Sylvia Lemos Hinrichsen

Candidemia em hospital terciário do nordeste do Brasil

We conducted a prospective, observational, laboratory-based study on candidemia to investigate the incidence of candidemia, species distribution and clinical conditions between September 2003 and March 2004 in a private tertiary hospital in Recife, northeastern Brazil. Cases of candidemia were defined as occurrences of isolation of Candida spp from blood cultures. The incidence rate was calculated per 1,000 admissions. A total of 5,532 patients were admitted to the hospital during the study period, and 1,745 blood cultures were processed. Twenty-one episodes of candidemia were observed in 18 patients. The incidence rate of candidemia was 3.9 episodes per 1,000 admissions. Non-albicans species accounted for more than 50% of the cases, and Candida parapsilosis (33%) and Candida tropicalis (24%) predominated. Eleven (61%) patients died. The incidence of candidemia was higher than that observed in a Brazilian multicenter study. Candidemia was caused predominantly by non-albicans species.

Aspectos epidemiológicos da hanseníase na cidade de Recife, PE em 2002

BACKGROUND: As a problem of Public Health in Brazil, leprosy is still important due mainly to its high endemicity. OBJECTIVES: Determine the main characteristics of this disease in the city of Recife, Pernambuco state (PE), in 2002. METHODS: Based on data acquired from a questionnaire completed by patients, a retrospective study was carried out to analyze 100 handbooks of patients attended to in a reference center of Recife in 2002. A data base was elaborated and EPI-INFO-6 software was used for the analysis. Simple variable frequencies were obtained and a bi-varied analysis was made by studying ratio differences by means of chi-square. The cut off point was p<0.05. RESULTS: An increase of leprosy was observed to occur with age (7.0% of cases in children and adolescents and 11.0% in adults over 65 years of age), (p<0.001). Distribution per sex showed significant differences (male 57.0%, female 43.0%), (p<0.001). The tuberculoid form had the highest prevalence in all of the age ranges studied, with 42.0% of cases (p<0.001), and its incidence was highest in females, while borderline cases predominated in males (x2=18.83; p<0.001). The paucibacillary forms (tuberculoid and indeterminate) showed only one lesion or two-to-five lesions in 55.4% and 37.5% of the cases, respectively (x2=37.04; p<0.001). CONCLUSIONS: It was possible to demonstrate that Recife is still an endemic region due to a high incidence of the tuberculoid form, i.e. the epidemiological pointer suggestive of increased endemic diseases in the region. Only with the diagnosis and early treatment of the cases can the transmission of the illness chain be broken.

Candida isolates in tertiary hospitals in northeastern Brazil

Candida e um patogeno oportunista que afeta pacientes de alto risco que estao tambem imunocomprometidos ou criticamente doentes, estando associada a quase 80% de todos os casos de infeccoes fungicas nosocomiais, representando a maior causa de fungemia com alta taxa de mortalidade (40%). Candida albicans e a principal causa de candidemia e dentre as especies nao-albicans a C. parapsilosis, C. glabrata e C. tropicalis sao os agentes mais frequentes. O objetivo deste estudo foi avaliar a distribuicao das especies de Candida em dois hospitais terciarios no Recife, nordeste do Brasil. Foi realizado um levantamento de todas as culturas positivas para Candida processadas pelo laboratorio de microbiologia de Setembro de 2003 a Setembro de 2006. Todas as culturas originadas de varios tipos de material biologico (sangue, urina, traqueia, cateter e outros) foram processadas pelo sistema Vitec® (Biomerrieux SA, France). Um total de 1.279 amostras (hospital A:837; hospital B: 442) foram positivas para Candida. As especies mais frequentes em ambos os hospitais foram: C.albicans (367), C. tropicalis (363), C. parapsilosis (147), C. glabrata (81), C. krusei (30) e C. guillermondii (14). Os isolados foram obtidos de 746 pacientes hospitalizados. Um total de 221 hemoculturas positivas foram detectadas em 166 diferentes pacientes em ambos os hospitais, e 113 (68,1%) destes pacientes com hemoculturas positivas apresentavam Candida em outros locais do corpo. Este estudo mostrou que Candida nao-albicans foi o principal agente isolado e prova a importância da C. tropicalis em infeccoes fungicas nosocomiais.

Sodoku: descrição de um caso

Rat-bite fever results from an infection with the organism Spirillum minus. The authors report a symptomatic patient with fever, malaise, and ulcer in forehead after a rodent exposure. The organism was identified in darkfield examination of the ulcer exudate. Penicillin was the drug used with clinical improvement of symptoms.

Developing core elements and checklist items for global hospital antimicrobial stewardship programmes: a consensus approach

OBJECTIVES With increasing global interest in hospital antimicrobial stewardship (AMS) programmes, there is a strong demand for core elements of AMS to be clearly defined on the basis of principles of effectiveness and affordability. To date, efforts to identify such core elements have been limited to Europe, Australia, and North America. The aim of this study was to develop a set of core elements and their related checklist items for AMS programmes that should be present in all hospitals worldwide, regardless of resource availability. METHODS A literature review was performed by searching Medline and relevant websites to retrieve a list of core elements and items that could have global relevance. These core elements and items were evaluated by an international group of AMS experts using a structured modified Delphi consensus procedure, using two-phased online in-depth questionnaires. RESULTS The literature review identified seven core elements and their related 29 checklist items from 48 references. Fifteen experts from 13 countries in six continents participated in the consensus procedure. Ultimately, all seven core elements were retained, as well as 28 of the initial checklist items plus one that was newly suggested, all with ≥80% agreement; 20 elements and items were rephrased. CONCLUSIONS This consensus on core elements for hospital AMS programmes is relevant to both high- and low-to-middle-income countries and could facilitate the development of national AMS stewardship guidelines and adoption by healthcare settings worldwide.

Fatores associados à bacteriúria após sondagem vesical na cirurgia ginecológica

OBJETIVOS: Determinar a frequencia e os principais fatores associados a bacteriuria apos a sondagem vesical em mulheres submetidas a cirurgia ginecologica eletiva. METODOS: Realizou-se um estudo do tipo coorte em mulheres submetidas a cirurgia ginecologica apos sondagem vesical no Instituto de Medicina Integral Prof. Fernando Figueira, no periodo de janeiro a maio de 2007. As uroculturas foram coletadas ate 24 horas apos a retirada da sonda e 7/10 dias apos a sondagem vesical. A analise estatistica bivariada e multivariada foi realizada calculando-se a razao de risco e os seus intervalos de confianca a 95%. RESULTADOS: Foram incluidas no estudo 249 mulheres. A frequencia de uroculturas positivas ate 24 horas depois da retirada da sonda foi de 23,6%, diminuindo para 11,1% 7/10 dias apos a sondagem. Destas, apenas 2,4% eram sintomaticas. Verificou-se menor risco de bacteriuria com 7/10 dias apos a sondagem vesical quando a paciente referiu vulvovaginite tratada nos ultimos tres meses, nao permanecendo estatisticamente significativa apos a analise multivariada. Nao houve associacao significativa com idade, escolaridade, numero de gestacoes, paridade, fase da vida reprodutiva, tipo e duracao da cirurgia, tipo da anestesia, uso de antibiotico profilatico, profissional que colocou a sonda e o tempo de permanencia da sonda vesical. CONCLUSAO: A frequencia de bacteriuria foi de 23,6% e 11,1% com 24 horas e 7/10 dias, respectivamente. Nao se encontrou associacao significativa das variaveis pesquisadas com a bacteriuria evidenciada na urocultura com 7/10 dias.

Glosas hospitalares e o uso de protocolos assistenciais: revisão integrativa da literatura

Os registros realizados no prontuario do paciente sao alvo de auditorias nas instituicoes de saude devido a sua importância no cuidado ao paciente e na relacao com o faturamento dos custos hospitalares. Esta revisao integrativa objetivou analisar a producao cientifica nacional publicada entre 2000 e 2015, sobre auditoria em enfermagem e o uso de protocolos assistenciais como ferramenta de minimizacao de glosas. Na busca bibliografica, foram utilizadas as fontes de informacoes: BVS, SciELO, LILACS, BDENF, CAPES e Google Academico, a partir dos descritores glosa hospitalar, protocolos assistenciais, auditoria e prontuario. A amostra constitui-se de onze trabalhos. Nao foram encontrados estudos utilizando protocolos assistenciais como base de tomada de decisoes no cuidado e consequentemente como elemento minimizador de glosas hospitalares. Percebe-se a necessidade de melhorar os registros do prontuario do paciente, assim como a utilizacao de protocolos sistematizados para controlar melhor as praticas assistenciais e os impactos na seguranca do paciente.

Percepção da equipe de enfermagem sobre fatores causais de quase-falhas (near miss) no atraso de medicamentos através da Análise do Tipo e Efeito de Falha (Failure Mode and Effects Analysis) – FMEA

A enfermagem e responsavel pelas ultimas etapas do processo de administracao de medicamentos, podendo identificar os eventos e evita-los, com objetivos de administrar medicamentos de forma correta. Para isto, e preciso identificar os tipos de eventos que possam levar a quase-falhas ( near miss ) assim como, os fatores de risco na ocorrencia destes, que podem finalizar com erros. O objetivo deste estudo foi o de identificar os fatores causais de eventos (quase-falhas/ near miss ) no ciclo da administracao medicamentos. Realizou-se uma pesquisa quantitativa, descritiva, observacional, exploratoria, pelo servico de enfermagem e nucleo de seguranca do paciente de um hospital terciario, de alta complexidade, localizado em Recife, que monitorou nao conformidades no uso de medicamentos a partir da sua prescricao para o paciente. Foram observadas 5.037 nao conformidades no ciclo do medicamento, a partir da prescricao eletronica com permissao de inclusoes manuais, relacionadas ao atraso de medicamento, segundo a percepcao da enfermagem. Em relacao aos dados obtidos atraves do FMEA (Analise do Tipo e Efeito de Falha) das nao conformidades identificadas, foi considerado inaceitavel a pratica de prescricao manual na prescricao eletronica. E fundamental que existam politicas e estrategias de melhorias que aumentem a seguranca do ciclo dos medicamentos, especialmente, no atraso destes, que podem gerar quase-falhas ( near miss) nas instituicoes que usam prontuario manual e principalmente eletronico. As estrategias somente estarao coerentes quando houver uma cultura de seguranca na medicacao e na melhoria da qualidade assistencial prestada a sua clientela e pacientes. Publicado em 21/11/2016.

Análise epidemiológica dos acidentes com material biológicos em um hospital oftalmológico

Objective: Toanalyzetheincidenceandcharacteristicsofaccidentswithbiological material in anophthalmologyhospital inthe Northeast ofBrazil. Methods: Retrospectivedescriptivestudyon ducted through a surveyof biological material accidents notifiedby Comunicação de Acidentes de Trabalho (CAT) during 2010-2013. Results: 34 accidents were reported, 26 (76.5%) workers were femalesand 8 (23.5%) were males. The mean age was 30.0 ± 5.9 years. Forty-eight (82.3%) accidentsoccurred in thesurgicalroomofthe hospital, 15 (44.1%) werewithauxiliary / practical nurses, 8 (23.5%) withsurgicaltechnologists, 5 (14.7%) with training physicians, 4 (11.8%) withtrainedphysiciansand 2 (5.9%) withcleaning staff. Accidentswerewith percutaneus in 30 (88.2%) cases, andcontactwith mucosa in 4 (11.7%). In 28 (82.4%) cases theaccidentwas in theupperlimb, 4 (11.8%) in the face, and 2 (5.8%) in the lowerlimbs. The accidentoccurredduringsurgery in 12 (35.3%) and 10 (29.4%) duringmanipulationofthe material aftersurgery. The injuries occurred with employees who had an average of two years of experience and after 5.5 hours worked.Conclusion:Occupational accidents with biological material in an ophthalmology hospital were more frequent with auxiliary/practical nurses, during surgery and in the manipulation of instruments after surgery.This study demonstrated the importance of identifying risks of occupational accidents among health professionals in ophthalmology.Objective: To analyze the incidence and characteristics of accidents with biological material in an ophthalmology hospital in the Northeast of Brazil. Methods: Retrospective descriptive study on ducted through a survey of biological material accidents notified by Comunicacao de Acidentes de Trabalho (CAT) during 2010-2013. Results: 34 accidents were reported, 26 (76.5%) workers were females and 8 (23.5%) were males. The mean age was 30.0 ± 5.9 years. Forty-eight (82.3%) accidents occurred in the surgical room of the hospital, 15 (44.1%) were with auxiliary / practical nurses, 8 (23.5%) with surgical technologists, 5 (14.7%) with training physicians, 4 (11.8%) with trained physicians and 2 (5.9%) with cleaning staff. Accidents were with percutaneus in 30 (88.2%) cases, and contact with mucosa in 4 (11.7%). In 28 (82.4%) cases the accident was in the upper limb, 4 (11.8%) in the face, and 2 (5.8%) in the lower limbs. The accident occurred during surgery in 12 (35.3%) and 10 (29.4%) during manipulation of the material after surgery. The injuries occurred with employees who had an average of two years of experience and after 5.5 hours worked. Conclusion: Occupational accidents with biological material in an ophthalmology hospital were more frequent with auxiliary/practical nurses, during surgery and in the manipulation of instruments after surgery.This study demonstrated the importance of identifying risks of occupational accidents among health professionals in ophthalmology.

Perfil dos microrganismos isolados no trato urinário após sondagem vesical em cirurgia ginecológica

OBJECTIVES: to determine the microorganisms mostfrequently found in urocultures after urinary catheterization and their antibiotic sensitivities in women undergoing elective gynecological surgery. METHODS: the study was carried out at theInstituto de Medicina Integral Professor FernandoFigueira, IMIP, in Recife, Pernambuco, Brazil, between January and May 2007. Urine cultures wereobtained from these patients on two occasions subsequent to the removal of the catheter: within the first 24h and 710 days later. RESULTS: urine samples were collected from 249 women. 23.6% (n=46) of the samples collected in the first 24h were found to have urine cultures and 11.1% (n=25) of those collected 710 days after removal of the catheter. No significant difference was observed regarding the microorganisms present in the uroculture, when comparing the two periods of sample collection. Klebsiella spp. was the most frequentmicroorganism found (first 24h=47.8% vs. 7/10 days=44.0%; p=0.76), followed by Escherichia coli, and other Gram negatives. The antibiotics, amicacine, cefepime, ciprofloxacin, meropenem andticarcilinclavulanate showed sensitivity equal to orgreater than 75% for the main microorganism isolated. CONCLUSIONS: Klebsiella spp. was the most frequent microorganism present in urocultures after urinary catheterization in women undergoing elective gynecological surgery. Ciprofloxacin was found to have a sensitivity of 95%.