Mirtes Loeschner Leichsenring

Successful prevention of the transmission of vancomycin-resistant enterococci in a Brazilian public teaching hospital

INTRODUCTION Vancomycin-resistant enterococci (VRE) can colonize or cause infections in high-risk patients and contaminate the environment. Our objective was to describe the epidemiological investigation of an outbreak of VRE, the interventions made, and their impact on its control. METHODS We conducted a retrospective, descriptive, non-comparative study by reviewing the charts of patients with a VRE-positive culture in the University Hospital of Campinas State University, comprising 380 beds, 40 of which were in intensive care units (ICUs), who were admitted from February 2008-January 2009. Interventions were divided into educational activity, reviewing the workflow processes, engineering measures, and administrative procedures. RESULTS There were 150 patients, 139 (92.7%) colonized and 11 (7.3%) infected. Seventy-three percent were cared for in non-ICUs (p = 0.028). Infection was more frequent in patients with a central-line (p = 0.043), mechanical ventilation (p = 0.013), urinary catheter (p = 0.049), or surgical drain (p = 0.049). Vancomycin, metronidazole, ciprofloxacin, and third-generation cephalosporin were previously used by 47 (31.3%), 31 (20.7%), 24 (16%), and 24 (16%) patients, respectively. Death was more frequent in infected (73%) than in colonized (17%) patients (p < 0.001). After the interventions, the attack rate fell from 1.49 to 0.33 (p < 0.001). CONCLUSIONS Classical risk factors for VRE colonization or infection, e.g., being cared for in an ICU and previous use of vancomycin, were not found in this study. The conjunction of an educational program, strict adhesion to contact precautions, and reinforcement of environmental cleaning were able to prevent the dissemination of VRE.

Conception and validation of a protocol for reuse of non-irrigated electrophysiology catheters in a Brazilian teaching hospital

PurposeSince the Brazilian current legislation permits the reuse of single-use devices under a validated processing protocol, the main purpose of our study was to develop and validate a method for reusing non-irrigated electrophysiology catheter (EC).MethodsManual and mechanical processing by ultrasonic washer was associated with the use of enzymatic solution and hydrogen peroxide with a final rinse with filtered water. Validation of the cleaning process, as well as catheter integrity, was done by observing the ECs in stereoscopic microscope at ×60 magnification, followed by HemoCheck-S® (HCS) test to monitor the presence of residual blood on their surfaces. Ethylene oxide (EO) was used for sterilization, and the final validations of the processing were performed by assays of sterility, pyrogenicity, and EO residuals. Lastly, a cost-minimization study was performed.ResultsCleaning process demonstrated absence of organic material detectable by HCS at the surfaces of the ECs. Assays for sterility were negative, and assays of EO residuals and endotoxins showed levels under established standards. The number of reuses was settled to a maximum of seven uses for the ECs with handle and ten uses for ECS without handle. The cost-minimization study showed an 84% savings, when considering seven reuses.ConclusionsProcessing of ECs was validated at all stages. Therefore, reuse of ECs under the conditions that we designed was considered safe for patients and cost-effective for our institution.

Avaliação de danos em nasofibroscópio flexível desinfetado com ácido peracético

Objective: To evaluate possible damages in naso-fiberscopes caused by disinfection with peracetic acid. Method: Applied research. Three new naso-fiberscopes subjected to disinfection with peracetic acid were monitored and photographed under stereoscopic microscope, for 18 months, to evaluate the behavior of the polymer and fiber naso-fiberscopes, related to the use of this disinfectant. Nurses and medical team were trained with emphasis on the correct handling and safe processing of the fibers. Results: Fibers were regularly analyzed and photographed during the study period, totaling 3,979 uses. In all fibers, cracking of the excess adhesive material around the fiber sealing area was observed, without functional impairment. After more than 2,000 uses, a flexible naso-fiberscope (FNF) developed surface cracks at the distal tip of the fiber cover, without however compromising the sealing test. Conclusion: The peracetic acid did not cause functional damage or oxidation in the FNFs, in the formulation used and during the study period, although the manufacturer recommends aldehydes solution to disinfect.

948Impact of active surveillance program to control VRE in a university hospital with low endemic rates

BACKGROUND Several strategies have been implemented to control VRE in hospital outbreaks. The delay in time for detecting the initial VRE colonization/infection may lead to a huge hospital dissemination. A major goal in healthcare facilities has been to stop VRE transmission. VRE was first isolated in our hospital in June 2007, from a urine culture of a patient from the gastroenterology clinic with an advanced stage of cirrhosis. From 2007 to 2009, a VRE outbreak in our hospital was controlled with: active surveillance of rectal swabs, isolation of colonized/infected patients, barrier precautions and antibiotic policies . Since 2009, protocols of control measures have been continuously implemented. This study evaluated the impact of maintaining the protocols for controlling VRE colonization/infection during the period of 2010 to July 2014 compared to the study done in 2007 to 2009