Julia Yaeko Kawagoe

Eficácia da esterilização de canetas de bisturi elétrico de uso único reprocessadas

No Brasil, a caneta de bisturi eletrico de uso unico (CBEUU) e um dos artigos mais comumente reutilizados. O presente estudo avaliou a eficacia da esterilizacao de CBEUUs reprocessadas, utilizando dois metodos de limpeza (manual ou automatizado), seguidos de um dos seguintes metodos de esterilizacao: plasma de peroxido de hidrogenio (PPH), oxido de etileno (OE) ou vapor de baixa temperatura de formaldeido (VBTF). Foram analisadas 360 CBEUUs apos sua primeira utilizacao. A probabilidade de falha de esterilizacao foi estimada considerando o numero de resultados positivos de cultura dos dispositivos estudados. A probabilidade geral de falha de esterilizacao das CBEUUs foi de 0,26. A menor probabilidade de falha foi obtida com o VBTF (0,01), seguida do OE (0,21) e do PPH (0,56). A limpeza automatizada obteve melhores resultados quando comparada a limpeza manual. O presente estudo demonstrou que a probabilidade de esterilizacao das CBEUUs reprocessadas e altamente dependente dos metodos de limpeza ou esterilizacao aplicados.In Brazil, single use diathermy pencils (SUDP) are among the most common reused devices. This study assesses the sterilization efficacy of reprocessing SUDP using two cleansing methods (manual or automated), followed by one of three of the low-temperature sterilization methods: Hydrogen Peroxide Plasma (HPP), Ethylene Oxide (ETO) or Low-Temperature Steam Formaldehyde (LTSF). The sample was composed of 360 SUDP after their first use. The probability of sterilization failure was estimated considering the number of positive microbiological results obtained by cultures of the studied devices. The overall sterilization failure probability for SUDP was 0.26. The sterilization method, which presented the lowest failure probability was the LTSF (0.01), followed by ETO (0.21) and HPP (0.56). Automated cleansing obtained a better result than manual cleansing. This trial demonstrated that the probability of sterilization in reprocessed SUDP is highly dependent on both the type of cleansing and the sterilization method applied.

Bacterial reduction of alcohol-based liquid and gel products on hands soiled with blood.

The antibacterial efficacy of three alcohol-based products (liquid and gel) were tested on the hands with blood and contaminated with Serratia marcescens (ATCC 14756), using EN 1500 procedures in 14 healthy volunteers. The alcohol-based products tested, either gel or liquid-based, reached bacterial reduction levels higher than 99.9% in the presence of blood and did not differ significantly (ANOVA test; P = 0.614).

A systematic review of surgical hand antisepsis utilizing an alcohol preparation compared to traditional products

Surgical hand antisepsis aims at preventing surgical site infections, an important cause of postoperative morbidity and mortality and escalating hospital costs. The objectives of this study were to compare the efficacy of alcohol preparations with traditional surgical hand antisepsis products by means of a systematic review of the literature. Primary and secondary studies were included, considering the microbial count or surgical site infection rates as outcomes. The search was performed on the BVS Portal, PubMed, Ask and MEDLINE. Twenty-five studies were selected (two systematic reviews, nineteen experimental and four cohort studies). The alcohol preparations promoted a microbial reduction equal to and/or greater than traditional products in 17 studies, and a lesser reduction in four studies; similar surgical site infection rates were identified. Therefore, there is scientific evidence that support the safety of alcohol preparations for surgical hand antisepsis.A antissepsia cirurgica das maos visa a prevencao de infeccoes do sitio cirurgico, importante causa de morbimortalidade pos-operatoria e aumento dos custos hospitalares. Este estudo teve como objetivo comparar a eficacia de preparacoes alcoolicas com os produtos tradicionais na antissepsia cirurgica das maos por meio de uma revisao sistematica da literatura. Foram considerados estudos primarios ou secundarios, tendo como desfecho a contagem microbiana das maos ou taxas de infeccoes do sitio cirurgico. A busca foi realizada no Portal BVS, PubMed, Ask e MEDLINE. Foram selecionados 25 estudos (2 revisoes sistematicas, 19 experimentais e 4 de coorte). As preparacoes alcoolicas tiveram uma reducao microbiana igual e/ou maior aos produtos tradicionais em 17 estudos e inferior em 4; as taxas de infeccoes do sitio cirurgico foram similares. Portanto, existem evidencias cientificas que suportam a seguranca das preparacoes alcoolicas para antissepsia cirurgica das maos.

The sterilization efficacy of reprocessed single use diathermy pencils

No Brasil, a caneta de bisturi eletrico de uso unico (CBEUU) e um dos artigos mais comumente reutilizados. O presente estudo avaliou a eficacia da esterilizacao de CBEUUs reprocessadas, utilizando dois metodos de limpeza (manual ou automatizado), seguidos de um dos seguintes metodos de esterilizacao: plasma de peroxido de hidrogenio (PPH), oxido de etileno (OE) ou vapor de baixa temperatura de formaldeido (VBTF). Foram analisadas 360 CBEUUs apos sua primeira utilizacao. A probabilidade de falha de esterilizacao foi estimada considerando o numero de resultados positivos de cultura dos dispositivos estudados. A probabilidade geral de falha de esterilizacao das CBEUUs foi de 0,26. A menor probabilidade de falha foi obtida com o VBTF (0,01), seguida do OE (0,21) e do PPH (0,56). A limpeza automatizada obteve melhores resultados quando comparada a limpeza manual. O presente estudo demonstrou que a probabilidade de esterilizacao das CBEUUs reprocessadas e altamente dependente dos metodos de limpeza ou esterilizacao aplicados.In Brazil, single use diathermy pencils (SUDP) are among the most common reused devices. This study assesses the sterilization efficacy of reprocessing SUDP using two cleansing methods (manual or automated), followed by one of three of the low-temperature sterilization methods: Hydrogen Peroxide Plasma (HPP), Ethylene Oxide (ETO) or Low-Temperature Steam Formaldehyde (LTSF). The sample was composed of 360 SUDP after their first use. The probability of sterilization failure was estimated considering the number of positive microbiological results obtained by cultures of the studied devices. The overall sterilization failure probability for SUDP was 0.26. The sterilization method, which presented the lowest failure probability was the LTSF (0.01), followed by ETO (0.21) and HPP (0.56). Automated cleansing obtained a better result than manual cleansing. This trial demonstrated that the probability of sterilization in reprocessed SUDP is highly dependent on both the type of cleansing and the sterilization method applied.

Revisão sistemática sobre antissepsia cirúrgica das mãos com preparação alcoólica em comparação aos produtos tradicionais

Surgical hand antisepsis aims at preventing surgical site infections, an important cause of postoperative morbidity and mortality and escalating hospital costs. The objectives of this study were to compare the efficacy of alcohol preparations with traditional surgical hand antisepsis products by means of a systematic review of the literature. Primary and secondary studies were included, considering the microbial count or surgical site infection rates as outcomes. The search was performed on the BVS Portal, PubMed, Ask and MEDLINE. Twenty-five studies were selected (two systematic reviews, nineteen experimental and four cohort studies). The alcohol preparations promoted a microbial reduction equal to and/or greater than traditional products in 17 studies, and a lesser reduction in four studies; similar surgical site infection rates were identified. Therefore, there is scientific evidence that support the safety of alcohol preparations for surgical hand antisepsis.A antissepsia cirurgica das maos visa a prevencao de infeccoes do sitio cirurgico, importante causa de morbimortalidade pos-operatoria e aumento dos custos hospitalares. Este estudo teve como objetivo comparar a eficacia de preparacoes alcoolicas com os produtos tradicionais na antissepsia cirurgica das maos por meio de uma revisao sistematica da literatura. Foram considerados estudos primarios ou secundarios, tendo como desfecho a contagem microbiana das maos ou taxas de infeccoes do sitio cirurgico. A busca foi realizada no Portal BVS, PubMed, Ask e MEDLINE. Foram selecionados 25 estudos (2 revisoes sistematicas, 19 experimentais e 4 de coorte). As preparacoes alcoolicas tiveram uma reducao microbiana igual e/ou maior aos produtos tradicionais em 17 estudos e inferior em 4; as taxas de infeccoes do sitio cirurgico foram similares. Portanto, existem evidencias cientificas que suportam a seguranca das preparacoes alcoolicas para antissepsia cirurgica das maos.

Ochrobactrum anthropi bacteremia in a preterm infant with cystic fibrosis

Ochrobactrum anthropi infection in newborn patients is rare, and the treatment is challenging because of its widespread and unpredictable resistance to antimicrobial agents and discrepancies between in vitro susceptibility and in vivo efficacy. We report the clinical and microbiological characteristics of Ochrobactrum anthropi bacteremia in a preterm patient.

Secular trends in the epidemiology of Clostridium difficile infection (CDI): relationship with alcohol gel and antimicrobial usage in a hospital

BACKGROUND Clostridium difficile-associated diarrhea (CDAD) has shown increasing incidence, morbidity, and mortality in recent years. We assessed the number of CDAD tests requested, CDAD positivity rates, the use of alcohol-based hand rubs, and antimicrobial utilization. METHODS We collected information on every adult patient (>18 years) who developed diarrhea and had a positive stool test for C. difficile toxin from June 2005 to December 2009 at a tertiary care hospital. A time-series analysis was performed using monthly data on the incidence of C. difficile infection (CDI) (i.e., cases of infection per 1000 patient-days), as well as the consumption of alcohol-based hand rubs (in liters/1000-patient days) and antibiotics (in defined daily doses per 1000 patient-days). RESULTS The mean number of annual requests for C. difficile tests was 1031, and the rates per 1000 patient-days for each year from 2005 to 2009 were 0.30, 0.46, 0.39, 0.31, and 0.40 overall in the hospital, and 0.18, 0.10, 0.53, 0.38, and 0.37 in the intensive care unit (ICU). The use of alcohol-based hand rubs per 1000 patient-days increased from 37.4 to 73.0, and from 41.5 to 129.4 in the hospital and in the ICU, respectively. CONCLUSIONS The incidence of CDI in the hospital and ICU remained low, despite the increased use of alcohol-based hand rubs and antimicrobials.

Risk factors for mortality in ventilator-associated tracheobronchitis: a case-control study

RESUMO Objetivo Descrever as caracteristicas microbiologicas e avaliar os fatores de risco para mortalidade na traqueobronquite associada a ventilacao mecânica em um estudo caso-controle de pacientes de terapia intensiva. Metodos Estudo realizado ao longo de 6 anos em uma unidade de terapia intensiva medico-cirurgica de 40 leitos, em um hospital privado e de nivel terciario em Sao Paulo, Brasil. O Grupo Caso foi identificado usando o banco de dados da Comissao de Controle de Infeccao Hospitalar. O Grupo Controle foi [...]

Adherence to precautions for preventing the transmission of microorganisms in primary health care: a qualitative study

BackgroundHealth care associated infections (HAIs) are a source of concern worldwide. No health service in any country can be considered HAI risk-free. However, there is scarcity of data on the risks to which both patients and health workers are subject in non-hospital settings. The aim of this study was to identify issues that determine the adherence of professionals to precautions for preventing transmission of microorganisms in primary health care.MethodThis was a qualitative study, using focus groups of primary health care staff, in two Brazilian municipalities. The data were analysed using content analysis.ResultsFour focus groups were conducted with 20 professionals (11 community health workers, 5 nursing assistants and 4 nurses), and the analysed content was organized into four thematic categories. These categories are: low risk perception, weaknesses in knowledge, insufficient in-service training and infrastructure limitations.Participants expressed their weaknesses in knowledge of standard and transmission based precautions, mainly for hand hygiene and tuberculosis. A lack of appropriate resources and standardization in sharps disposal management was also highlighted by the participants.ConclusionThe study points out the need to provide in-service training for professionals on the transmission of microorganisms in primary health care to ensure adequate level of risk perception and knowledge. Further recommendations include investment to improve infrastructure to facilitate adherence to precautions and to minimize the risk of disease transmission for both patients and health care workers.

Multiple interventions in a postanesthesia care unit: Impact on hand hygiene compliance

Hand hygiene (HH) is an important patient safety measure in the postanesthesia care unit (PACU) to prevent health care–associated infections (HCAIs),1,2 but studies about PACU’s HH compliance are rare.1 In our hospital, the PACU’s HH compliance was much lower than in other units, even though the World Health Organization (WHO) Multimodal HH Improvement Strategy3 has been applied since 2008. We conducted a prospective, interventional quasiexperimental study in 2 PACUs totaling 25 beds of the surgical center of a private, tertiary, 600-bed hospital in São Paulo, Brazil, which was performing 3,000 surgeries per month. This study was approved by the ethics and research committee and carried out in 3 phases: preintervention (PI) (July 2013), intervention (PII) (July 2014), and postintervention (PIII) (September 2014). We aimed to evaluate if multiple interventions in the workplace focusing on the PACU’s team and activities could increase HH compliance. HH compliance was measured using the WHO direct observation method at 5 moments (1: before touching a patient; 2: before a clean-aseptic procedure; 3: after contact with body fluids; 4: after touching a patient; and 5: after touching patient surroundings)4 by a trained and validated infection preventionist nurse (IPN) in the morning and afternoon shifts. We used a minimum of 200 opportunities of HH,4 which were considered compliant if the technique was correct. To assess the interventions’ impact on HH compliance, the χ2 test was used, and the statistical significance was 2-sided with a significance level set at 0.05. The actions and results of the 3 phases are subsequently presented. In PI, 27 health care workers (HCWs), including 14 nurse technicians, 3 nurses, and 10 physicians, answered the WHO questionnaires about HH and HCAI knowledge and perception. The number of correct answers by the HCWs for the questions about HH and HCAI knowledge are as follows: (1) the main route of crosstransmission of microorganisms between patients in a health care facility (21 HCWs; 77.8%); (2) the minimal time needed for alcoholbased handrub (ABHR) is 20 seconds (20 HCWs; 74.1%) and (3) ABHR is more effective against germs than handwashing with soap (11 HCWs; 40.7%). The answers for the questions about HH perceptions can be seen in Table 1. HH practices were observed for 1 week, and overall compliance was 40.2% (99/246) (Table 2). In PII, IPN conducted 4 focus group sessions with HCWs to identify and discuss HH barriers, and forgetfulness and high work demands were the main reasons for low HH compliance. One week later, a 7-minute educational video showing 5 moments in the PACU was presented in loco to all HCWs, and immediate HH feedback was given during direct observation for 1 week. There was a significant HH compliance increase from PI (40.2%) to PII (74.3%) (P < .001). Better HH compliance was achieved by nurse technicians (86.6%) and nurses (82.7%), and at moments 2 (93.3%), 3 (100.0%), and 4 (81.0%). There were 52 episodes of feedback in 202 opportunities (25.7%) (Table 2). In PIII, we achieved an overall HH compliance of 49.3% (101/ 205). From PI to PIII, there was an increase of 22.6% in HH compliance (P = .06). Nurses achieved higher HH compliance with an increase of 70.8% (43.9% to 75%), nurse technicians’ HH compliance was 54.5% with an increase of 6% (51.4% to 54.5%), and physicians had an increase of 75.5% (10.2% to 17.9%) and the least use of ABHR (40%) compared with nurses (94.4%) and nurse technicians (100%). Moments 3 (66.7%), 4 (56.3%), and 1 (54.1%) had better HH compliance (Table 2). We have not confirmed our hypothesis that multiple interventions aimed at PACU activities and teams could improve HH compliance. According to Pittet et al,1 PACU HH compliance is a highly complex and challenging issue considering its patient flow and high number of procedures and contacts between HCWs and patients, which leads to a high risk of cross-contamination. They have also found lower HH compliance in the PACU at patient admission (19.6%) and after patient admission (12.5%), and a lower use of ABHR of 79.0%,1 compared with our data. Table 1 HCW perception answers about HH in the postanesthesia care unit (N = 27), 2013