Hospital Infection Control Service Research Articles

The health care management by nurses from the hospital infection control service in light of the Nursing Role Effectiveness Model

The objective was to reflect on the key concepts of the Middle Range Theory (TMA) Nursing Role Effectiveness Model (NREM) and its applicability in the management practices of Nurses working in the Hospital Infection Control Service. This is a theoretical-reflective study, which starts from the philosophical and epistemological conceptions of the TMA - NREM in order to reflect its applicability in the managerial actions of nurses who work in the Hospital Infection Control Service. For this reflection, the authors were based on the main concepts of the theory: structure (organization, nurse and patient), processes (independent, dependent and interdependent actions) and results (care sensitive to the nurse's actions). Through reflection, it can be seen that the key concepts of the aforementioned theory apply and at the same time support the theoretical reflection on the managerial actions of nurses who work in the Hospital Infection Control Service, contributing to elucidate how the interrelationship between the variables of this medium-range theory can favor better results than the reduction of infections in hospital units. It was possible to conclude that the managerial actions of nurses who work in the Hospital Infection Control Service are interrelated, capable of generating sensitive nursing care for patients hospitalized in hospital units.

Assessment of pneumonia rates associated with mechanical ventilation in a covid-19 unit after insertion of the dentist into the multidisciplinary team

The aim of this research is to evaluate whether there was a difference after the insertion of the dental surgeon in an Intensive Care Unit (ICU) that cares for patients with COVID-19 in relation to ventilator-associated pneumonia (VAP) control, length of stay and mortality. The dentist was added to the multidisciplinary team for three months. A training session with the nurses and nursing technicians was held at the start of every month. The Hospital Infection Control Service gathered data on VAP, hospital stay length, and ICU mortality in the three months before and three months after the dentist joined the team. After statistical analysis, the hospitalization rate increased in the period in which the dentist was working in the COVID-19 unit, but the p value was not significant in this variant (p > 0.062). The percentage of VAP in the period before and after the dentist's intervention in the COVID-19 unit decreased with a significant difference between the evaluated periods (p < 0.0001). Regarding mortality, it was found that there was an increase in the number of deaths over time, however without statistical significance (p > 0.2790). The pandemic came to confirm the importance of dental care in the hospital environment and the integration of the professional dentist in the health team, contributing to the oral health and quality of life of critical patients.

Compliance with surgical site infection prevention measures in hospitals

Objective: To assess compliance with actions for surgical site infection prevention and control, adopted in clinical practice in accordance with the recommendations proposed by the World Health Organization: auditing the moment of antibiotic administration, trichotomy with an electric clipper/disposable blade, material sterility confirmation, and surveillance and dissemination of surgical site infection rates. Methods: This is a cross-sectional observational study, carried out in 30 hospitals in the state of Minas Gerais, from February 2018 to April 2019, based on an audit of a surgical procedure, situational diagnosis and interview with Hospital Infection Control Services. Results In 93.3% of Hospital Infection Control Services, protocols for prophylactic antibiotic use and compliance audits were reported, 69% reported trichotomy with an electric clipper. All carried out surgical site infection surveillance, however, only 63.3% carried out rate disclosure. In the situational diagnosis, trichotomy was performed in 76.7% inside the operating room with an electric clipper (56.7%). In the audit of the moment of antimicrobial administration between 30-60 minutes before surgical incision, compliance was identified in 63.3%; 93.3% of services confirmed material sterility through process indicators. Conclusion: Differences were found between recommendations from the Hospital Infection Control Service and compliance with good practices during situational diagnosis and auditing of surgical procedures, reinforcing the need for training and audits aimed at effectively complying with professionals’ practices regarding such measures.

The Nursing Activities Score and its association with healthcare-associated infections in a Brazilian adult intensive care unit

The intensive care unit (ICU) requires a specialized team with adequate human resources, including nursing. For an adequate measurement of the workload of nursing professionals of Brazilian ICUs, the Nursing Activities Score (NAS) has been used to promote better adequacy of work scales. Work overload can increase the incidence of adverse events, including healthcare-associated infections (HAI). Objective: To associate the nursing workload measured by the NAS with the rates of HAI in an Adult ICU of a university hospital, in addition to evaluating the impact of the separation of ICUs by unit, or type of specialization. Method: Data collection was performed at Brazil, in the Adult ICU: stratified by the Surgical, Neurological and Medical specialties; including the calculation of the means of NAS and the monthly rates of HAI of each ICU unit, from 2016 to April 2019. NAS data were collected from secondary spreadsheets, without identification of the patient, and the rates of HAIs were collected from information from the Hospital Infection Control Service. Results: The mean NAS was different for each unit, with Neurological unit with the highest mean. In relation to HAIs, neurological unit patients had a higher incidence of HAIs and patients with HAIs. Pneumonia associated with mechanical ventilation (VAP) was higher in Surgical and Neurological units. Bloodstream and urinary tract infection were higher in the Medical unit. There was a positive correlation for NAS and VAP in the Medical unit and with urinary tract infection in the Surgical unit. In the Neurological unit there was a negative correlation with the rate of HAI and rate of patients with HAI. Conclusion: The mean NAS observed by us was lower when compared to other ICUs and variations may be associated with the type of hospital and clinical profile of patients. It was possible to observe that each unit has its particularity regarding the incidence of HAIs and the association between NAS (nursing workload) and rates, reinforcing the need for stratification and association of indicators per unit.

PERFIL EPIDEMIOLÓGICO DE GESTANTES PORTADORAS DO VÍRUS HIV EM MATERNIDADE DE SÃO PAULO - SP, BRASIL

OBJECTIVE: Acquired immunodeficiency syndrome (AIDS) is a pandemic disease that poses a public health challenge. This study aimed to trace the epidemiological profile of pregnant women with the HIV virus treated at a high complexity Maternity Hospital in the north of the city of São Paulo – SP, Brazil. METHODS: Data were obtained through an active search in the medical records of hospitalized patients and in the HIV case notification forms, from the Hospital Infection Control Service (SCIH) in the period from 2019 to 2021. RESULTS: The results showed that the majority of the HIV positive pregnant women seen at the maternity hospital during the study period were young, between 21 and 31 years old, 40% were single and 39% said they were in a consensual union, 60% completed only elementary school, most were unemployed, 58.5% declared themselves to be brown, and 35% were diagnosed with HIV during pregnancy. Of the total, 89.4% adhered to treatment and the main route of delivery was vaginal delivery, which demonstrates the adherence to antiretroviral therapy (ART) prophylaxis. Almost all neonates received antiretroviral prophylaxis. CONCLUSION: Early diagnosis and treatment are essential for the healthy birth of the baby. The data obtained in this study allow us to better understand the profile of HIV-positive pregnant women treated at the maternity ward, and thus to develop assistance programs in the gestation and postpartum period.

Pseudo-outbreak of Stenotrophomonas Maltophilia in an Intensive Care Unit in São Paulo – Brazil

<h3>Background</h3> In April 2020, a group of identical isolates of Stenotrophomonas maltophilia was observed in adult intensive care units (ICU), Covid - 19 units and surgical ICU in a large general hospital in greater São Paulo. The hospital infection control service team (SCIH) of the institution, in agreement with the care team of the intensive care units, started to investigate a possible outbreak, as well as all the processes related to the care of these patients. <h3>Methods</h3> This is a prospective study in which we followed all patients with results of tracheal secretion samples admitted to the ICUs; and we evidenced a significant in-crease in S. maltophilia isolates, which, for the most part, met epidemiological criteria for tracheobronchitis associated with mechanical ventilation, at the time it was not possible to perform typing using pulse field gel electrophoresis (PFGE). <h3>Results</h3> 100% of the cases of tracheobronchitis associated with mechanical ventilation were hospitalized in the ICU and using mechanical ventilation for more than 5 days, all cases remained with the closed suction system during the entire period of mechanical ventilation, this system was only changed if dirt or malfunction. In August 2020, after reviewing the entire process, we changed the closed suction system before collecting tracheal secretions. After this intervention, no other sample of tracheal secretions was isolated from S. maltophilia for three consecutive months. <h3>Conclusions</h3> We cannot exclude the potential for colonization of respiratory rats, but after changing the process, it became evident that this was the most effective measure to control the increase in S. maltophilia cases in ICUs.

Impact of the Systematic Performance of the SCIH in Monitoring Precautions and Isolation in the Face of the Pandemic Scenario

BackgroundOne of the attributions of the Hospital Infection Control Service (SCIH) is to ensure that the precautions and isolation applicable to the suspicion attributed to the patient are applied, according to transmission routes: contact, droplets, and aerosols. These precautions must be effectively instituted to ensure the non-transmission of microorganisms between patients and healthcare professionals. Due the pandemic scenario, the SCIH starts the daily active monitoring of isolation patients, having the precautions extended, altered, or suspended, when necessary, based in institutionally defined criteria. Evaluate and validate the maintenance of precautions instituted by the care team, adapting them, when necessary, in a general private hospital in São Paulo/Brazil.MethodsThe SCIH monitored daily the precautions applied to patients in the inpatient and intensive care units through the health management software from February (Feb) to November (Nov) 2021. The precautions monitored by units were computed and after evaluation by the SCIH were tabulated and recorded in an Excel spreadsheet.ResultsThe SCIH evaluated 8011 patients in isolation during the period (Feb/Nov 2021). Before this period, the non-compliance rate of the precautions monitored weekly was 14.7% (mean 85.3% compliance) and the intra-hospital transmission of COVID-19 was 0.16% (5 cases per 40170 patient days in non-COVID-19 units). After validation was instituted for daily, a non-compliance rate dropped to 3.5% (mean 96.5% compliance) and intra-hospital transmission dropped to 0.02% (2 cases per 58801 patient days in non-COVID-19 units).ConclusionsThe evaluation and validation of precautions and isolations by the SCIH is essential in preventing the cross-transmission of microorganisms. Increasing the frequency of this monitoring and involvement of the care team is essential to ensure patient safety in the institution, especially during the COVID-19 pandemic period.

PREVALÊNCIA E FATORES ASSOCIADOS À DOENÇA CRÍTICA CRÔNICA EM HOSPITALIZADOS POR TRAUMA EM TERAPIA INTENSIVA

ABSTRACT Objective to identify the prevalence of chronic critical disease and associated factors in patients hospitalized for trauma in the Intensive Care Unit. Method case-control study, with data from medical records of adults hospitalized for trauma in an Intensive Care Unit, between 2013 and 2019. Data were collected from the patient admission book, the electroni cmedical records and the records of the Hospital Infection Control Service. The dependent variable was the occurrence of chronic critical disease, and the independent variables were related to sociodemographic characteristics, comorbidities, trauma, pre-hospital care, prognostic indices, procedures and complications. Multiple logistic regression analysis was performed, which estimated the Ods Ratio (OR) and respective confidence intervals (CI). Results chronic critical disease occurred in 150 patients (24.2%), of the 619 patients studied. The factors associated with CCD were organic dysfunction (OR=1.09) and gastrointestinal complications (OR=2.71). Patients with chronic critical disease, in addition to proseeding for surgical procedures, developed organic dysfunctions in different systems, presenting high scores in prognostic indexes, i.e., a worse prognosis, in addition to developing complications. Conclusion the identification of gastrointestinal complications and the increase in organic dysfunction as factors associated with chronic critical patients become useful to compose the clinical profile of patients and to plan intensive care for the traumatized patients, thus contributing to the prevention and management of these patients by nurses.

Panorama of congenital syphilis in school hospital of the hospital of the South region of city of São Paulo

Introduction: Congenital syphilis is an infectious disease that has the etiological agent Treponema pallidum. Its transmission is vertical hematogenous, transplacental, of infected pregnant untreated or inadequately treated for its concept. It divides into two periods: early to the second year of life, and after the second year of life, late. Detection during prenatal care is performed by screening the third trimester of pregnancy with preterm labor, as early as in the maternity ward. The detection of Treponema pallidum through non-treponemal test (VDRL), presents little specificity, high sensitivity, low cost and fast negativation in response to the treatment avoiding that the concept is born with sequels. Thus, prenatal care is an important tool in the control of the disease, and it is necessary to improve care quality, since 70% of the mothers in Brazil are prenatal, not all of them are diagnosed or have the appropriate treatment of syphilis. Objective: To establish an epidemiological panorama of the incidence of Congenital Syphilis in the socioeconomic and cultural context in which the School Hospital of the Southern Region of the city of São Paulo is inserted. Patients and Methods: This is an individualized, observational, cross-sectional study carried out by means of a medical records survey of the Hospital Infection Control Service of Hospital Escola da Região Sul in the city of São Paulo. The survey of data referring to the form with questions of interest to the mother and the newborns diagnosed with Congenital Syphilis in the period from 2012 to 2016 was developed. This project was submitted and approved by the Ethics Committee of the Santo Amaro University - SP (Plataforma Brasil - CAAE: 68103317.6.3001.5447). Results: A total of 183 cases of Congenital Syphilis were registered in the Hospital Infection Control Service of the São Paulo School Hospital from 2012 to 2016, and among these, 126 medical records were reinforced. Prenatal performance (p = 0.0060), schooling (p = 0.5107) and schooling (p = 0.8603) did not influence disease screening by showing insignificant statistical data. Success occurred with companion treatment (p = 0.0451), which showed the highest incidence in 2014 (48.1%) and 2016 (58.3) when compared to the others. Conclusion: In the presented scenario, it was verified that although prenatal and maternal treatment were performed, they were inefficient to prevent pregnant women from transmitting the disease. This is probably related to the inefficiency of the treatment of the companions, who although in the year 2014 and 2016 presented a higher incidence of accomplishment, coincided with the increase of notifications in those same years. There were no statistically significant differences in relation to other factores, a fact that causes concern in the field of Public Health.

Adesão à higienização das mãos dos profissionais da saúde em unidade de terapia intensiva neonatal

OBJETIVO: Avaliar a adesão dos profissionais de saúde quanto à higienização das mãos em um serviço de Terapia Intensiva Neonatal. MÉTODO: Trata-se de uma pesquisa seccional, realizada por meio de um checklist utilizado pelo Serviço de Controle de Infecções Hospitalares para verificar a adesão das equipes multidisciplinares à higienização das mãos. A coleta ocorreu na unidade de Terapia Intensiva Neonatal, em todos os turnos de trabalho. Foram contabilizadas 1096 observações, analisadas sob estatística descritiva. RESULTADOS: A taxa de adesão foi de 55,4%, destas 83% com água e sabão e 17% por fricção com álcool. O momento de maior adesão com água e sabão foi antes e após o contato com o paciente; e a ação com álcool, antes do contato com o paciente. Os fonoaudiólogos obtiveram a taxa mais elevada de higienização das mãos (93,7%). CONCLUSÃO: Verificou-se baixa taxa de adesão pelos profissionais de saúde à HM, exceto os fonoaudiólogos, especialmente após risco de exposição a fluídos corporais.

Processo f chemical disifection of health products: review of the standard operating procedure and socialization with the nursing team

Objective: to review and socialize Standard Operating Procedure (SOP) on the process of disinfecting health products (PPS). Method: An experience report study of an intervention performed in a hospital in the Northwest region of the State of Rio Grande do Sul, in the second semester of 2018, with the participation of the nursing team of the Material and Sterilization Center (CME) and the nurse responsible for the Hospital Infection Control Service (SCIH). The activities took place after contact with the nurse responsible for the unit, who passed on the SOP to be reviewed, there was also the elaboration of a mural on high-level disinfection. Results: five nursing professionals and five academic students who interned at the location participated in the action. It was noticed that two important actions of the PPS disinfection process were not described in the CME POPs, which are: hand hygiene and the use of personal protective equipment (PPE). The team interacted through the exchange of ideas, a principle of permanent health education. Final considerations: The nurse must act as an educator seeking constant updating of his team and solutions for his practice. Finally, the execution of the project made it possible to review the SOPs and discuss with the unit's team and, in addition, it also showed the need for further studies in this area.

Impact of NHSN-CDC Mucosal Barrier Injury Surveillance on Central-Line–Associated Bloodstream Infection Rates in HSCT

Background: Bloodstream infection (BSI) is the most challenging conditions in patients who undergo hematopoietic stem cell transplantation (HSCT). These infections may be related to health care in cases of central-line–associated bloodstream infection (CLABSI) or to translocation secondary to mucosal barrier injury (MBI). In 2013, MBI surveillance was incorporated into the CDC NHSN. The aim was to increase the CLABSI diagnostic accuracy by proposing more effective preventive care measures. The objective of this study was to evaluate impact of the MBI surveillance on CLABSI incidence density in a Brazilian university hospital. Methods: The CLABSI incidence densities from the period before BMI surveillance (2007–2012) and the period after BMI surveillance was implemented (2013–2018) were analyzed and compared. Infections during the preintervention period were reclassified according to the MBI criterion to obtain an accurate CLABSI rate for the first period. The average incidence densities for the 2 periods were compared using the Student t test after testing for no autocorrelation (P &gt; .05). Results: After reclassification, the preintervention period incidence density (10 infections per 1,000 patient days) was significantly higher than the postintervention period incidence density (6 infections per 1,000 patients day; P = .011) (Table 1). Therefore, the reclassification of nonpreventable infections (MBI) in the surveillance system made the diagnosis of CLABSI more specific. The hospital infection control service was able to introduce specific preventive measures related to the insertion and management of central lines in HSCT patient care. Conclusions: The MBI classification improved the CLABSI diagnosis, which upgraded central-line prevention measures, then contributed to the decrease of CLABSI rates in this high-risk population.Funding: NoneDisclosures: None

Surgical Site Infection Prevention: An Analysis of Compliance With Good Practice in Large Hospitals

Background: Surgical site infection (SSI) is considered one of the most frequent adverse events globally. One of the strategies to mitigate its occurrence was proposed by the WHO in 2008 as part of the Safe Surgery Saves Lives program to reduce the rate of SSI by 25% by 2020. Objectives: To evaluate adherence to SSI prevention and control actions in large hospitals using a score. Methods: This cross-sectional study was conducted in 30 hospitals in Minas Gerais, Brazil, from February 2018 to April 2019. Data collection was performed through interviews with the coordinator of the hospital infection control service (HICS), situational diagnoses, and observation of a surgical procedures at the time of the visit. Data were analyzed using SPSS software. The variables were described using descriptive statistics. The project was approved by the Research Ethics Committee of the Federal University of Minas Gerais (COEP/UFMG) (CAAE: 30782614.3.00005149). A score was determined to identify the degree of compliance of institutions to SSI prevention practices. Results: In 93.3% of the HICSs, routines or protocols for the use of prophylactic antibiotic in surgery and compliance audits were mentioned, 69% reported hair removal with a clipper. SSI surveillance occurred in all institutions; however, only 63.3% disclosed SSI rates. In the situational observations, 60% of the professionals performed hand antisepsis within 3–5 minutes. Most frequently, hair removal was performed inside the operating room in 76.7% of the observed procedures and an electric clipper was used 56.7% of the time. In the surgery audit, prophylactic antimicrobial administration occurred between 30 and 60 minutes before surgical incision in only 63.3% of the observed procedures. The traffic in the operation room was limited to the necessary minimum in only 53.3% of observed procedures and unnecessary opening of the doors occurred in 76.7% of the observations. Patient temperature was not monitored in 70% of the audited procedures. Conclusions: According to the proposed score, 1 of the institutions (3.3%) complied with SSI prevention and control measures sufficiently; 25 complied partially (83.3%); and 4 (13.3%) demonstrated poor compliance.Funding: NoneDisclosures: None

Caracterização das infecções relacionadas à assistência à saúde em um hospital de ensino

Justificativa e Objetivos: Caracterizar as principais Infecções Relacionadas à Assistência à Saúde (IRAS) de um hospital público de ensino. Métodos: Estudo epidemiológico, descritivo, retrospectivo, transversal e quantitativo realizado por meio de análise de documentos internos do Serviço de Controle de Infecção Hospitalar (SCIH) referente às infecções de corrente sanguínea, infecções de sítio cirúrgico e pneumonia hospitalar identificadas em pacientes admitidos na instituição entre maio 2017 e maio 2018. Resultados: Foram notificados 846 casos de IRAS no período do estudo. Deste total, foram analisados 582 prontuários, dos quais 298 (51,21%) do sexo masculino e 284 (48,79%) do sexo feminino. Dentre as infecções mais prevalentes, 197 (23,28%) eram do sítio cirúrgico, 183 (21,63%) de pneumonia associada a ventilação mecânica e 164 (19,38%) eram infecção primária de corrente sanguínea. Os microrganismos predominantes encontrados após análise microbiológica foram: Acinetobacter spp. em 33 (21%) infecções, seguido do gênero Pseudomonas spp. em 30 (19,1%) e Enterobacter spp. em 17 (10,8%). As especialidades médicas com maior prevalência de IRAS, foram a neurologia com 218 (25,76%) infecções, clínica geral com 157 (18,55%) e pediatria com 154 (18,20%). Conclusão: As infecções de sitio cirúrgico, pneumonia associada a ventilação mecânica e infecção primária de corrente sanguínea foram prevalentes. O apoio laboratorial foi um grande aliado na identificação do microrganismo patogênico, e os de maior incidência nas IRAS foram Acinetobacter spp., Pseudomonas spp. e Enterobacter spp. com. Na análise por especialidade, a neurologia teve significativa predominância nas infecções relacionadas a assistência.

Implementation of enteral feeding protocol in an intensive care unit: Before-and-after study.

AIMTo determine the effects of implementing an enteral feeding protocol on the nutritional delivery and outcomes of intensive care patients.METHODSAn uncontrolled, observational before-and-after study was performed in a tertiary mixed medical-surgical intensive care unit (ICU). In 2013, a nurse-driven enteral feeding protocol was developed and implemented in the ICU. Nutrition and outcome-related data from patients who were treated in the study unit from 2011-2012 (the Before group) and 2014-2015 (the After group) were obtained from a local electronic database, the national Population Registry and the hospital’s Infection Control Service. Data from adult patients, readmissions excluded, who were treated for at least 7 d in the study unit were analysed.RESULTSIn total, 231 patients were enrolled in the Before and 249 in the After group. The groups were comparable regarding demographics, patient profile, and severity of illness. Fewer patients were mechanically ventilated on admission in the After group (86.7% vs 93.1% in the Before group, P = 0.021). The prevalence of hospital-acquired infections, length of ICU stay and ICU, 30- and 60-d mortality did not differ between the groups. Patients in the After group had a lower 90-d (P = 0.026) and 120-d (P = 0.033) mortality. In the After group, enteral nutrition was prescribed less frequently (P = 0.039) on day 1 but significantly more frequently on all days from day 3. Implementation of the feeding protocol resulted in a higher cumulative amount of enterally (P = 0.049) and a lower cumulative amount of parenterally (P < 0.001) provided calories by day 7, with an overall reduction in caloric provision (P < 0.001). The prevalence of gastrointestinal symptoms was comparable in both groups, as was the frequency of prokinetic use. Underfeeding (total calories < 80% of caloric needs, independent of route) was observed in 59.4% of the study days Before vs 76.9% After (P < 0.001). Inclusion in the Before group, previous abdominal surgery, intra-abdominal hypertension and the sum of gastrointestinal symptoms were found to be independent predictors of insufficient enteral nutrition.CONCLUSIONThe use of a nurse-driven feeding protocol improves the delivery of enteral nutrition in ICU patients without concomitant increases in gastrointestinal symptoms or intra-abdominal hypertension.

Adherence to the five moments for hand hygiene among intensive care professionals

To identify the adherence of health professionals of an intensive care unit to the five moments for hand hygiene. Cross-sectional analytical study with a quantitative approach, based on secondary data from a database of a hospital infection control service at an institution in southern Brazil. A total of 793 observations were analyzed from July to December 2012. Hand washing was not performed in 446 (56.2%) of the observations, and the adherence rate was 43.7%. The greatest adherence to hand hygiene was among the physiotherapists (53.5%) and the lowest adherence was among the nursing staff (29.2%). The indications with the lowest adherence rates to hand hygiene were "before touching the patient" (18.4%) and "before aseptic procedure" (20.9%). We conclude that adherence to hand washing does not comply with the national and international guidelines, especially when we consider the current scenario of growing infections caused by multidrug-resistant microorganisms.

Infecciones asociadas a la atención de salud en un Hospital de Oncología: el análisis de cinco años

Retrospective epidemiological study, carried out in 2009, to analyze healthcare-associated infection rates in cancer patients, according to infection site, lethality and data were collected from records filed at the institution’s Hospital Infection Control Service (SCIH), between 2004 and 2008. The project was submitted and approved by the Research Ethics Committee. Regarding the healthcare infection rate, it was observed that 8.24% (5,821) of episodes occurred during the period. These rates ranged from 6.51% (1,017) in 2004 to 10.82% (1,790) in 2007, with a standard deviation of ± 1.91. Regarding the number of patients with infection, a rate of 5.75% (4.064) was found, ranging from 4.89% (765) in 2004 to 7.47% (1,237) in 2007. The most affected sites were surgical site (26.11%), bloodstream (24.11%) and respiratory tract (18.50%). Infection associated lethality and mortality rates corresponded to 23.86% and 1.37% of deaths, respectively. The multiple factors involved in this process need to be assessed, so that the institution can develop infection prevention and control strategies and can intervene timely.

Errors in Administrative-Reported Ventilator-Associated Pneumonia Rates: Are Never Events Really So?

Ventilator-associated pneumonia (VAP) is a common problem in an intensive care unit (ICU), although the incidence is not well established. This study aims to compare the VAP incidence as determined by the treating surgical intensivist with that detected by the hospital Infection Control Service (ICS). Trauma and surgical patients admitted to the surgical critical care service were prospectively evaluated for VAP during a 5-month time period. Collected data included the surgical intensivist's clinical VAP (SIS-VAP) assessment using Centers for Disease Control and Prevention (CDC) VAP criteria. As part of the hospital's VAP surveillance program, these patients' medical records were also reviewed by the ICS for VAP (ICS-VAP) using the same CDC VAP criteria. All patients suspected of having VAP underwent bronchioalveolar lavage (BAL). The SIS-VAP and ICS-VAP were then compared with BAL-VAP. Three hundred twenty-nine patients were admitted to the ICU during the study period. One hundred thirty-three were intubated longer than 48 hours and comprised our study population. Sixty-two patients underwent BAL evaluation for the presence of VAP on 89 occasions. SIS-VAP was diagnosed in 38 (28.5%) patients. ICS-VAP was identified in 11 (8.3%) patients (P < 0.001). The incidence of VAP by BAL criteria was 23.3 per cent. When compared with BAL, SIS-VAP had 61.3 per cent sensitivity and ICS-VAP had 29 per cent sensitivity. VAP rates reported by hospital administrative sources are significantly less accurate than physician-reported rates and dramatically underestimate the incidence of VAP. Proclaiming VAP as a never event for critically ill for surgical and trauma patients appears to be a fallacy.

Nosocomial infections in human immunodeficiency virus type 1 (HIV-1) infected and AIDS patients: major microorganisms and immunological profile.

Antiretroviral therapy advances have proportioned to AIDS patients a survival increase. At the same time, the permanence of the seropositive people in the nosocomial environment becomes common not only by the adverse reactions caused by this therapy, but also by several opportunistic diseases that take them into and out of hospital environment. During the hospital permanence, the patients expose their impaired immune system to the nosocomial virulent microorganisms, and acquire destructive nosocomial infections that sometimes can be lethal. Among several hospital syndromes described, little is known about infections in immunocompromised patients and how their immune system is able to determine the course of the infection. The objective of this study was to describe the major microorganisms involved in the nosocomial infections of HIV-1 seropositive patients associated with their immunological status. The survey was carried out with the Hospital Infection Control Service records, from University Hospital, Londrina, Paraná, Southern of Brazil, during the period from July 2003 to July 2004. From all the cases studied (n=969), 24 patients (2.5%) had AIDS diagnosis and a half of them was women with the mean of CD4+ T cells counts of 158/mm3. The main topography of the infection was pulmonary (50.0%) and the main isolated microorganisms were Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli. A major incidence of infection was observed in patients with CD4+ T cells counts lower than 50/mm3. The study of the relationship between the impairment of the immune system and infectious agents could provide a better healthcare of people living with HIV/AIDS and advances into the nosocomial infection control systems.

The nursing team’s knowledge of care for patients suspected of having or diagnosed with pulmonary tuberculosis – an exploratory study.

Nursing professionals at health care institutions should be prepared to suspect and identify cases of pulmonary tuberculosis at the earliest possible stage, in view of the risk of their contagion and consequent sickness. The prevention aspects should be valued in the performance of their activities, to the effect of remaining continuously attentive, to adopt safety measures that prevent the intra-hospital transmission of the disease. This study was aimed at identifying the knowledge of nursing team members of protective measures to be deployed in caring for adult patients suspected of having or diagnosed with pulmonary tuberculosis, confined in clinical-surgical and emergency units of a university hospital. This exploratory, transversal onsite study included 280 nursing professionals, comprising nurses (31-11.43%) and nursing assistants (249-88.57%). The material was gathered by applying a questionnaire with closed and open-ended questions. The material gathered was organized and the content analysis was used for the handling of data. The nursing professionals expressed their understanding of the disease and their knowledge of protective measures in the care of patients suspected of having or diagnosed with pulmonary tuberculosis. The study provided means of identifying the needs of nursing professionals focused on biosafety aspects in relation to the performance of their practice, permitting the formulation of subsidies for the continued education service and Hospital Infection Control Service of the Institution (SCIH).