Carlos Ernesto Ferreira Starling

Prevalence of nosocomial infections in general hospitals in Belo Horizonte

OBJECTIVE To assess the magnitude of nosocomial infections (NI) in general hospitals of Belo Horizonte. DESIGN Multicenter point-prevalence study of nosocomial infections. SETTING All of the 11 general hospitals of Belo Horizonte that have more than 20 beds, from August 27 to October 5, 1992. RESULTS Of the 2,339 patients surveyed, 267 patients had 328 nosocomial infections. The global prevalence rate of NI was 14.0%, ranging from 4.6% to 27.3% in the hospitals surveyed. The most prevalent infections were found to be pneumonia and surgical-wound infections, representing 19.5% and 19.2%, respectively, of the total infections. The highest prevalence rates of NI were observed in the cardiac surgery (31.9%), pediatric (27.2%), and orthopedic (20.7%) services. The most frequently isolated microorganisms were Staphylococcus aureus, Escherichia coli, Pseudomonas species, and Klebsiella species. CONCLUSION The study allowed a thorough evaluation of the NI distribution profile in Belo Horizonte, Minas Gerais, Brazil, and showed it to be a serious public health problem that requires interinstitutional efforts so that effective action can be taken.

Are there regional variations in the diagnosis surveillance, and control of methicillin-resistant Staphylococcus aureus?

OBJECTIVE To assess the way healthcare facilities (HCFs) diagnose, survey, and control methicillin-resistant Staphylococcus aureus (MRSA). DESIGN Questionnaire. SETTING Ninety HCFs in 30 countries. RESULTS Evaluation of susceptibility testing methods showed that 8 laboratories (9%) used oxacillin disks with antimicrobial content different from the one recommended, 12 (13%) did not determine MRSA susceptibility to vancomycin, and 4 (4.5%) reported instances of isolation of vancomycin-resistant S. aureus but neither confirmed this resistance nor alerted public health authorities. A MRSA control program was reported by 55 (61.1%) of the HCFs. The following isolation precautions were routinely used: hospitalization in a private room (34.4%), wearing of gloves (62.2%), wearing of gowns (44.4%), hand washing by healthcare workers (53.3%), use of an isolation sign on the patients door (43%), or all four. When the characteristics of HCFs with low incidence rates (< 0.4 per 1,000 patient-days) were compared with those of HCFs with high incidence rates (> or = 0.4 per 1,000 patient-days), having a higher mean number of beds per infection control nurse was the only factor significantly associated with HCFs with high incidence rates (834 vs 318 beds; P = .02). CONCLUSION Our results emphasize the urgent need to strengthen the microbiologic and epidemiologic capacities of HCFs worldwide to prevent MRSA transmission and to prepare them to address the possible emergence of vancomycin-resistant S. aureus.

Fatores preditores da mortalidade hospitalar e de complicações per-operatórias graves em cirurgia de revascularização do miocárdio

OBJECTIVE To investigate preoperative predictive factors of severe perioperative intercurrent events and in-hospital mortality in coronary artery bypass graft (CABG) surgery and to develop specific models of risk prediction for these events, mainly those that can undergo changes in the preoperative period. METHODS We prospectively studied 453 patients who had undergone CABG. Factors independently associated with the events of interest were determined with multiple logistic regression and Cox proportional hazards regression model. RESULTS The mortality rate was 11.3% (51/453), and 21.2% of the patients had 1 or more perioperative intercurrent events. In the final model, the following variables remained associated with the risk of intercurrent events: age > or = 70 years, female sex, hospitalization via SUS (Sistema nico de Sa de - the Brazilian public health system), cardiogenic shock, ischemia, and dependence on dialysis. Using multiple logistic regression for in-hospital mortality, the following variables participated in the model of risk prediction: age > or = 70 years, female sex, hospitalization via SUS, diabetes, renal dysfunction, and cardiogenic shock. According to the Cox regression model for death within the 7 days following surgery, the following variables remained associated with mortality: age > or = 70 years, female sex, cardiogenic shock, and hospitalization via SUS. CONCLUSION The aspects linked to the structure of the Brazilian health system, such as factors of great impact on the results obtained, indicate that the events investigated also depend on factors that do not relate to the patients intrinsic condition.

Applicability of the national nosocomial infections surveillance system risk index for the prediction of surgical site infections: a review

This review outlines the evolution of risk rates of surgical site infection adopted by the Study on the Efficacy of Nosocomial Infection Control (SENIC) and the National Nosocomial Infections Surveillance (NNIS) system, and evaluates their advantages and limitations. The types of surgical procedures for which the NNIS index has proven to be an efficient system for the classification of patients are presented. The necessity of adapting the NNIS index to take into account specific characteristics associated with hospitals and practices in various regions and countries is stressed. The requirement for further testing and development of the rate concerning specific procedures, particularly those involving orthopaedic surgery, is discussed.

Surgical site infection in patients submitted to orthopedic surgery: the NNIS risk index and risk prediction

UNLABELLED The applicability of the risk index for surgical site infection of the National Nosocomial Infection Surveillance (NNIS) has been evaluated for its performance in different surgeries. In some procedures, it is necessary to include other variables to predict. OBJECTIVE to evaluate the applicability of the NNIS index for prediction of surgical site infection in orthopedic surgeries and to propose an alternative index. The study involved a historical cohort of 8236 patients who had been submitted to orthopaedic surgery. Statistical analysis was performed using multivariate logistic regression to fit the model. The incidence of infection was 1.41%. Prediction models were evaluated and compared to the NNIS index. The proposed model was not considered a good predictor of infection, despite moderately stratified orthopedic surgical patients in at least three of the four scores. The alternative model scored higher than the NNIS models in the prediction of infection.La aplicabilidad del Indice de Riesgo de Infeccion Quirurgica del National Nosocomial Infection Surveillance-NNIS ha sido evaluada en cuanto a su desempeno en diferentes cirugias. En algunos procedimientos es necesaria la inclusion de otras variables de prediccion. El objetivo de este estudio fue evaluar la aplicabilidad del Indice NNIS para la prediccion de la Infeccion de Sitio Quirurgico en cirugias ortopedicas y proponer un indice alternativo. Se realizo un estudio de cohorte historica en 8.236 pacientes sometidos a cirugias ortopedicas. Se utilizo el modelo logistico multivariado para ajustar el modelo. La incidencia de infeccion fue 1,41%. Modelos de prediccion fueron evaluados y comparados al Indice NNIS. El modelo propuesto fue aquel que presento mayor precision en clasificar pacientes con y sin infeccion. El Indice NNIS no fue considerado un buen factor de prediccion de la infeccion, a pesar de haber estratificado moderadamente a los pacientes quirurgicos ortopedicos en por el menos tres de los cuatro puntajes. El modelo alternativo fue superior al modelo NNIS en la prediccion de infeccion.

Pediatric mortality due to nosocomial infection: a critical approach

Nosocomial infection is a frequent event with potentially lethal consequences. We reviewed the literature on the predictive factors for mortality related to nosocomial infection in pediatric medicine. Electronic searches in English, Spanish and Portuguese of the PubMed/MEDLINE, LILACS and Cochrane Collaboration Databases was performed, focusing on studies that had been published from 1996 to 2006. The key words were: nosocomial infection and mortality and pediatrics/neonate/ newborn/child/infant/adolescent. The risk factors found to be associated with mortality were: nosocomial infection itself, leukemia, lymphopenia, neutropenia, corticosteroid therapy, multiple organ failure, previous antimicrobial therapy, catheter use duration, candidemia, cancer, bacteremia, age over 60, invasive procedures, mechanical ventilation, transport out of the pediatric intensive care unit, methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, and Burkholderia cepacia infections, acute physiology and chronic health evaluation (APACHE) II scores over 15. Among these factors, the only one that can be minimized is inadequate antimicrobial treatment, which has proven to be an important contributor to hospital mortality in critically-ill patients. There is room for further prognosis research on this matter to determine local differences. Such research requires appropriate epidemiological design and statistical analysis so that pediatric death due to nosocomial infection can be reduced and health care quality improved in pediatric hospitals.

Nosocomial infections in brazilian pediatric patients: using a decision tree to identify high mortality groups

Nosocomial infections (NI) are frequent events with potentially lethal outcomes. We identified predictive factors for mortality related to NI and developed an algorithm for predicting that risk in order to improve hospital epidemiology and healthcare quality programs. We made a prospective cohort NI surveillance of all acute-care patients according to the National Nosocomial Infections Surveillance System guidelines since 1992, applying the Centers for Disease Control and Prevention 1988 definitions adapted to a Brazilian pediatric hospital. Thirty-eight deaths considered to be related to NI were analyzed as the outcome variable for 754 patients with NI, whose survival time was taken into consideration. The predictive factors for mortality related to NI (p < 0.05 in the Cox regression model) were: invasive procedures and use of two or more antibiotics. The mean survival time was significantly shorter (p < 0.05 with the Kaplan-Meier method) for patients who suffered invasive procedures and for those who received two or more antibiotics. Applying a tree-structured survival analysis (TSSA), two groups with high mortality rates were identified: one group with time from admission to the first NI less than 11 days, received two or more antibiotics and suffered invasive procedures; the other group had the first NI between 12 and 22 days after admission and was subjected to invasive procedures. The possible modifiable factors to prevent mortality involve invasive devices and antibiotics. The TSSA approach is helpful to identify combinations of predictors and to guide protective actions to be taken in continuous-quality-improvement programs.

Improving Water Quality Can Reduce Pyrogenic Reactions Associated With Reuse of Cardiac Catheters

OBJECTIVE To report the results of our preintervention investigation and subsequent 19-month three-phase intervention study designed to reduce pyrogenic reactions among patients undergoing cardiac catheterization using reprocessed catheters. DESIGN A case-control study for the preintervention period and a prospective cohort study for the intervention period. SETTING A 400-bed hospital in Belo Horizonte, Brazil. PARTICIPANTS Any patient undergoing cardiac catheterization in the hospital. INTERVENTIONS Three intervention phases were implemented to improve the quality of the water supplied to the cardiac catheter reprocessing laboratory. Standard operating procedures for reprocessing cardiac catheters were established and reprocessing staff were trained and educated. RESULTS The rate of pyrogenic reactions decreased significantly during the intervention phases, from 12.8% (159 of 1,239) in phase 1 to 5.3% (38 of 712) in phase 2 to 0.5% (4 of 769) in phase 3 (chi-square test for linear trend, 97.5; P < .001). CONCLUSION Improving water quality and using standard operating procedures for reprocessing catheters can prevent pyrogenic reactions in hospitalized patients.

Using Ozires, a Humanoid Robot, to Continuing Education of Healthcare Workers: A Pilot Study.

Continuing education of health professionals in relation to hand hygiene practices or other issues is a challenge for health services. How to take a healthcare worker from his work sector, for example, Intensive Care Units (ICUs) or Operating Room, to give him classes and lectures? Here we investigated whether or not it is possible to adapt a toy robot as a tool to continuous education of healthcare workers in the context of hand hygiene compliance, a big problem for hospital infection. We got to adapt the MeccaNoid G15KS, a toy programmable robot named Ozires, as an instrument of health training to improve the compliance with hand hygiene. The robot was adapted with mini projector, spy camera, an automatic alcohol hand sanitizer dispenser, a cell phone and a cell phone support and an audio amplifier. Ozires, accompanied by infection control practitioners, performs short video-lecture presentations and own reports of the institutions data regarding infections and the hand hygiene rate, working from 10 to 15 minutes in each target sector. After the insertion of Ozires in three ICUs, the hand hygiene rate increased from about 36%, between January and July, to 65% in August-November/2016.

Infección de sitio quirúrgico en pacientes sometidos a cirugías ortopédicas: el índice de riesgo NNIS y la predicción de riesgo

UNLABELLED The applicability of the risk index for surgical site infection of the National Nosocomial Infection Surveillance (NNIS) has been evaluated for its performance in different surgeries. In some procedures, it is necessary to include other variables to predict. OBJECTIVE to evaluate the applicability of the NNIS index for prediction of surgical site infection in orthopedic surgeries and to propose an alternative index. The study involved a historical cohort of 8236 patients who had been submitted to orthopaedic surgery. Statistical analysis was performed using multivariate logistic regression to fit the model. The incidence of infection was 1.41%. Prediction models were evaluated and compared to the NNIS index. The proposed model was not considered a good predictor of infection, despite moderately stratified orthopedic surgical patients in at least three of the four scores. The alternative model scored higher than the NNIS models in the prediction of infection.La aplicabilidad del Indice de Riesgo de Infeccion Quirurgica del National Nosocomial Infection Surveillance-NNIS ha sido evaluada en cuanto a su desempeno en diferentes cirugias. En algunos procedimientos es necesaria la inclusion de otras variables de prediccion. El objetivo de este estudio fue evaluar la aplicabilidad del Indice NNIS para la prediccion de la Infeccion de Sitio Quirurgico en cirugias ortopedicas y proponer un indice alternativo. Se realizo un estudio de cohorte historica en 8.236 pacientes sometidos a cirugias ortopedicas. Se utilizo el modelo logistico multivariado para ajustar el modelo. La incidencia de infeccion fue 1,41%. Modelos de prediccion fueron evaluados y comparados al Indice NNIS. El modelo propuesto fue aquel que presento mayor precision en clasificar pacientes con y sin infeccion. El Indice NNIS no fue considerado un buen factor de prediccion de la infeccion, a pesar de haber estratificado moderadamente a los pacientes quirurgicos ortopedicos en por el menos tres de los cuatro puntajes. El modelo alternativo fue superior al modelo NNIS en la prediccion de infeccion.