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Objetivo: descrever o perfil epidemiológico de infecções por bactérias do grupo ESKAPE em pacientes internados em uma unidade de terapia intensiva de um hospital de ensino da cidade de Juiz de Fora - MG. Métodos: Trata-se de um estudo epidemiológico observacional, descritivo de caráter retrospectivo, com participantes que adquiriram IRAS entre 2017 e 2018, dos quais foram isoladas e identificadas linhagens bacterianas pertencentes ao grupo ESKAPE no serviço de rotina bacteriológica do laboratório de microbiologia clínica. Resultados: Considerando o fenótipo de multirresistência entre as bactérias do grupo ESKAPE avaliadas, foi observada a ocorrência de 122 (88,4%) para Acinetobacter baumanii resistente aos carbapenêmicos, 87 (60,8%) para Klebsiella pneumoniae resistente aos carbapenêmicos, 57 (53,3%) para Pseudomonas aeruginosa resistente aos carbapenêmicos, 36 (55,4%) para MRSA e 19 (48,7%) para Enterobacter sp. resistente aos carbapenêmicos. Conclusões: A análise do perfil epidemiológico, clínico e microbiológico de infecções por bactérias do grupo ESKAPE em pacientes internados em uma UTI é de majorada importância para protocolos de terapia com o correto manejo de antibioticoterapia e redução da prevalência de resistência antimicrobiana.

Objective: To describe the epidemiological profile of ESKAPE group bacteria infections in patients admitted to an intensive care unit of a teaching hospital in Juiz de Fora, Minas Gerais. Methods: This is an observational, descriptive epidemiological study of retrospective nature, with participants who acquired IRAS between 2017 and 2018, from which bacterial strains belonging to the ESKAPE group were isolated and identified in the bacteriological routine service of the clinical microbiology laboratory. Results: Considering the multidrug resistance phenotype among the ESKAPE group bacteria evaluated, the occurrence of 122 (88.4%) for carbapenem- resistant Acinetobacter baumanii, 87 (60.8%) for carbapenem-resistant Klebsiella pneumoniae, 57 (53.3%) for carbapenem-resistant Pseudomonas aeruginosa, 36 (55.4%) for MRSA, and 19 (48.7%) for carbapenem-resistant Enterobacter sp. was observed. Conclusions: The analysis of the epidemiological, clinical and microbiological profile of infections caused by bacteria of the ESKAPE group in patients in an ICU is of major importance for therapy protocols with the correct management of antibiotic therapy and reduction of the prevalence of antimicrobial resistance.

Objetivo: Describir el perfil epidemiológico de las infecciones por bacterias del grupo ESKAPE en pacientes internados en la unidad de terapia intensiva de un hospital escuela de Juiz de Fora, Minas Gerais. Método: Se trata de un estudio epidemiológico observacional, descriptivo, de carácter retrospectivo, con participantes que adquirieron IRAS entre 2017 y 2018, de los cuales se aislaron e identificaron cepas bacterianas pertenecientes al grupo ESKAPE en el servicio de rutina bacteriológica del laboratorio de microbiología clínica. Resultados: Considerando el fenotipo de resistencia a múltiples fármacos entre las bacterias del grupo ESKAPE evaluadas, se observó la ocurrencia de 122 (88,4%) para Acinetobacter baumanii resistente a carbapenemes, 87 (60,8%) para Klebsiella pneumoniae resistente a carbapenemes, 57 (53,3%) para Pseudomonas aeruginosa resistente a carbapenemes, 36 (55,4%) para MRSA y 19 (48,7%) para Enterobacter sp. resistente a carbapenemes. Conclusiones: El análisis del perfil epidemiológico, clínico y microbiológico de las infecciones causadas por bacterias del grupo ESKAPE en pacientes ingresados en una UCI es de gran importancia para los protocolos terapéuticos con el correcto manejo de la antibioticoterapia y la reducción de la prevalencia de resistencias antimicrobianas.

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BACKGROUND: Clostridioides difficile infection (CDI) is a disease that is potentially preventable by vaccination. A good knowledge of its epidemiology, which can change over time, is warranted for prevention purposes and to help decision-making on the use of vaccines in public health programs. The objective of the research was to determine the epidemiology of healthcare-associated CDI (HA-CDI) and community-associated CDI (CA-CDI) in hospitalized patients in Spain using point prevalence data. METHODS: Point prevalence survey data on infections of hospitalized patients for years 2012-2019 were analyzed. HA-CDI and CA-CDI prevalence rates were calculated. Both HA-CDI and CA-CDI, as well as age group prevalence rates, were examined for trends. Patient comorbidities were tested for association to CDI. RESULTS: The prevalence of CDI in Spanish hospitals has grown exponentially from 14.1% in 2012 to 35.9% in 2019 (cases/10.000 hospitalized patients). Almost two thirds of the cases are of nosocomial onset. This increase was observed for HA-CDI and CA-CDI at an annual rate of 1.11% (CI 95% 1.08-1.15) and 1.09% (CI 95% 1.04-1.13), respectively. Patients 50 years old or older represent 87% of the total number of cases. Patients suffering from neoplasm (OR 1.39), immunodeficiency (OR 3.26), neutropenia (OR 3.70), cirrhosis (OR 1.92) and chronic renal failure (OR 1.91) have a significant increased risk of developing CDI, after adjusting for age. CONCLUSION: In Spain, the prevalence rate of both HA-CDI and CA-CDI have been increasing. Burden of CDI as well as clinical and epidemiological characteristics of CDI patients will help to support public health decision-making.

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BackgroundClostridioides difficile infection (CDI) is a disease that is potentially preventable by vaccination. A good knowledge of its epidemiology, which can change over time, is warranted for prevention purposes and to help decision-making on the use of vaccines in public health programs. The objective of the research was to determine the epidemiology of healthcare-associated CDI (HA-CDI) and community-associated CDI (CA-CDI) in hospitalized patients in Spain using point prevalence data.MethodsPoint prevalence survey data on infections of hospitalized patients for years 2012–2019 were analyzed. HA-CDI and CA-CDI prevalence rates were calculated. Both HA-CDI and CA-CDI, as well as age group prevalence rates, were examined for trends. Patient comorbidities were tested for association to CDI.ResultsThe prevalence of CDI in Spanish hospitals has grown exponentially from 14.1% in 2012 to 35.9% in 2019 (cases/10.000 hospitalized patients). Almost two thirds of the cases are of nosocomial onset. This increase was observed for HA-CDI and CA-CDI at an annual rate of 1.11% (CI 95% 1.08–1.15) and 1.09% (CI 95% 1.04–1.13), respectively. Patients 50 years old or older represent 87% of the total number of cases. Patients suffering from neoplasm (OR 1.39), immunodeficiency (OR 3.26), neutropenia (OR 3.70), cirrhosis (OR 1.92) and chronic renal failure (OR 1.91) have a significant increased risk of developing CDI, after adjusting for age.ConclusionIn Spain, the prevalence rate of both HA-CDI and CA-CDI have been increasing. Burden of CDI as well as clinical and epidemiological characteristics of CDI patients will help to support public health decision-making.

AntecedentesLa infección por Clostridioides difficile (ICD) es una enfermedad potencialmente prevenible mediante vacunación. Es necesario conocer adecuadamente su epidemiología para ayudar a la toma de decisiones sobre su prevención y el uso de vacunas en programas de salud pública. El objetivo de esta investigación es determinar la epidemiología de ICD relacionada con la asistencia sanitaria (IRAS-CD) e ICD asociada a la comunidad (IAC-CD) en pacientes hospitalizados en España.MétodosAnalizamos los datos de encuestas de prevalencia puntual en pacientes hospitalizados durante los años 2012-2019. Calculamos las tasas de prevalencia de IRAS-CD e IAC-CD, y por grupos de edad, examinando sus tendencias. Evaluamos la asociación de ciertas comorbilidades con la ICD.ResultadosLa prevalencia de ICD en hospitales españoles ha crecido exponencialmente desde el 14,1% en 2012 al 35,9% en 2019 (casos/10.000 pacientes hospitalizados). Casi 2/3 de los casos son de inicio nosocomial. Este aumento se ha observado en IRAS-CD (1,11%; IC 95%: 1,08-1,15) e IAC-CD (1,09%; IC 95%: 1,04-1,13). Los pacientes de 50 años o más representan el 87% del total de casos. Los pacientes con neoplasia (OR: 1,39), inmunodeficiencia (OR: 3,26), neutropenia (OR: 3,70), cirrosis (OR: 1,92) e insuficiencia renal crónica (OR: 1,91) tienen un riesgo significativamente mayor de desarrollar ICD tras ajustar por edad.ConclusiónEn España la tasa de prevalencia de IRAS-CD e IAC-CD ha ido en aumento. Conocer la carga de la ICD y las características clínicas y epidemiológicas de los pacientes con ICD ayudará a la toma de decisiones en salud pública.

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Objetivo. La higiene de manos (HM) es la medida individual más efectiva para reducir el riesgo de infecciones relacionadas con la atención sanitaria. Sin embargo, es habitual encontrar bajos resultados de cumplimiento de las indicaciones de HM entre profesionales sanitarios. El objetivo de este trabajo es evaluar la implementación de la aplicación de una estrategia multimodal para impulsar la promoción de la HM. Métodos. Se utilizó la «Guía de aplicación de la estrategia multimodal de la Organización Mundial de la Salud para la mejora de la higiene de manos», conformado por: cambio del sistema, formación y entrenamiento, evaluación y retroalimentación, recordatorio en el lugar del trabajo, clima institucional de seguridad y vigilancia de la adherencia a la HM. La estrategia se planteó como un estudio de intervención para promover la HM en el Complejo Hospitalario Universitario Insular Materno Infantil en el período 2012-2020. Resultados. El cumplimiento global de las indicaciones de HM al final del periodo de estudio fue del 59,2%. El consumo de productos de base alcohólica aumentó con respecto a los años anteriores (p<0,05), siendo en el último año de 70 litros por cada 1000 estancias. La encuesta reveló que la formación y la existencia de preparado de base alcohólica en cada punto de atención eran percibidas por parte de los profesionales sanitarios como los principales aspectos facilitadores de la práctica de HM. Conclusiones. La implementación de una intervención multimodal mejoró significativamente la adhesión al lavado de manos y el uso de productos de base alcohólica entre los profesionales sanitarios. A pesar de tener formación previa sobre higiene de manos, los conocimientos de los profesionales son incompletos. La formación previa seguido del tiempo trabajado son los determinantes más importantes de las conocimientos y percepciones sobre higiene de manos (AU)

Objective. Hand hygiene (HH) is the single most important and effective measure to reduce the risk of healthcare-related infections. However, low compliance with HH indications among healthcare professionals is often low. The objective of this study was to evaluate the implementation of a multimodal strategy to promote HH among healthcare professionals. Methods. We used the “Application guide of the multimodal strategy of the World Health Organization for the improvement of hand hygiene”, which consists of: changes to the system, education and training, evaluation and feedback, workplace reminders, organizational safety climate and monitoring of compliance with HH. The strategy was designed as an intervention study to promote HH in the Maternal and Child Insular University Hospital Complex in the period 2012-2020. Results. Overall compliance with the HH indications at the end of the study period was 59.2%. The use of alcoholic-based products increased with respect to previous years (p <0.05), reaching 70 liters/1000 hospital admissions in the final year. Healthcare professionals perceived training and accessibility to an alcohol-based preparation at each point of care as the most effective measures for promoting good HH practice. Conclusions. The implementation of a multimodal intervention significantly improved compliance with handwashing and the use of alcohol-based products among healthcare professionals. Despite having previous training on hand hygiene, HH knowledge among professionals remains incomplete. Prior training followed by time worked are the most important determinants of knowledge and perceptions about hand hygiene (AU)

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BACKGROUND: Clostridioides difficile infection (CDI) is a disease that is potentially preventable by vaccination. A good knowledge of its epidemiology, which can change over time, is warranted for prevention purposes and to help decision-making on the use of vaccines in public health programs. The objective of the research was to determine the epidemiology of healthcare-associated CDI (HA-CDI) and community-associated CDI (CA-CDI) in hospitalized patients in Spain using point prevalence data. METHODS: Point prevalence survey data on infections of hospitalized patients for years 2012-2019 were analyzed. HA-CDI and CA-CDI prevalence rates were calculated. Both HA-CDI and CA-CDI, as well as age group prevalence rates, were examined for trends. Patient comorbidities were tested for association to CDI. RESULTS: The prevalence of CDI in Spanish hospitals has grown exponentially from 14.1% in 2012 to 35.9% in 2019 (cases/10.000 hospitalized patients). Almost two thirds of the cases are of nosocomial onset. This increase was observed for HA-CDI and CA-CDI at an annual rate of 1.11% (CI 95% 1.08-1.15) and 1.09% (CI 95% 1.04-1.13), respectively. Patients 50 years old or older represent 87% of the total number of cases. Patients suffering from neoplasm (OR 1.39), immunodeficiency (OR 3.26), neutropenia (OR 3.70), cirrhosis (OR 1.92) and chronic renal failure (OR 1.91) have a significant increased risk of developing CDI, after adjusting for age. CONCLUSION: In Spain, the prevalence rate of both HA-CDI and CA-CDI have been increasing. Burden of CDI as well as clinical and epidemiological characteristics of CDI patients will help to support public health decision-making.

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The approach to public health, patient safety and quality of care has led to analysing health situations or problems from a population perspective, in a wide way and giving priority to factors that can normally be left in the background from a clinical point of view. For years, the problem of the use and abuse of antimicrobials, the increase and diffusion of microorganisms resistant to them, cross-transmission, and healthcare related infections have been prioritised both nationally and internationally. To combat these problems, various strategies are being developed and put into practice, from the policies of rational use and optimization of antimicrobials, surveillance, and control of infections related to health care, to training information and awareness strategies. One of the pillars of surveillance and control is the correct application of standard and specific precautions, which within the framework of these comprehensive programs aim to control the transmission of microorganisms of special microbiological and/or epidemiological interest through a series of measures. In hospitals, the application of these precautions (single room, barrier measures, restrictions on access to rooms, waste management…) in patients infected or colonised by these microorganisms can have different repercussions, both for patients and the professionals that attend them, and it is considered pertinent that the protocols and/or programs of specific precautions explicitly include the analysis of the ethical aspects in their preparation, implementation, and monitoring.

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OBJECTIVES: An evaluation is made of the impact of a series of five interventions on the incidence of hospital-related infections in a level iii neonatal unit. MATERIAL AND METHODS: Quasi-experimental, pre-post intervention study, which included preterm infants weighing 1,500g at birth or delivered at <32 weeks gestation, admitted in the 12 months before and after the measures were implemented (January 2014). The measures consisted of: optimising hand washing, following a protocol for insertion and handling of central intravenous catheters, encouraging breastfeeding; applying a protocol for rational antibiotic use, and establishing a surveillance system for multi-resistant bacteria. The primary endpoint was to assess the incidence of hospital-acquired infections before and after implementing the interventions. RESULTS: Thirty-three matched patients were included in each period. There was an incidence of 8.7 and 2.7 hospital-related infections/1,000 hospital stay days in the pre- and post-intervention periods, respectively (P<.05). Additionally, patients in the treatment group showed a statistically-significant decrease in days on mechanical ventilation, use of blood products, and vasoactive drugs. CONCLUSIONS: The strategy, based on implementing five specific measures in a unit with a high rate of hospital-related infections, proved effective in reducing their incidence. This reduction could contribute to lowering the use of mechanical ventilation, blood products, and vasoactive drugs.

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INTRODUCTION: Long-term care facilities (LTCFs) have become receptors of patients with a high risk of healthcare-associated infections (HAIs). OBJECTIVE: To determine the prevalence of HAIs in LTCFs. METHOD: During the period 2011-2014 2 annual prevalence studies were performed according to Healthcare-associated infections in long-term-care facilities (HALT) study definitions and methodology. RESULTS: A total of 28,360 patients were included in the study. The overall prevalence rate of HAIs was 10.2%. Subacute units and palliative care units showed the highest rates, 22.3% and 18.7%, respectively. Main infections were respiratory tract infection (35.8%) and urinary tract infection (35.8%). CONCLUSION: These results were higher than other similar experiences, a fact that suggests the need to extend the specific strategies and programs to LTCFs, and ensuring a sufficient number of specialised staff in infection control.

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INTRODUCTION: Preventive isolation of patients with multidrug-resistant microorganisms is considered an effective measure to prevent outbreaks in hospitals. The objective of this study is to assess compliance by healthcare workers and family of contact isolation precautions in colonised/infected patients with multidrug-resistant microorganisms. METHODS: An observational study was conducted from October 2014 to March 2015. A checklist with a structure was designed (equipment trolley), including knowledge of the situation and compliance by the patients, families, and healthcare workers. Univariate and bivariate analyses were performed. Non-parametric tests Mann-Whitney and Kruskal-Wallis were used. RESULTS: Out of the 467 observations made, the equipment trolley was correctly situated in 97% (453) of cases, the sphygmomanometer in 90% (421), the stethoscope 43.9% (205), and thermometer 16.5% (77). A dustbin and the alcoholic solution were observed in over 98.7% (461) of cases. The antiseptic soap for patient hygiene was observed to be correctly placed in 348 (74%) of occasions. The situation was known by 84.9% (305) of patients and 91.4% (234) of families. As regards compliance by professionals with the placement/removal of disposable gowns and gloves was about 50% for entering the room (49.5%, 56 gown and 53.09%, 60 gloves), and 40% (28) for leaving the room by professionals. Hand hygiene compliance was 26.5% (30) for entering and 35.2% (25) when leaving. CONCLUSIONS: There is significant room for improvement in the compliance with isolation precautions. Non-compliance to isolation procedures is not due to a deficit of materials, but to individual behaviours. It is important to implement and evaluate programs based on psychosocial intervention models that can change attitudes and behaviours related to contact isolation precautions for multidrug-resistant microorganisms.

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INTRODUCTION: Cystoscopes are used for diagnostic and therapeutic purposes and can be vehicles for transmitting healthcare-associated infections. Performing urine cultures before manipulation or administering prophylaxis is determined by the presence or not of risk factors for urinary tract infection. METHODS: Between October and November 2014, we identified an unusual aggregation of Salmonella spp. isolates in urine cultures at the University Hospital Santa Lucía of Cartagena (Murcia). An epidemiological investigation was conducted to assess the possible relationship between the cases. RESULTS: Four patients had a urinary tract infection by Salmonella spp. within a short period, which suggests the presence of an outbreak. All of the patients had undergone cystoscopy. The index case had a urinary colonisation by Salmonella spp. prior to the procedure, and none of the reported cases had received prophylaxis. The environmental control cultures and the involved material cultures resulted negative. Intensification of the cystoscope cleaning and disinfection protocol achieved eradication of the outbreak. CONCLUSION: This is the first reported outbreak of Salmonella spp. related to the use of cystoscopes. The indication for a urine culture should be carefully assessed before conducting invasive urological procedures, as should the need for antibiotic prophylaxis, for patients with risk factors for severe infection. Strict control in the cleaning and disinfection of endoscopy material can prevent the transmission of infections related to this type of procedure.

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Health-care associated infections are an important public health problem worldwide. The rates of health-care associated infections are indicators of the quality of health care. The infection control activities related to prevention of transmission of hospital microorganisms can be grouped in 4 mayor areas: standard precautions, specific precautions (including isolation if appropriate), environmental cleaning and disinfection, and surveillance activities (including providing infection rates and monitoring procedures). Hand hygiene and the correct use of gloves are the most important measures to prevent health-care associated infections and to avoid the dissemination of multidrug-resistant microorganisms. Continuous educational activities aimed at improving adherence to hand hygiene are needed. Periodical assessment of adherence to hand hygiene recommendations with feed-back have been shown to provide sustained improvement. Several complementary activities are being evaluated, including skin decolonization prior to certain surgeries, a package of measures in patients with central venous catheters or mechanical ventilation, and universal body hygiene with chlorhexidine. The present area of discussion concerns in which situations and in which groups would such measures be effective and efficient.

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