Janete Aparecida Machado

O uso de antimicrobianos em um hospital de ensino: uma breve avaliação

OBJETIVO: Os antimicrobianos sao utilizados de forma indiscriminada na pratica medica, contribuindo com a emergencia de cepas microbianas resistentes. METODOS: Este estudo descreve a auditoria de antimicrobianos realizada por analise prospectiva de 846 prontuarios de pacientes internados no Hospital Santa Cruz, em Santa Cruz do Sul - Rio Grande do Sul - Brasil. RESULTADOS: Do total dos pacientes analisados, 134 (15,8%) receberam antimicrobianos. A auditoria foi realizada de modo interativo, com intervencao e discussao com o medico prescritor. Considerando-se o diagnostico presumido e a droga prescrita, verificou-se que 74,6% dos pacientes em uso de antimicrobiano receberam o tratamento considerado de primeira escolha. A inadequacao do antimicrobiano para o diagnostico clinico (5,2%) e a falta do ajuste para a funcao renal (43,7%) foram os equivocos mais frequentes. CONCLUSAO: Um planejamento estrategico direcionado ao uso racional de antimicrobianos baseado em praticas educacionais intervencionistas pode auxiliar o medico do controle de infeccao a adequar as rotinas com melhoria da qualidade da assistencia.

New carbapenases in Brazil

Response to: Maya JJ, Ruiz SJ, Blanco VM et al. Current status of carbapenemases in Latin America. Expert Rev. Anti Infect Ther. 11(7), 657–667 (2013).

Antibiotic prescription in a teaching hospital: a brief assessment

OBJECTIVE Antimicrobials are used interchangeably in medical practice, contributing to the emergence of resistant microbial strains. METHODS This study describes the antimicrobial audit performed by forecasting analysis of medical records of 846 patients at the Hospital Santa Cruz, Santa Cruz do Sul - Rio Grande do Sul - Brazil. RESULTS Of the patients studied, 134 (15.8%) received antimicrobials. The audit was conducted interactively, with intervention and discussion with the prescriber. Considering the presumptive diagnosis and prescribed drug, it was verified that 74.6% of patients on antimicrobials received what was considered the first choice treatment. Inadequate antimicrobial agent for clinical diagnosis (5.2%) and lack of adjustment for renal function (43.7%) were the most frequent errors. CONCLUSION A strategic plan aimed at the rational use of antimicrobials based on educational and interventionist practices can help the infection control professional to adjust the routines to improve healthcare quality.

Infection control and monitoring after discharge in orthopedic surgery

Aprovechamos para felicitar los colegas de la UFMG por el estudio “Riesgo para infeccion de sitio quirurgico en pacientes sometidos a cirugias ortopedicas”, que relata la incidencia de infeccion de sitio quirurgico con un significativo muestreo (3.543 pacientes). La incidencia de infeccion ortopedica fue del 1,8% (IC 95% y p<0,05) a traves de un grupo historico. All infection control officers know that notifications by passive methodology - that is, through re- hospitalization figures or notifications by the doctor providing treatment - do not represent the true incidence of the issue. This method tends to provide information only about the most serious cases, excluding cases of superficial infection of the surgical site - the majority of cases are of this type - as well as patients who are re- hospitalized in other institutions. In the authorsinstitution, after the completion of a retrospective cohort made up of 262 orthopedic procedures involving implants, through an active post-discharge search between January 2009 and March 2011 involving the randomized contacting by telephone of 82 patients (CI 99.9%, p <0.05), the authors found an infection frequency of 11.1%. Analysis with the application of this active search was 7.3. The epidemiological difference demonstrated by changing the method is considerable. However, inherent difficulties must be exposed: important limiting factors for this sampling system include the fact of it being a retrospective study, where forgetting depends on the interviewee, the changing of telephone contact details, being or not at home at the time of the contact, the interviewees understanding of the issue and the reliability of the information passed on. Despite this, this method provides greater security in the analysis of the data, making it possible to estimate an infection rate which is closer to reality. However, situations such as being re-hospitalized in a different hospital or simply being dealt with in the outpatients department provide indications of a lower infection rate, lulling health care professionals into a false sense of security such that they fail to take preventive measures or control measures.

Incidence of infection in orthopedic surgeries: do we actually know it?

Orthopedic surgeries with elective prostheses are becoming increasingly more common, constituting an important tool in relieving the discomfort of patients with joint diseases. Arthroplasties are associated with rates of superficial surgical site infection (SSI) of 1% to 5%; however, because patients, in most cases, are not followed for 1 year after surgery, a period during which infections can still occur, these rates may be underestimated.1 Considering the relevance of the topic, this study aimed to evaluate the incidence of SSI in patients undergoing hip and knee arthroplasty, comparing the results obtained during hospitalization and through active search by telephone contact. This was a population-based, randomized, retrospective study with patients undergoing total hip or knee replacement with the use of prostheses, performed at Hospital Santa Cruz, Santa Cruz do Sul, state of Rio Grande do Sul, Brazil. A total of 134 patients was included between January 2009 and January 2011. Data were collected by active search through medical records and telephone contact with patients 12 months after the procedure, using a standardized form previously validated by the Hospital Infection Control Commission, where the following criteria were assessed: healing difficulty, heat, redness, swelling, fever, and local purulent discharge (Tables 1 and 2).2 Themeanhospital lengthof staywas4.20 2.46days,andof these, approximately 0.56 1.46 days were before the procedure and, on average, 3.64 1.90 days after the procedure. There were no deaths. It was observed that the overall incidence of superficial SSI obtained by active hospital search was 1.5%, whereas the rate reported by telephone after discharge was 6.7%, with a loss index <10%. No deep SSI cases were notified. The frequency found represents an increase of 450% in the incidence of SSI. A high rate of underreporting was observed among infection cases. For the health care services, it means increased costs with medications, as well as increased length of hospital stay.3,4 According to the criteria of the National Agency for Sanitary Surveillance in orthopedic surgeries that require the use of prostheses, the patient should be followed for a period of 1 year after the procedure. According to National Agency for Sanitary Surveillance, the diagnostic criteria for SSI include the presence of at least 1 of the following criteria: purulent drainage from the superficial incision, positive culture of secretions or tissue from the superficial incision, aseptically obtained; the superficial incision is deliberately opened by the surgeon in the presence of at least 1 of the following signs or symptoms: pain, increased sensitivity, local edema, redness, or heat, except when the culture is negative.2

Control de infección y vigilancia pos alta en cirugías ortopédicas

Aprovechamos para felicitar los colegas de la UFMG por el estudio “Riesgo para infeccion de sitio quirurgico en pacientes sometidos a cirugias ortopedicas”, que relata la incidencia de infeccion de sitio quirurgico con un significativo muestreo (3.543 pacientes). La incidencia de infeccion ortopedica fue del 1,8% (IC 95% y p<0,05) a traves de un grupo historico. All infection control officers know that notifications by passive methodology - that is, through re- hospitalization figures or notifications by the doctor providing treatment - do not represent the true incidence of the issue. This method tends to provide information only about the most serious cases, excluding cases of superficial infection of the surgical site - the majority of cases are of this type - as well as patients who are re- hospitalized in other institutions. In the authorsinstitution, after the completion of a retrospective cohort made up of 262 orthopedic procedures involving implants, through an active post-discharge search between January 2009 and March 2011 involving the randomized contacting by telephone of 82 patients (CI 99.9%, p <0.05), the authors found an infection frequency of 11.1%. Analysis with the application of this active search was 7.3. The epidemiological difference demonstrated by changing the method is considerable. However, inherent difficulties must be exposed: important limiting factors for this sampling system include the fact of it being a retrospective study, where forgetting depends on the interviewee, the changing of telephone contact details, being or not at home at the time of the contact, the interviewees understanding of the issue and the reliability of the information passed on. Despite this, this method provides greater security in the analysis of the data, making it possible to estimate an infection rate which is closer to reality. However, situations such as being re-hospitalized in a different hospital or simply being dealt with in the outpatients department provide indications of a lower infection rate, lulling health care professionals into a false sense of security such that they fail to take preventive measures or control measures.

Controle de infecção e vigilância após a alta em cirurgias ortopédicas

Aprovechamos para felicitar los colegas de la UFMG por el estudio “Riesgo para infeccion de sitio quirurgico en pacientes sometidos a cirugias ortopedicas”, que relata la incidencia de infeccion de sitio quirurgico con un significativo muestreo (3.543 pacientes). La incidencia de infeccion ortopedica fue del 1,8% (IC 95% y p<0,05) a traves de un grupo historico. All infection control officers know that notifications by passive methodology - that is, through re- hospitalization figures or notifications by the doctor providing treatment - do not represent the true incidence of the issue. This method tends to provide information only about the most serious cases, excluding cases of superficial infection of the surgical site - the majority of cases are of this type - as well as patients who are re- hospitalized in other institutions. In the authorsinstitution, after the completion of a retrospective cohort made up of 262 orthopedic procedures involving implants, through an active post-discharge search between January 2009 and March 2011 involving the randomized contacting by telephone of 82 patients (CI 99.9%, p <0.05), the authors found an infection frequency of 11.1%. Analysis with the application of this active search was 7.3. The epidemiological difference demonstrated by changing the method is considerable. However, inherent difficulties must be exposed: important limiting factors for this sampling system include the fact of it being a retrospective study, where forgetting depends on the interviewee, the changing of telephone contact details, being or not at home at the time of the contact, the interviewees understanding of the issue and the reliability of the information passed on. Despite this, this method provides greater security in the analysis of the data, making it possible to estimate an infection rate which is closer to reality. However, situations such as being re-hospitalized in a different hospital or simply being dealt with in the outpatients department provide indications of a lower infection rate, lulling health care professionals into a false sense of security such that they fail to take preventive measures or control measures.

The importance of infection prevention bundles related to construction/renovations in hospital environment

A total of 40 specimens (20 from soft toys and 20 fromhard toys) were collected from5 kindergartens and 5 households. The samples were inoculated on blood agar, deoxycholate citrate agar, MacConkey agar, and nutrient agar. The bacteria were identified by colony characteristics, Gram staining, and biochemical tests. Twenty-seven (67.5%) toys were positive for at least 1 potential pathogenic bacteria, 7 (25.9%) were positive for coagulase negative staphylococci, 8 (29.6%) showed the presence of Bacillus species, and 15 (55.6%) were positive for coliforms. Furthermore, toys from kindergartens were contaminated at higher rate than toys from households (75% vs 60%) and hard toys were more contaminated than soft toys (66.7% vs 33.3%; P < .05). The use of hard toys was significantly associated with bacterial contamination (P < .05). Coliforms were detected at higher percentage in soft toys from kindergartens than soft toys from households (83.3% vs 33.3%). It was also noted that the toys from both kindergartens and households were cleaned by dusting once aweek andmachinewashed as often as possible. Moreover, 2 kindergartens allowed children to bring personal toys from home. The growth of coagulase negative staphylococci, Bacillus species, and fecal coliforms indicated that toys from kindergartens and households could play important role in cross-infection in a similar manner as toys from health care settings.1-3 Presence of coliforms on environmental samples has been associated with outbreaks of diarrhea in child day care centers and coagulase negative staphylococci have also been increasingly reported as a causative agent of otitis media, a common pediatric infectious disease.4,5 Being a hard toy was a significant predictor for bacterial growth (P < .05). One study reported similar findings,3 although another study concluded 100% of contamination rate from soft toys and 91% from hard toys.6 A higher rate of contamination was observed at kindergartens where toys are normally shared among children at a higher frequency. Furthermore, in kindergartens, children are normally confined to limited space, which could be an important factor in increasing the risk of spread of potential pathogens by close contact and sharing of toys. Coliforms and other potential pathogenic bacteria were isolated despite kindergartens and households members reporting that toys were machine washed frequently. It should be noted that the use of washingmachines was not found to be an adequatemeans to decrease bacterial count from soft toys.7 Toys from both kindergartens and households harbor potential pathogenic bacteria, although hard toys were more prone to bacterial growth. In kindergartens, the practice of bringing personal toys from home and back home on a routine basis should be discouraged.

Hantavirus pulmonary syndrome: when should you consider this diagnosis?

MSc≥in≥Microbiology,≥ Universidade≥Estadual≥ de≥Londrina≥(UEL),≥ PR;≥Specialist≥in≥ Infectology,≥UEL,≥PR;≥ Professor≥of≥Infectology,≥ Universidade≥de≥Santa≥ Cruz≥do≥Sul≥(UNISC),≥ RS;≥Coordinator,≥ Epidemiology≥Unit,≥ Hospital≥Santa≥Cruz≥ (HSC),≥RS,≥Brazil Medical≥Student,≥UNISC,≥ RS;≥Trainee≥at≥CCIH≥ć≥ HSC,≥RS,≥Brazil≥ Specialist,≥Viceć Coordinator,≥ Epidemiology≥Unit,≥HSC,≥ RS,≥Brazil≥ Specialist,≥Technician,≥ Epidemiology≥Unit,≥HSC,≥ RS,≥Brazil≥