Marise Reis de Freitas

The changing epidemiology of Acinetobacter spp. producing OXA carbapenemases causing bloodstream infections in Brazil: a BrasNet report

We evaluated the epidemiology of Acinetobacter spp. recovered from patients diagnosed with bloodstream infections in 9 tertiary hospitals located in all Brazilian geographic regions between April and August 2014. Although OXA-23-producing Acinetobacter baumannii clones were disseminated in most hospitals, it was observed for the first time the spread of OXA-72 among clonally related A. baumannii isolated from distinct hospitals. Interestingly, Acinetobacter pittii was the most frequent species found in a Northern region hospital. Contrasting with the multisusceptible profile displayed by A. pittii isolates, the tetracyclines and polymyxins were the only antimicrobials active against all A. baumannii isolates.

Efficacy of a program of prevention and control for methicillin-resistant Staphylococcus aureus infections in an intensive-care unit.

Methicillin-resistant Staphylococcus aureus (MRSA) is endemic in most Brazilian Hospitals, and there are few studies which show the efficacy of control measures in such situations. This study evaluated intensive care unit (ICU) patients, in two years divided in control, intervention and post-intervention group. Intervention measures: hands-on educational programs for healthcare workers; early identification of MRSA infected or colonized patients, labeled with a bed-identification tag for contact isolation; nasal carriers, patients, and healthcare professionals treated with topical mupirocin for five days. The hospital infection rates in the control period were compared to the ones in the post-intervention period. Hospital infection rates were found by means of the NNISS methodology The incidence coefficients of MRSA hospital infection (monthly average of 1,000 pts/day) in the control, intervention and post-intervention groups were respectively: 10.2, 5.1 and 2.5/1,000 pts/day (p<0.001) and MRSA-originated bloodstream infections were 3.6, 0.9 and 1.8/1,000 central venous catheter/day (p=0.281). Nasal colonization in both intervention and post-intervention periods was of 30.9% and 22.1% among the hospitalized patients, respectively 54.4% and 46.1% of whom were already MRSA-positive when admitted to the unit. In the intervention period, most of those MRSA infected patients (76.2%) were nasal carrier. Mortality rates were, respectively 26.6%; 27.3% and 21.0% (p<0.001). Nasal carriers, both patients (93.7%) and healthcare professionals (88.2%), were successfully treated with topical mupirocin. Intervention measures for the prevention and control of MRSA infections in ICUs, have been efficient in the reduction of the bloodstream and MRSA-originated hospital infections incidence, and reduced the overall mortality rate significantly.

Avaliação da adesão ao checklist de cirurgia segura da OMS em cirurgias urológicas e ginecológicas, em dois hospitais de ensino de Natal, Rio Grande do Norte, Brasil

The WHO surgical safety checklist is a useful tool for decreasing the number of adverse events in hospitals, but its implementation is still a challenge. This study aimed to assess adherence to the checklist in urological and gynecological surgeries at two teaching hospitals in Natal, Rio Grande do Norte, Brazil. A cross-sectional observational design was used, elective surgeries were selected, and data were collected from medical charts. Adherence was based on the quality and proper completion of the checklist, and the association of structural and socio-professional factors was analyzed using multiple regression. Of the 375 surgeries reviewed, 61% included a checklist and 4% were correctly filled out. The existence of a checklist was associated with gynecological surgeries (OR = 130.18) and longer operating time (OR = 2.13), while quality of the checklist was related to urological surgeries (β = 26.36). Adherence to the checklist needs to be improved, and the observed differences suggest the influence of distinct implementation strategies at the two institutions.The WHO surgical safety checklist is a useful tool for decreasing the number of adverse events in hospitals, but its implementation is still a challenge. This study aimed to assess adherence to the checklist in urological and gynecological surgeries at two teaching hospitals in Natal, Rio Grande do Norte, Brazil. A cross-sectional observational design was used, elective surgeries were selected, and data were collected from medical charts. Adherence was based on the quality and proper completion of the checklist, and the association of structural and socio-professional factors was analyzed using multiple regression. Of the 375 surgeries reviewed, 61% included a checklist and 4% were correctly filled out. The existence of a checklist was associated with gynecological surgeries (OR = 130.18) and longer operating time (OR = 2.13), while quality of the checklist was related to urological surgeries (β = 26.36). Adherence to the checklist needs to be improved, and the observed differences suggest the influence of distinct implementation strategies at the two institutions.

ANTIBIOTIC RESISTANCE PATTERNS OF URINARY TRACT INFECTIONS IN A NORTHEASTERN BRAZILIAN CAPITAL

Urinary tract infection is a common problem worldwide. Its clinical characteristics and susceptibility rates of bacteria are important in determining the treatment of choice and its duration. This study assessed the frequency and susceptibility to antimicrobials of uropathogens isolated from community-acquired urinary tract infections in the city of Natal, Rio Grande do Norte State capital, northeastern Brazil, from 2007 to 2010. A total of 1,082 positive samples were evaluated; E. coli was the most prevalent pathogen (60.4%). With respect to the uropathogens susceptibility rates, the resistance of enterobacteria to ciprofloxacin and sulfamethoxazole-trimethoprim was 24.4% and 50.6%, respectively. Susceptibility was over 90% for nitrofurantoin, aminoglycosides and third-generation cephalosporins. High resistance rates of uropathogens to quinolones and sulfamethoxazole-trimethoprim draws attention to the choice of these drugs on empirical treatments, especially in patients with pyelonephritis. Given the increased resistance of community bacteria to antimicrobials, local knowledge of susceptibility rates of uropathogens is essential for therapeutic decision making regarding patients with urinary tract infections.

Assessment of adherence to the WHO surgical safety checklist in urological and gynecological surgeries at two teaching hospitals in Natal, Rio Grande do Norte State, Brazil

The WHO surgical safety checklist is a useful tool for decreasing the number of adverse events in hospitals, but its implementation is still a challenge. This study aimed to assess adherence to the checklist in urological and gynecological surgeries at two teaching hospitals in Natal, Rio Grande do Norte, Brazil. A cross-sectional observational design was used, elective surgeries were selected, and data were collected from medical charts. Adherence was based on the quality and proper completion of the checklist, and the association of structural and socio-professional factors was analyzed using multiple regression. Of the 375 surgeries reviewed, 61% included a checklist and 4% were correctly filled out. The existence of a checklist was associated with gynecological surgeries (OR = 130.18) and longer operating time (OR = 2.13), while quality of the checklist was related to urological surgeries (β = 26.36). Adherence to the checklist needs to be improved, and the observed differences suggest the influence of distinct implementation strategies at the two institutions.The WHO surgical safety checklist is a useful tool for decreasing the number of adverse events in hospitals, but its implementation is still a challenge. This study aimed to assess adherence to the checklist in urological and gynecological surgeries at two teaching hospitals in Natal, Rio Grande do Norte, Brazil. A cross-sectional observational design was used, elective surgeries were selected, and data were collected from medical charts. Adherence was based on the quality and proper completion of the checklist, and the association of structural and socio-professional factors was analyzed using multiple regression. Of the 375 surgeries reviewed, 61% included a checklist and 4% were correctly filled out. The existence of a checklist was associated with gynecological surgeries (OR = 130.18) and longer operating time (OR = 2.13), while quality of the checklist was related to urological surgeries (β = 26.36). Adherence to the checklist needs to be improved, and the observed differences suggest the influence of distinct implementation strategies at the two institutions.

Adaptation and validation of the World Health Organization’s on Safe Childbirth Checklist for the Brazilian context

A mortalidade materno-infantil ainda e um grave problema de saude publica no Brasil, apesar do amplo acesso a partos institucionalizados. A Organizacao Mundial da Saude desenvolveu o Safe Childbirth Checklist, uma tecnologia potencialmente util para melhorar a qualidade da assistencia durante o parto e favorecer melhores resultados em saude. O objetivo deste trabalho e adaptar culturalmente e validar a Lista de Verificacao para o Parto Seguro da OMS para os hospitais brasileiros, pois a simples traducao entra em choque com praticas clinicas nacionais consolidadas. Apos traducao para o portugues do Brasil, houve tres etapas de adaptacao e validacao: 1- grupo nominal com painel de especialistas, sendo tres enfermeiras obstetras e seis medicas (tres obstetras e tres pediatras), que se realizou de forma presencial (duas primeiras votacoes) e finalizou a distância (votacao final); 2- Conferencia de Consenso em dois Hospitais Universitarios, em reunioes ampliadas para todos os profissionais que utilizariam a lista; e 3- questionario estruturado aos profissionais de saude (n=40) apos estudo piloto de 30 dias utilizando a lista. Os criterios da validacao foram a validade de face e conteudo da lista, adequacao aos protocolos nacionais, terminologia e viabilidade no contexto local. Na primeira etapa, todos os 29 itens foram aprovados apos 3 rodadas e algumas adaptacoes nacionais (ex. teste rapido para HIV em vez de CD4). Na segunda etapa, ocorreu acrescimo de 24 itens e modificacoes em itens iniciais. Na terceira etapa, ocorreu a exclusao de 3 itens nao viaveis, 2 itens sofreram juncao e 1 item foi acrescentado devido a sua importância clinica no contexto brasileiro. O processo de validacao possibilitou a disponibilizacao de uma Lista de Verificacao para o Parto Seguro de 49 itens potencialmente util para o contexto brasileiro, apresentando indicios de validade e viabilidade para o contexto nacional que devem ser confirmados em estudos futuros com foco na efetividade ou validade de criterio.

Development and validation of indicators for best patient safety practices: the ISEP-Brazil Project

Um monitoramento eficaz da seguranca do paciente precisa focar a implantacao de praticas baseadas em evidencias que evitem danos desnecessarios ligados a assistencia a saude. O objetivo do Projeto ISEP-Brasil foi desenvolver e validar indicadores de boas praticas de seguranca do paciente para o contexto brasileiro. Tomou por base a traducao e adaptacao dos indicadores validados no Projeto ISEP-Espanha, alem do documento Safe Practices for Better Healthcare do National Quality Forum dos Estados Unidos, que possui 34 recomendacoes de boas praticas. Realizou-se validacao por um painel de 25 especialistas e analise da confiabilidade e viabilidade em um estudo-piloto realizado em tres hospitais com diferentes tipos de gestao (estadual, federal e privada). Aprovaram-se 75 indicadores de boas praticas (39 de estrutura; 36 de processo) para 31 das 34 recomendacoes. Os indicadores foram considerados validos, confiaveis e uteis para o monitoramento da seguranca do paciente em hospitais brasileiros.Efficacious patient safety monitoring should focus on the implementation of evidence-based practices that avoid unnecessary harm related to healthcare. The ISEP-Brazil project aimed to develop and validate indicators for best patient safety practices in Brazil. The basis was the translation and adaptation of the indicators validated in the ISEP-Spain project and the document Safe Practices for Better Healthcare (U.S. National Quality Forum), recommending 34 best practices. A 25-member expert panel validated the indicators. Reliability and feasibility were based on a pilot study in three hospitals with different management formats (state, federal, and private). Seventy-five best practice indicators were approved (39 structure; 36 process) for 31 of the 34 recommendations. The indicators were considered valid, reliable, and useful for monitoring patient safety in Brazilian hospitals.

Desarrollo y validación de indicadores de buenas prácticas de seguridad del paciente: Proyecto ISEP-Brasil

Um monitoramento eficaz da seguranca do paciente precisa focar a implantacao de praticas baseadas em evidencias que evitem danos desnecessarios ligados a assistencia a saude. O objetivo do Projeto ISEP-Brasil foi desenvolver e validar indicadores de boas praticas de seguranca do paciente para o contexto brasileiro. Tomou por base a traducao e adaptacao dos indicadores validados no Projeto ISEP-Espanha, alem do documento Safe Practices for Better Healthcare do National Quality Forum dos Estados Unidos, que possui 34 recomendacoes de boas praticas. Realizou-se validacao por um painel de 25 especialistas e analise da confiabilidade e viabilidade em um estudo-piloto realizado em tres hospitais com diferentes tipos de gestao (estadual, federal e privada). Aprovaram-se 75 indicadores de boas praticas (39 de estrutura; 36 de processo) para 31 das 34 recomendacoes. Os indicadores foram considerados validos, confiaveis e uteis para o monitoramento da seguranca do paciente em hospitais brasileiros.Efficacious patient safety monitoring should focus on the implementation of evidence-based practices that avoid unnecessary harm related to healthcare. The ISEP-Brazil project aimed to develop and validate indicators for best patient safety practices in Brazil. The basis was the translation and adaptation of the indicators validated in the ISEP-Spain project and the document Safe Practices for Better Healthcare (U.S. National Quality Forum), recommending 34 best practices. A 25-member expert panel validated the indicators. Reliability and feasibility were based on a pilot study in three hospitals with different management formats (state, federal, and private). Seventy-five best practice indicators were approved (39 structure; 36 process) for 31 of the 34 recommendations. The indicators were considered valid, reliable, and useful for monitoring patient safety in Brazilian hospitals.

Desenvolvimento e validação de indicadores de boas práticas de segurança do paciente: Projeto ISEP-Brasil

Um monitoramento eficaz da seguranca do paciente precisa focar a implantacao de praticas baseadas em evidencias que evitem danos desnecessarios ligados a assistencia a saude. O objetivo do Projeto ISEP-Brasil foi desenvolver e validar indicadores de boas praticas de seguranca do paciente para o contexto brasileiro. Tomou por base a traducao e adaptacao dos indicadores validados no Projeto ISEP-Espanha, alem do documento Safe Practices for Better Healthcare do National Quality Forum dos Estados Unidos, que possui 34 recomendacoes de boas praticas. Realizou-se validacao por um painel de 25 especialistas e analise da confiabilidade e viabilidade em um estudo-piloto realizado em tres hospitais com diferentes tipos de gestao (estadual, federal e privada). Aprovaram-se 75 indicadores de boas praticas (39 de estrutura; 36 de processo) para 31 das 34 recomendacoes. Os indicadores foram considerados validos, confiaveis e uteis para o monitoramento da seguranca do paciente em hospitais brasileiros.Efficacious patient safety monitoring should focus on the implementation of evidence-based practices that avoid unnecessary harm related to healthcare. The ISEP-Brazil project aimed to develop and validate indicators for best patient safety practices in Brazil. The basis was the translation and adaptation of the indicators validated in the ISEP-Spain project and the document Safe Practices for Better Healthcare (U.S. National Quality Forum), recommending 34 best practices. A 25-member expert panel validated the indicators. Reliability and feasibility were based on a pilot study in three hospitals with different management formats (state, federal, and private). Seventy-five best practice indicators were approved (39 structure; 36 process) for 31 of the 34 recommendations. The indicators were considered valid, reliable, and useful for monitoring patient safety in Brazilian hospitals.

Fatores associados ao custo das internações hospitalares por doenças infecciosas em idosos em hospital de referência na cidade do Natal, Rio Grande do Norte

This study examined the factors associated with direct cost of hospitalizations for infectious diseases in the elderly. We conducted a case study of the costs of hospitalization in elderly patients with 60 or more years admitted in a reference hospital in the city of Natal, state of Rio Grande do Norte, during the period from January 2005 to December 2009. The Multiple Linear Regression model (log-linear) was applied to analyze the factors associated with hospitalization costs. The results of the regression model showed that each additional day of hospitalization determined a 3% increase in average spending and admissions of elderly who died produced a 71.6% increase in costs relative to admissions of patients discharged.