Carmem L Pessoa-Silva

Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review.

Aerosol generating procedures (AGPs) may expose health care workers (HCWs) to pathogens causing acute respiratory infections (ARIs), but the risk of transmission of ARIs from AGPs is not fully known. We sought to determine the clinical evidence for the risk of transmission of ARIs to HCWs caring for patients undergoing AGPs compared with the risk of transmission to HCWs caring for patients not undergoing AGPs. We searched PubMed, EMBASE, MEDLINE, CINAHL, the Cochrane Library, University of York CRD databases, EuroScan, LILACS, Indian Medlars, Index Medicus for SE Asia, international health technology agencies and the Internet in all languages for articles from 01/01/1990 to 22/10/2010. Independent reviewers screened abstracts using pre-defined criteria, obtained full-text articles, selected relevant studies, and abstracted data. Disagreements were resolved by consensus. The outcome of interest was risk of ARI transmission. The quality of evidence was rated using the GRADE system. We identified 5 case-control and 5 retrospective cohort studies which evaluated transmission of SARS to HCWs. Procedures reported to present an increased risk of transmission included [n; pooled OR(95%CI)] tracheal intubation [n = 4 cohort; 6.6 (2.3, 18.9), and n = 4 case-control; 6.6 (4.1, 10.6)], non-invasive ventilation [n = 2 cohort; OR 3.1(1.4, 6.8)], tracheotomy [n = 1 case-control; 4.2 (1.5, 11.5)] and manual ventilation before intubation [n = 1 cohort; OR 2.8 (1.3, 6.4)]. Other intubation associated procedures, endotracheal aspiration, suction of body fluids, bronchoscopy, nebulizer treatment, administration of O2, high flow O2, manipulation of O2 mask or BiPAP mask, defibrillation, chest compressions, insertion of nasogastric tube, and collection of sputum were not significant. Our findings suggest that some procedures potentially capable of generating aerosols have been associated with increased risk of SARS transmission to HCWs or were a risk factor for transmission, with the most consistent association across multiple studies identified with tracheal intubation.

Use of peripherally inserted central catheters to prevent catheter-associated bloodstream infection in children.

Infection in Children • Author(s): E. Goes‐Silva, RN, MSc; T. F. Abreu, MD, PhD; A. C. C. Frota, MD, MSc; C. L. Pessoa‐ Silva, MD, PhD; A. J. L. A. Cunha, MD, PhD; C. B. Hofer, MD, PhD Source: Infection Control and Hospital Epidemiology, Vol. 30, No. 10 (October 2009), pp. 10241026 Published by: The University of Chicago Press on behalf of The Society for Healthcare Epidemiology of America Stable URL: http://www.jstor.org/stable/10.1086/606040 . Accessed: 16/05/2014 11:37

Infection prevention and control of the Ebola outbreak in Liberia, 2014–2015: key challenges and successes

Prior to the 2014–2015 Ebola outbreak, infection prevention and control (IPC) activities in Liberian healthcare facilities were basic. There was no national IPC guidance, nor dedicated staff at any level of government or healthcare facility (HCF) to ensure the implementation of best practices. Efforts to improve IPC early in the outbreak were ad hoc and messaging was inconsistent. In September 2014, at the height of the outbreak, the national IPC Task Force was established with a Ministry of Health (MoH) mandate to coordinate IPC response activities. A steering group of the Task Force, including representatives of the World Health Organization (WHO) and the United States Centers for Disease Control and Prevention (CDC), supported MoH leadership in implementing standardized messaging and IPC training for the health workforce. This structure, and the activities implemented under this structure, played a crucial role in the implementation of IPC practices and successful containment of the outbreak. Moving forward, a nationwide culture of IPC needs to be maintained through this governance structure in Liberia’s health system to prevent and respond to future outbreaks.

Nosocomial Transmission of Severe Acute Respiratory Syndrome: Better Quality of Evidence Is Needed

demiologic analysis and genotypic characterization of a nosocomial outbreak of vancomycin-resistant Enterococci. J Clin Microbiol 1993; 31:1280–5. 8. Carmeli Y, Eliopoulos GM, Samore MH. Antecedent treatment with different antibiotic agents as a risk factor for vancomycin-resistant Enterococcus. Emerg Infect Dis 2002; 8:802–7. 9. Donskey CJ, Chowdhry TK, Hecker MT, et al. Effect of antibiotic therapy on the density of vancomycin-resistant Enterococci in the stool of colonized patients. N Engl J Med 2000; 343: 1925–32. 10. Teasley DG, Gerding DN, Olson MM, et al. Prospective randomized trial of metronidazole versus vancomycin for Clostridium difficile–associated diarrhea and colitis. Lancet 1983; 2:1043–6. 11. Wenisch C, Parschalk B, Hasenhundl M, Hirschl AM, Graninger W. Comparison of vancomycin, teicoplanin, metronidazole, and fusidic acid for the treatment of Clostridium difficile–associated diarrhea. Clin Infect Dis 1996; 22:813–8.

Quality of antenatal care as a risk factor for early onset neonatal infections in Rio de Janeiro, Brazil

BACKGROUND Neonatal infection is a serious public health problem. The aim of this study was to assess the influence of the antenatal care on the risk of early-onset neonatal healthcare associated infection in two Brazilian maternities. METHODS Cohort study - Newborns admitted at two public neonatal intensive care units from 2008 to 2009 were included in the study. Data on antenatal and perinatal variables were collected from maternal prenatal cards and medical charts. Newborns were actively surveyed for early-onset neonatal healthcare associated infection, defined as a neonatal infection diagnosed within 48h after birth. Multiple logistic regression was used to assess variables independently associated with early-onset neonatal healthcare associated infection. RESULTS 561 neonate-mother pairs were included in the study. Early-onset neonatal healthcare associated infection was diagnosed in 283 neonates (51%), an incidence rate of 43.5/1000 live births. Neonates whose mothers had less then six antenatal visits were under risk significantly higher for early-onset neonatal healthcare associated infection (OR=1.69, 95% CI=1.11-2.57), after adjusting for birth weight, membranes ruptured for >18h, maternal complications during delivery, maternal infection at admission, and hospital where patients received care. CONCLUSIONS The risk of neonatal early-onset neonatal healthcare associated infection was significantly associated with insufficient number of antenatal care visits. Further studies assessing the quality of antenatal care and targeting its improvement are warranted.

Moving forward in tackling antimicrobial resistance: WHO actions

Although the key focus of this supplement is related to antimicrobial resistance (AMR) in a sexually transmitted infection, Neisseria gonorrhoeae, the purpose of this article is to highlight the wider public health impact of AMR and the need for different disciplines of health to coordinate and collaborate in their selection and use of antimicrobial agents. AMR is being detected in health areas ranging from simple drugs used to treat common bacterial infections to the complex formulations used to treat tuberculosis, malaria and HIV infection, and on all continents. Tackling and containing AMR present an ordeal to international and national health authorities on many fronts. In June 2012, WHO launched the WHO Global Action Plan to Control the Spread and Impact of Antimicrobial Resistance in Neisseria gonorrhoeae with a vision to enhance the global response to the prevention, diagnosis and control of N gonorrhoeae infection and mitigate the health impact of AMR through enhanced, sustained, evidence-based and collaborative multisectoral action. This global action plan is positioned within a long-standing commitment of WHO to the issue of AMR with the launch of the Global Strategy on AMR in 2001 and World Health Day on AMR in 2011.

Nosocomial Infection Among Children With Symptomatic Human Immunodeficiency Virus Infection

A prospective cohort study was conducted during a 15-month period to compare nosocomial infections (NIs) among pediatric patients without (n = 989 and with (n = 50) symptomatic human immunodeficiency virus (HIV) infection. Patients with symptomatic HIV infection presented higher overall NI incidence density rates (relative risk, 1.65; P= .0001), and may represent a population at high risk for the acquisition of NI.