Dissertations / Theses: 'Hospital infection'

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Yang, Chao-Ying. "Influencers on hospital infection control policy : what incentives could promote infection control in hospitals?" Thesis, University of Birmingham, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.433632.

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Glenister, Helen Mary. "Surveillance methods for hospital infection." Thesis, University of Surrey, 1991. http://epubs.surrey.ac.uk/664/.

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Eight selective surveillance methods were assessed for their effectiveness in detecting hospital infection and the time required for data collection. The methods were compared with a reference method which was designed to identify all patients and infections in the study population (patients occupying 122 beds of a district general hospital). The selective methods were: - laboratory based ward surveillance - laboratory based telephone surveillance - ward liaison surveillance - laboratory based ward liaison surveillance - risk factor surveillance - temperature chart surveillance - treatment chart surveillance - temperature and treatment chart surveillance. The proportions of community acquired infection (CAI) and hospital acquired infection (HAI) detected by the selective surveillance methods varied; the highest proportion of CAI (70%) was identified by treatment chart surveillance, and temperature and treatment chart surveillance, and of HAI (71%), detected by laboratory based ward liaison surveillance. The time for data collection ranged from 1.5 hours/122 beds/week for laboratory based telephone surveillance to almost 8 hours for temperature and treatment chart surveillance. The time for the reference method was 22.1 hours/122 beds/week. Using the proportion of patients with HAI detected and time required for data collection to assess the methods, laboratory based ward liaison surveillance was the most effective and an efficient method. This method was revised minimally and introduced into six district general hospitals by infection control nurses. The time for data collection ranged from 4 to almost 8 hours/120 beds/week. The revision did not affect the proportion of HAI detected, however, the proportion of CAI identified was significantly reduced. The reproducibility of laboratory based ward liaison surveillance was good. The results will enable infection control teams to make an objective and rational choice of methods for the surveillance of hospital infection.

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Makin, Thomas. "Legionellae and the hospital environment." Thesis, University of Liverpool, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.261833.

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This thesis investigates the distribution of legionellae in water systems in the Royal Liverpool University Hospital (RLUH) and examines some of the factors that affect colonisation by these organisms. The effect of persistent contamination of the domestic water system on immunocompromised patients was monitored, and the envirorunental control of legionellae by various methods was assessed. A fluorescent monoclonal antibody (DFA) was evaluated for its ability to detect L. pneumophila in domestic and cooling water, and was highly sensitive and specific for this purpose. DFA detected non-culturable L. pneumophila in the cold water system (CWS) that were not recovered following heat shock procedures. Legionellae were not isolated from air conditioning humidifiers, and were rarely detected in cooling towers despite treatment with inadequate concentrations of biocide. A high pH assisted in preventing legionella colonisation. Calorifier sediment contained legionellae and high levels of insoluble copper oxides. Culture media and a low pH, released Cuions from sediment which were markedly inhibitory to legionellae. Low concentrations of Cuions were detected in domestic hot water. At temperatures below 60°C legionellae were detected in the hot water supply to the wards, and calorifiers were regularly re-seeded by legionellae returning from contaminated peripheral parts of the system. Legionellae were not detected in the HWS when 60°C was achieved. L. pneumophila sgps 6, 12 and L. bozemanii predominated in domestic water. L. pneumophila sgp 1 was detected on one occasion only in a cold water storage tank and a calorifier, and did not colonise any of the water systems. L. pneumophila sgps 6 and 12 were isolated from three nosocomial cases of Legionnaires' disease. Endemic legionellae prepared as yolk sac antigens, detected significant titres of legionella antibodies (~ 1 :64) in samples from six subjects which did not react ( < 1: 16) with the PHLS L. pneumophUa sgp 1 yolk sac antigen. Most raised titres were to L. pneumophila sgp 12, and the highest titre in heterologous responses identified the infecting serogroup of L. pneumophila. Routine culture of respiratory samples from susceptible patients. detected only one undiagnosed case of Legionnaires' disease. Legionellae were not detected in water from showers that were regularly flushed or irradiated with UV light. Re-colonisation of showers by legionellae was closely associated with the reappearance of amoebae. A trace heating element was effective at maintaining dead-legs at 50°C (± 1.5) and reduced legionellae in these sites. Legionellae proliferated where pipes and heating element were not adequately insulated. Re-circulating the HWS through dead-legs eradicated legionellae from this site but resulted in heavy colonisation of adjacent mixer valves. Automatic drain valves failed to prevent legionellae from colonising shower hoses and mixer valves, and hyperchlorination of shower hoses and water strainers had only a short term effect. Showers heated electrically at point of use were not colonised by legionellae entering in the CWS, or by wild strains of legionellae introduced with calorifier sediment. This appeared to be due to rapid throughput of water, extensive use of copper, and pasteurisation of calorifier contents following discharge of heat from the heating elements, after the shower ceased operating.

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Qian, Hua. "Ventilation for controlling airborne infection in hospital environments." Click to view the E-thesis via HKUTO, 2007. http://sunzi.lib.hku.hk/hkuto/record/B38974551.

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Qian, Hua, and 錢華. "Ventilation for controlling airborne infection in hospital environments." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2007. http://hub.hku.hk/bib/B38974551.

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McHaney, Megan. "Intra-Hospital Transfers and the Associated Risk of Hospital-Onset Clostridium Difficile Infection." The Ohio State University, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=osu1524668971169289.

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Nascimento, Flávia Alves Ferreira Rossini. "Sucesso no controle da transmissão de Enterococcus spp. em um hospital universitário brasileiro." [s.n.], 2011. http://repositorio.unicamp.br/jspui/handle/REPOSIP/311646.

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Orientador: Plínio Trabasso
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Enterococos resistentes a vancomicina (ERV) representam grande problema na assistência hospitalar, com dificuldades terapêuticas e de controle ambiental, pois colonizam trato gastrintestinal e são capazes de sobreviver no ambiente por tempo prolongado. A transmissão ocorre principalmente através das mãos de profissionais de saúde e contato com equipamentos ou superfícies contaminadas. O objetivo deste trabalho foi descrever um surto de ERV em hospital de ensino brasileiro e avaliar o impacto de medidas adotadas para o seu controle. Foi realizado um estudo retrospectivo envolvendo 150 pacientes admitidos no Hospital de Clínicas da Universidade Estadual de Campinas, de fevereiro de 2008 a janeiro de 2009, com identificação de ERV; foi realizada revisão dos prontuários médicos para obtenção de dados demográficos, comorbidades, fatores de risco e unidades de internação. Os desfechos primários foram colonização ou infecção por ERV e morte. A associação entre variáveis categóricas foi verificada com aplicação do teste x2 ou teste exato de Fisher quando necessário e para variáveis contínuas através do teste de Mann-Whitney. O nível de significância adotado foi 5% (p? 0,05). Entre os 150 pacientes identificados, 94 (63%) eram do sexo masculino e a mediana de idade foi 50 anos. As principais comorbidades foram infecção na admissão em 90 (60%) pacientes, câncer em 60 (40%) e hipertensão arterial em 49 (33%). Clínica Médica, Onco-Hematologia, Trauma, Emergência e Gastroenterologia corresponderam a 73% dos pacientes. Os casos foram identificados através de esfregaços retais em 139 (92,7%) indivíduos e em outros sítios em 11 (7,3%) pacientes, sendo sangue em 5 casos (3,4%), líquido ascítico em 2 (1,3%) e cateter venoso central, líquido pleural, urina e secreção de ferida cirúrgica em 1 paciente (0,7%) cada. Enterococcus faecium foi a espécie identificada em 147 (98%) pacientes, representando uma mudança na epidemiologia do hospital, pois durante o período inicial do surto havia maior número de casos de E. faecalis. Não houve diferenças entre os pacientes colonizados ou infectados em relação a sexo, idade e comorbidades. Infecção ocorreu com maior frequencia entre pacientes em uso de ventilação mecânica (p = 0,013), cateter venoso central (p = 0,043), cateter urinário (p = 0,049) e drenos (p = 0,049). A morte foi mais frequente entre os pacientes infectados (73%) do que nos colonizados (17%) (p < 0,001). Uma campanha informativa foi realizada, através de palestras e distribuição de folhetos explicativos para pacientes e familiares. A limpeza do ambiente foi reforçada e dispensadores de álcool gel foram amplamente distribuídos. Precauções de contato para todos pacientes com ERV e restrição às visitas foram implementadas. O acompanhamento do surto revelou decréscimo significativo no número de casos, com 40 novos casos nos onze meses posteriores, representando uma taxa de ataque de 0,33%, comparada com a taxa prévia de 1,49% (p<0,001). A prevenção da transmissão cruzada de ERV, bem como a redução da contaminação ambiental foram baseadas em medidas educativas, reforço da limpeza ambiental e estímulo à higienização das mãos, sendo eficazes para controle do surto
Abstract: Vancomycin-resistant Enterococci (VRE) represent an important problem in hospital care, because of the therapeutic and environmental control difficulties, because they colonize the gastrointestinal tract and therefore are able to survive in the environment for long periods. Transmission occurs primarily through the hands of health care professionals and contact with contaminated surfaces or equipments. The goal of this study was to describe an outbreak of VRE in Brazilian teaching hospital and evaluate the impact of measures taken for its control. We conducted a retrospective study of patients admitted to the Hospital de Clínicas of Universidade Estadual de Campinas, from February 2008 to January 2009, with identification of VRE. We reviewed the medical records to obtain demographic data, comorbidities, risk factors and inpatient wards. The primary outcomes were VRE colonization or infection and death. The association between categorical variables was assessed by applying the x2 test or Fisher's exact test and the Mann-Whitney test for continuous variables. The level of significance was 5% (p ? 0.05). Among the 150 patients identified, 94 (63%) were male and median age was 50 years. The main comorbidities were prior infection at admission in 90 (60%) patients, cancer in 60 (40%) and hypertension in 49 (33%). The main wards were Internal Medicine, Onco-Hematology, Trauma, Emergency and Gastroenterology, representing 73.0% of patients, while only 9 (6.0%) cases were cared for at ICU. Among the identified cases, VRE was isolated from rectal swab in 139 (92.7%) cases and from others sites in 11 (7.3%) cases, being 5 (3.4%) in blood, 2 (1.3%) in peritoneal fluid and in central line catheter, pleural effusion, urine and surgical wound infection in 1 (0.7%) each. Enterococcus faecium was isolated from 147 (98.0%) patients, representing a substantial change in the hospital epidemiology, since during the initial outbreak period, the majority of cases were caused by E. faecalis. There were no differences between patients in respect of being colonized or infected by VRE according to gender, age and underlying conditions. Patients with infection were more frequently observed among those in mechanical ventilation (p=0.013), central line catheter (p=0.043), indwelling urinary catheter (p=0.049) or surgical drains (p=0.049). Death was statistically significant higher in the infected patients than in the colonized individuals (p<0.001). An informative campaign was conducted through lectures and distributing leaflets for patients and their relatives. Environmental cleaning was reinforced and alcohol gel dispensers were widely distributed. Contact precautions for all patients with VRE and restrictions on visits have been implemented. The follow up of the outbreak revealed a significant decrease in the number of cases, with 40 new cases in the next eleven months, representing an attack rate of 0.33%, compared with the previous rate of 1.49% (p <0.001). The prevention of cross transmission of VRE, as well as reduction of environmental contamination were based on educational measures, strengthening of environmental cleaning and encouraging hand washing, being effective to control the outbreak
Mestrado
Clinica Medica
Mestre em Clinica Medica

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Choi, Kelly Baekyung. "Cost Attributable to Hospital-acquired Clostridium difficile infection (CDI)." Thèse, Université d'Ottawa / University of Ottawa, 2013. http://hdl.handle.net/10393/30198.

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Introduction: Clostridium difficile infection (CDI) is a common hospital-acquired infection and a financial burden on the healthcare system. There is a need to reduce its impact on patients and the entire health system. More accurate estimates of the financial impact of CDI will assist hospitals in creating better CDI reduction strategies with limited resources. Previous research has not sufficiently accounted for the skewed nature of hospital cost data, baseline patient mortality risk, and the time-varying nature of CDI. Objective: We conducted a retrospective cohort study to estimate the cost impact of hospital-acquired CDI from the hospital perspective, using a number of analytical approaches. Method: We used clinical and administrative data for inpatients treated at The Ottawa Hospital to construct an analytical data set. Our primary outcome was direct costs and our primary exposure was hospital-acquired CDI. We performed the following analyses: Ordinary least square regression and generalized linear regression as time-fixed methods, and Kaplan-Meier survival curve and Cox regression models as time-varying methods. Results: A total of 49,888 admissions were included in this study (mean (SD) age of 64.6 ± 17.8 years, median (IQR) baseline mortality risk of 0.04 (0.01-0.14)). 360 (0.73%) patients developed CDI. Estimates of incremental cost due to CDI were substantially higher when using time-fixed methods than time-varying methods. Using methods that appropriately account for the time-varying nature of the exposure, the estimated incremental cost due to CDI was $8,997 per patient. In contrast, estimates from time-fixed methods ranged from $49,150 to $55,962: about a six fold difference. Conclusion: Estimates of hospital costs are strongly influenced by the time-varying nature of CDI as well as baseline mortality risk. If studies do not account for these factors, it is likely that the impact of hospital-acquired CDI will be overestimated.

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Moura, Josely Pinto de. "A adesão dos profissionais de enfermagem às precauções de isolamento na assistência aos portadores de microrganismos multirresistentes." Universidade de São Paulo, 2004. http://www.teses.usp.br/teses/disponiveis/22/22132/tde-12082004-125447/.

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Com o evento da resistência dos microrganismos aos antimicrobianos, surgiram as cepas multirresistentes de difícil tratamento, e com isso tornou-se imprescindível a adesão total dos profissionais de saúde às precauções empregadas na assistência aos portadores desses microrganismos, visando evitar a sua disseminação no ambiente hospitalar. Este estudo do tipo descritivo transversal foi realizado em uma instituição de saúde filantrópica do interior de Minas Gerais, teve como objetivos avaliar a adesão dos enfermeiros, técnicos e auxiliares de enfermagem às medidas preventivas empregadas na assistência aos portadores desses microrganismos multirresistentes. A coleta de dados ocorreu no período de outubro a novembro de 2003 e os dados foram analisados qualitativa e quantitativamente. Utilizou-se do Método de análise de conteúdo de BARDIN (1977) e para a análise quantitativa de alguns dados, empregou-se a estatística descritiva, sendo os mesmos interpretados com base no significado atribuído por ROSENSTOCK (1974a). O Modelo de Crenças em Saúde (MCS) possibilitou identificar as barreiras físicas, cognitivas e psicológicas que justificaram a não-adesão de alguns profissionais às medidas preventivas direcionadas ao portador de Bactérias Multirresistentes (BMR). Como resultado destas avaliações, identificou-se que as percepções dos profissionais de enfermagem relacionadas à severidade das doenças causadas por BMR eram adequadas, que a maioria dos profissionais entrevistados associou a gravidade das doenças causadas por BMR a tratamento difícil ou a maior índice de mortalidade, e outros associaram-nas a tratamento inexistente. Quanto à susceptibilidade da doença, o conhecimento dos profissionais a respeito da temática apresentou-se bastante limitado. Os profissionais se aperceberam como susceptíveis de contrair BMR, entretanto, somente alguns conseguiram identificar os grupos mais susceptíveis à infecção causada por BMR. Observou-se uma influência favorável da instituição ao se constatar que proporciona aos profissionais as condições necessárias para que estes empreguem o Protocolo de Isolamento Específico. O comportamento dos profissionais em relação ao uso dos Equipamentos de Proteção Individual (EPI) evidenciou controvérsias, pois muitos relataram utilizar freqüentemente os paramentos, contudo admitiram que alguns profissionais não os utilizam rigorosamente por diversos motivos, sendo mais freqüentes: a crença de que não vão contrair a doença, diagnóstico tardio, ou por resistência, ou seja, injustificadamente ... não usa porque não quer .... Observou-se que muitos profissionais não aderem totalmente às precauções por opção pessoal, eles não têm o hábito de lavar as mãos ou friccioná-las com álcool na freqüência que deveriam, apesar de terem os materiais disponíveis. Acreditam que os benefícios à adesão são: proteção, prevenção de adquirir infecção/doenças, o fato de evitar a disseminação e sua segurança. Quanto às barreiras, mencionaram principalmente a falta de vagas, o diagnóstico tardio e a falta de alguns materiais. O estímulo para a ação, referido preferencialmente pelos profissionais, foi a abordagem informal na prática diária. Identificaram-se, ainda, a necessidade de elaborar estratégias de intervenção capazes de aprimorar a conduta dos profissionais de enfermagem e o levantamento dos problemas considerados imprescindíveis para percepção das crenças dos profissionais, a fim de se implementar efetivamente as estratégias que devem alterar positivamente a situação observada.
As microorganisms acquired resistance against antimicrobial agents, multiresistant strains appeared which are difficult to treat. Hence, the total adhesion of health professionals to the precaution measures used in care for patients with multiresistant microorganisms has become essential, with a view to avoiding their dissemination in the hospital environment. This descriptive transverse study was carried out at a philanthropic health institution in the interior of Minas Gerais, Brazil and aimed to evaluate the adhesion of nurses, nursing technicians and auxiliaries to prevention measures used in care for patients with these multiresistant microorganisms. Data were collected in October and November 2003 and were subject to qualitative and quantitative analysis. BARDINs (1977) content analysis method was used. Descriptive statistics was used with a view to the quantitative analysis of some data, which were interpreted on the basis of the meaning attributed by ROSENSTOCK (1974a). The Health Belief Model (HBM) allowed us to identify the physical, cognitive and psychological obstacles that justify some professionals non-adhesion to the prevention measures oriented towards patients with Multiresistant Bacteria (MRB). As a result of these evaluations, it was identified that nursing professionals adequately perceived the seriousness of diseases caused by MRB, that most of the interviewees linked up the gravity of diseases caused by MRB with difficult treatment or higher mortality rates, while others associated it with the inexistence of treatment. With respect to disease susceptibility, professionals demonstrated a rather limited knowledge about the theme. They perceived themselves as susceptible to MRB, although only some professionals managed to identify the groups that are most susceptible to infection by MRB. A favorable institutional influence was observed when verifying that the institution provides its professionals with the necessary conditions to use the Specific Isolation Protocol. Professional behavior in relation to Individual Protection Equipment (IPE) usage revealed controversies, since many of them mentioned frequent usage, although they admitted that some professionals do not use this equipment in a strict way, for different reasons, among which the most frequent were: the belief that they will not contract the disease, late diagnosis, or due to resistance, that is, without any justification ... they do not use it because they do not want to .... It was observed that many professionals choose not to adhere totally to the precaution measures. They are not used to washing their hands or scrubbing them with alcohol as frequently as they should, although the material is available. They believe that benefits of adhesion are: protection, prevention of infection/diseases, avoiding dissemination and their safety. With respect to obstacles, they mainly mentioned the lack of beds, late diagnosis and the lack of some kinds of material. As a stimulus towards action, professionals prefer the informal approach in daily practice. We also identified the need to elaborate intervention strategies capable of improving nursing professionals behavior and surveyed the problems considered essential to perceive professional beliefs, with a view to the efficient implementation of strategies that should positively change this situation.

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Nascimento, Ariane Cristina Mendes de Oliveira Bruder [UNESP]. "Susceptibilidade antifúngica, produção de biofilme e caracterização do gene ALS3 em isolados de Candida albicans e não-albicans do hospital das clínicas, UNESP, Botucatu." Universidade Estadual Paulista (UNESP), 2009. http://hdl.handle.net/11449/87810.

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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
Leveduras oportunistas do gênero Candida são capazes de disseminar-se em hospedeiros susceptíveis, num processo crescente nos últimos anos. Um fator complicador destes quadros ocorre quando estas leveduras são capazes de produzir biofilme, principalmente quando associadas a cateteres ou outros dispositivos médicos, elevando o poder de penetração e invasão em órgãos do hospedeiro. Por também conferir maior resistência às drogas antifúngicas do que as células dispersas, o biofilme fúngico tornou-se um dos maiores problemas no combate a estas infecções. A base genética da produção de biofimes nestas leveduras é complexa, porém já foi determinado o envolvimento de genes da família ALS, codificadores de glicoproteínas de adesão. Dentre os oito genes desta família (ALS1 ao ALS7 e ALS9), destaca-se o papel de ALS3. O gene ALS3, assim como todos os outros genes da família, apresenta uma estrutura composta por 3 domínios. O domínio 5’, região bem conservada; um domínio central que apresenta motifs de 108pb repetidos em tandem, com variações de tamanho entre os genes da mesma família e entre o mesmo gene em diferentes espécies, em uma mesma espécie e até mesmo entre alelos de uma mesma cepa, e o domínio 3, menos conservado que o domínio 5’, que pode apresentar variações de tamanho e de algumas seqüências de aminoácidos. Tendo em vista a crescente incidência de infecções por esse microrganismo em todo o mundo, o presente estudo objetivou investigar a freqüência das diferentes espécies de Candida em nossa região e caracterizá-las quanto à susceptibilidade a drogas antifúngicas e produção de biofilme, e possível correlação da produção de biofilme com polimorfismos de tamanho do gene ALS3. Os resultados obtidos confirmam a crescente incidência de espécies não-albicans, principalmente isoladas de infecções invasivas como cultura...
Opportunistic yeasts of the genus Candida are able to disseminate into the bloodstream in susceptible hosts, in an increasing course in the recent years. A complicating factor is when these yeasts are capable of producing biofilms, especially associated with catheters or other medical devices. Biofilm also confers greater resistance to antifungal drugs than dispersed cells, so the fungal biofilm has become one of the greatest problems in combating these infections. The genetic basis of the biofim production by yeasts is complex, but it has been know the involvement of ALS gene family, encoders of adhesion glycoproteins. Among the eight genes of this family (ALS1 to ALS7 and ALS9), the ALS3 are considered the most important. The ALS3 gene, such as the others members of the family, have three general domains: the 5’domain, conserved, with approximately 1300-pb; followed by a central domain consisting entirely of tandem-repeats of a 108-pb sequence, that are somewhat variable; and the 3’ domain, which is least conserved in length and sequence. Considering the increase incidence of these infections worldwide, the aims of this study were identify the frequency of Candida species in our region, to characterize the profile of antifungal susceptibility; to quantify the biofilm production and to correlate this production with the ALS3 gene length polymorphism. Our data confirm the increase incidence of non-albicans species, mainly when obtained from invasive infections, such as blood and peritoneal fluid, in which C. parapsilosis was the most frequent isolated species. The same was also observed to biofilm production, in which isolates obtained from invasive infections (blood and peritoneal fluid) are more biofilm producers than that obtained from vaginal secretion and urine. Among the different species, isolates of non-albicans also are more biofilm producers than C. albicans. Polimerase... (Complete abstract click electronic access below)

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Lam, Wai-yee Wendy. "Abdominal wound infection after caesarean delivery in a district hospital." View the Table of Contents & Abstract, 2006. http://sunzi.lib.hku.hk/hkuto/record/B36887122.

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Lam, Wai-yee Wendy, and 林慰儀. "Abdominal wound infection after caesarean delivery in a district hospital." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2006. http://hub.hku.hk/bib/B39724335.

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Nascimento, Ariane Cristina Mendes de Oliveira Bruder. "Susceptibilidade antifúngica, produção de biofilme e caracterização do gene ALS3 em isolados de Candida albicans e não-albicans do hospital das clínicas, UNESP, Botucatu /." Botucatu : [s.n.], 2009. http://hdl.handle.net/11449/87810.

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Orientador: Eduardo Bagagli
Banca: Marcia de Souza Carvalho Melhem
Banca: Paulo José Fortes Villas Boas
Resumo: Leveduras oportunistas do gênero Candida são capazes de disseminar-se em hospedeiros susceptíveis, num processo crescente nos últimos anos. Um fator complicador destes quadros ocorre quando estas leveduras são capazes de produzir biofilme, principalmente quando associadas a cateteres ou outros dispositivos médicos, elevando o poder de penetração e invasão em órgãos do hospedeiro. Por também conferir maior resistência às drogas antifúngicas do que as células dispersas, o biofilme fúngico tornou-se um dos maiores problemas no combate a estas infecções. A base genética da produção de biofimes nestas leveduras é complexa, porém já foi determinado o envolvimento de genes da família ALS, codificadores de glicoproteínas de adesão. Dentre os oito genes desta família (ALS1 ao ALS7 e ALS9), destaca-se o papel de ALS3. O gene ALS3, assim como todos os outros genes da família, apresenta uma estrutura composta por 3 domínios. O domínio 5', região bem conservada; um domínio central que apresenta motifs de 108pb repetidos em tandem, com variações de tamanho entre os genes da mesma família e entre o mesmo gene em diferentes espécies, em uma mesma espécie e até mesmo entre alelos de uma mesma cepa, e o domínio 3, menos conservado que o domínio 5', que pode apresentar variações de tamanho e de algumas seqüências de aminoácidos. Tendo em vista a crescente incidência de infecções por esse microrganismo em todo o mundo, o presente estudo objetivou investigar a freqüência das diferentes espécies de Candida em nossa região e caracterizá-las quanto à susceptibilidade a drogas antifúngicas e produção de biofilme, e possível correlação da produção de biofilme com polimorfismos de tamanho do gene ALS3. Os resultados obtidos confirmam a crescente incidência de espécies não-albicans, principalmente isoladas de infecções invasivas como cultura... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Opportunistic yeasts of the genus Candida are able to disseminate into the bloodstream in susceptible hosts, in an increasing course in the recent years. A complicating factor is when these yeasts are capable of producing biofilms, especially associated with catheters or other medical devices. Biofilm also confers greater resistance to antifungal drugs than dispersed cells, so the fungal biofilm has become one of the greatest problems in combating these infections. The genetic basis of the biofim production by yeasts is complex, but it has been know the involvement of ALS gene family, encoders of adhesion glycoproteins. Among the eight genes of this family (ALS1 to ALS7 and ALS9), the ALS3 are considered the most important. The ALS3 gene, such as the others members of the family, have three general domains: the 5'domain, conserved, with approximately 1300-pb; followed by a central domain consisting entirely of tandem-repeats of a 108-pb sequence, that are somewhat variable; and the 3' domain, which is least conserved in length and sequence. Considering the increase incidence of these infections worldwide, the aims of this study were identify the frequency of Candida species in our region, to characterize the profile of antifungal susceptibility; to quantify the biofilm production and to correlate this production with the ALS3 gene length polymorphism. Our data confirm the increase incidence of non-albicans species, mainly when obtained from invasive infections, such as blood and peritoneal fluid, in which C. parapsilosis was the most frequent isolated species. The same was also observed to biofilm production, in which isolates obtained from invasive infections (blood and peritoneal fluid) are more biofilm producers than that obtained from vaginal secretion and urine. Among the different species, isolates of non-albicans also are more biofilm producers than C. albicans. Polimerase... (Complete abstract click electronic access below)
Mestre

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LOPES, Lilian Kelly de Oliveira. "INFECÇÃO PELO Mycobacterium tuberculosis ENTRE OS PROFISSIONAIS DA EQUIPE DE ENFERMAGEM, EM UM HOSPITAL DE DOENÇAS INFECCIOSAS, GOIÂNIA - GO." Universidade Federal de Goiás, 2006. http://repositorio.bc.ufg.br/tede/handle/tde/742.

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According to the World Health Organization (WHO), an hundred million of individuals are infected by M. tuberculosis, annually. Health care workers play an important role to control of tuberculosis, but they are also at high risk for this infection. Then, the objectives of the present study were to evaluate the prevalence of M tuberculosis infection in nursing professionals from the Tropical Diseases Hospital in Goiânia City, State of Goiás, to analyze the factors associated to tuberculin skin test (TST) positivity and to determine the TB infection incidence density in susceptible professionals Initially, the prevalence and factors associated to TST were investigated in 128 eligible individuals. Further, susceptible professionals (n=32) were followed up during three years (2001-2004) to detect TST conversion. Of the total individuals investigated, 69.5% (IC 95%: 60.7-77.2) were positive to TST. Two occupational factors were independently associated to skin test positivity: duration of profissional activity longer than 5 years (Adjustd OR = 6.3; 95% CI: 1.5-26.2) and occupational contact with a person with pulmonary TB ≤ 2 years (Adjusted OR = 12.2; 95% CI: 1.2-106.3). Seven profissionals showed tuberculinic conversion during the three years of follow up, and an incidence density of 11.5 new conversions to 100 persons-year was detected. All of them had taken care of patients during the period of the study. Two individuals developed tuberculosis disease. The data of this study ratify the high risk of tuberculosis in nursing team, and highlight the importance of this infection as an occupational disease to nursing professionals of our region.
De acordo com a Organização Mundial de Saúde (OMS), cem milhões de pessoas são infectadas pelo M. tuberculosis, a cada ano. Os profissionais de saúde são importantes para o controle da tuberculose, mas também um grupo de risco elevado para esta infecção. Assim, o presente estudo teve como objetivos avaliar a prevalência da infecção causada pelo M. tuberculosis em profissionais de enfermagem de uma instituição especializada em doenças infecciosas, em Goiânia Go, analisar os fatores associados à positividade à prova tuberculínica nesta população e determinar a densidade de incidência da infecção pelo M. tuberculosis, nos profissionais susceptíveis. Inicialmente, verificou-se a prevalência e os fatores associados à positividade à PT. A seguir, os profissionais suscetíveis à infecção (n=32) foram acompanhados, por três anos (2001-2004), para detecção de conversão tuberculínica. Do total de profissionais investigados, 69,5% (IC 95%: 60,7- 77,2) foram positivos à PT. Dois fatores ocupacionais foram independentemente associados à positividade à PT: tempo de atividade profissional > 5 anos (OR ajustado = 6,3; IC 95%: 1,5-26,2) e último contato laboral com alguém com TB ≤ 2 anos (OR ajustado = 12,2; IC95%: 1,2-106,3). Sete profissionais apresentaram viragem tuberculínica, resultando em uma densidade de incidência de 11,5 novas conversões por 100 pessoas/ano. Todos desenvolviam atividades assistenciais, durante o período do estudo. Duas profissionais desenvolveram tuberculose doença. Os resultados, deste estudo, ratificam o elevado risco de tuberculose nos profissionais de enfermagem, e evidenciam a importância desta infecção como doença ocupacional para equipe de enfermagem de nossa região.

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Gosse, Jéssica Thandara 1988. "Avaliação do potencial de extratos provenientes da microbiota associada a insetos no controle de microrganismos causadores de infecções hospitalares." [s.n.], 2013. http://repositorio.unicamp.br/jspui/handle/REPOSIP/317024.

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Orientador: Marcelo Brocchi
Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Biologia
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Abstract: The abstract is available with the full electronic document when available
Mestrado
Genetica de Microorganismos
Mestra em Genética e Biologia Molecular

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Mesquita, Ana Maria Ribeiro Cardoso. "Diarreia nosocomial e doenÃa associada ao clostridium difficile em pacientes imunossuprimidos de hospital universitÃrio em Fortaleza - CE." Universidade Federal do CearÃ, 2014. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=12377.

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nÃo hÃ
Diarreia nosocomial (DN) Ã uma infecÃÃo relacionada Ã assistÃncia Ã saÃde (IRAS) com incidÃncia e severidade crescentes. PropÃe-se determinar a incidÃncia da DN, os fatores de risco e a incidÃncia da doenÃa associada a Clostridium difficile (C. difficile). Para isso, um estudo caso â controle, pareando pacientes por idade, sexo, perÃodo de admissÃo, clÃnica e diagnÃstico, foi conduzido, de 06/ fev/12 a 05/fev/13, no Hospital UniversitÃrio da UFC. Casos ̶ pacientes com DN e Controles ̶ pacientes sem DN. Definiu-se DN como fezes lÃquidas, trÃs ou mais vezes em 24 horas, com duraÃÃo superior a 12 horas, sem outras causas inflamatÃrias ou procedimentos diagnÃsticos. DN foi detectada mediante busca ativa, visitando-se os pacientes das Unidades de Hematologia, Transplante HepÃtico e Renal. O teste ELISA TOX A/B II foi utilizado para detectar as toxinas A e/ou B e diagnosticar doenÃa associada ao C. difficile. Demais IRAS foram investigadas por intermÃdio de fichas de notificaÃÃo de infecÃÃo hospitalar (IH). O Ãndice geral de IH foi de 7,17%. A incidÃncia da DN nas enfermarias de Hematologia, Transplante HepÃtico e Renal foi 4,80% (44/925) e da DN associada ao C. difficile 0,12% (01/925). Detectaram-se toxinas A/B de C. difficile em caso [1/43 (2,32%)] e controles [3/72 (4,17%)]. DN foi significantemente associada ao uso prÃvio > 6 antimicrobianos por paciente, alÃm do uso prÃvio de ciprofloxacina, metronidazol, polimixina B e dieta enteral (p≤ 0,05). Pacientes com DN permaneceram mais tempo internados, tiveram mais vÃmitos, cÃlicas e febre, verificando-se alta significÃncia estatÃstica (p≤ 0,05). Outras IRAS identificadas, nos casos e controles, foi infeÃÃo do trato urinÃrio 54% (15/28), seguida da corrente sanguÃnea 32% (8/28), do sÃtio cirÃrgico 11% (3/28) e de infecÃÃo de partes moles 4% (1/28). DN impÃe riscos aos pacientes jÃ debilitados. Os dados demonstram a presenÃa endÃmica do C. difficile. A atualizaÃÃo da epidemiologia local orienta medidas de controle da IH, como uso judicioso de antibiÃticos, cautelas com a dieta enteral e precauÃÃes de contato, para os pacientes com diarreia nosocomial.
Nosocomial diarrhea (ND) is a healthcare - associated infections (HAI) with increasing incidence and severity. It is proposed to determine the incidence of ND, the associated risk factors and the incidence of disease associated to Clostridium difficile (C. difficile). For this, a case - control study, pairing patients by age, sex, length of admission, and clinical diagnosis was conducted 06 / Feb/12 to 05/Fev/13 in the University Hospital of the UFC. Cases: patients with DN and controls: patients without ND. Nosocomial diarrhea is defined as watery stools, three or more times within 24 hours, over 12 hours without further diagnostic procedures or inflammatory causes. ND was detected by active surveillance, visiting the patients of Hematology, Liver and Renal Transplant. DN was defined as loose stools, 3 or more times in 24 hours, with duration longer than 12 hours, without other inflammatory causes or diagnostic procedures. The ELISA TOX A / B II test was used to detect toxin A and/or B and to diagnose C. difficile associated disease. Others HAI were investigated by the notification records of nosocomial infection (NI). The overall rate of Nosocomial infection was 7.17 %. The incidence of DN in the wards of Hematology, Liver and Renal Transplant was 4.80% (44/925) and C. difficile associated with DN was 0.12 % (01/925). Toxins A/B were detected in the case of C. difficile [1/43 (2.32%)] and controls [3/72 (4.17%)]. DN was significantly associated with previous use > 6 antimicrobials per patient, beyond the prior use of ciprofloxacin, metronidazole, polymyxin B and enteral feeding (p ≤ 0.05). Patients with ND remained in hospital longer, had more vomiting, cramps and fever, verifying high statistical significance (p ≤ 0.05). Other identified HAI were mainly urinary infection 54% (15/28), followed by bacterial bloodstream infection 32% (8/28), surgical site infection 11% (3/28) and soft tissue infection 4% (1/28). ND entails risks to the already debilitated patients. The data demonstrate the presence of endemic C. difficile. The updated of the local epidemiology guide control measures NI, such as judicious use of antibiotics, enteral feeding precautions and contact precautions for patients with nosocomial diarrhea.

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Hathaway, Hollie. "Biomodification of abiotic surfaces for the prevention of hospital-associated infection." Thesis, University of Bath, 2017. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.760935.

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This research aims to investigate the application of medical biotechnology with regard to the detection and treatment of hospital-associated infection. Various strategies focused on the implementation of biological detection agents and biotherapeutics are discussed, with particular emphasis placed on surface-anchoring technologies. This thesis is presented in the alternative format, consisting of published research papers embedded within the text. An extended introduction precedes each publication and a reflective commentary accompanies each research paper. For the purpose of continuity, all figure captions and references are in keeping with the body of the text. Part A concerns the detection of residual sources of transmissible infection, via the utilisation of an enzymatic detection agent, capable of modelling clinical surface contamination post sterilisation. Chapter 1 details the development of a current clinical biosensor, focused on modification of polymeric substrates via plasma activation. Covalent immobilisation facilitated enhanced proteinaceous surface retention, alongside retention of biological activity, potentially providing a more stringent assessment of hospital sterilisation measures. Chapter 2 (unpublished) investigates the possibility of protein engineering for further development of the aforementioned biosensor. This research focuses on genetic modification of the detection agent and subsequent covalent conjugation to a fluorescent reporting system, with the intention of quantifying surface contamination in the clinical setting. Part B focuses on the development of potential biological therapeutics for the treatment of infection. Chapter 3 aims to provide the theoretical background to the proceeding research in the form of a review paper. Chapter 4 concerns the utilisation of surface-anchored, polymeric nanoparticles as delivery vectors for bacteriophage, facilitating the controlled delivery of the antimicrobial cargo at an elevated temperature associated with chronic wound infection. Chapter 5 is presented as an extension of the preceding research, detailing the use of a synergistic enzybiotic cocktail as oppose to bacteriophage, in an attempt to alleviate certain regulatory concerns.

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Dame, Joycelyn Assimeng. "Pseudomonas aeruginosa bloomstream infection at a tertiary referral hospital for children." Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/32633.

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Introduction This study describes the disease burden, clinical characteristics, antibiotic management, impact of multidrug resistance and outcome of Pseudomonas aeruginosa bloodstream infection (PABSI) among children admitted to a tertiary referral hospital for children in Cape Town, South Africa. Methods A retrospective descriptive study was conducted at a paediatric referral hospital in Cape Town, South Africa. Demographic and clinical details, antibiotic management and patient outcome information were extracted from medical and laboratory records. Antibiotic susceptibility results of identified organisms were obtained from the National Health Laboratory Service database. Results The overall incidence risk of PABSI was 5.4 PABSI episodes / 10,000 hospital admissions and the most common presenting feature was respiratory distress, 34/91 (37%). Overall, 69/91 (76%) of the PA isolates were susceptible to all antipseudomonal antibiotic classes evaluated. Fifty (55%) of the PABSI episodes were treated with appropriate empiric antibiotic therapy. The mortality rate was 24% and in multivariable analysis, empiric antibiotic therapy to which PA isolate was not susceptible to, infections present on admission, and not being in the intensive care unit at the time that PABSI was diagnosed were significantly associated with 14-day mortality. Conclusion The study provided insight into factors associated with PABSI in a tertiary hospital in SubSaharan Africa. Empiric antipseudomonal antibiotic therapy was associated with a decrease in 14-day mortality.

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Scott, Elizabeth. "The survival and transfer of potentially pathogenic bacteria from environmental sites and surfaces." Thesis, King's College London (University of London), 1990. https://kclpure.kcl.ac.uk/portal/en/theses/the-survival-and-transfer-of-potentially-pathogenic-bacteria-from-environmental-sites-and-surfaces(23b8e7b3-c7b2-495a-8a6f-0dee3cb90e86).html.

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Barbosa, Gilberto da Luz. "Infecção hospitalar no Centro de Tratamento Intensivo Geral de um hospital escola da Região Sul do Brasil." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2002. http://hdl.handle.net/10183/1584.

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Objetivos Avaliamos a incidência de infecção hospitalar no CTI clínico-cirúrgico de um hospital escola no sul do Brasil. Foram utilizadas taxas ajustadas para o tempo de permanência dos pacientes e para o tempo de exposição aos procedimentos invasivos. Também investigamos a influência da causa básica de internação (trauma, neurológico e clínico-cirúrgico) nas taxas de infecções. Material e Métodos Os pacientes internados no CTI Clínico-cirúrgico de março a dezembro de 1999, foram prospectivamente seguidos para a detecção de infecção hospitalar. Para o diagnóstico de infecção hospitalar utilizou-se as definições do Centro de Controle e Prevenção de Doenças dos EUA (CDC) e as taxas foram calculadas de acordo com a metodologia NNIS (Sistema Nacional de Vigilância Epidemiológica). Resultados Foram acompanhados 686 pacientes (4201 pacientes-dia). Ocorreram 125 infecções hospitalares, sendo que a incidência global foi de 18,2% ou 29,8 infecções por 1000 pacientes-dia. Os sítios de infecção mais freqüente foram: pneumonia (40%), infecção urinária (24%) e septicemia primária (12,8%). As taxas de infecções hospitalares, associadas aos procedimentos invasivos, foram as seguintes: 32,2 pneumonias por 1000 ventiladores mecânico-dia, 9,7 infecções urinárias por 1000 sondas vesicais-dia e 7 septicemias por 1000 cateteres venosos centrais-dia. A incidência global de infecção nos pacientes com trauma (26,8) e neurológicos (20,7%) foi superior quando comparada com o grupo clínico-cirúrgico (12,2%), p < 0,001. Conclusões Encontramos altas taxas de infecções relacionadas com os procedimentos invasivos neste CTI. A causa básica de internação influenciou as taxas de infecção, sugerindo a necessidade de analisar-se estratificadamente os pacientes em CTI clínico-cirúrgico.
Objectives The incidence of nosocomial infections in the General ICU of the Hospital São Vicente de Paulo was evaluated using adjusted rates for patients’ lenght of stay and time of device exposure. We also determined the differences in the rates of infections according basic reason for admission (trauma, neurological, and medical-surgical). Material and Methods From March 1 to December 31 1999, patients in the General ICU were prospectively followed for detection of nosocomial infection during their stay. Diagnosis of nosocomial infection was made according to the Centers for Disease Control e Prevention (CDC) definitions and the rates were calculated according to the methods of the National Nosocomial Infections Surveillance (NNIS) System. Results Six hundred eighty-six patients (4,201 patient-days) were followed. One hundred twenty-five nosocomial infections occurred and the overall rate was 18.2% or 29.8 infections per 1,000 patient-days. The most commonly found infection sites were: pneumonia (40%), urinary tract infection (24%), and primary bloodstream infections (12.8%). Device-associated nosocomial infection rates were as follows: 32.2 pneumonias per 1,000 ventilator-days, 9.7 urinary infections per 1,000 indwelling urinary catheter-days, and 7 bloodstream infection per 1,000 central venous catheter-days. Overall incidence of infection in trauma (26.8) and neurological (20.7%) groups was higher than in the medical-surgical group (12.2%), p<0.001. Conclusions Our study found a high incidence of pneumonia and high rates of nosocomial infections associated with use of an invasive device in this ICU. The basic cause for admission affected infection rates, suggesting the need for a stratified analysis of patients in the General ICU by basic reason for admission.

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Neves, Ana Paula Amâncio. "Avaliação microbiológica de luvas de procedimento em ambiente hospitalar revisão integrativa /." Universidade Estadual Paulista (UNESP), 2018. http://hdl.handle.net/11449/153767.

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Introdução: Infecção hospitalar é definida como qualquer tipo de infecção adquirida durante a hospitalização, desde que não esteja incubada anteriormente à internação, ou então relacionada a algum procedimento, podendo manifestar-se inclusive após a alta do paciente. Podem resultar em internação prolongada, aumento de resistência microbiana aos antimicrobianos, aumento da mortalidade, além de custos adicionais para o sistema de saúde, pacientes e seus familiares. Atualmente representam além de uma preocupação dos serviços de saúde, um problema social, ético e jurídico frente às implicações na vida dos pacientes e os riscos a que estão submetidos. Objetivo: Analisar as publicações nacionais e internacionais referentes à contaminação de luvas de procedimento em ambiente hospitalar. Metodologia: Trata-se de uma revisão integrativa de literatura, método de pesquisa utilizado na Prática Baseada em Evidências. Resultados: Como resultado obteve-se 49 artigos científicos. Após leitura de títulos e resumos foram selecionadas doze artigos para leitura na íntegra, dos quais apenas quatro relacionavam-se ao tema proposto. Um estudo apontou elevada taxa microbiana das luvas, analisadas antes da abertura das caixas, questionando sobre a contaminação durante a fabricação ou modo de armazenamento das caixas. Outros dois artigos referem-se à possibilidade de implementação de luvas revestidas com material antimicrobiano, uma vez que mostraram-se com menor carga microbiana, em comparação às luvas de procedimento comum. Por fim, um estudo analisou a contaminação das luvas em três momentos distintos, início, meio e fim da caixa, para investigar se o tempo de abertura interfere na possível contaminação das luvas, porém não houve diferença estatisticamente significativa entre esses momentos. Considerações finais: As luvas de procedimento mostram a presença de microrganismos patogênicos, os quais podem ocasionar danos tanto para o paciente como o profissional de saúde. Faz-se necessário uma politica de fiscalização em relação ao fluxograma que abrange desde sua fabricação e liberação na indústria até o uso nos ambientes de saúde.
Background: Hospital infection is defined as any type of infection acquired during hospitalization, provided that it is not incubated prior to hospitalization or related to any procedure, and may even occur after patient's discharged from the hospital. They may result in prolonged hospitalization, increased microbial resistance to antimicrobials, increased mortality, and additional costs for the health system, patients, and their families. Nowadays, they represent a social, ethical and legal problem in addition to a concern of the health services, considering the implications in patients’ life and the risks they are subjected to. Aim: Analyze national and international publications regarding the contamination of procedure gloves in a hospital environment. Methods: This is an integrative literature's review, a research method used in Evidence-Based Practice. Results: A total of 49 scientific articles were obtained. After reading titles and abstracts, twelve articles were selected for a full read, of which only four were related to the proposed theme. A study indicated a high gloves' microbial rate, analyzed before boxes being opened, questioning about the manufacture or storage contamination. Two other articles show the possibility of implementing gloves coated with an antimicrobial material since they showed lower microbial burden compared to gloves of common procedure. Finally, a study analyzed gloves' contamination at three different moments, beginning, middle, and ending box, in order to check if the opening time interferes in the gloves’ contamination, but there was no statistically significant difference between these moments. Conclusions: Procedure gloves have pathogenic microorganisms, which can damage both the patient and the health professional. There is a need for a control policy regarding the flowchart that covers everything from its manufacture and releases from the industry to the use in health environments.

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Mengal, Muhammad Hashim. "Infectious disease control knowledge and practice among health care workers in Bolan Medical College Hospital Quetta Pakistan." Thesis, Södertörns högskola, Institutionen för naturvetenskap, miljö och teknik, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:sh:diva-27097.

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Background Hospital-acquired infections are significant cause of morbidity and mortality among hospitalized patients worldwide. Healthcare workers during job are exposed to blood borne pathogens through contact with infected body parts, blood and body fluids. World health organization (WHO) estimated that globally about 2.5% of HIV and 40% of hepatitis viral infected cases are among health workers due to exposures. The most important mechanism of spread of these pathogens is through contaminated hands of the healthcare workers. Standard precautions measures are essential to prevent and control healthcare associated infection among healthcare workers and patients. In developing countries despite the development of detailed guideline for infection control the knowledge of standard precautions is low and not properly applied. The aim of this study is to assess the knowledge and practice of health care workers regarding standard precautions and hand hygiene to infectious disease control. Aim The aim of this study was to assess the knowledge and practice of health care workers regarding hand wash and standard precautions to control infectious diseases in BMCH. In addition create awareness among participants and encourage them to practice regularly hand hygiene and standard precautions to control or reduce nosocomial infections in health care facilities Methods The study design is cross-sectional evaluation of healthcare worker knowledge and practices about standard precautions and hand hygiene for infectious disease control. A questionnaire administered to health care workers (doctors and nurses). The questionnaire was divided in two parts and the first part concerns demographic information, asking knowledge and practice. The second part asked opinions about risk and prevention of HAIs. The questionnaire was developed with consultation of other studies of the same kind. It has been pre tested and is finalized for survey. The ethical approval was given by hospital superintendent and informs consent from all study participants. Statistic analysis was done on Excel and statistical software SPSS version 20. Data was described in numbers, percentages and Chi Square test done for association among categorical variables, significant level was considered P= <0.05. Results Two hundred questionnaires were distributed to HCWs in BMCH and 169 completely fill questionnaire were returned. The male gender respondents were 42% and female respondents were 58%. The basic questions about knowledge of hand hygiene and standard precautions were answered well in both categories; about 73% were with sufficient knowledge. The practice of hand hygiene and standard precautions was not satisfactory among both categories; about 47% found with good practice. Differences found in sub groups, young age none trained doctors and nurses answered wrong and shown lack of knowledge. This study found an association of age, profession and job experience with knowledge and practice regarding hand hygiene and standard precautions. Open handed questions described well the major issue regarding HAIs and participants emphasized on risk and prevention methods. Conclusions The respondents were HCWs (doctors and nurses) of both sex and this study found that majority of HCWs have good knowledge and practice about control of HAIs but difference were found in age groups, sex and profession. Above half of the HCWs were not trained for infection control in health facilities, thus getting training of infection control is important but more important is implementation of it during practice.

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Antonio, Charline Santos. "Prevalência de genes codificadores de carbapenemases em isolados multirresistentes de Acinetobacter baumannii recuperados de amostras clínicas de hospitais do Sudeste e Sul do Brasil." Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/9/9136/tde-11062013-172116/.

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Acinetobacter baumannii (Ab) é um dos principais agentes de infecção hospitalar, principalmente em Unidades de Terapia Intensiva (UTI). A principal característica da bactéria é a sua resistência intrínseca a diversos antimicrobianos, o que favorece sua persistência no ambiente hospitalar, causando infecções de difícil controle e tratamento. Nos esquemas terapêuticos, os antibióticos carbapenêmicos são os fármacos de escolha, porém nos últimos anos a resistência a estas drogas tem aumentado drasticamente em função da emergência e disseminação de cepas produtora de carbapenemases [i.e., oxacilinases (OXA) e metalo-beta-lactamases (MβL)]. O objetivo do presente trabalho foi avaliar a produção de enzimas carbapenemases do tipo OXA e MβLs, em 36 amostras multirresistentes de A. baumannii, previamente triadas, provenientes de 8 hospitais brasileiros, durante 2004/2008. A caracterização fenotípica e genotípica dos isolados foi realizada por meio da determinação de CIM, hidrólise enzimática e PCR para pesquisa dos genes blaOXA e blaMβL, assim como seqüências de inserção (ISAba-1, ISAba-3) responsáveis pela mobilização dos determinantes de resistência do tipo blaOXA. Finalmente a análise da diversidade genética foi realizada por ERIC-PCR com análise de clusters por coeficiente de Dice. Todos os 36 isolados apresentaram 100% de resistência para imipenem (CIM90 > 64 µg/mL), meropenem, ceftazidima, ciprofloxacina e iperacilina/tazobactam, enquanto que os antibióticos com maior atividade in vitro foram a ampicilina/sulbactam (61,2%) > tobramicina (61,1%) > gentamicina (47,3%) > amicacina (28%). Em todos os isolados foi confirmada a presença intrínseca dos genes blaOXA-51 e ISAba-1, não apresentando colinearidade entre eles, enquanto que 41,6% dos isolados carregaram a combinação dos genes ISAba-1/blaOXA-23 (Genbank accession FJ628170), um isolado (2,7%) carregou a combinação de genes ISAba3/blaOXA-58/ISAba3 (Genbank accession FJ492877) e dois isolados (5,5%) clonalmente relacionados, carregaram o gene blaOXA-72 (Genbank accession FJ969387). Surpreendentemente, em um centro hospitalar foi documentada a presença de um surto de infecção por Ab produtor de OXA-23. Finalmente a tipagem epidemiológica dos isolados revelou a presença de 13 clusters, sendo que 8 diferentes clusters carregavam o gene blaOXA-23. Em resumo, nossos resultados confirmam a disseminação de cepas produtoras de OXA-23 associadas com ISAba-1 no Brasil, assim como a presença intrínseca do gene blaOXA-51 em Ab. Por outro lado, este é o primeiro relato de isolados carbapenem resistentes carregando os genes blaOXA-58 e blaOXA-72 em hospitais brasileiros, os quais aparentemente surgiram em 2004 e 2008, respectivamente.
Acinetobacter baumannii (Ab) is a leading cause of hospital infection, mainly in intensive care units. The main characteristic of the bacterium is its intrinsic resistance to diverse antimicrobial agents, which contribute to persistence in hospital environments causing infections of difficult control and treatment. In therapeutic schedules, carbapenems are choice antibiotics, however in recent years the resistance to these drugs has increased drastically in function of the emergency and dissemination of carbapenemase-producing isolates [i.e., oxacilinases (OXA) and metalo-beta-lactamases (MβLs)]. The aim of this work was to evaluate the production of OXA- and MβL-like carbapenemases, in 36 isolates previously screened as multidrug-resistant (MDR) A. baumannii, recovered from 8 Brazilian hospitals, during 2004/2008. Phenotypic and genotypic characterization of MDR Ab was carried out using CIM determination, enzymatic hydrolysis and PCR for screening of the blaOXA- and blaMβL-like genes, and insertion sequences (ISAba-1, ISAba-3) responsible for mobilization of blamOXA-like gene cassettes. Analysis of genetic relationship was carried out by ERIC-PCR with analysis of clusters for Dice`s coefficient. All of the 36 isolates showed 100% resistance to imipenem (CIM90 > 64 µg/mL), meropenem, ceftazidime, ciprofloxacin and piperacillin/tazobactam, whereas antibiotics exhibiting a best in vitro activity were ampicillin/sulbactam (61.2%) > tobramycin (61.1%) > gentamicin (47.3%) > amikacin (28%). Presence of blaOXA-51 and ISAba-1 genes was confirmed in all isolates, not presenting collinearity between them, whereas 41.6% isolates carried the ISAba-1/blaOXA-23 gene array (Genbank accession FJ628170). One Ab isolate harbored the ISAba-3/blaOXA-58/ISAba-3 gene array (2.7%) (Genbank accession FJ492877) and 5.5% of Ab isolates harbored the blaOXA-72 gene (Genbank accession FJ969387). Surprisingly, an outbreak of infection with MDR Ab producing OXA-23 enzyme was documented. Finally the ERIC-PCR typing revealed the presence of 13 clusters, of which 8 different clusters carried the blaOXA-23 gene. In summary, our results confirm the dissemination of OXA-23-producing Ab isolates associated with the ISAba-1 gene, in Brazil, as well as the intrinsic presence of the blaOXA-51 gene cassette. On the other hand, this is the first report of carbapenem-resistant Ab isolates harboring genes blaOXA-58 and blaOXA-72 recovered in Brazilian hospitals, which most likely emerged in 2004 and 2008, respectively.

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24

Martins, Fernanda Calixto. "InfecÃÃo hospitalar em unidade de terapia intensiva pediÃtrica em Fortaleza-CearÃ: caracterÃsticas epidemiolÃgicas, etiologia e fatores de risco." Universidade Federal do CearÃ, 2008. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=6316.

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Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico
A infecÃÃo hospitalar Ã atualmente a mais freqÃente e importante causa de Ãbito de pacientes internados em unidades de terapia intensiva pediÃtrica. Para conhecer a dimensÃo desse problema em um Hospital PediÃtrico que possui um atendimento terciÃrio localizado no CearÃ, foi realizado um estudo de coorte prospectivo de todas as crianÃas internadas na UTIP no perÃodo de 01 de agosto de 2007 a 31 de janeiro de 2008. Uma coorte de 66 pacientes foi seguida da internaÃÃo a alta ou Ãbito. Ao todo 18 variÃveis do paciente e hospitalares foram pesquisadas em cada membro da coorte. Os testes estatÃsticos utilizados foram: Mann-Whitney e o teste exato de FISCHERâS, o cÃlculo do risco relativo com os respectivos intervalos de confianÃa. Em seguida procedeu-se a anÃlise multivariada com transformaÃÃo para regressÃo logÃstica dos fatores mais significativos (p<0,05). Ao final, um fator foi selecionado como preditor independente da infecÃÃo hospitalar: intubaÃÃo orotraqueal (OR=2,29, IC95%=1,38 a 3,82). A incidÃncia de infecÃÃo hospitalar foi de 54,6% (35IH/64pacientes). As bactÃrias mais prevalentes dos casos confirmados foram os bacilos gram-negativos (73,3%). A internaÃÃo dos pacientes com infecÃÃo hospitalar foi de 2,9 vezes superior a internaÃÃo dos pacientes nÃo acometido. A probabilidade de Ãbito global esperado foi de 13% e a observada foi de 43,9%. Este estudo poderÃ ser Ãtil para futuras estratÃgias com vistas a diminuir a morbimortalidade por infecÃÃo hospitalar.

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25

Hlady, Christopher Scott. "Nosocomial infection modeling and simulation using fine-grained healthcare data." Diss., University of Iowa, 2011. https://ir.uiowa.edu/etd/4856.

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Simulation has long been used in healthcare settings to study a range of problems, such as determining ideal staffing levels, allocating patient beds, and assisting with medical decision making. Some of this work naturally focuses on the spread of infection within hospitals, where the importance of hospitals as loci and amplifiers of infection was demonstrated during the 2002-2003 SARS outbreak. Increasingly, fine-grained healthcare data is being collected (e.g., patient care data stored in electronic medical record systems, and healthcare worker data from sources including nurse locator badges), presenting an opportunity to develop models that can drive more realistic simulations. We seek to build a realistic hospital simulator that can be used to answer a wide variety of questions about infection prevention, the allocation and placement of expensive resources, and issues surrounding patient care. Our simulation framework requires three primary inputs: architectural, healthcare worker, and patient data. We used data from the University of Iowa Hospitals and Clinics to build our virtual hospital. We manually constructed a weighted, directed, 19,000 node graph-theoretic representation of the facility based on printed architectural drawings. Using timestamped location information from electronic medical record system logins and algorithms inspired by prior work on location-aware search, each healthcare worker is modeled by one or more “centers” of activity. Centers are determined using a maximum likelihood approach to fit a location and appropriate decay parameters that best describe the observed data. Finally, we developed compartmental patient models of varying granularity, with each compartment representing some subset of patient care areas within the hospital. Transition probabilities and patient length of stay were fit using three years of patient data. In designing our simulator, we were able to minimize assumptions about how healthcare workers and patients move, avoiding the “random mixing” assumption common to many infectious disease simulators. We translated techniques from location-aware search into the hospital environment, developed data structures for use in efficiently processing millions of location data points in tens of thousands of rooms for thousands of healthcare workers, improved the performance of the algorithm for identifying optimal single-center healthcare worker models, and introduced heuristics for training multi-center models. We validated our models by comparing the properties of simulated data to known quantities, and testing against expert expectations. To the best of our knowledge, this is the first agent-level hospital-wide simulator based on fine-grained location and interaction data for healthcare workers and patients.

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Jamal, Wafaa. "Epidemiological study of hospital-acquired Clostridium difficile infection in Kuwait teaching hospitals and investigation of their virulence characteristics." Thesis, Cardiff University, 2009. http://orca.cf.ac.uk/55843/.

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Clostridium difficile infection (CDI) is the most common type of infectious nosocomial diarrhoea. Overwhelming evidence indicate that the most important risk factors are prior antibiotic use and elderly patients. The severity of the disease varies from asymptomatic carrier to mild diarrhoea to colitis (AAC) and life threatening pseudomembranous colitis (PMC). Because little is known about C. difficile and CDI in Kuwait, this study was undertaken to determine the nosocomial acquisition of C. difficile by new patients admitted to the intensive care units (ICU) of 4 teaching hospitals in Kuwait between February 2001 and January 2002 (first part) and January 2003 to December 2005 (second part) and evaluate cytotoxin (toxin B) production by clinical isolates upon exposure to minimum inhibitory concentrations (MICs) and sub-MICs of certain antibiotics. The first part of the study was accomplished by serially culturing the stool specimens of 922 newly admitted patients to the ICUs screening their stools for toxins A/B and screening their immediate environment for C. difficile. The isolates were typed by the PCR ribotyping technique developed in the Anaerobe Reference Unit, Cardiff. The effects of various concentrations of antibiotics that could predispose to CDI and those used for its therapy on the production of cell-bound and cell-free toxin B produced by C difficile was investigated by experiments using cell cultures of the Vero cell line. Prevalence, epidemiology and risk factors of CDI in Kuwait hospitals was investigated during second part of the study by culturing patients' stool specimens, ribotyping the isolates and detection of toxin A/B in stool samples. The susceptibility of all isolates was assessed by MIC determination to 16 antibiotics using the E test method. During the first part of the study, 95 (10.3%) out of 922 patients with negative cultures initially on the day of admission acquired C difficile during their hospitalisation at various time intervals. Of these, 65 (68%) remained symptom-free while 30 (32%) were symptomatic 2 patients had PMC, 4 AAC and 24 AAD. C. difficile toxin A/B was present in 28 (93%) of 30 symptomatic patients but in only 7 (10.8%) of 65 symptom-free patients. The hospital environments occupied by symptomatic patients as well as those occupied by asymptomatic patients were contaminated by C. difficile. The 95 isolates from patients belonged to a total of 32 different ribotypes. Ribotypes 097 and 078 were responsible for >40% of C. difficile infections in Kuwait ICUs. There was a heterogeneous relationship between antibiotic exposure and intra- and extra cellular toxin production by the toxigenic strains. Clinical strains of C. difficile when exposed to MIC and sub-inhibitory concentrations of certain antibiotics produced high level of cytotoxin. Ampicillin and clindamycin were the most potent inducers of cytotoxin followed by metronidazole and vancomycin. Cefotaxime induced the least amount of the cytotoxin activity. During the second part of the study, 73 (10.5%) out of 697 met the diagnosis of CDI. Out of these 73, 56 (76.7%) were hospital-acquired and 17 (23.3%) were from outpatient clinics. Thus, the prevalence of hospital-acquired CDI was 8% over the study period. The prevalence of hospital-acquired CDI in 2003, 2004 and 2005 were, 9.7%, 7.8% and 7.2%, respectively. Our data showed that 42.9% of the CDI patients were above 60 years out of which over 79% were aged 71 years and above. Patients with CDI were more likely than the controls to have been exposed to immunosuppressive drugs and feeding via naso-gastric tube. The most common ribotypes isolated during the second part of the study were 002 and 001. The later was isolated only from one environmental sample in the first part of the study. PCR-ribotype 027 was not isolated during 2003-2005 study. None of our 151 C. difficile isolates were resistant to amoxicillin-clavulanic acid, ampicillin, linezolid, metronidazole, piperacillin-tazobactam, teicoplanin or vancomycin. Resistance to penicillin and meropenem among the clinical isolates increased from 2.4 to 16.4% and 4.8 to 21.4%, respectively while resistance to imipenem (another carbapenem) was extremely high in both studies.

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Pinheiro, Monica de Souza Bomfim. "Epidemiologia da infecção hospitalar e mortalidade intra-hospitalar de uma unidade de terapia intensiva neonatal em hospital de referência regional de São Paulo." Universidade de São Paulo, 2008. http://www.teses.usp.br/teses/disponiveis/5/5141/tde-29012009-113032/.

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As taxas de infecção hospitalar (IH) entre centros neonatais variam consideravelmente, sugerindo que fatores de risco possam ser modificados pela qualidade da assistência, as características do recém-nascido (RN) e o controle das infecções. O objetivo deste estudo foi analisar a epidemiologia da infecção e da mortalidade hospitalar na Unidade de Terapia Intensiva Neonatal do Hospital Geral de Itapecerica da Serra SECONCI SP OSS de 1º de janeiro de 2002 a 31 de dezembro de 2003. O estudo foi desenvolvido em modelo de coorte e a análise dos dados referentes às IH precoces e tardias foi retrospectiva, mas eles foram coletados prospectivamente, seguindo os métodos do NNIS (National Nosocomial Infection Surveillance System). Os RN foram classificados pelo Neonatal Therapeutic Intervention Scoring System (NTISS) para avaliar sua gravidade, dentro das primeiras 24 horas após a admissão. Foram incluídos no estudo 486 RN: 426 de origem interna (87,7%) e 60 de origem externa (12,3%). A incidência acumulada de IH foi de 30,6% e a densidade de 25,1 por 1.000 pacientes-dia (7,9 para infecção precoce e 17,2 para a tardia). A sepse foi o tipo de infecção mais freqüente (54,0%) seguida pela pneumonia (20,0%). Dos agentes microbianos isolados, 54,3% foram gram-positivos, sendo o mais encontrado o Staphylococcus coagulase negativo. A maioria dos RN teve um escore de gravidade menor ou igual a 19 (88,1%), sendo a pontuação máxima encontrada de 39, e os RN externos obtiveram uma pontuação significantemente maior. A aquisição de IH, tanto precoce como tardia, mostrou-se associada com a gravidade do RN à admissão. A taxa de mortalidade hospitalar foi de 8,6% e mostrou-se mais elevada entre os RN de origem externa. As IH foram a causa ou contribuíram para o óbito em 26 (61,9%) dos RN que faleceram. Não houve associação estatística entre o local de nascimento e a ocorrência de infecção hospitalar precoce e tardia. A análise univariada mostrou os seguintes fatores de risco para infecção tardia: prematuridade, baixo peso, pequeno para a idade gestacional, número de consultas de prénatal, reanimação na sala de parto, uso de respirador, cateter central, nutrição parenteral, tempo de permanência e escore de gravidade à admissão. Na análise múltipla, o modelo final incluiu as variáveis: peso de nascimento, escore terapêutico nas primeiras 24 horas após a admissão e uso de nutrição parenteral. A epidemiologia da infecção hospitalar da UTIN do HGIS está de acordo com o observado na literatura médica. Ela está sujeita às características dos RN assistidos, às práticas assistenciais e de controle de infecção hospitalar implementadas pelo serviço de terapia intensiva neonatal, independente do local de nascimento do RN admitido na UTIN.
Nosocomial infections rates varies widely among Neonatal Centers suggesting that risk factors can be modify by assistance quality, newborn characteristics and infection control practices. The aim of this study was to analyze nosocomial infections epidemiology and mortality rate among neonates admitted to a Neonatal Intensive Care Unit of Hospital Geral de Itapecerica da Serra SECONCI SP OSS from January 1, 2002 to December 31, 2003. The study was carried out in a cohort model, with data analyze retrospectively but collected by active surveillance following the NNIS (National Nosocomial Infection Surveillance System) methodology. Neonates were classified according to Neonatal Therapeutic Intervention Scoring System (NTISS) to assess illness severity within the first 24 hours of admission. 486 newborn infants were included in the study: 426 (87.7%) inborn infants and 60 (12.3%) out born infants. Nosocomial infection incidence rate was 30.6% and the incidence density was 25.1 per 1000 patients-day (7.9 for early infections and 17.2 for late infections). Sepsis was the most frequent infection (54.0%), followed by pneumonia (20.0%). Among microbial agents isolated 54.3% were Gram-positive organisms, and coagulase-negative staphylococci were the most frequent. Most neonates have shown a severity score lower or equal to 19 (88.1%), and the maximum score was 39. Outborn neonates have shown a significant higher severity score. Nosocomial infections were associated with newborn severity index at admission. Nosocomial mortality rate was 8.6% and higher among out born neonates. Hospital infections were classified as cause or contributed for death in 26 (61.9%) neonates. No statistic association was seen between the neonate birth place and nosocomial infections. Univariate analyzes showed the following risk factors for late infections: prematurity, low birth weigh, low weight for gestational age, prenatal visits number, resuscitation following birth, respirator, central catheter and parenteral nutrition use, length of stay and severity score at admission. Multivariate logistic regression model included the following variables: birth weigh, therapeutic score within 24 hours of admission and parenteral nutrition use. Nosocomial infection epidemiology at HGIS´s UTIN is similar with what was observed in medical literature. It is dependent of newborn characteristics, assistance and infection control practices within the neonatal intensive care therapy, and is independent of newborn place of birth

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Delage, Debora Gotardelo Audebert. "Prevenção e controle das infecções hospitalares: um desafio em instituições públicas, privadas e filantrópicas do município de Juiz de Fora." Universidade Federal de Juiz de Fora, 2011. https://repositorio.ufjf.br/jspui/handle/ufjf/2159.

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CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
As infecções hospitalares (IH’s) são um desafio na saúde pública e por isso é fundamental que as atividades de prevenção e controle das IH’s permaneçam na linha de frente e na base das instituições hospitalares. Para que estas ações sejam efetivas é imprescindível a instalação e manutenção de um Programa de Controle de Infecções Hospitalar (PCIH) que sustente e qualifique estas ações e atividades mínimas de controle e prevenção. Portanto, este estudo de abordagem qualitativa teve como objeto de investigação o Programa de Controle de Infecções Hospitalar (PCIH) em instituições de saúde públicas, privadas e filantrópicas no município de Juiz de Fora. Os objetivos foram: avaliar o Programa de Controle de Infecção Hospitalar (PCIH) em instituições de saúde privadas, públicas e filantrópicas do município de Juiz de Fora e sua relação com a prática dos profissionais dos Serviços e Comissões de Controle de Infecção hospitalar; conhecer o PCIH de instituições hospitalares públicas, privadas e filantrópicas do município de Juiz de Fora; conhecer as ações da Vigilância Sanitária de Juiz de Fora no que tange o controle das infecções hospitalares e analisar as percepções dos profissionais de saúde que atuam nas CCIH’s e SCIH’s sobre as ações de controle e prevenção das IH’s. Os dados foram coletados em dois momentos: primeiramente, para caracterização dos PCIH’s, utilizamos uma manual operacional e planilha de indicadores e posteriormente para coleta dos relatos dos profissionais, utilizamos entrevista semiestruturada. Para análise das entrevistas utilizamos a técnica de análise temática que permitiu-nos definir as seguintes categorias de análise: percepção dos profissionais na organização dos SCIH’s e CCIH’s; atividades de controle de infecção desempenhadas pelos profissionais do SCIH e da CCIH; o controle e prevenção em IH: o lugar da educação permanente; a fiscalização das Infecções hospitalares e sua relação com a Vigilância Sanitária e o desafio no controle das Infecções Hospitalares. Foi possível observar que na realidade estudada os PCIH’s apresentam diversas inconformidades, e grandes são os desafios apontados pelos sujeitos. É preciso pensar o PCIH como parte fundamental para uma melhor assistência em saúde nas instituições hospitalares. É essencial que não apenas a instituição de saúde valorize o controle de infecção, mas que todos profissionais de saúde realmente entendam a importância do PCIH e sua relação no controle e prevenção das infecções hospitalares.
Nosocomial infections (NI’s) are a public health challenge and therefore, it is fundamental that prevention and control actions remain on the front line and on the basis of hospital institutions. For these actions to be effective it is of utmost importance to implement and maintain a Nosocomial Infections Control Programme (NICP) that may support and qualify them. This study of qualitative approach aims to investigate the NICP in public and private health institutions in the city of Juiz de Fora. The objectives are: to evaluate the Nosocomial Infections Control Programme (NICP) of public, private and philantropic hospital institutions in the city of Juiz de Fora and its relationship with the practice of professionals of Nosocomial Infections Control Commissions (NICC´s) and Services (NICS´s); to know the NICP of public, private and philantropic hospital institutions of Juiz de Fora; to know the actions of Juiz de fora Health Surveillance Agency concerning the control of nosocomial infections and to analyse the perceptions of health professionals that work in the NICC’s and NICS’s over the actions of control and prevention of NI’s. The data was collected in two moments: primarily, in order to characterize the NICP’s, we utilized an operational manual and indicators spreadsheets and, posteriorly, in order to collect the professional’s reports, we used semi-structured interview. For the analyses of the interviews we used the thematic analysis technique, wich allowed us to define the following categories: professional’s perception over the organization of NICC’s and NICS’s; the control and prevention of NI’s; the importance of continuing education; inspection of nosocomial infections and its relationship with Health surveillance and the challenge of controlling nosocomial infections. It was possible to observe that in the studied reality, the NICP’s shows many nonconformity's, and grand are the challenges pointed out by the subjects. It is necessary to view the NICP as a fundamental part of a better health assistance in hospital institutions. It is essential that not only the health institution values the infection control, but that all health professionals in fact understand the importance of the NICP and its relationship with the control and prevention of nosocomial infections.

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Macbeth, Deborough Anne. "An investigation of the assumptions that inform contemporary hospital infection control programs." Queensland University of Technology, 2005. http://eprints.qut.edu.au/16113/.

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The purpose of the study was to investigate the assumptions that underpin contemporary hospital infection control programs from the perspective of the influence of clinical culture on the integration and ownership of the infection control program. The results of numerous studies have linked low levels of adherence with infection control principles amongst health care providers as the most significant factor contributing to nosocomial infection. Despite early successes in reducing nosocomial infection rates, results derived from current research demonstrate that nosocomial infection has remained a challenge to healthcare providers and patients alike and outbreaks are regularly reported in the infection control literature. Serious economic and social impact has resulted from the increasing levels of antibiotic resistance that have been reported amongst pathogens associated with nosocomial infection. This interpretive study takes an ethnographic approach, using multiple data sources to provide insight into the culture and context of infection control practice drawing upon clinicians' work and the clinician's perspective. There were three approaches to data collection. A postal survey of surgeons was conducted, a group of nurses participated in a quality activity, and a clinical ethnography was conducted in an intensive care unit and an operating theatre complex. Data were analysed in accordance with the qualitative and quantitative approaches to data management. Findings indicate that the clinical culture exerts significant influence over the degree to which the infection control program activities change practice and that rather than imposing the infection control program on the clinical practice setting from outside, sustained practice change is more likely to be achieved if the motivation and impetus for change is culturally based. Moreover surveillance, if it is to influence clinicians and their practice, must provide confidence in its accuracy. It must be meaningful to them and linked to patient care outcomes. Contemporary hospital infection control programs, based on assumptions about a combination of surveillance and control activities have resulted in decreased nosocomial infection rates. However, sustained infection control practice change has not been achieved despite the application of a range of surveillance and control strategies. This research project has utilized an ethnographic approach to provide an emic perspective of infection control practice within a range of practice contexts. The findings from this study are significant within the context of spiraling health costs and increasing antibiotic resistance associated with nosocomial infection.

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Smith, Sharon Lanier. "Effects of an Educational Intervention on Hospital Acquired Urinary Tract Infection Rates." UNF Digital Commons, 2009. http://digitalcommons.unf.edu/etd/309.

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In today's hospital environment, good care has become synonymous with positive patient outcomes. Marring this landscape is the alarming rate of hospital acquired (nosocomial) infections. Urinary tract infection (UTI) is one of the most common hospital acquired infections. The major cause associated with these infections is the use of indwelling urinary catheters. Bacteria invade the lower urinary tract by ascending through or around the catheter. Morbidity associated with urinary catheter-associated UTI can be minimized by prudent decisions concerning catheter usage and good catheter care. The principle route of dispersal of nosocomial infections is likely from patient-to-patient via transiently contaminated hands of hospital personnel. The purpose of this evidence-based project was to determine if hospital-acquired catheter-associated urinary tract infection rates among patients admitted to an acute care facility could be decreased through staff education and consistent application of nursing care using selected perineal infection control interventions. The setting was a 43-bed medical/surgical floor in a 321 bed not for profit Magnet hospital in Northeast Florida. Twenty-four registered nurses and 18 patient care technicians completed targeted in-service education on general nosocomial infections, perineal care, and hand hygiene. A catheter dwell time notification system was also implemented. Chart review data was obtained from 383 admissions (197 pre-intervention, 133 after the educational intervention, and 53 after the dwell time notification). There was a significant difference in catheter-associated urinary tract infection rates after the interventions (11.17 pre-intervention, 10.53 after the educational intervention and 0.392 after the dwell time notification). A longer length of time in practice an on this hospital unit was associated with lower infection rates.

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Spir, Patricia Rodrigues Naufal. "Epidemiologia das infecções de corrente sangüinea de origem hospitalar em hospital de assistência terciária, São Paulo, Brasil." Universidade de São Paulo, 2007. http://www.teses.usp.br/teses/disponiveis/5/5141/tde-20022009-143433/.

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INTRODUÇÃO: As infecções hospitalares (IH) representam uma causa importante de morbidade e mortalidade em crianças criticamente enfermas. Há poucos trabalhos na faixa etária pediátrica e a maioria deles demonstra que a infecção de corrente sangüínea (ICS) é a causa mais importante de IH em pacientes graves. O OBJETIVO deste estudo foi analisar a epidemiologia das infecções de corrente sangüínea de origem hospitalar em crianças internadas no Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo hospital de ensino e de assistência terciária, no período de janeiro de 1996 a agosto de 2003. MÉTODOS: O estudo foi feito no modelo de coorte, com análise retrospectiva de dados referentes às infecções de corrente sangüínea, coletados por método de vigilância ativa, seguindo os métodos validados pelo NNIS (National Nosocomial Infections Surveillance System). RESULTADOS: As infecções hospitalares (n = 4233) foram uma causa significativa de morbidade intra-hospitalar no local e período estudados. O risco de um paciente desenvolver uma ou mais infecções hospitalares foi de 11,5 para 100 saídas. As ICS representaram mais de um terço das IH nos oito anos analisados, com uma densidade de incidência que variou de 20,4 na Oncologia, 7,7 na UTI Neonatal, 7,3 na Pediátrica até 1,9 por 1000 pacientes-dia na Cirurgia. Ocorreram com maior freqüência em crianças com idade 5 anos (70,0%), com cateter venoso central (66,7%), e com doenças de base graves (80,4%). Pelo menos um agente infeccioso foi isolado em 78,9% dos episódios de ICS, sendo 41,5% gram-positivos e 44,8% gram-negativos. O microrganismo mais freqüente foi o Staphylococcus coagulase negativo (22,7%). A resistência do S. aureus e dos Staphylococcus coagulase negativos à oxacilina atingiu 58,9 e 80,3%, respectivamente. As cepas dos principais gram-negativos isolados (Klebsiella spp, Enterobacter spp, Pseudomonas spp e E.coli) mostraram-se amplamente resistentes à ceftriaxona, ao aztreonam e, em cerca de 35 a 57%, aos aminoglicosídeos. As ICS foram a causa ou contribuinte para o óbito em 21,9% dos pacientes, mas durante o período do estudo houve um decréscimo significante na mortalidade dos pacientes com ICS. CONCLUSÕES: A ICS foi uma causa importante de morbidade e mortalidade em pacientes pediátricos, predominando em crianças jovens e com doenças de base graves. Os principais fatores associados a ICS incluíram o uso de cateter vascular central e doença de base grave. Patógenos gram-negativos predominaram em todos os anos. O diagnóstico e terapêutica precoce são essenciais para a prevenção da morbidade e mortalidade e com a caracterização das ICS de origem hospitalar, pode-se auxiliar o programa de prevenção destas infecções e suas repercussões
INTRODUCTION: The hospital infections (HI) are main causes of morbidity and mortality in critically ill children. There are only few studies in pediatric age groups, and most of them demonstrated that the bloodstream infection (BSI) is the most important cause of HI in critically ill children. The OBJECTIVE of this study was to analyze the epidemiology of the nosocomial bloodstream infections (BSI) in children admitted to Instituto da Criança of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo a teaching hospital with complex care attendance, from January 1996 to August 2003. METHODS: The study was carried out in a cohort model, with retrospective data analyses regarding bloodstream infections collected through active surveillance, following the methods validated by the National Nosocomial Infection Surveillance System NNIS. RESULTS: The HI represented a significant cause of morbidity in patients admitted to the hospital within period and local studied. The patients risk for developing one or more HI was 11,5 per 100 exits. The BSI represented more than one third of the HI in the eight analyzed years, with a incidence density varying from 20,4 at Oncology, 7,7 on Neonatal Intensive Care Unit, 7,3 at Pediatric Intensive Care Unit up to 1.9 per 1000 patient-days at Surgery. It occurred more frequently on children on the age of < 5 years old (70,0%), with central vein catheter (66,7%), and critically ill (80,4%). At least one infection agent was isolated in 78,9% of the BSI episodes, 41,5% gram-positive and 44,8% gram-negative. The most frequent pathogen was coagulase-negative staphylococci (22,7%). The proportion of S. aureus and coagulase-negative staphylococci methicillin resistant reached 58,9 and 80,3%, respectively. The main isolated gram-negatives (Klebsiella spp, Enterobacter spp, Pseudomonas spp and E.coli) showed thoroughly resistance to ceftriaxone, to aztreonam and on 35 to 57% to aminoglycosides. The BSIs were the cause or contribution for death in 21,9% of the patients, but during the period of this study, there was a significant lowering on mortality rate of patients with BSI. CONCLUSIONS: The BSI was important cause of morbidity and mortality in pediatric patients, predominantly in young and critically ill children. The main factors associated to BSI included the use of central vascular catheter and severe disease. Gram-negative pathogens predominated in every one all the years. The diagnoses and precocious therapy are essential on the prevention of morbidity, mortality and the characterization of nosocomial BSI, and would help on prevention programs of these infections and its repercussions

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Chorazy, Margaret Lynn. "Polymicrobial respiratory tract infections in a hospital-based pediatric population, with particular emphasis on the role of human rhinoviruses." Diss., University of Iowa, 2010. https://ir.uiowa.edu/etd/788.

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Pediatric acute respiratory tract infections (ARTIs) are a leading cause of morbidity and mortality. The objectives of this study were to describe the epidemiology of polymicrobial ARTI in a hospital-based pediatric population and to investigate the association of polymicrobial infection and severity of illness. We conducted a retrospective study of 559 archived respiratory specimens from 421 children under the age of 10 years collected from March 28, 2008 through June 30, 2009 and stored by the University of Iowa Hospital and Clinics Clinical Microbiology Laboratory. Specimens were tested by immunofluorescence assay and/or viral culture at the time of collection (influenza A and B, parainfluenza [PIV] 1-3, respiratory syncytial virus [RSV], adenovirus [Ad]) and uniformly by RT-PCR (human metapneumovirus [hMPV], rhinovirus [HRV], human bocavirus [HBoV]) and PCR (Ad) for the current study. Demographic and clinical data were abstracted from electronic medical records. Results from this study suggest that polymicrobial respiratory tract infections are common in this population. A virus was identified in 61.3% of 349 respiratory specimens from children with confirmed or suspected ARTI. HRV (27.5%), RSV (18.9%), HBoV (8.3%), hMPV (7.7%), and PIV (6.6%) were the most common viruses detected. A viral coinfection was identified in 21.5% of the 214 virus-positive specimens and was most often detected for Ad (53.3% of 15 Ad-positive specimens), HBoV (51.7% of 29 HBoV-positive specimens), PIV (43.5% of 23 PIV-positive specimens), HRV (35.4% of 96 HRV-positive specimens), and RSV (34.8% of 66 RSV-positive specimens). Among the 46 specimens with dual or triple viral coinfections detected, the most frequent virus-virus combination was HRV-RSV (n=12). We hypothesized that certain host-specific risk factors were associated with the likelihood of viral coinfection. While none of the covariates in the final model were significant, the results were suggestive. Male gender (OR 1.70, 95% CI 0.83-3.46), age between 6 months to 1 year (as compared to children less than 6 months old, OR 2.15, 95% CI 0.75-6.19), and history of any chronic condition that may result in immunosuppression (OR 2.05, 95% CI 0.99-4.23) were each associated with increased odds of viral coinfection (p > 0.05). We also hypothesized that children with coinfections would be more likely to have severe ARTI. Children with viral-bacterial coinfection, as compared to children with viral mono-infection, were more likely to be admitted to an intensive care unit (OR 6.00, 95% CI 2.51-14.33) even after controlling for age, history of prematurity, urban/rural residence, and leukocytosis. This study will inform medical and public health professionals with regard to the epidemiology of polymicrobial infections and their potential importance as a cause of severe acute respiratory tract infection in children. Furthermore, results of this study may contribute to the ongoing discussion of the importance of diagnostic ability to reliably detect multiple concurrent pathogens in a single individual.

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Thomas, Claudia. "The epidemiology and control of Clostridium difficile infection in a Western Australian hospital." University of Western Australia. School of Population Health, 2003. http://theses.library.uwa.edu.au/adt-WU2004.0011.

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[Truncated abstract] The prinicipal aim of this thesis was to explore the relationship between 3rd generation cephalosporin antibiotics and hospital-acquired Clostridium difficile-associated diarrhoea (CDAD). This antibiotic class has been implicated in the aetiology of CDAD; therefore restriction of these antibiotics via antibiotic policies represents a potential strategy for prevention and control of CDAD. Successful control of CDAD in hospitals translates to improved quality of care for patients, and a reduction of pressure on hospital resources. Therefore, the objectives of this study were to determine whether 3rd generation cephalosporins were related to CDAD, to evaluate the effect of changes to antibiotic policy on the incidence of CDAD, and to determine the impact of CDAD on patient length of stay and hospital costs. The study was conducted in Sir Charles Gairdner Hospital (SCGH), a public teaching hospital located in Perth, the capital city of the state of Western Australia. Evidence for an association between 3rd generation cephalosporins and CDAD was obtained from studies of ecologic- and individual-level data. A time series analysis of the relationship between monthly consumption of 3rd generation cephalosporins and the incidence of CDAD in SCGH was undertaken covering the period 1994 to 2000. The results demonstrated a positive relationship between the use of 3rd generation cephalosporins and CDAD. A matched case-control study that involved 193 adult inpatients diagnosed with CDAD and 386 adult inpatients without CDAD, selected from the period 1996 to 2000, was conducted. Information was collected on exposure to 3rd generation cephalosporin antibiotics during hospitalisation, as well as exposure to other antibiotics and medications, procedures, and comorbidities. Results from conditional logistic regression analyses found CDAD cases were six times more likely to be exposed to 3rd generation cephalosporins during their admission, prior to the onset of diarrhoea, than controls (adjusted odds ratio [OR] = 6.17, 95% confidence interval [CI] = 1.56-24.37). Approximately one third of CDAD in the study population could be attributed to 3rd generation cephalosporins. CDAD cases were also four times more likely to have been exposed to either amoxicillin-clavulanate or ticarcillin-clavulanate (adjusted OR=4.23, 95% CI=1.81-9.93). In October 1998, an antibiotic policy was introduced at SCGH that restricted the use of ceftriaxone, the 3rd generation cephalosporin most commonly used by the hospital. During 1999 and 2000, the incidence of CDAD halved as ceftriaxone consumption fell in response to this policy. The effect of this policy was demonstrated in the time series model; during the post-policy period the relationship between ceftriaxone and CDAD that was evident prior to the policy was cancelled out. From the individual-level data, obtained from the case-control study, a reduction in the prevalence of exposure to 3rd generation cephalosporins from 11% to 1% accounted for a 30% reduction in the incidence of CDAD. Data from the case-control study was also used to analyse the independent contribution of CDAD to length of stay and admission costs using multiple linear regression

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Copeland, Alexa. "The Impact of Patient Room Design on Airborne Hospital-Acquired Infections (HAI)." Kent State University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=kent1462362700.

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Forrester, Marie Leanne. "Epidemic models and inference for the transmission of hospital pathogens." Queensland University of Technology, 2006. http://eprints.qut.edu.au/16419/.

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The primary objective of this dissertation is to utilise, adapt and extend current stochastic models and statistical inference techniques to describe the transmission of nosocomial pathogens, i.e. hospital-acquired pathogens, and multiply-resistant organisms within the hospital setting. The emergence of higher levels of antibiotic resistance is threatening the long term viability of current treatment options and placing greater emphasis on the use of infection control procedures. The relative importance and value of various infection control practices is often debated and there is a lack of quantitative evidence concerning their effectiveness. The methods developed in this dissertation are applied to data of methicillin-resistant Staphylococcus aureus occurrence in intensive care units to quantify the effectiveness of infection control procedures. Analysis of infectious disease or carriage data is complicated by dependencies within the data and partial observation of the transmission process. Dependencies within the data are inherent because the risk of colonisation depends on the number of other colonised individuals. The colonisation times, chain and duration are often not visible to the human eye making only partial observation of the transmission process possible. Within a hospital setting, routine surveillance monitoring permits knowledge of interval-censored colonisation times. However, consideration needs to be given to the possibility of false negative outcomes when relying on observations from routine surveillance monitoring. SI (Susceptible, Infected) models are commonly used to describe community epidemic processes and allow for any inherent dependencies. Statistical inference techniques, such as the expectation-maximisation (EM) algorithm and Markov chain Monte Carlo (MCMC) can be used to estimate the model parameters when only partial observation of the epidemic process is possible. These methods appear well suited for the analysis of hospital infectious disease data but need to be adapted for short patient stays through migration. This thesis focuses on the use of Bayesian statistics to explore the posterior distributions of the unknown parameters. MCMC techniques are introduced to overcome analytical intractability caused by partial observation of the epidemic process. Statistical issues such as model adequacy and MCMC convergence assessment are discussed throughout the thesis. The new methodology allows the quantification of the relative importance of different transmission routes and the benefits of hospital practices, in terms of changed transmission rates. Evidence-based decisions can therefore be made on the impact of infection control procedures which is otherwise difficult on the basis of clinical studies alone. The methods are applied to data describing the occurrence of methicillin-resistant Staphylococcus aureus within intensive care units in hospitals in Brisbane and London

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Kinnula, S. (Sohvi). "Hospital-associated infections and the safety of alcohol hand gels in children." Doctoral thesis, Oulun yliopisto, 2012. http://urn.fi/urn:isbn:9789514299001.

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Abstract Viral infections are common in childhood and a usual cause for hospitalization. Viruses are easily transmitted among children both in pediatric wards and in other child care facilities, like child day-care centers. Hand hygiene is an important part of prevention of the transmission of viruses. Since hospitalization times are getting shorter, hospital-associated infections often manifest after discharge. The aim of the study was to evaluate the magnitude of hospital-associated infections during and after hospitalization in pediatric wards with a focus on the effect of the ward structure. Data were collected during two periods of two years in the pediatric infectious diseases ward in Oulu University Hospital; data collection in the latter period was done using electronic follow-up methods. A two-year study period was also carried out in University Children’s hospital in Basel and in North Karelia Central Hospital in Joensuu. Paper questionnaires and electronic questionnaires were compared as methods of doing continuous surveillance of hospital-associated infections during and after hospitalization. The safety of alcohol-based hand gels in children’s use was studied using alcometer measurements after hand rub. Experiences on the use of alcohol-based hand gels in child day-care centers were collected by interviewing the personnel with questionnaires. Altogether 5.8 to 17.5% of hospitalized children (N=7046) got a hospital-associated infection; 65 to 93% of the infections became evident after discharge. The number of hospital-associated infections was lowest in wards where single rooms and cohorting based on infection etiology were used. Increased risk for hospital-associated infection was associated with young age, longer hospitalization time and a shared room. A higher response rate was achieved with electronic follow-up compared with questionnaires on paper, 84 vs. 61%. The costs of follow-up were €13.61 and €15.07 per patient in electronic and conventional follow-up, respectively. Electronic follow-up decreased annual expenses by 17.1%. Alcohol-based hand gels were found to be safe in children’s use, as no absorption was detected despite several contacts between hands and mucous membranes. Personnel in child day-care centers were active in using hand rubs and found them useful and easy to use. Earlier, there had been one incident with fire when using matches while hands were still wet with alcohol. The majority of hospital-associated infections in children become evident after discharge, and electronic follow-up is useful in evaluating their magnitude. The number of hospital-associated infections can be decreased with single room bedding and careful infection control. Alcohol-based hand gels are safe in children’s hand hygiene
Tiivistelmä Lapset sairastavat usein virusinfektioita, jotka ovat yleinen sairaalahoidon syy. Virukset leviävät herkästi lasten keskuudessa, lastentautien osastoilla ja lapsiryhmissä, kuten päiväkodeissa. Virusten leviämistä voidaan estää hyvällä käsihygienialla. Lyhyiden hoitoaikojen vuoksi osa virusten aiheuttamista sairaalainfektioista ilmenee vasta kotona. Tutkimuksen tarkoituksena oli selvittää sairaalainfektioiden määrä hoidon aikana ja kotiutuksen jälkeen sekä osastorakenteen vaikutus sairaalainfektioihin lastentautien osastoilla. Sairaalainfektioaineisto kerättiin Oulun yliopistollisen sairaalan lasten infektio-osastolla kahtena kahden vuoden jaksona, joista jälkimmäisessä käytettiin sähköistä seurantajärjestelmää. Lisäksi kahden vuoden aineistot kerättiin Pohjois-Karjalan keskussairaalan lastentautien osastolla ja Baselin yliopistollisen sairaalan lastenosastoilla. Paperikyselylomakkeilla ja sähköisesti tehdyn sairaalainfektioseurannan toteutusta verrattiin. Lisäksi tutkittiin alkoholikäsihuuhteiden käytön turvallisuutta lapsilla päiväkotiolosuhteissa. Alkoholin imeytymistä tutkittiin poliisin tarkkuusalkometrillä käsihuuhteen käytön jälkeen. Oulun kaupungin päiväkodeista kysyttiin käsihuuhteiden käyttökokemuksista kyselylomakkeilla. Sairaalainfektion sai 5,8-17,1 % sairaalassa hoidetuista lapsista (N=7046). Infektioista 65-93 % tuli oireisiksi kotiutuksen jälkeen. Sairaalainfektioiden määrä oli pienin osastoilla, jossa käytettiin yhden hengen huoneita ja potilaiden kohortointia taudinaiheuttajan mukaan. Sairaalainfektion riskiä lisäsivät lapsen nuori ikä, pitkä sairaalahoitoaika ja jaettu potilashuone. Sähköisessä sairaalainfektioseurannassa oli parempi kotiutuksen jälkeinen vastausprosentti kuin paperilomakkeilla, 84 % vrt. 61 %. Potilasta kohden kuluja tuli sähköisessä seurannassa 13,61 euroa ja paperilomakkeilla tehdyssä seurannassa 15,07 euroa. Sähköisen seurannan käyttö laski vuosikuluja 17,1 %. Alkoholikäsihuuhteiden käyttö todettiin turvalliseksi lapsilla. Useista limakalvokontakteista huolimatta käsihuuhteen käytön jälkeen alkoholia ei imeytynyt verenkiertoon. Käsihuuhteiden käyttö päiväkodeissa on aktiivista, ja henkilökunta koki sen helpoksi ja hyödylliseksi. Aiemmin oli tapahtunut yksi vaaratilanne tulen kanssa tulitikkua sytytettäessä käsien ollessa vielä käsihuuhteesta märät. Lasten sairaalainfektioista suuri osa ilmenee kotiutuksen jälkeen, ja näiden infektioiden määrää voidaan arvioida sähköisellä seurantajärjestelmällä. Sairaalainfektioiden määrää voidaan vähentää käyttämällä yhden hengen huoneita ja huolehtimalla hyvästä hygieniasta. Alkoholihuuhteiden käyttö lasten käsihygieniassa on turvallista

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37

Debesai, Yohannes. "Strategies Healthcare Managers Use to Reduce Hospital-Acquired Infections." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6414.

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Every year, 2 million patients in the United States suffer with at least 1 hospital-acquired infection resulting in an estimated 99,000 deaths annually. The purpose of this exploratory single case study was to explore strategies healthcare managers in U.S. hospitals used to reduce hospital-acquired infections. The study included face-to-face, semistructured interviews with 5 healthcare managers from a hospital in Maryland who were successful in reducing these infections. The conceptual framework was human capital theory. Field notes, hospital documents, and transcribed interviews were analyzed to identify themes regarding strategies used by healthcare managers. The data analysis and coding process resulted in 5 major themes: use of HAI-related data; implementation of detailed cleaning method; implementation of define, measure, analyze, implement, and control; education and training of staff; and implementation of the Antimicrobial Stewardship Program. The findings from this study might benefit healthcare managers in implementing and sustaining successful strategies to reduce hospital-acquired infections. The implications for positive social change included reducing hospital-acquired infections, thereby leading to fewer hospitalization days for patients and a faster recovery time to return to normal life. Reducing hospital acquired infections might reduce patient deaths related to the infections.

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Lima, LucimÃ Alves Pereira. "AvaliaÃÃo do Programa de Controle de InfecÃÃo Hospitalar em Hospitais no MunicÃpio de Teresina-PI." Universidade Federal do CearÃ, 2011. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=7541.

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nÃo hÃ
O controle de infecÃÃo hospitalar (IH) ao longo dos anos evoluiu e evidenciou-se como um fenÃmeno que nÃo se restringe apenas ao meio hospitalar, mas, tambÃm, a todos os estabelecimentos da Ãrea de saÃde, nos quais se desenvolvem aÃÃes consideradas de risco para o aparecimento das infecÃÃes. Para que o controle de IH seja realizado de forma sistemÃtica, por todos os que participam direta ou indiretamente do processo, e atenda Ãs necessidades de cada serviÃo, a existÃncia de um Programa de Controle de IH (PCIH) tem o papel de organizaÃÃo desta sistemÃtica, e pode funcionar como importante ferramenta da qualidade, pois permite o planejamento e a execuÃÃo das aÃÃes de controle de IH. Avaliar o desempenho do Programa de Controle de InfecÃÃo Hospitalar nos hospitais no municÃpio de Teresina, com base nos indicadores validados nacionalmente.Trata-se de um estudo epidemiolÃgico descritivo, avaliativo do tipo estudo de caso mÃltiplo, realizado em 10 hospitais que aceitaram participar formalmente deste estudo. As varÃveis estudadas dizem respeito Ã Estrutura e Processo de trabalho. Com relaÃÃo Ã estrutura foram avaliados o espaÃo fÃsico, os recursos materiais, humanos e regulamentaÃÃo. Quanto ao processo foram avaliadas as prÃticas operacionais que envolvem as atividades de vigilÃncia epidemiolÃgica, alÃm de ensino e pesquisa. A coleta de dados foi realizada com formulÃrio com questÃes fechadas, avaliaÃÃo documental e entrevistas. A populaÃÃo do estudo foi constituÃda por enfermeiros membros das CCIHs de cada hospital. Na avaliaÃÃo no grau de adequaÃÃo de funcionamento das CCIHs dos hospitais estudados, foi estabelecido sistema de escores, classificando-os em muito adequado, adequado, inadequado e muito inadequado. Os resultados mostraram que dois hospitais se destacaram, onde um apresentou pontuaÃÃo final muito adequado e o outro muito inadequado, sendo que este Ãltimo nÃo tem CCIH atuante. Observou-se que em relaÃÃo Ã estrutura fÃsica e material seis CCIHs apresentaram aspectos muito adequados, duas inadequadas e um muito inadequado. Quanto aos recursos humanos, duas CCIHs com pontuaÃÃo muito adequada por atender na Ãntegra a portaria, seis inadequadas e uma adequada. No tocante Ãs prÃticas operacionais, o tipo II, apenas um hospital apresentou pontuaÃÃo muito adequada (100%), enquanto trÃs apresentaram percentuais entre 74 â 86,9%, sendo considerado nesse quesito como adequados. Quanto Ãs prÃticas operacionais III que correspondem ao ensino e pesquisa, observa-se que apenas dois obtiveram pontuaÃÃo muito adequados, dois tambÃm apresentaram pontuaÃÃo adequado e os outros foram considerados como inadequados e muito inadequados. Portanto, os dados obtidos apontam a necessidade do interesse e apoio por parte dos gestores, da organizaÃÃo dos profissionais de saÃde envolvidos em mudar o referencial em direÃÃo Ã competÃncia profissional, fazendo investimentos em conhecimento cientifico, no desenvolvimento em habilidades tÃcnicas, esteja ele representando a organizaÃÃo ou a equipe.
The control of hospital infection (HI) was, over the years, evolving and showing like a phenomenon that is not restricted to the hospital, but also to all health care establishments, which develop actions considered risk for the onset of infection. For the control of hospital infection to be carried out systematically by all who participate directly or indirectly in the process, and to meet the needs of each service, the existence of a Control Program of HI (CPHI) has the role of organizing this systematic and can act as an important tool of quality, because it allows the planning and execution of control actions in terms of HI. To evaluate the performance of the Program for Infection Control in hospitals in the city of Teresina, based on indicators validated nationally. Itâs about a multiple case, descriptive, evaluative epidemiological study, conducted in 10 hospitals agreed formally to participate in this study. The variables studied relate to the structure and process. With regard to the structure were evaluated physical space, material, human resources and regulations. On the process, were evaluated operational practices that involve the activities of epidemiological surveillance as well as teaching and research. Data collection was performed with form closed questions, documents evaluation and interviews. The study population consisted of nurse members of HICCs of each hospital. In assessing the operation adequacy degree of the HICCs in the studied hospitals, was established scoring system, classifying them into very adequate, adequate, inadequate and very inadequate. The results showed that two hospitals stood out, where one presented a very adequate final score and the other, very inadequate. The latter has no active HICC. It was observed that in relation to the physical structure and material, six HICCs had very appropriate feature, two inadequate and one, very inadequate. As for human resources two HICCs scored very adequate for meeting the legal requirements in full, six inadequate and one adequate. With regard to operational practices, the type II, only one hospital had very adequate score (100%), while five had percentages between 69 - 84%, being considered as adequate in this regard. As for the operational practices III, that correspond to teaching and research, we note that only two scored very adequate, also two had appropriate scores and the others were considered inadequate and very inadequate. Therefore, the data obtained indicate the need for interest and support from managers, the organization of health professionals involved in changing the direction in reference to professional competence, making investments in scientific knowledge, development of technical skills, being it representing the organization or team.

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Msibi, Bafana Elliot. "Infection prevention and control practices at Charlotte Maxeke Central Hospital Neonatal Unit, Johannesburg, South Africa." Thesis, University of Limpopo, 2019. http://hdl.handle.net/10386/3051.

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Thesis (MPH.) --University of Limpopo, 2019.
Background: The purpose of this study was to investigate the extent of adherence to Infection Prevention and Control (IP&C) practices and programs amongst healthcare workers (HCWs) in the neonatal ward at Charlotte Maxeke Central Hospital (CMCH). Methods: Quantitative research was conducted on 57 Clinicians directly providing care to the patients and 5 Health Care Workers indirectly providing care to the patients by means of supporting the environment and logistics where patients are being taken care. Data collection was done using structured questionnaires. Because the population was so small, all available HCWs, who were willing to participate in the study were selected to participate in the study. Furthermore, the SAS statistical software was used to describe and analyse data received from the data collection tools. Results: Two groups of respondents participated in the study which were (n=57) who in the neonatal ward at CMCH and Health Care Workers (n=5), most of the clinicians were having 1 – 4 years’ experience working in the neonatal unit at 54.6% followed by 5 – 9 years at 21.8%. Participants were in the age group ≤ 30 years at 39.3% followed by 31 – 40 years (32.1%) and least being at ≥ 51 years (5.4%). Clinicians included 46% of professional nurses, 28.6% Auxiliary Nursing Assistant, 16.1% student nurses and 8.9% medical doctors. The findings revealed that there are some areas where there’s inconsistent in using gloves when anticipating exposure to blood or body fluids, drying of hands after washing and removing jewellery during clinical care among clinicians particularly doctors, professional nurses and student nurses about IPC practices during clinical care. In Conclusion: There was inadequate compliance with IPC standards and there’s a need for regular trainings to improve the knowledge about IPCs and awareness of its importance among clinicians and health care workers in the neonatal unit. The IPC committee need to be revitalized by the hospital management to be able to undertake its mandate. Furthermore, the Hospital administration should provide copies of IPPC policy Guidelines in all wards/units and ensure effective implementation through vi constant supervision and adequate supplies and conduct regular audits to enhance compliance and implementation of IPPC policy. The study concluded that there was inadequate compliance with IPC and there’s a need for regular trainings to improve the knowledge about IPCs and awareness of its importance among clinicians and health care workers in the neonatal unit.

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Jacob, Jerry. "Clostridium difficile in an Urban, University-affiliated Long-Term Acute Care Hospital." Master's thesis, Temple University Libraries, 2016. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/373090.

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Epidemiology
M.S.
Background: Clostridium difficile is the most common cause of healthcare-associated infections in the United States, and has been associated with adverse outcomes in the acute care setting. However, little is known regarding the burden or impact of C. difficile infection (CDI) in long-term acute care hospitals (LTACHs). Methods: A retrospective matched cohort study was performed among patients at an urban, university-affiliated LTACH between July 2008 and October 2015. The incidence rate of LTACH-onset CDI was assessed and patient characteristics associated with adverse outcomes examined. Patients with CDI were matched to concurrently hospitalized LTACH patients without a diagnosis of CDI. A multivariable model using logistic regression was developed to determine characteristics associated with a composite primary outcome of either 30-day readmission to an acute care hospital or mortality. Subgroup analyses were performed for patients with a diagnosis of severe CDI. Results: The overall incidence of CDI was 21.4 cases per 10,000 patient-days. Patients with CDI had a mean age (±SD) of 70 ±14 years and a mean admission Charlson Comorbidity Index (CCI) of 4 ±2. Median (IQR) time between admission and diagnosis of CDI was 16 days (range: 9-23 days). In the final multivariable model, CDI was not a significant risk factor for the primary outcome (OR, 1.06 [95% confidence interval {CI}, 0.53-2.10]). Congestive heart failure (OR, 2.27 [95% CI, 1.15-4.57]), albumin level (OR, 0.44 [95% CI, 0.22-0.79]), and immunosuppression (OR, 2.94 [95% CI, 1.06-8.39]) were independent risk factors for the primary outcome. On subgroup analysis, severe CDI and CCI were significant risk factors for the primary outcome in bivariable analysis (OR, 2.91 [95% CI 1.03-8.20] and OR, 1.36 [95% CI 1.06-1.80], respectively). Only CCI remained significant in the multivariable model (OR, 1.32 [95% CI 1.02-1.75]). Conclusions: LTACH-onset CDI was found to have a relatively high incidence in an urban, university affiliated LTACH. CDI was not a significant risk factor for the composite outcome of 30-day readmission or mortality. Future research should focus on infection prevention and antibiotic stewardship measures to decrease CDI specifically in the LTACH setting.
Temple University--Theses

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Zorzin, Leila Crystina Dias. "Aspectos relacionados a rotina cirúrgica de um hospital veterinário universitário como potencial ao desenvolvimento de infecção hospitalar." Universidade Federal de Goiás, 2017. http://repositorio.bc.ufg.br/tede/handle/tede/8053.

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This study followed 30 dogs of different races, sex, band and performed 36 surgical procedures, some of which occurred simultaneously to no animal at all. The objectives sought were correlated with certain risk factors for the occurrence of nosocomial infections, to trace the microbiological profile of the animals, professionals involved in small animal surgeries and also a profile of bacterial susceptibility at the Veterinary Hospital of the Federal University of Goiás. The results were submitted to descriptive analysis to calculate the frequencies and comparison of means and standard deviation. Multivariate analysis using a dendrogram by the UPGMA method was used to evaluate the similarity of the sites regarding the presence of different microorganisms. The software R (R Core Team, 2017) was used for the statistical analysis. The most of the surgeries were classified as clean in relation to the clean-contaminated ones, the mean time of surgery was 74 minutes and an average of six people per surgery. The microbiological evaluation was obtained 272 isolates in total, which enabled the identification of 21 bacterial genera. Fifty-five percent of the bacteria identified were Gram-positive, and among these, the genera Staphylococcus spp. and Streptococcus spp as the most frequent. Among the bacteria characterized as Gram-negative (25%), the genus Pseudomonas spp. was checked in greater quantity. Isolates from animals showed a higher prevalence of Pseudomonas spp. and coagulase positive Staphylococcus. In the nostrils, hands and gloves of professionals with a higher frequency of bacteria of the genus Micrococcus spp. and coagulase-negative Staphylococcus. The bacterial majority of Micrococcus spp. Was identified in the samples collaborations of the CCPA environment. The average growth rate was 6UFC/m² / h and 9UFC/m²/h on CCPA and 18UFC/m²/h and 19UFC/m/h on SI of enterobacteria and fungi respectively for both. In the evaluation of antibiotic therapy, it was observed that 93.4% of the surgeries performed adopted the administration of antimicrobials without a therapeutic scheme, and that among the drugs tested, a penicillin had the highest resistance index for the isolates. The IH in the area of Veterinary Medicine is already a worrying reality for public health. Thus, these health institutions should be concerned with the implementation of PCIH to monitor, avoid and control IH.
Este estudo acompanhou 30 cães de diferentes raças, sexo e faixa etária que realizaram 36 procedimentos cirúrgicos, sendo que alguns destes aconteceram simultaneamente no mesmo animal. Os objetivos buscados foram correlacionar determinados fatores de risco para a ocorrência de infecções hospitalares, traçar o perfil microbiológico dos animais, profissionais e ambiente envolvidos em cirurgias de pequenos animais e ainda o perfil de suscetibilidade bacteriana no Hospital Veterinário da Universidade Federal de Goiás. Os resultados foram submetidos a análise descritiva para cálculo das frequências e comparação das médias e desvio padrão. Foi empregada análise multivariada por meio de dendrograma pelo método UPGMA para avaliar a similaridade dos locais quanto à presença de diferentes microrganismos. Utilizou-se o software R (R Core Team, 2017) para as análises estatísticas. Na avaliação dos fatores de risco a maior parte das cirurgias foram classificadas como limpas em relação às limpa-contaminadas, o tempo médio de cirurgia foi de 74 minutos e teve-se como média seis pessoas por cirurgia. A avaliação microbiológica obteve-se 272 isolados no total, que possibilitaram a identificação de 21 gêneros bacterianos. Caracterizaram-se como Gram positivas 75% das bactérias identificadas, e dentre estas, os gêneros Staphylococcus spp. e Streptococcus spp foram as mais frequentes. Entre as bactérias caracterizadas como Gram negativas (25%), o gênero Pseudomonas spp. foi verificado em maior quantidade. Nos isolados a partir de animais mostraram maior prevalência de Pseudomonas spp. e Staphylococcus coagulase positiva. Nos provenientes narinas, mãos e luvas dos profissionais teve-se a maior frequência bactérias dos gêneros Micrococcus spp. e Staphylococcus coagulase negativa. Já nas amostras colhidas do ambiente do CCPA identificou-se maioria bacteriana de Micrococcus spp.. Obteve-se a média de crescimento 6UFC/m²/h e 9UFC/m²/h no CCPA e 18UFC/m²/h e 19UFC/m/h no SI de enterobactérias e fungos respectivamente para ambos. Na avaliação da antibioticoterapia, observou-se que 93,4% das cirurgias realizadas adotaram a administração de antimicrobianos no esquema terapêutico, e que dentre os fármacos testados, a penicilina apresentou o maior índice de resistência para os isolados. A IH na área da Medicina Veterinária já é uma realidade preocupante para saúde pública. Assim essas instituições de saúde devem se preocupar com a implantação de PCIH para que se monitore, evite e controle a IH.

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Hayward, Richard A. "The changing concept of infection and its influence on hospital design, 1850-1890." Thesis, Keele University, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.267452.

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Lyrio, Lucas Nogueira Santos. "As ações para o controle das infecções hospitalares em Aracaju: resultados de um inquérito da Vigilância Sanitária Municipal." Instituto de Saúde Coletiva, 2012. http://repositorio.ufba.br/ri/handle/ri/16227.

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As infecções hospitalares (IH) são eventos adversos decorrentes de procedimentos diagnósticos e terapêuticos realizados no ambiente hospitalar. Devido ao aumento em sua incidência nas últimas décadas, as IH tornaram-se importante foco de atenção e medidas para prevenção, controle e promoção de um ambiente livre da infecção hospitalar foram adotadas mundialmente. No Brasil, normas regulamentando a criação e funcionamento de comissões e programas de controle de infecção hospitalar (CCIH e PCIH) existem desde 1983. Entretanto, poucos estudos avaliaram o grau de conformidade com a legislação dos PCIH implantados. Este estudo teve como objetivo verificar o grau de conformidade dos PCIH dos 16 hospitais de Aracaju em relação às normas definidas pela Portaria GM/MS nº 2616/98, no ano de 2011. Além disso, buscou obter informações sobre as ações de prevenção e controle de IH desenvolvidas pelas CCIH destes hospitais, e sobre a estrutura e funcionamento das CCIH destes hospitais, com intuito de oferecer subsídios para discussão a respeito da política de controle de IH do sistema de saúde em Aracaju. Tratou-se de um estudo descritivo, de corte transversal, onde foram utilizados dados secundários fornecidos pela Coordenação de Vigilância Sanitária de Aracaju (COVISA/AJU) de inspeções sanitárias realizadas em 16 hospitais de Aracaju no ano de 2011. Durante as inspeções, a COVISA/AJU utilizou um instrumento padronizado, constituído por quatro grupos de indicadores específicos relacionados à qualidade do PCIH: 1) estrutura técnico-operacional do PCIH; 2) diretrizes operacionais de controle e prevenção de IH; 3) sistema de vigilância epidemiológica de IH; e 4) atividades de controle e prevenção de IH. As análises foram realizadas através do programa Epi Info. Estas constaram de estatísticas descritivas, como frequência absoluta e relativa, relacionadas aos grupos de indicadores citados. Foi determinada e descrita a frequência de conformidade dos PCIH com base na Portaria GM/MS nº 2616/98. O padrão de conformidade dos 16 hospitais para cada grupo de indicadores foi de 68%, 68%,57% e 57%, respectivamente. Em relação à frequência de conformidade dos grupos de indicadores, segundo a natureza administrativa dos hospitais, observou-se melhores desempenhos para o grupo relacionado às diretrizes operacionais de controle e prevenção de IH nos hospitais privados e públicos em comparação aos filantrópicos. Os demais grupos de indicadores apresentaram frequências de conformidade semelhantes entre os hospitais das três naturezas. Conclui-se que os programas de prevenção e controle de IH desenvolvidos pelos hospitais de Aracaju são incipientes e que não atendem integralmente os requisitos da legislação sanitária vigente. Recomenda-se ao município de Aracaju constituir Coordenação Municipal de Controle de Infecção Hospitalar para conduzir a incorporação de medidas de controle de IH nos hospitais instalados em seu território e apoiá-los na aplicação dessas medidas.

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Gasser, Raphael Götz-Ulrich. "Quantitative Erfassung nosokomialer Infektionen auf der interdisziplinären operativen Intensivstation des Universitätsklinikums Leipzig." Doctoral thesis, Universitätsbibliothek Leipzig, 2017. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-219965.

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Nosokomiale Infektionen (NKI) gehören zu den häufigsten Komplikationen eines Krankenhausaufenthaltes, insbesondere auf Intensivstationen mit einer Prävalenz von rund 18,65%. Die Folgen sind eine längere Verweildauer, erhöhte Morbidität und Letalität sowie höhere Kosten für das Gesundheitssystem. Die Erfassung NKI stellt einen wichtigen Qualitäts- Parameter für Intensivstationen dar. Ziel dieser Arbeit war es, die Übereinstimmung von nur nach KISS (Krankenhaus-InfektionsSurveillance System)- Definitionen erfassten Infektionen mit der klinisch diagnostizierten nosokomialen Infektion zu prüfen und den Zusammenhang zwischen ärztlicher Diagnose und den laborchemischen und klinisch erhobenen Kriterien darzustellen. Hierfür wurden auf einer interdisziplinären operativen Intensivstation nosokomiale Infektionen sowohl nach ITS- KISS (VAP, ZVK- assoziierte Infektionen und HWI), als auch nach ärztlicher Diagnose plus Beginn oder Eskalation einer Antibiotikatherapie erfasst. Zusätzlich zu den KISS-Parametern wurden laborchemische Entzündungsparameter (CRP und PCT) registriert. Es traten 32 Infektionen nach ITS- KISS und 69 Infektionen nach ärztlicher Diagnose auf. Acht Infektionen wurden ausschließlich nach KISS und 45 ausschließlich nach der ärztlichen Diagnose erfasst. Die Infektionsrate nach KISS für VAP lag bei 20,6, für ZVK bei 5,9 und für HWI bei 2 Infektionen, jeweils pro 1000 Devicetage. Spezifität und positiv prädiktiver Wert hinsichtlich der Vorhersage einer ärztlich diagnostizierten Infektion waren gering. Auch durch Kombination verschiedener Parameter wurden keine höheren prädiktiven Werte erreicht. Die geringe Übereinstimmung der beiden Methoden legt nahe, dass KISS die klinisch relevanten Infektionen nicht wesentlich erfasst und relevante Infektfoci nicht berücksichtigt werden, beispielsweise abdominelle Infektionen. Zudem erlauben die erfassten Laborparameter keine zuverlässige Diagnose bzw. Prädiktion einer nosokomialen Infektion. Die ärztliche Diagnose in Verbindung mit dem Beginn oder der Eskalation einer Antibiotikatherapie könnte eine vereinfachte Methode zur Surveillance nosokomialer Infektionen darstellen.

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Fernando, Francine da Silva e. Lima de. "Ocorrência de fungos patogênicos em leito hospitalar e interferência química de agentes desinfetantes." Faculdade de Medicina de São José do Rio Preto, 2015. http://hdl.handle.net/tede/269.

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Introduction: Fungal diseases have increased recently these years in many parts of the world and in different health care settings, being attributed to several factors, inherent or not to the patient, such as increased aggressive therapeutic practices, previous exposure to antifungals, and diseases or immunosuppressive drugs. These morbidities arise in the hospital as nosocomial infections, being the main cause of morbidity and mortality in hospitalized patients. The high rates of hospital or nosocomial infection may be associated with limitated physical and therapeutic resources, or insufficient investment in training programs, implementation and control of CCIHs, and limited number of health workers. Such factors corroborate greater demands on health services, associated to the lack of qualified professionals and the deficiency in the cleaning and disinfection of environments. Studies has shown that busy environment by infected or colonized patients by resistant microorganisms, constitutes a risk factor for maintaining this colonization or infection of these patients, subsequent and team. Objective: Analyze the occurrence of pathogenic fungi in a hospital bed and the chemical interference of disinfectants.Results: in 74 mattresses reviews of a public hospital, there was growth of yeasts in 28 (38.2%), 19 (67.9%) before and 9 (32.1%) after cleaning and disinfection. In particular hospital, in 25 mattresses reviewed, there was growth of Candida spp.in 15 (60.0%), being 10 (66.7%) of them before and 5 (33.3%) after cleaning / disinfection. Both hospitals showed occurrence of Candida spp. before and after terminal cleaning, the prevalented species was C. parapsilos. Conclusion: The persistence of Candida spp. in both hospital mattresses, after disinfection, demonstrates that the process is flawed, and that mattresses can serve as reservoirs or fungal vectors potentially pathogenic, representing a cross risk of acquiring infection for the patient to professionals and as contamination of surfaces in hospitals. It is necessary to reassess the techniques used for disinfection of mattresses, adoption of new measures, such as the pre-cleaning or the use of a detergent / disinfectant to carry out the process of cleaning and disinfection in one step, definition of roles, investments in training, supplies and supervision, in both of the team responsible for the procedure, and the nursing staff, in an attempt to reduce the prevalence of these findings, thus ensuring a microbiologically safe to the patient and to all involved in the care environment.
Introdução: Doenças provocadas por fungos aumentaram nos últimos anos, em várias partes do mundo, e em diferentes ambientes de assistência à saúde, fato este atribuído a inúmeros fatores, inerentes ou não ao paciente, tais como aumento de práticas terapêuticas agressivas, exposição prévia a antifúngicos, doenças e ou medicamentos imunossupressores. Estas morbidades surgem no ambiente hospitalar como infecções nosocomiais, e encontram-se como principal causa de morbimortalidade em pacientes internados. As altas taxas de infecção hospitalar ou nosocomial podem estar associadas a limitação de recursos físicos e terapêuticos, bem como investimentos insuficientes em programas de treinamento, implementação e controle das CCIHs, além de número limitado de trabalhadores da saúde. Tais fatores corroboram com grandes demandas nos serviços de saúde, associados à carência de profissionais qualificados e adeficiencia nos processos de limpeza e desinfecção dos ambientes. Estudos demonstram que ambiente ocupado, por pacientes infectados ou colonizados, por microrganismos resistentes, constituise em fator de risco para manutenção desta colonização ou infecção destes pacientes, dos subsequentes e da equipe. Objetivo: Analisar a ocorrência de fungos patogênicos em leito hospitalar e a interferência química de agentes desinfetantes. Resultados: dos 74 colchões avaliados de um hospital público, houve crescimento de leveduras em 28 (38,2%), sendo 19 (67,9%) antes e 9 (32,1%) depois da limpeza e desinfecção. No hospital particular, dos 25 colchões avaliados, houve crescimento de espécies de Candida spp. em 15 (60,0%), sendo 10 (66,7%) antes e cinco (33,3%) depois da limpeza/desinfecção. Nos dois hospitais houve a ocorrência de Candida spp. antes e após limpeza terminal e a espécie prevalente foi a C. parapsilos.Conclusão: A persistência de Candida spp. nos colchões de ambos os hospitais, após a desinfecção, demonstra que o processo é falho e, que os colchões podem servir de reservatórios ou vetores de fungos, potencialmente patogênicos, representando um risco de aquisição de infecção cruzada para os pacientes, para profissionais, assim como contaminação das superfícies no ambiente hospitalar. Faz-se necessário reavaliar as técnicas empregadas para desinfecção dos colchões, adoção de novas medidas, tais como a limpeza prévia ou a utilização de um detergente/desinfetante que realize o processo de limpeza e desinfecção em uma única etapa, definição de papéis, investimentos em treinamentos, insumos e supervisão, tanto da equipe responsável pelo procedimento, quanto da equipe de Enfermagem, na tentativa de diminuir a prevalência destes achados, garantindo assim um ambiente microbiologicamente seguro ao paciente e a todos os envolvidos na assistência.

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CUNHA, Cristiano Berardo Carneiro da. "Avaliação microbiológica dos aparelhos celulares dentro da sala de cirurgia – avaliação em um hospital beneficente de Pernambuco." Universidade Federal de Pernambuco, 2016. https://repositorio.ufpe.br/handle/123456789/18600.

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Introdução: A infecção hospitalar é um problema frequente e crescente em todo o mundo. Tentar determinar fatores que possam contribuir com a disseminação de bactérias dentro do ambiente hospitalar faz parte da estratégia de controle deste infortúnio. Os telefones celulares, dispositivos presentes no cotidiano de qualquer ambiente, incluindo os estabelecimentos de saúde, podem servir de reservatórios de patógenos, e, em seu manuseio, ajudar na disseminação de infecção nos hospitais. Essa preocupação se eleva ao se tratar de aparelhos pertencentes a funcionários de ambientes potencialmente colonizados por bactérias resistentes. Objetivo: O objetivo deste trabalho foi avaliar o grau de contaminação dos aparelhos celulares dos funcionários de um bloco cirúrgico de um hospital, verificando se há diferença entre as funções destes profissionais, tais como cirurgiões, anestesistas, perfusionistas, enfermeiros, e instrumentadores. Material e Métodos: Foram colhidos swabs umedecidos em caldo enriquecedor de 50 telefones celulares de funcionários do bloco cirúrgico. Esses swabs foram encubados e semeados, tendo suas leituras sido realizadas em 24 e 48h, tendo os resultados separados de acordo com cada especialidade. Resultados: Dos 50 aparelhos celulares avaliados, 88% (44) estavam colonizados. A bactéria mais comum foi o Estafilococos coagulase-negativa, seguido do Bacillus subtillis (15,9%) e Micrococcus sp (9,1%). Não houve diferença estatisticamente significativa do grau de contaminação entre as especialidades avaliadas. Conclusão: Foi verificado que os aparelhos celulares dos profissionais de saúde que trabalham no bloco cirúrgico do Hospital do Coração do Hospital Português de Beneficência em Pernambuco estavam contaminados com bactérias potencialmente causadoras de infecção. Não foi possível encontrar diferença estatística entre os aparelhos pertencentes às diversas especialidades que exercem suas atividades laborais no referido bloco cirúrgico.
Introduction: Hospital infection has been a frequent and growing problem worldwide. To try to determine factors that might contribute to the spread of bacteria in the hospital environment is part of the control strategy of this evil. Mobile phones, which are devices present in everyday life in any environment on the planet, including health facilities, can serve as reservoirs of pathogens, and its handling might help in the spread of infection in hospitals. This concern rises when it comes appliances belonging to potentially colonized environments of employees by resistant bacteria environments. Objective: The objective of this study was to evaluate the degree of contamination of mobile phones of employees of a surgical ward of a hospital, checking for differences between the functions of these professionals, such as surgeons, anesthetists, perfusionists, nurses, and scrub nurses. Methods: We collected swabs moistened in enriching broth 50 mobile phones of employees of the surgical rooms. These swabs were hatched and sown, and his reading was held on 24 and 48 hours, with separate results according to each specialty. Results: Of 50 evaluated handsets, 88% (44) were colonized. The most common bacteria were coagulase-negative staphylococci, followed by Bacillus subtilis (15.9%) and Micrococcus sp (9.1%). There was no statistically significant difference in the degree of contamination among the evaluated specialties. Conclusion: It was found that the cell phones of health professionals working in the surgical ward of the Hospital Português de Beneficência em Pernambuco were contaminated with potentially cause bacterial infection. It could not find statistically significant differences between devices belonging to different specialties who perform their professional activities in that operating room.

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Torres, Lilian Machado. "Readmissão por infecção de sítio cirúrgico em um hospital público de Belo Horizonte (MG)." Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/7/7139/tde-22072011-114317/.

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A crescente preocupação sobre as infecções relacionadas à assistência à saúde levou a Organização Mundial da Saúde a promover a criação da Aliança Mundial para a Segurança do Paciente, enfatizando ações básicas de controle de infecções. A redução de sua incidência implica em proteção para o paciente, profissionais e instituições, favorecendo a prestação da assistência livre de riscos. Dentre as mais frequentes, a infecção do sítio cirúrgico deve ser compreendida como elemento qualificador do cuidado e, os dados relacionados, o ponto de partida para as ações preventivas e de controle. Os hospitais têm dificuldades para realizar a vigilância epidemiológica pós-alta, tarefa complexa haja vista a tendência de redução do tempo de internação. Conhecer dados sobre a readmissão contribui para melhorar os dados de vigilância pós-alta. Foi realizado um estudo exploratório com o objetivo de descrever a epidemiologia das readmissões por infecções de sítio cirúrgico em pacientes em um hospital público de Belo Horizonte (MG). Foram avaliados 98 registros médicos e da Comissão de Controle de Infecção Hospitalar referentes aos indivíduos readmitidos por este motivo entre janeiro/2008 e dezembro/2009. Os resultados demonstraram que um quarto dos pacientes que desenvolveu infecção do sítio cirúrgico na instituição necessitou de nova internação. A idade média dos indivíduos foi de 57,2 anos; mais da metade apresentava diabetes mellitus, e um terço, hipertensão arterial sistêmica; no entanto, o risco anestésico para a maioria foi classificado como baixo. As infecções ocorreram com maior frequência em cirurgias limpas e potencialmente contaminadas, e as especialidades com maior número de pacientes readmitidos foram ortopedia, com mais da metade dos procedimentos relacionados à correção de fraturas, e cirurgia geral, na qual as hernioplastias/rafias e colecistectomias predominaram. Metade dos indivíduos recebeu biomaterial em suas intervenções. Os tempos cirúrgicos e de internação não diferiram dos estudos encontrados na literatura. Praticamente todos os pacientes utilizaram antibioticoprofilaxia, segundo protocolo da instituição. Os primeiros sinais e sintomas surgiram, em média, após 33,2 dias, e metade dos infectados teve o diagnóstico nos primeiros 30 dias de pós-operatório. A classificação das infecções mostrou que metade dos pacientes apresentou infecção de órgãos e cavidades e, para 60% deles, foram necessárias novas intervenções cirúrgicas, além do tratamento antimicrobiano. O micro-organismo predominante nas infecções ortopédicas foi Staphylococcus aureus e nas infecções da cirurgia geral Escherichia coli, ambos com perfil de resistência abaixo daqueles encontrados na literatura. O estudo permite concluir que a vigilância pós-alta e o monitoramento das taxas de readmissão contribuem para o redimensionamento do problema e definição de ações pontuais para seu controle.
The growing concern about infections related to health care led the World Health Organization to promote the creation of the World Alliance for Patient Safety, emphasizing basic actions to infection control. The reduction in the incidence of surgical site infection implies protection for patients, professionals and institutions favoring the assistance free of risks. Among the most frequent, surgical site infection should be understood as a qualifying element of care, and related data, the starting point for preventive and control measures. Hospitals have difficulties in achieving post-discharge surveillance, complex task given the trend of reduced hospital stay. Knowledge of the of readmission rates helps to improve reporting of post-discharge surveillance. An exploratory and descriptive study was conducted in order to describe the epidemiology of readmissions for surgical site infections in patients in a governmental hospital in Belo Horizonte (MG). We evaluated 98 medical records and the reports of the Hospital Infection Control Committee related to readmitted patients for this reason among january/2008 and december/2009. The results showed that one quarter of patients who developed surgical site infection in the hospital needed a new hospitalization. The mean age of subjects was 57.2 years; more than a half had diabetes mellitus, and a third, hypertension, however, the anesthetic risk for the majority was classified as low. The infections occurred more frequently in clean and potentially contaminated surgeries and the medical specialties with higher number of patients readmitted was orthopedic, with more than half of surgeries related to the correction of fractures, and general surgery, where the hernia and gallbladder surgery predominated. Half of the subjects received biomaterial in its proceedings. The surgical and hospitalization times did not differ from others studies in the literature. Virtually all patients received antibiotic prophylaxis for indications mentioned in the protocol. Early signs and symptoms appeared after an average of 33.2 days, and half of the patients were diagnosed within the first 30 days postoperatively. The classification of infections showed that half of the patients had infection of organs and cavities and 60% were required surgical interventions, in addition to antimicrobial treatment. Staphylococcus aureus predominated in orthopedic procedures and Escherichia coli in general surgery, both with multi-resistance profile below the results presented in other studies. The study concludes that the post-discharge surveillance and monitoring of readmission rates contribute to the scaling of the problem and define specific actions for its control.

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Rodrigues, Eliete Cristina da Angela. "Investigação dos casos de candidemia na Unidade de Terapia Intensiva Neonatal do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo no periodo de 2002 a 2008." Universidade de São Paulo, 2009. http://www.teses.usp.br/teses/disponiveis/5/5133/tde-05032010-154431/.

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Introdução: A Candida spp é considerada uma das principais causas de infecção fúngica invasiva em unidades de terapia intensivas neonatais (UTIN), sendo a terceira levedura mais comum isolada de culturas de sangue, podendo levar a septicemia e óbito. Objetivos: O objetivo deste estudo foi analisar a incidência da C. parapsilosis em candidemias em UTI-N nos últimos sete anos e investigar as possíveis causas do surto durante este período. Método: Foram revisados os prontuários dos neonatos com candidemia incluídos no estudo entre os anos de 2002 a 2008 e isoladas amostras das mãos dos 71 funcionários que tinham contato direto com os recém-nascidos e do sangue dos recém-nascidos acometidos por candidemia em um surto ocorrido no período de maio de 2004 a julho de 2005. As técnicas utilizadas para a análise das amostras biológicas foram: (i) identificação dos isolados pela micologia clássica e bioquímica (Auxanograma, Zimograma e API ID32), (ii) a análise do DNA genômico por meio do Pulsed Field Gel Eletrophoresis (PFGE) e Ramdomly Amplified Polymorphic DNA (RAPD) e (iii) seqüenciamento da região conservada ITS1/ 4. Resultados: Os resultados obtidos, no período de 2003 a 2005 demonstraram que houve um aumento significativo de aproximadamente 75% nos casos de C. parapsilosis confirmando a ocorrência de um surto de candidemia. Nos isolados destes recém nascidos, 80% das leveduras recuperadas foram identificadas como C. parapsilosis, e nos funcionários este agente foi recuperado em 11% das amostras. A análise do polimorfismo genômico destas amostras, pelos métodos PFGE e RAPD apresentou baixo poder discriminatório entre os isolados dos recém-nascidos e funcionários, não os correlacionado. Conclusões: Os resultados obtidos confirmam a ocorrência de um surto da C. parapsilosis no período de 2003 a 2005 na UTI-N, apesar de não ter sido possível identificar a fonte de origem deste agente. O aumento da incidência da C. parapsilosis na UTI-N no período de 2002 a 2008 e a caracterização de um surto entre os anos de 2003 a 2005 pode ser utilizado como indicador da necessidade de iniciativas de melhoria nas práticas de controle de infecção hospitalar e profilaxia de infecções na unidade de cuidados intensivos neonatais.
Introduction: Candida spp is considered one of the main causes of fungal invasive infection in the neonatal intensive care unit (NICU), and the third most common yeast isolated in blood cultures that could lead to septicemia and death. Objectives: This studys goal is to analyze the incidence of C. parapsilosis in NICU candidemias in the past seven years and investigate possible causes for an outbreak during this time period. Method: Clinical files of neonates with candidemia included in the study between 2002 and 2008 were revised, and hand samples of 71 employees that came into direct contact with newborns, and neonate candidemia infected blood samples were isolated, which occurred during an outbreak between May 2004 and July 2005. Techniques used to analyze the biological samples, were: (i) isolates identification by classic mycology and biochemistry (Auxanogram, Zymogram and API ID32), (ii) genomic DNA analysis by means of Pulsed Field Gel Electrophoresis (PFGE) and Randomly Amplified Polymorphic DNA (RAPD) and (iii) ITS1/ 4 preserved area sequence. Results: Results obtained between 2003 and 2005 showed a significant increase of approximately 75% in C. parapsilosis cases, confirming the occurrence of a candidemia outbreak. In these neonate isolates, 80% of the retrieved yeast was identified as C. parapsilosis, and on employees this agent was retrieved in 11% of the samples. The genomic polyphormism analysis of theses samples, using PFGE and RAPD methods, presented a non-correlating, low discriminatory strength between neonate and employee isolates. Conclusions: Obtained results confirmed the C. parapsilosis outbreak from 2003 to 2005 in the NICU, although it was not possible to identify the origin source of this agent. The increase of C. parapsilosis incidence in the NICU between 2002 and 2008, and the characteristics of an outbreak from 2003 to 2005, can be used as an indication for the need of improved initiatives in the control of hospital infection and infection prophylaxis in the Neonatal Intensive Care Unit.

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Wang, Wenjun. "A Perspective Survey on Hand Hygiene to Protect Healthcare Workers at The Ohio State University Veterinary Medical Center." The Ohio State University, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=osu1593598144663899.

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50

Sonntag, Kim. "A retrospective review of surgical site infection following caesarean section at Mowbray Maternity Hospital." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/22808.

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Introduction: Pregnancy related sepsis is a major cause of maternal mortality and morbidity in South Africa. Caesarean section (CS) is the most important risk factor in the development of puerperal infection, and surgical site infection (SSI) after CS increases maternal morbidity as well as medical costs. Mowbray Maternity Hospital (MMH), is a secondary level, public maternity hospital. The caesarean section rate at MMH has increased considerably over the last fifteen years, and the perception has been that there have been increasing numbers of patients developing SSI post-CS. This study was designed to look more closely at the incidence of SSI and to describe the patients identified with SSI. Methods: This was a retrospective observational study. Cases of severe SSI, as defined by the Centres for Disease Control and Prevention (CDC), following CS at MMH from December 2011 to December 2014 were identified. Following ethical approval, patient records were sourced, data collected and analysed using Stata and Statistica. Results: In the 3-year study period, 14982 CS were performed with 98 patients identified with severe SSI. Folders were retrieved for 96 patients, with 2 patients' folders missing and 29 patients with a missing maternity case record (MCR). The overall incidence of severe SSI was 0.65%, with an incidence of 0.88% in Year 1, 0.90 in Year 2 and 0.70 in Year 3. Of the cases, 79 (80.6%) had been in labour, 16 (16.3%) patients had had prolonged rupture of membranes (PROM) and 32 (32.7%) had prolonged labour, with a median of 5 vaginal examinations. An emergency CS was performed in 90 (91.8%) patients, 7 (7.2%) had an elective CS and 1 (1.0%) patient had this data missing. Deep incisional SSI was diagnosed in 74 (75.5%) patients and 24 (24.5%) patients were identified with organ/space SSI. Intravenous (IV) antibiotics was the main treatment in all 96 cases, with 23 (23.5%) patients requiring a wound debridement, 17 (17.2%) a laparotomy, which proceeded to a hysterectomy in 12 (12.3%) patients. In the majority of cases, no organism was cultured, Whereas multiple organisms were cultured in 16 cases, of which 12 were identified as MRSA, and 18 as Klebsiella pneumoniae. There were no maternal deaths or Intensive Care Unit (ICU) admissions. Discussion and Conclusion: The incidence of severe SSI is in keeping with other institutions, with the lowest incidence being found in Year 3, which may be explained by the change in referral population and/ or the full implementation of the Best Care Always (BCA) bundles of care. Of the 98 patients with severe SSI, 80.6% had been in labour, 32.7% had prolonged labour and 91.8% had an emergency CS performed. These are all factors which are known to increase the likelihood for development of post-CS SSI.

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