Cristiana M. Toscano

Reprocessing and reuse of single-use medical devices used during hemodynamic procedures in Brazil: A widespread and largely overlooked problem

BACKGROUNDnSeveral medical devices used during hemodynamic procedures, particularly angiographic diagnostic and therapeutic cardiac catheters, are manufactured for single use only. However, reprocessing and reuse of these devices has been reported, to determine the frequency of reuse and reprocessing of single-use medical devices used during hemodynamic procedures in Brazil and to evaluate how reprocessing is performed.nnnDESIGNnNational survey, conducted from December 1999 to July 2001.nnnMETHODSnMost of the institutions affiliated with the Brazilian Society of Hemodynamic and Interventional Cardiology were surveyed by use of a questionnaire sent in the mail.nnnRESULTSnThe questionnaire response rate was 50% (119 of 240 institutions). Of the 119 institutions that responded, 116 (97%) reported reuse of single-use devices used during hemodynamic procedures, and only 26 (22%) reported use of a standardized reprocessing protocol. Cleaning, flushing, rinsing, drying, sterilizing and packaging methods varied greatly and were mostly inadequate. Criteria for discarding reused devices varied widely. Of the 119 institutions that responded, 80 (67%) reported having a surveillance system for adverse events associated with the reuse of medical devices, although most of these institutions did not routinely review the data, and only 38 (32%) described a training program for the personnel who reprocessed single-use devices.nnnCONCLUSIONSnThe reuse of single-use devices used during hemodynamic procedures was very frequent in hospitals in Brazil. Basic guidance on how to reuse and reprocess single-use medical devices is urgently needed, because, despite the lack of studies to support reusing and reprocessing single-use medical devices, such devices are necessary in limited-resource areas in which these practices are current.

Sexually transmitted diseases in Latin America and the Caribbean

Las enfermedades de transmision sexual (ETS) constituyen un problema de salud publica con importantes consecuencias y secuelas que incluyen la enfermedad inflamatoria pelvica, la infertilidad, el carcinoma cervical y los desenlaces adversos del embarazo. En la ultima decada, la estrecha asociacion entre la presencia de ETS y el aumento del riesgo de transmision sexual del virus de la inmunodeficiencia humana ha renovado el interes por la prevencion y control de las ETS. Sin embargo, en America Latina y el Caribe, la informacion epidemiologica sobre la magnitud del problema de las ETS es escasa y, en general, esta limitada a un pequeno numero de estudios y a datos oficiales incompletos de los paises de la zona. Tras una cuidadosa revision de la literatura y un analisis de los datos que posee la Organizacion Mundial de la Salud sobre cada pais, hemos estimado la prevalencia e incidencia en America Latina y el Caribe de cuatro ETS curables (sifilis, gonorrea, infeccion por clamidias y tricomoniasis) en hombres y mujeres de 15 a 49 anos de edad. Para ello se utilizaron parametros tales como la duracion de la infeccion, la estimacion de los pacientes tratados frente a los no tratados y los datos de poblacion. En 1996, el numero estimado de casos en America Latina y el Caribe fue de 1,3 millones para la sifilis, de 7,1 millones para la gonorrea, de 10,0 millones para las infecciones clamidiales y de 17,7 millones para la tricomoniasis. Con una cifra estimada total que, en el mejor de los casos, es superior a 36 millones de casos anuales, las ETS tratables parecen constituir un importante problema de salud publica en la zona.

Cost-effectiveness of sick leave policies for health care workers with influenza-like illness, Brazil, 2009.

TOC Summary: Seven-day leave was more costly and no more effective than 2 days plus reevaluation.

Gram-negative bloodstream infections in hematopoietic stem cell transplant patients: the roles of needleless device use, bathing practices, and catheter care.

BACKGROUNDnBetween August 1 and October 30, 1998 (outbreak period), an increased incidence of central venous catheter (CVC)-associated gram-negative bacterial bloodstream infection (GN-BSI) was detected in hematopoietic stem cell transplantation (HSCT) candidates and recipients in an outpatient HSCT unit. The objectives of the present study were to determine strategies for controlling the outbreak and identify risk factors for GN-BSI.nnnMETHODSnTwo case-control studies, an assessment of infection control practices, microbiologic studies, and water quality analysis were conducted. A case was defined as any outpatient with a CVC and a primary GN-BSI during the outbreak period.nnnRESULTSnAll of the 31 case patients identified had needleless intravenous (IV) access devices. Independent risk factors for CVC-associated GN-BSI were self-administered IV infusion (odds ratio [OR] = 6.2; P = .02), lower frequency of needleless device changes (OR = 15.2; P = .03), and more frequent baths (OR = 1.4; P = .05). Interventions included increased frequency of needleless device change, recommending showers rather than baths, and use of CVC protection during showering/bathing. After these interventions, the CVC-associated GN-BSI rate declined to below the preoutbreak period rate (2.1/1000 vs 0.3/1000 CVC-days; P < .01).nnnCONCLUSIONSnThis study demonstrated an increased risk of CVC-associated GN-BSIs related to self-IV infusion, bathing habits, and frequency of needleless device change. Infection control practices associated with the use of needleless devices may expose susceptible patients to increased risk for BSI.

Improving hand hygiene adherence in an endoscopy unit.

BACKGROUND AND STUDY AIMSnAlthough hand hygiene is the most important measure in preventing infection transmission in healthcare settings, adherence to recommendations among healthcare workers is low. We implemented and assessed the impact of a World Health Organization-recommended educational intervention to improve hand hygiene adherence at the endoscopy unit of a Brazilian tertiary hospital.nnnPATIENTS AND METHODSnHand hygiene adherence and techniques used by healthcare workers of the endoscopy unit in the course of their duties were observed unobtrusively by four nurses from the infection control unit. Data were collected at every opportunity for hand hygiene. Evaluations were carried out before and 1 and 10 months after an educational intervention. The intervention consisted of task-orientated training sessions, with live demonstrations of the multitude of opportunities for hand hygiene and the appropriate techniques. In addition to assessing hand hygiene practices, we also evaluated staff knowledge through standardized questionnaires administered before and after the education intervention. Adherence was defined as hand hygiene/disinfection at an opportunity for hand hygiene.nnnRESULTSnAdherence improved from 21.4 % before the intervention to 63.3 % 1 month and 73.5 % 10 months after the educational intervention. Correct answers to the questionnaire were 82.1 % on pre-intervention test and 85.7 % on post-intervention test.nnnCONCLUSIONnHand hygiene rates were low before the education intervention and improved significantly after it. Against expectations, adherence to hand hygiene practices had increased further at 10 months after the intervention, reinforcing the interventions positive impact.

Colonization pressure as a risk factor for colonization by multiresistant Acinetobacter spp and carbapenem-resistant Pseudomonas aeruginosa in an intensive care unit

OBJECTIVE: To determine factors associated with colonization by carbapenem-resistant Pseudomonas aeruginosa and multiresistant Acinetobacter spp. METHODS: Surveillance cultures were collected from patients admitted to the intensive care unit at admission, on the third day after admission and weekly until discharge. The outcome was colonization by these pathogens. Two interventions were implemented: education and the introduction of alcohol rubs. Compliance with hand hygiene, colonization pressure, colonization at admission and risk factors for colonization were evaluated. RESULTS: The probability of becoming colonized increased during the study. The incidence density of colonization by carbapenem-resistant P. aeruginosa and multiresistant Acinetobacter spp. and colonization pressure were different between periods, increasing gradually throughout the study. The increase in colonization pressure was due to patients already colonized at admission. The APACHE II score, colonization pressure in the week before the outcome and male gender were independent risk factors for colonization. Every 1% increase in colonization pressure led to a 2% increase in the risk of being colonized. CONCLUSION: Colonization pressure is a risk factor for carbapenem-resistant P. aeruginosa and multiresistant Acinetobacter spp. colonization. When this pressure reaches critical levels, efforts primarily aimed at hand hygiene may not be sufficient to prevent transmission.