Isa Rodrigues da Silveira

Outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in an intermediate-risk neonatal unit linked to onychomycosis in a healthcare worker.

OBJECTIVE To describe an outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in an intermediate-risk neonatal unit. METHODS After the identification of the first cases, the situation was regarded as an outbreak, and basic preventive measures against nosocomial infections were strictly enforced, and possible sources of dissemination were investigated. RESULTS The outbreak lasted for 6 months and affected 36 newborn infants, causing seven infections and 29 colonizations. In the first stage of the outbreak, patients developed infection, but in the second stage, they were asymptomatic and were only identified by surveillance cultures. The outbreak was controlled after the identification and treatment of the healthcare worker who had been diagnosed with onychomycosis and whose hands were contaminated with extended-spectrum beta-lactamase-producing Klebsiella pneumoniae. CONCLUSIONS The detection and control of occult dissemination of this multiresistant bacterium among low-risk newborn infants prevented its endemic dissemination in the neonatal unit, as well as the exposure of critically ill and susceptible patients to the infection.

Higiene bucal: prática relevante na prevenção de pneumonia hospitalar em pacientes em estado crítico

The objective of this article was to update knowledge on the microbiological aspects of the oral cavity and, verify the relation of oral hygiene with the prevention of pneumonia associated with mechanical ventilation. The studies analyzed were in favor of the use of antiseptics for decontaminating the oral cavity and pharynx, although there is still no standardization of procedures on the technique and products used in this process.The objective of this article was to update knowledge on the microbiological aspects of the oral cavity and, verify the relation of oral hygiene with the prevention of pneumonia associated with mechanical ventilation. The studies analyzed were in favor of the use of antiseptics for decontaminating the oral cavity and pharynx, although there is still no standardization of procedures on the technique and products used in this process.

Protocol of the Animal Assisted Activity Program at a University Hospital

A Assistencia Auxiliada por Animais (AAA) consiste na visitacao e recreacao por meio do contato com animais, propondo o entretenimento e a melhora no relacionamento interpessoal entre pacientes e equipe. Para evitar acidentes e zoonoses, a permissao para os animais visitarem uma instituicao exige um protocolo com normas e rotinas de seguranca. Este artigo objetivou descrever pontos importantes do protocolo de implementacao do programa de AAA. O protocolo contempla: introducao, objetivos, criterios de inclusao e exclusao dos animais, dos condutores e dos pacientes; recomendacoes aos condutores e a equipe de saude, responsabilidades da Comissao Controle de Infeccao Hospitalar, quadro de zoonoses, calendario vacinal de caes e gatos, termo de responsabilidade para participacao do programa e ficha de analise comportamental dos animais. Consideramos que a divulgacao do protocolo, fundamentado em estudos cientificos, favorece a implantacao de novos programas em instituicoes, visto a escassez de publicacoes nacionais.Animal-Assisted Activity (AAA) consists in visitation and recreation through contact with animals, aiming at entertainment and improving the interpersonal relationship between patients and staff. Permission for the animals to visit an Institution requires a protocol with rules and safety routines to avoid accidents and zoonoses. The objective of this study is to describe the important points of the protocol to implement the AAA program. The protocol includes: introduction, objectives, inclusion and exclusion criteria for animals, drivers and patients; recommendations to the handlers and the health team, responsibilities of the Nosocomial Infection Control Committee, zoonoses posters, vaccination schedule for dogs and cats, free-informed consent to take part in the program and records with behavioral analysis of the animals. We believe that disclosing the protocol, based on scientific studies, favors the implementation of new programs in institutions considering the lack of national publications.

Protocolo do Programa de Assistência Auxiliada por Animais no Hospital Universitário

A Assistencia Auxiliada por Animais (AAA) consiste na visitacao e recreacao por meio do contato com animais, propondo o entretenimento e a melhora no relacionamento interpessoal entre pacientes e equipe. Para evitar acidentes e zoonoses, a permissao para os animais visitarem uma instituicao exige um protocolo com normas e rotinas de seguranca. Este artigo objetivou descrever pontos importantes do protocolo de implementacao do programa de AAA. O protocolo contempla: introducao, objetivos, criterios de inclusao e exclusao dos animais, dos condutores e dos pacientes; recomendacoes aos condutores e a equipe de saude, responsabilidades da Comissao Controle de Infeccao Hospitalar, quadro de zoonoses, calendario vacinal de caes e gatos, termo de responsabilidade para participacao do programa e ficha de analise comportamental dos animais. Consideramos que a divulgacao do protocolo, fundamentado em estudos cientificos, favorece a implantacao de novos programas em instituicoes, visto a escassez de publicacoes nacionais.Animal-Assisted Activity (AAA) consists in visitation and recreation through contact with animals, aiming at entertainment and improving the interpersonal relationship between patients and staff. Permission for the animals to visit an Institution requires a protocol with rules and safety routines to avoid accidents and zoonoses. The objective of this study is to describe the important points of the protocol to implement the AAA program. The protocol includes: introduction, objectives, inclusion and exclusion criteria for animals, drivers and patients; recommendations to the handlers and the health team, responsibilities of the Nosocomial Infection Control Committee, zoonoses posters, vaccination schedule for dogs and cats, free-informed consent to take part in the program and records with behavioral analysis of the animals. We believe that disclosing the protocol, based on scientific studies, favors the implementation of new programs in institutions considering the lack of national publications.

Oral hygiene: a relevant practice to prevent hospital pneumonia in critically ill patients

The objective of this article was to update knowledge on the microbiological aspects of the oral cavity and, verify the relation of oral hygiene with the prevention of pneumonia associated with mechanical ventilation. The studies analyzed were in favor of the use of antiseptics for decontaminating the oral cavity and pharynx, although there is still no standardization of procedures on the technique and products used in this process.The objective of this article was to update knowledge on the microbiological aspects of the oral cavity and, verify the relation of oral hygiene with the prevention of pneumonia associated with mechanical ventilation. The studies analyzed were in favor of the use of antiseptics for decontaminating the oral cavity and pharynx, although there is still no standardization of procedures on the technique and products used in this process.

Evidence on the best chlorhexidine concentration to perform oral hygiene: meta-analysis

Although scientific literature has demonstrated the relevance of oral hygiene with chlorhexidine in preventing ventilation-associated pneumonia, there is a wide variation of concentrations, frequency and techniques when using the antiseptic. The aim of this research was to assess the best chlorhexidine concentration used to perform oral hygiene to prevent ventilation-associated pneumonia. A systematic review followed by four meta-analysis using chlorhexidine concentration as criterion was carried out. Articles in English, Spanish or Portuguese indexed in the Cochrane, Embase, Lilacs, PubMed/Medline and Ovid electronic databases were selected. The research was carried out from May to June 2011. The primary outcome measure of interest was ventilation-associated pneumonia. Ten primary studies were divided in four groups (G1-4), based on chlorhexidine concentration criterion. G1 (5 primary studies, chlorhexidine 0.12%) showed homogeneity among studies and the use of chlorhexidine represented a protective factor. G2 (3 primary studies, chlorhexidine 0.20%) showed heterogeneity among studies and chlorhexidine did not represent a protective factor. G3 (2 primary studies, chlorhexidine 2,00%) showed homogeneity among studies and the use of chlorhexidine was significant. G4 (10 primary studies with different chlorhexidine concentrations) showed homogeneity among studies and the common Relative Risk was significant. Statistic analyses showed a protective effect of oral hygiene with chlorhexidine in preventing ventilation-associated pneumonia. However, it was not possible to identify a standard to establish optimal chlorhexidine concentration.

Protocolo del Programa de Atención Auxiliada por Animales en el Hospital Universitario

A Assistencia Auxiliada por Animais (AAA) consiste na visitacao e recreacao por meio do contato com animais, propondo o entretenimento e a melhora no relacionamento interpessoal entre pacientes e equipe. Para evitar acidentes e zoonoses, a permissao para os animais visitarem uma instituicao exige um protocolo com normas e rotinas de seguranca. Este artigo objetivou descrever pontos importantes do protocolo de implementacao do programa de AAA. O protocolo contempla: introducao, objetivos, criterios de inclusao e exclusao dos animais, dos condutores e dos pacientes; recomendacoes aos condutores e a equipe de saude, responsabilidades da Comissao Controle de Infeccao Hospitalar, quadro de zoonoses, calendario vacinal de caes e gatos, termo de responsabilidade para participacao do programa e ficha de analise comportamental dos animais. Consideramos que a divulgacao do protocolo, fundamentado em estudos cientificos, favorece a implantacao de novos programas em instituicoes, visto a escassez de publicacoes nacionais.Animal-Assisted Activity (AAA) consists in visitation and recreation through contact with animals, aiming at entertainment and improving the interpersonal relationship between patients and staff. Permission for the animals to visit an Institution requires a protocol with rules and safety routines to avoid accidents and zoonoses. The objective of this study is to describe the important points of the protocol to implement the AAA program. The protocol includes: introduction, objectives, inclusion and exclusion criteria for animals, drivers and patients; recommendations to the handlers and the health team, responsibilities of the Nosocomial Infection Control Committee, zoonoses posters, vaccination schedule for dogs and cats, free-informed consent to take part in the program and records with behavioral analysis of the animals. We believe that disclosing the protocol, based on scientific studies, favors the implementation of new programs in institutions considering the lack of national publications.

Higiene bucal: práctica relevante en la prevención de neumonía hospitalaria en pacientes en estado crítico

The objective of this article was to update knowledge on the microbiological aspects of the oral cavity and, verify the relation of oral hygiene with the prevention of pneumonia associated with mechanical ventilation. The studies analyzed were in favor of the use of antiseptics for decontaminating the oral cavity and pharynx, although there is still no standardization of procedures on the technique and products used in this process.The objective of this article was to update knowledge on the microbiological aspects of the oral cavity and, verify the relation of oral hygiene with the prevention of pneumonia associated with mechanical ventilation. The studies analyzed were in favor of the use of antiseptics for decontaminating the oral cavity and pharynx, although there is still no standardization of procedures on the technique and products used in this process.