies are about adenoviral infection and tonometer use, researchers have found viral and bacterial loads on other common surfaces, indicating a need for further research. SUMMARY: Proper hygiene in eye clinics requires special attention because of the potential to examine many patients at a time and because multiple instruments are often used during a single exam. Studies reinforce the link between hygiene and outbreak prevention, and more research can be done to determine the specific links between certain instruments and nosocomial infections.


Assuntos
Infecção Hospitalar/prevenção & controle , Desinfecção/métodos , Higiene das Mãos , Controle de Infecções/métodos , Oftalmologia/instrumentação , Esterilização/métodos , Instituições de Assistência Ambulatorial/normas , Humanos , Oftalmologia/normas
8.
Orv Hetil ; 160(49): 1957-1962, 2019 Dec.
Artigo em Húngaro | MEDLINE | ID: mdl-31786938

RESUMO

Introduction: Infections affect about 30-50% of intensive care unit patients resulting in substantial morbidity and mortality. Multimodal interventions proved to be successful in the prevention of healthcare-associated infections. Appropriate hand hygiene including correct disinfection technique and timing is essential. Aim: The aim of our study was to investigate the hand hygiene practice among the intensive care unit healthcare workers by immediate feedback system implementation and compliance study. Method: A 3-week-long observational study was conducted at the Department of Anaesthesiology and Intensive Therapy, Semmelweis University, during November and December, 2018. Data regarding hand hygiene technique were collected by using the Semmelweis Scanner technology, while compliance data were recorded by direct observations. Statistical analysis was performed by Kruskal-Wallis test, Fisher's exact test and χ2-test. Results: 604 measurements were recorded by the electronic system. Hand disinfection was appropriate in 86.5% of cases. The median value of coverage was 99.87%. The trend of these indices showed persistently high values. A lower error rate was observed in the physiotherapy group compared to others (doctors: p<0.01, nurses: p = 0.03, assistant nurses: p = 0.03). 162 opportunities were recorded during direct observations. The mean compliance rate was 60.49%, with the lowest among doctors (53.97%). The difference was non-significant compared to nurses (62.92%, p = 0.26). Conclusions: Hand hygiene technique during the study period was found to be highly and permanently appropriate, while compliance was lower than expected. The immediate feedback system may be useful in achieving appropriate hand disinfection technique, although further interventions are needed for higher compliance rates. Orv Hetil. 2019; 160(49): 1957-1962.


Assuntos
Fidelidade a Diretrizes/estatística & dados numéricos , Desinfecção das Mãos/normas , Higiene das Mãos , Pessoal de Saúde/estatística & dados numéricos , Unidades de Terapia Intensiva/organização & administração , Infecção Hospitalar/prevenção & controle , Pessoal de Saúde/educação , Humanos
9.
BMC Infect Dis ; 19(1): 1072, 2019 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-31864284

RESUMO

BACKGROUND: Stenotrophomonas maltophilia (SMA) is present in hospital environments and has been one of the pathogens that cause nosocomial contamination and infections. To investigate the occurrence of Stenotrophomonas maltophilia (SMA) in bronchoscope lavage fluid (BALF) among 25 cases treated in the Division of Infection and to trace the contamination source and transmission route. METHODS: 25 cases of SMA positive BALF occurring from May 11 to August 10, 2018 were tested for drug sensitivity. Environmental hygiene conditions were investigated to identify the source of contamination and the route of transmission. RESULTS: BALF associated SMA was in all cases sensitive to minocycline, levofloxacin and chloramphenicol and resistant to ceftazidime and imipenem. 92.3% of samples were sensitivity to compound sulfamethoxazole. Investigation of environmental hygiene parameters revealed SMA growing on the inner wall of the fiberoptic bronchoscope as a likely source of contamination. CONCLUSION: Incomplete cleaning and sterilization of the fiberoptic bronchoscope led to SMA nosocomial contamination. Strict sterilization procedures are required to prevent and control nosocomial contamination.


Assuntos
Broncoscópios/microbiologia , Infecção Hospitalar/diagnóstico , Infecções por Bactérias Gram-Negativas/diagnóstico , Stenotrophomonas maltophilia/isolamento & purificação , Antibacterianos/farmacologia , Ceftazidima/farmacologia , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/transmissão , Farmacorresistência Bacteriana Múltipla , Infecções por Bactérias Gram-Negativas/prevenção & controle , Infecções por Bactérias Gram-Negativas/transmissão , Humanos , Imipenem/farmacologia , Testes de Sensibilidade Microbiana , Stenotrophomonas maltophilia/efeitos dos fármacos
10.
Klin Lab Diagn ; 64(11): 693-699, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31747501

RESUMO

Staphylococcus aureus asymptomatically persists on the nasal mucosa, and also causes serious diseases in carriers (endogenous infection) and in patients in a hospital (nosocomial infection). Decolonization of nasal carriers of S. aureus is an important measure aimed at reducing the incidence of staphylococcal infections. Carriage is a form of nasal dysbiosis, therefore, the effectiveness of antibiotics for the decolonization of carriers, by definition, is low. The review discusses the prospects of using probiotics to restore the nasal microbiota. The commercial production of nasal probiotics has not yet been established, but developments in this direction are being carried out in different countries. The experimental substantiation of the possibility of using corynebacteria and other representatives of the nasal microbiota for the decolonization of staphylococcal carriers is presented, as well as the authors' ideas on how to improve the methods of microbial therapy. In particular, it was proposed to use biofilm probiotics, autoprobiotics, and autovaccines for this purpose.


Assuntos
Portador Sadio/microbiologia , Probióticos/uso terapêutico , Infecções Estafilocócicas/terapia , Antibacterianos/uso terapêutico , Infecção Hospitalar/microbiologia , Infecção Hospitalar/prevenção & controle , Humanos , Staphylococcus aureus
12.
BMC Health Serv Res ; 19(1): 743, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31651305

RESUMO

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is an opportunistic bacterial organism resistant to first line antibiotics. Acquisition of MRSA is often classified as either healthcare-associated or community-acquired. It has been shown that both healthcare-associated and community-acquired infections contribute to the spread of MRSA within healthcare facilities. The objective of this study was to estimate the incremental inpatient cost and length of stay for individuals colonized or infected with MRSA. Common analytical methods were compared to ensure the quality of the estimate generated. This study was performed at Alberta Ministry of Health (Edmonton, Alberta), with access to clinical MRSA data collected at two Edmonton hospitals, and ministerial administrative data holdings. METHODS: A retrospective cohort study of patients with MRSA was identified using a provincial infection prevention and control database. A coarsened exact matching algorithm, and two regression models (semilogarithmic ordinary least squares model and log linked generalized linear model) were evaluated. A MRSA-free cohort from the same facilities and care units was identified for the matched method; all records were used for the regression models. Records span from January 1, 2011 to December 31, 2015, for individuals 18 or older at discharge. RESULTS: Of the models evaluated, the generalized linear model was found to perform the best. Based on this model, the incremental inpatient costs associated with hospital-acquired cases were the most costly at $31,686 (14,169 - 60,158) and $47,016 (23,125 - 86,332) for colonization and infection, respectively. Community-acquired MRSA cases also represent a significant burden, with incremental inpatient costs of $7397 (2924 - 13,180) and $14,847 (8445 - 23,207) for colonization and infection, respectively. All costs are adjusted to 2016 Canadian dollars. Incremental length of stay followed a similar pattern, where hospital-acquired infections had the longest incremental stays of 35.2 (16.3-69.5) days and community-acquired colonization had the shortest incremental stays of 3.0 (0.6-6.3) days. CONCLUSIONS: MRSA, and in particular, hospital-acquired MRSA, places a significant but preventable cost burden on the Alberta healthcare system. Estimates of cost and length of stay varied by the method of analysis and source of infection, highlighting the importance of selecting the most appropriate method.


Assuntos
Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas/economia , Idoso , Alberta , Antibacterianos/economia , Antibacterianos/uso terapêutico , Estudos de Coortes , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/economia , Infecção Hospitalar/economia , Infecção Hospitalar/prevenção & controle , Feminino , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Pacientes Internados/estatística & dados numéricos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Meticilina/economia , Meticilina/uso terapêutico , Pessoa de Meia-Idade , Estudos Retrospectivos
13.
MMWR Morb Mortal Wkly Rep ; 68(39): 851-854, 2019 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-31581162

RESUMO

Infection prevention and control (IPC) in health care facilities is essential to protecting patients, visitors, and health care personnel from the spread of infectious diseases, including Ebola virus disease (Ebola). Patients with suspected Ebola are typically referred to specialized Ebola treatment units (ETUs), which have strict isolation and IPC protocols, for testing and treatment (1,2). However, in settings where contact tracing is inadequate, Ebola patients might first seek care at general health care facilities, which often have insufficient IPC capacity (3-6). Before 2014-2016, most Ebola outbreaks occurred in rural or nonurban communities, and the role of health care facilities as amplification points, while recognized, was limited (7,8). In contrast to these earlier outbreaks, the 2014-2016 West Africa Ebola outbreak occurred in densely populated urban areas where access to health care facilities was better, but contact tracing was generally inadequate (8). Patients with unrecognized Ebola who sought care at health care facilities with inadequate IPC initiated multiple chains of transmission, which amplified the epidemic to an extent not seen in previous Ebola outbreaks (3-5,7). Implementation of robust IPC practices in general health care facilities was critical to ending health care-associated transmission (8). In August 2018, when an Ebola outbreak was recognized in the Democratic Republic of the Congo (DRC), neighboring countries began preparing for possible introduction of Ebola, with a focus on IPC. Baseline IPC assessments conducted in frontline health care facilities in high-risk districts in Uganda found IPC gaps in screening, isolation, and notification. Based on findings, additional funds were provided for IPC, a training curriculum was developed, and other corrective actions were taken. Ebola preparedness efforts should include activities to ensure that frontline health care facilities have the IPC capacity to rapidly identify suspected Ebola cases and refer such patients for treatment to protect patients, staff members, and visitors.


Assuntos
Infecção Hospitalar/prevenção & controle , Surtos de Doenças/prevenção & controle , Administração de Instituições de Saúde , Doença pelo Vírus Ebola/prevenção & controle , Controle de Infecções/organização & administração , República Democrática do Congo/epidemiologia , Pesquisa sobre Serviços de Saúde , Doença pelo Vírus Ebola/epidemiologia , Humanos , Medição de Risco , Uganda
14.
BMC Health Serv Res ; 19(1): 689, 2019 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-31606053

RESUMO

BACKGROUND: Antimicrobial resistance is an increasing problem in hospitals world-wide. Following other countries, English hospitals experienced outbreaks of carbapenemase-producing Enterobacteriaceae (CPE), a bacterial infection commonly resistant to last resort antibiotics. One way to improve CPE prevention, management and control is the production of guidelines, such as the CPE toolkit published by Public Health England in December 2013. The aim of this research was to investigate the implementation of the CPE toolkit and to identify barriers and facilitators to inform future policies. METHODS: Acute hospital trusts (N = 12) were purposively sampled based on their self-assessed CPE colonisation rates and time point of introducing local CPE action plans. Following maximum variation sampling, 44 interviews with hospital staff were conducted between April and August 2017 using a semi-structured topic guide based on the Capability, Opportunity, Motivation and Behaviour Model and the Theoretical Domains Framework, covering areas of influences on behaviour. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. RESULTS: The national CPE toolkit was widely disseminated within infection prevention and control teams (IPCT), but awareness was rare among other hospital staff. Local plans, developed by IPCTs referring to the CPE toolkit while considering local circumstances, were in place in all hospitals. Implementation barriers included: shortage of isolation facilities for CPE patients, time pressures, and competing demands. Facilitators were within hospital and across-hospital collaborations and knowledge sharing, availability of dedicated IPCTs, leadership support and prioritisation of CPE as an important concern. Participants using the CPE toolkit had mixed views, appreciating its readability and clarity about patient management, but voicing concerns about the lack of transparency on the level of evidence and the practicality of implementation. They recommended regular updates, additional clarifications, tailored information and implementation guidance. CONCLUSIONS: There were problems with the awareness and implementation of the CPE toolkit and frontline staff saw room for improvement, identifying implementation barriers and facilitators. An updated CPE toolkit version should provide comprehensive and instructive guidance on evidence-based CPE prevention, management and control procedures and their implementation in a modular format with sections tailored to hospitals' CPE status and to different staff groups.


Assuntos
Enterobacteriáceas Resistentes a Carbapenêmicos , Infecção Hospitalar/prevenção & controle , Surtos de Doenças/prevenção & controle , Infecções por Enterobacteriaceae/prevenção & controle , Controle de Infecções/métodos , Adulto , Idoso , Antibacterianos/uso terapêutico , Inglaterra , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Adulto Jovem
16.
Lett Appl Microbiol ; 69(5): 333-338, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31536642

RESUMO

Due to increasing antibiotic resistance Klebsiella pneumoniae is a serious threat for the hospitalized patients. The aim of this study was the assessment of radiant catalytic ionization (RCI) efficacy on K. pneumoniae reduction in the air and on selected surfaces. Four K. pneumoniae NDM and ESBLs-producing strains were included in the study. Three types of surface were tested: cotton-polyester, terry and PVC. It was found that RCI significantly reduced the number of bacteria from all types of surface (terry: 0·56-1·22 log CFU m2 , cotton-polyester: 2·15-3·71 log CFU per m2 , PVC: 4·45-4·92 log CFU per m2 ) as well as from the air (1·80 log CFU per m3 ). The RCI technology may be a useful disinfection method in hospitals. SIGNIFICANCE AND IMPACT OF THE STUDY: Microbial contamination of air and surfaces in hospitals play an important role in healthcare-associated infections. The aim was the assessment of Klebsiella pneumoniae elimination using radiant catalytic ionization (RCI). K. pneumoniae are aetiological agent of nosocomial infections, such as: pneumonia, infections of urinary tract, blood, e.t.c. The strains producing the New Delhi metallo-ß-lactamases are one of the greatest epidemiological threat. The use of RCI eliminate the tested bacteria from the hospital environment, but can also be effective in food processing plants or public facilities, ensuring the safety of people and products. This research is scarce in references and has a large innovation and application potential.


Assuntos
Proteínas de Bactérias/metabolismo , Infecção Hospitalar/prevenção & controle , Infecções por Klebsiella/prevenção & controle , Klebsiella pneumoniae/efeitos da radiação , beta-Lactamases/metabolismo , Microbiologia do Ar , Proteínas de Bactérias/genética , Infecção Hospitalar/microbiologia , Humanos , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/enzimologia , Klebsiella pneumoniae/crescimento & desenvolvimento , Viabilidade Microbiana/efeitos da radiação , Radiação Ionizante
17.
PLoS Comput Biol ; 15(9): e1007284, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31525183

RESUMO

According to the Centers for Disease Control and Prevention (CDC), one in twenty five hospital patients are infected with at least one healthcare acquired infection (HAI) on any given day. Early detection of possible HAI outbreaks help practitioners implement countermeasures before the infection spreads extensively. Here, we develop an efficient data and model driven method to detect outbreaks with high accuracy. We leverage mechanistic modeling of C. difficile infection, a major HAI disease, to simulate its spread in a hospital wing and design efficient near-optimal algorithms to select people and locations to monitor using an optimization formulation. Results show that our strategy detects up to 95% of "future" C. difficile outbreaks. We design our method by incorporating specific hospital practices (like swabbing for infections) as well. As a result, our method outperforms state-of-the-art algorithms for outbreak detection. Finally, a qualitative study of our result shows that the people and locations we select to monitor as sensors are intuitive and meaningful.


Assuntos
Infecção Hospitalar , Surtos de Doenças , Algoritmos , Infecções por Clostridium , Clostridium difficile , Biologia Computacional , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/transmissão , Surtos de Doenças/prevenção & controle , Surtos de Doenças/estatística & dados numéricos , Humanos , Modelos Estatísticos
18.
Public Health ; 175: 145-147, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31494335

RESUMO

OBJECTIVES: Aspergillus spp could be responsible of nosocomial aspergillosis in immunocompromised patients. In 2018, it was decided to demolish a building of Careggi Hospital (Florence, Italy), the Chief Medical Officer ordered a 9-months-long air and surface microbiological sampling and extraordinary preventive measures. STUDY DESIGN: A 9-months-long prospective study. METHODS: After mapping the at-risk areas, air and surface samples were collected in different locations: in corridors, in rooms (high efficiency particulate air filter (HEPA) filtered or not), and outdoors. The samples were collected during the critical phases of the demolition. Air temperature and weather conditions were determined and recorded at the beginning of each sampling. RESULTS: Seventy-eight air samples and 72 surface samples were collected. The results showed highest contamination at time zero (before extraordinary preventive measures) and in the wards without HEPA filtered air. No specific prophylaxis strategy was implemented at our hospital for immunocompromised patients, and no cases of aspergillosis were recorded. CONCLUSIONS: Our results showed that extraordinary protective measures, the use of air treatment systems, and a continuous monitoring could be associated with decreased Aspergillus air contamination during construction, renovation, or demolition works.


Assuntos
Microbiologia do Ar , Aspergilose/prevenção & controle , Aspergillus/isolamento & purificação , Infecção Hospitalar/prevenção & controle , Arquitetura Hospitalar , Aspergilose/epidemiologia , Infecção Hospitalar/epidemiologia , Humanos , Itália/epidemiologia , Estudos Prospectivos
19.
Cochrane Database Syst Rev ; 8: CD012248, 2019 08 30.
Artigo em Inglês | MEDLINE | ID: mdl-31476022

RESUMO

BACKGROUND: Hospital-acquired infection is a frequent adverse event in patient care; it can lead to longer stays in the intensive care unit (ICU), additional medical complications, permanent disability or death. Whilst all hospital-based patients are susceptible to infections, prevalence is particularly high in the ICU, where people who are critically ill have suppressed immunity and are subject to increased invasive monitoring. People who are mechanically-ventilated are at infection risk due to tracheostomy and reintubation and use of multiple central venous catheters, where lines and tubes may act as vectors for the transmission of bacteria and may increase bloodstream infections and ventilator-associated pneumonia (VAP). Chlorhexidine is a low-cost product, widely used as a disinfectant and antiseptic, which may be used to bathe people who are critically ill with the aim of killing bacteria and reducing the spread of hospital-acquired infections. OBJECTIVES: To assess the effects of chlorhexidine bathing on the number of hospital-acquired infections in people who are critically ill. SEARCH METHODS: In December 2018 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trial registries for ongoing and unpublished studies, and checked reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA: We included randomised controlled trials (RCTs) that compared chlorhexidine bathing with soap-and-water bathing of patients in the ICU. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed study eligibility, extracted data and undertook risk of bias and GRADE assessment of the certainty of the evidence . MAIN RESULTS: We included eight studies in this review. Four RCTs included a total of 1537 individually randomised participants, and four cluster-randomised cross-over studies included 23 randomised ICUs with 22,935 participants. We identified one study awaiting classification, for which we were unable to assess eligibility.The studies compared bathing using 2% chlorhexidine-impregnated washcloths or dilute solutions of 4% chlorhexidine versus soap-and-water bathing or bathing with non-antimicrobial washcloths.Eight studies reported data for participants who had a hospital-acquired infection during the ICU stay. We are uncertain whether using chlorhexidine for bathing of critically ill people reduces the rate of hospital-acquired infection, because the certainty of the evidence is very low (rate difference 1.70, 95% confidence interval (CI) 0.12 to 3.29; 21,924 participants). Six studies reported mortality (in hospital, in the ICU, and at 48 hours). We cannot be sure whether using chlorhexidine for bathing of critically-ill people reduces mortality, because the certainty of the evidence is very low (odds ratio 0.87, 95% CI 0.76 to 0.99; 15,798 participants). Six studies reported length of stay in the ICU. We noted that individual studies found no evidence of a difference in length of stay; we did not conduct meta-analysis because data were skewed. It is not clear whether using chlorhexidine for bathing of critically ill people reduced length of stay in the ICU, because the certainty of the evidence is very low. Seven studies reported skin reactions as an adverse event, and five of these reported skin reactions which were thought to be attributable to the bathing solution. Data in these studies were reported inconsistently and we were unable to conduct meta-analysis; we cannot tell whether using chlorhexidine for bathing of critically ill people reduced adverse events, because the certainty of the evidence is very low.We used the GRADE approach to downgrade the certainty of the evidence of each outcome to very low. For all outcomes, we downgraded evidence because of study limitations (most studies had a high risk of performance bias, and we noted high risks of other bias in some studies). We downgraded evidence due to indirectness, because some participants in studies may have had hospital-acquired infections before recruitment. We noted that one small study had a large influence on the effect for hospital-acquired infections, and we assessed decisions made in analysis of some cluster-randomised cross-over studies on the effect for hospital-acquired infections and for mortality; we downgraded the evidence for these outcomes due to inconsistency. We also downgraded the evidence on length of stay in the ICU, because of imprecision. Data for adverse events were limited by few events and so we downgraded for imprecision. AUTHORS' CONCLUSIONS: Due to the very low-certainty evidence available, it is not clear whether bathing with chlorhexidine reduces hospital-acquired infections, mortality, or length of stay in the ICU, or whether the use of chlorhexidine results in more skin reactions.


Assuntos
Anti-Infecciosos Locais/uso terapêutico , Clorexidina/uso terapêutico , Estado Terminal , Infecção Hospitalar/prevenção & controle , Banhos , Cateteres Venosos Centrais/efeitos adversos , Humanos , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Sepse/prevenção & controle
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