Guilherme Augusto Armond

Risk factors and lethality of laboratory-confirmed bloodstream infection caused by non-skin contaminant pathogens in neonates

OBJECTIVE To evaluate risk factors and lethality of late onset laboratory-confirmed bloodstream infection (LCBI) in a Brazilian neonatal unit for progressive care (NUPC). METHODS This was a case-control study, performed from 2008 to 2012. Cases were defined as all newborns with late onset LCBI, excluding patients with isolated common skin contaminants. Controls were newborns who showed no evidence of late onset LCBI, matched by weight and time of permanence in the NUPC. Variables were obtained in the Hospital Infection Control Committee (HICC) database. Analysis was performed using the Statistical Package for the Social Sciences (SPSS). The chi-squared test was used, and statistical significance was defined as p < 0.05, followed by multivariate analysis. RESULTS 50 patients with late onset LCBI were matched with 100 patients without late onset LCBI. In the group of patients with late onset LCBI, a significant higher proportion of patients who underwent surgical procedures (p = 0.001) and who used central venous catheter (CVC) (p = 0.012) and mechanical ventilation (p = 0.001) was identified. In multivariate analysis, previous surgery and the use of CVC remained significantly associated with infection (p = 0.006 and p = 0.047; OR: 4.47 and 8.99, respectively). Enterobacteriacea was identified in 14 cases, with three (21.4%) deaths, and Staphylococcus aureus was identified in 20 cases, with three (15%) deaths. CONCLUSIONS Surgical procedures and CVC usage were significant risk factors for LCBI. Therefore, prevention practices for safe surgery and CVC insertion and manipulation are essential to reduce these infections, in addition to training and continuing education to surgical and assistance teams.

Infecções relacionadas à assistência a saúde baseada em critérios internacionais, realizada em unidade neonatal de cuidados progressivos de referência de Belo Horizonte, MG

OBJECTIVE To describe occurrence of Healthcare Related Infections in a neonatal unit of public reference service in Belo Horizonte-MG, based on international criteria. METHODS This is a descriptive study, performed by active searching, in the Progressive Care Unit Neonatal Hospital das Clinicas, Federal University of Minas Gerais (HC / UFMG), from 2008 to 2009. Notification of infections was based on National Healthcare Safety Network (NHSN) criteria. The database and analysis were performed in a internal program. RESULTS A total of 325 episodes of infection in newborns were notified and overall incidence density of infections was 22.8/1,000 patient-days, with a rate of 36.7% of newborns. Sepsis was the main infection (62.5%) reported. The incidence density of infections was higher in neonates weighing lower than 750g (42.4/1,000 patient-days). There were 18.15 episodes of central venous catheter related sepsis/1,000 central venous catheter-day and 19.29 umbilical catheter related sepsis /1,000 umbilical catheter-days. Microorganisms were isolated in 122 (37.5%) cases of reported infections, mainly defined as Staphylococcus coagulase negative and Staphylococcus aureus (51 cases). Mortality and lethality rates were 4.3% and 17,12%, respectively. CONCLUSION The use of standardized criteria for reporting infections is necessary for the construction of indicators in neonatology, which are scarce in the country and highlight the need for evaluation of national criteria proposed by National Agency of Sanitary Surveillance (ANVISA).

Evaluation of national health‐care related infection criteria for epidemiological surveillance in neonatology

OBJECTIVE to assess the use of the Brazilian criteria for reporting of hospital-acquired infections (HAIs) in the neonatal unit and compare them with the criteria proposed by the National Healthcare Safety Network (NHSN). METHODS this was a cross-sectional study conducted from 2009 to 2011. It included neonates with HAI reporting by at least one of the criteria. Statistical analysis included calculation of incidence density of HAIs, distribution by weight, and by reporting criterion. Analysis of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the national criteria was performed considering the NHSN as the gold standard, with agreement assessed by kappa. RESULTS a total of 882 newborns were followed, and 330 had at least one infection notified by at least one of the criteria. A total of 522 HAIs were reported, regardless of the criteria. An incidence density of 27.28 infections per 1,000 patient-days was observed, and the main topographies were sepsis (58.3%), candidiasis (15.1%), and conjunctivitis (6.5%). A total of 489 (93.7%) were notified by both criteria, eight infections were notified only by the national criteria (six cases of necrotizing enterocolitis and two cases of conjunctivitis), and 25 cases of clinical sepsis were reported by NHSN criteria only. The sensitivity, specificity, PPV, and NPV were 95.1%, 98.6%, 98.4%, and 95.7%, respectively, for all topographies, and were 91.8%, 100%, 100%, and 96.3% for the analysis of sepsis. Kappa analysis showed an agreement of 96.9%. CONCLUSION there was a high rate of agreement between the criteria. The use of the national criteria facilitates the reporting of sepsis in newborns, and can help to improve the specificity and PPV.

Notificação de infecções em unidade neonatal com critérios nacionais.

Justifi cativa e Objetivos: : O controle de infeccoes relacionadas a assistencia a saude em neonatos representa um desafi o e um sistema de vigilância ativa e essencial defi nir medidas preventivas. Este estudo tem como objetivo descrever as principais topografi as e indicadores de infeccoes relacionadas a assistencia a saude em Unidade Neonatal conforme os criterios de vigilância epidemiologica estabelecidos pela Agencia Nacional de Vigilância Sanitaria. Metodos: Trata-se estudo transversal, observacional, prospectivo, realizado de 2009 a 2010. Foram incluidos todos os pacientes sob risco e a notifi cacao de infeccoes seguiu os criterios recomendados pela Agencia Nacional de Vigilância Sanitaria. Analise estatistica, com calculo da densidade de incidencia de infeccoes, frequencia e percentual de microrganismos, mortalidade, letalidade e densidade de incidencia de infeccoes associadas a procedimentos invasivos. Resultados: Foram acompanhados 609 neonatos sob risco, totalizando 13.215 pacientes-dia no periodo. A densidade incidencia de infeccao foi de 26,3 por 1000 pacientes-dia, predominando infeccao de corrente sanguinea (58,8%). Em 116 (33,4%) casos de infeccoes notifi cadas, houve isolamento de microrganismo, predominando Staphylococcus coagulase negativo. Conclusao: Os principais indicadores de infeccoes e topografi as foram semelhantes a outros estudos conduzidos previamente. A defi nicao de parâmetros de vigilância epidemiologica de infeccoes relacionadas a assistencia a saude em nivel nacional e fundamental para o planejamento de acoes com o objetivo de prevenir estes agravos em populacoes suscetiveis como neonatos. Backgound and Objectives: Healthcare Associated Infections in neonates represent a challenge and an active surveillance system is essential to develop preventive measures. This study aims to describe the main sites and data of Healthcare Associated Infections according to the criteria defi ned by National Agency for Sanitary Surveillance at a reference Neonatal Unit. Methods: This is a prospective observational study conducted from 2009 to 2010. We included all patients at risk and notifi cation of infections followed criteria defi ned by Agencia Nacional de Vigilância Sanitaria. For Statistical analysis, we calculated the incidence density of Healthcare Associated Infections, frequency and percentage of microorganisms, mortality, and incidence density of deviceassociated infections. Results: This study followed 609 newborns, with 13,215 patient-days. Incidence density of infection was 26.3 per 1000 patient-days, predominantly bloodstream infection (58.8%). microorganisms were isolated, in 116 (33.4%) cases, predominantly coagulase negative Staphylococcus. Conclusion: The main sites and data of IRAS were similar to other previous studies. The defi nition of parameters for national surveillance of Healthcare Associated Infections is critical for planning actions in order to prevent these diseases in susceptible populations as neonates.

Educadores do controle de infecção: a presença da comunidade na prevenção e controle das infecções relacionadas à assistência a saúde

As Infeccoes Relacionadas a Assistencia a Saude (IRAS) representam uma preocupacao nao somente dos orgaos de saude, mas um problema de ordem social, etica e juridica em face as implicacoes na vida dos usuarios. Considerando a influencia do contexto social na prevencao das IRAS, foi instituido em 2007 pelo Servico de Controle de Infeccao Hospitalar (SCIH) do Hospital Sofia Feldman, instituicao filantropica de atencao a mulher e ao recem-nascido de Belo Horizonte, Minas Gerais, os “Educadores do Controle de Infeccao”. Este grupo composto por usuarios do Sistema Unico de Saude (SUS), membros do Conselho Local de Saude e da Associacao Comunitaria de Amigos e Usuarios do Hospital Sofia Feldman (ACAU/HSF), foi previamente capacitado pelos profissionais do SCIH. A formacao do grupo de “Educadores” foi possivel devido a participacao da comunidade no cotidiano da instituicao desde a sua fundacao. A formalizacao da ACAU – HSF foi em 1994, constituida por voluntarios da comunidade. Ja o Conselho Local de Saude foi instituido em 2006 e conta com a participacao de trabalhadores, usuarios e gestores.