RESUMO
OBJECTIVES: We report the results of the International Nosocomial Infection Control Consortium prospective surveillance study from January 2004 to December 2009 in 33 pediatric intensive care units of 16 countries and the impact of being in a private vs. public hospital and the income country level on device-associated health care-associated infection rates. Additionally, we aim to compare these findings with the results of the Centers for Disease Control and Prevention National Healthcare Safety Network annual report to show the differences between developed and developing countries regarding device-associated health care-associated infection rates. PATIENTS: A prospective cohort, active device-associated health care-associated infection surveillance study was conducted on 23,700 patients in International Nosocomial Infection Control Consortium pediatric intensive care units. METHODS: The protocol and methodology implemented were developed by International Nosocomial Infection Control Consortium. Data collection was performed in the participating intensive care units. Data uploading and analyses were conducted at International Nosocomial Infection Control Consortium headquarters on proprietary software. Device-associated health care-associated infection rates were recorded by applying Centers for Disease Control and Prevention National Healthcare Safety Network device-associated infection definitions, and the impact of being in a private vs. public hospital and the income country level on device-associated infection risk was evaluated. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Central line-associated bloodstream infection rates were similar in private, public, or academic hospitals (7.3 vs. 8.4 central line-associated bloodstream infection per 1,000 catheter-days [p < .35 vs. 8.2; p < .42]). Central line-associated bloodstream infection rates in lower middle-income countries were higher than low-income countries or upper middle-income countries (12.2 vs. 5.5 central line-associated bloodstream infections per 1,000 catheter-days [p < .02 vs. 7.0; p < .001]). Catheter-associated urinary tract infection rates were similar in academic, public and private hospitals: (4.2 vs. 5.2 catheter-associated urinary tract infection per 1,000 catheter-days [p = .41 vs. 3.0; p = .195]). Catheter-associated urinary tract infection rates were higher in lower middle-income countries than low-income countries or upper middle-income countries (5.9 vs. 0.6 catheter-associated urinary tract infection per 1,000 catheter-days [p < .004 vs. 3.7; p < .01]). Ventilator-associated pneumonia rates in academic hospitals were higher than private or public hospitals: (8.3 vs. 3.5 ventilator-associated pneumonias per 1,000 ventilator-days [p < .001 vs. 4.7; p < .001]). Lower middle-income countries had higher ventilator-associated pneumonia rates than low-income countries or upper middle-income countries: (9.0 vs. 0.5 per 1,000 ventilator-days [p < .001 vs. 5.4; p < .001]). Hand hygiene compliance rates were higher in public than academic or private hospitals (65.2% vs. 54.8% [p < .001 vs. 13.3%; p < .01]). CONCLUSIONS: Country socioeconomic level influence device-associated infection rates in developing countries and need to be considered when comparing device-associated infections from one country to another.
Assuntos
Infecções Relacionadas a Cateter/epidemiologia , Países em Desenvolvimento , Unidades de Terapia Intensiva Pediátrica , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Classe Social , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/etiologia , Fidelidade a Diretrizes , Desinfecção das Mãos , Humanos , Estudos ProspectivosRESUMO
BACKGROUND: Several medical devices used during hemodynamic procedures, particularly angiographic diagnostic and therapeutic cardiac catheters, are manufactured for single use only. However, reprocessing and reuse of these devices has been reported, to determine the frequency of reuse and reprocessing of single-use medical devices used during hemodynamic procedures in Brazil and to evaluate how reprocessing is performed. DESIGN: National survey, conducted from December 1999 to July 2001. METHODS: Most of the institutions affiliated with the Brazilian Society of Hemodynamic and Interventional Cardiology were surveyed by use of a questionnaire sent in the mail. RESULTS: The questionnaire response rate was 50% (119 of 240 institutions). Of the 119 institutions that responded, 116 (97%) reported reuse of single-use devices used during hemodynamic procedures, and only 26 (22%) reported use of a standardized reprocessing protocol. Cleaning, flushing, rinsing, drying, sterilizing and packaging methods varied greatly and were mostly inadequate. Criteria for discarding reused devices varied widely. Of the 119 institutions that responded, 80 (67%) reported having a surveillance system for adverse events associated with the reuse of medical devices, although most of these institutions did not routinely review the data, and only 38 (32%) described a training program for the personnel who reprocessed single-use devices. CONCLUSIONS: The reuse of single-use devices used during hemodynamic procedures was very frequent in hospitals in Brazil. Basic guidance on how to reuse and reprocess single-use medical devices is urgently needed, because, despite the lack of studies to support reusing and reprocessing single-use medical devices, such devices are necessary in limited-resource areas in which these practices are current.
Assuntos
Cateterismo Cardíaco/instrumentação , Equipamentos Descartáveis , Técnicas Eletrofisiológicas Cardíacas/instrumentação , Reutilização de Equipamento/estatística & dados numéricos , Procedimentos Cirúrgicos Vasculares/instrumentação , Brasil , Infecção Hospitalar/etiologia , Infecção Hospitalar/prevenção & controle , Desinfecção/métodos , Segurança de Equipamentos , Pesquisas sobre Atenção à Saúde , Humanos , Esterilização/métodos , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: To determine the cause of an outbreak of Klebsiella pneumoniae bloodstream infections (BSIs) among neonates in a high-risk nursery and to institute control measures. DESIGN: During the on-site investigation, a cohort study to identify risk factors for K. pneumoniae BSI, a point-prevalence study to assess K. pneumoniae colonization, a maternal cohort study to determine maternal K. pneumoniae colonization, and an observational study to evaluate healthcare worker (HCW) compliance with infection control practices were conducted. PATIENTS AND SETTING: Neonates in a 40-bed high-risk nursery in a 700-bed university hospital in Cali, Colombia. INTERVENTION: Cohorting of neonates colonized with K. pneumoniae. RESULTS: The overall K. pneumoniae BSI attack rate was 10 of 105 (9.5%). In the retrospective cohort study, the number of blood transfusions (OR, 3.1 per transfusion; P = .02; CI95, 1.4-9.7) and intravenous injections (OR, 1.2 per injection; P = .04; CI95, 1.0-1.5) were independently associated with K. pneumoniae BSI. The overall prevalence of K. pneumoniae colonization was 61% among neonates and 7% among mothers. During the HCW assessment, suboptimal intravenous therapy practices were observed. A cohorting intervention resulted in a significant reduction in K. pneumoniae colonization (12% vs 61%; RR, 0.19; P < .001). During the intervention period, no K. pneumoniae BSIs occurred. CONCLUSIONS: This investigation suggested that the outbreak probably occurred due to widespread colonization and suboptimal infection control and intravenous therapy practices. Cohorting successfully reduced the overall prevalence of K. pneumoniae colonization and, along with improved infection control practices, probably prevented K. pneumoniae BSIs
Assuntos
Bacteriemia/etiologia , Cateteres de Demora/microbiologia , Infecção Hospitalar/microbiologia , Contaminação de Equipamentos , Unidades de Terapia Intensiva Neonatal , Infecções por Klebsiella/etiologia , Klebsiella pneumoniae/isolamento & purificação , Bacteriemia/microbiologia , Bacteriemia/prevenção & controle , Patógenos Transmitidos pelo Sangue , Estudos de Coortes , Colômbia/epidemiologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Surtos de Doenças/prevenção & controle , Feminino , Fidelidade a Diretrizes , Hospitais Universitários , Humanos , Recém-Nascido , Controle de Infecções/métodos , Controle de Infecções/normas , Transmissão de Doença Infecciosa do Profissional para o Paciente , Infusões Intravenosas/efeitos adversos , Infusões Intravenosas/instrumentação , Infecções por Klebsiella/epidemiologia , Infecções por Klebsiella/prevenção & controle , MasculinoRESUMO
OBJECTIVE: To report the results of our preintervention investigation and subsequent 19-month three-phase intervention study designed to reduce pyrogenic reactions among patients undergoing cardiac catheterization using reprocessed catheters. DESIGN: A case-control study for the preintervention period and a prospective cohort study for the intervention period. SETTING: A 400-bed hospital in Belo Horizonte, Brazil. PARTICIPANTS: Any patient undergoing cardiac catheterization in the hospital. INTERVENTIONS: Three intervention phases were implemented to improve the quality of the water supplied to the cardiac catheter reprocessing laboratory. Standard operating procedures for reprocessing cardiac catheters were established and reprocessing staff were trained and educated. RESULTS: The rate of pyrogenic reactions decreased significantly during the intervention phases, from 12.8% (159 of 1,239) in phase 1 to 5.3% (38 of 712) in phase 2 to 0.5% (4 of 769) in phase 3 (chi-square test for linear trend, 97.5; P < .001). CONCLUSION: Improving water quality and using standard operating procedures for reprocessing catheters can prevent pyrogenic reactions in hospitalized patients.
Assuntos
Cateterismo Cardíaco/efeitos adversos , Infecção Hospitalar/prevenção & controle , Descontaminação/métodos , Contaminação de Equipamentos , Reutilização de Equipamento , Controle de Infecções/métodos , Sepse/prevenção & controle , Microbiologia da Água , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Cateterismo Cardíaco/instrumentação , Estudos de Casos e Controles , Cateterismo/efeitos adversos , Cateterismo/normas , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/etiologia , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Pirogênios/sangue , Sepse/epidemiologia , Sepse/etiologia , Purificação da ÁguaRESUMO
OBJECTIVES: To determine risk factors for acquiring Burkholderia cepacia complex among patients with cystic fibrosis (CF). STUDY DESIGN: A case-control study was conducted with active surveillance for B cepacia complex colonization/infection among patients at 21 CF centers from April 1986 to March 1989 (study period). A case-patient was defined as any CF patient with B cepacia complex colonization for the first time during the study period. Control patients were patients with CF not B cepacia complex colonized during the study period. For each patient, a questionnaire was completed semiannually. RESULTS: In multivariate analyses, hospitalization for pulmonary exacerbations, living with a B cepacia complex-positive person, attending a CF summer camp, and direct contact with a B cepacia complex-colonized CF person outside of camp and home were associated with B cepacia complex acquisition. Receiving antimicrobial aerosol therapy or cleaning and drying a home-used nebulizer between uses were associated with a decrease in B cepacia complex acquisition. CONCLUSIONS: Numerous factors inside and outside the health care setting are associated with person-to-person transmission of B cepacia complex among patients with CF. Prevention programs should reduce direct or indirect contact between noncolonized and B cepacia complex-colonized/infected patients with CF.
Assuntos
Infecções por Burkholderia/epidemiologia , Burkholderia cepacia , Fibrose Cística/microbiologia , Administração por Inalação , Adolescente , Adulto , Infecções por Burkholderia/tratamento farmacológico , Infecções por Burkholderia/etiologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Fibrose Cística/tratamento farmacológico , Fibrose Cística/epidemiologia , Feminino , Seguimentos , Humanos , Lactente , Modelos Logísticos , Masculino , Análise Multivariada , América do Norte/epidemiologia , Razão de Chances , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de DoençaRESUMO
OBJECTIVE: To describe the investigation and control of an outbreak of extended-spectrum beta-lactamase producing Salmonella enterica subsp. enterica serotype Infantis in a neonatal unit in Brazil. METHODS: A case-control study for risk factors for Salmonella Infantis systemic infection, environmental cultures, and evaluation of staffing and overcrowding and an assessment of infection control practices were performed. RESULTS: During July 1998 to June 1999, 140 Salmonella Infantis culture-positive patients were identified in the neonatal unit. Presence of a peripheral intravascular catheter was identified as an independent risk factor (odds ratio = 4.98; 95% CI = 1.59-19.31; P =.01) and each 250-g increase in birth weight as a protective factor (odds ratio = 0.76; 95% CI = 0.57-0.95; P =.03). Hospital stay was significantly longer and costs higher in case patients than in control patients. Salmonella Infantis was isolated from multiple environmental sources. Neonatal unit personnel were observed to make several breaks in infection control practices. The unit was understaffed and overcrowded. Prompt case identification, cohorting of patients, enhanced staff hand hygiene, and environmental cleaning terminated the outbreak. CONCLUSIONS: Inadequate infection control practices, nursery overcrowding, and understaffing can have an adverse effect on patient morbidity, mortality rates, and hospital cost.
Assuntos
Infecção Hospitalar/prevenção & controle , Surtos de Doenças/prevenção & controle , Infecções por Salmonella/prevenção & controle , Salmonella enterica , beta-Lactamases/metabolismo , Brasil/epidemiologia , Estudos de Casos e Controles , Infecção Hospitalar/epidemiologia , Feminino , Humanos , Recém-Nascido , Controle de Infecções/métodos , Unidades de Terapia Intensiva Neonatal/organização & administração , Masculino , Análise Multivariada , Fatores de Risco , Infecções por Salmonella/epidemiologia , Estatísticas não ParamétricasRESUMO
A nursery outbreak of fever and clinical sepsis resulted in the deaths of 36 neonates in Roraima, Brazil. To determine the cause, epidemiologic studies were performed, along with culture and endotoxin analysis of intravenous (iv) fluids. Affected neonates were more likely to have lower birth weight (2.1 vs. 3.2 kg; P<.01), lower APGAR (activity, pulse, grimace, appearance, and respiration) score at 1 (7 vs. 8; P=.1) or 5 min (8 vs. 9; P=.03), lower gestational age (32 vs. 39 weeks; P=.001), or to receive iv medications (20/20 vs. 2/40; P<.0001). Fever occurred only after iv medication administration. Although culture results of unopened iv medications were negative, endotoxin levels of glucose and distilled water for injection were elevated (3.3 and 1.2 U/mL, respectively). Endotoxin-contaminated iv medications were distributed nationally and may have caused other outbreaks of unexplained death. These results highlight the importance of monitoring both pharmaceutical quality and postmarketing surveillance for adverse events.
Assuntos
Surtos de Doenças , Febre/epidemiologia , Berçários Hospitalares , Sepse/epidemiologia , Peso ao Nascer , Brasil/epidemiologia , Estudos de Casos e Controles , Estudos de Coortes , Contaminação de Medicamentos , Endotoxinas/análise , Feminino , Febre/etiologia , Hidratação/efeitos adversos , Humanos , Mortalidade Infantil , Recém-Nascido , Recém-Nascido Prematuro , Infusões Intravenosas , Masculino , Nutrição Parenteral , Fatores de Risco , Sepse/etiologiaRESUMO
OBJECTIVE: To determine the prevalence of intensive care unit-acquired infections, a major cause of morbidity in pediatric intensive care unit (PICU) patients. METHODS: Pediatric Prevention Network hospitals (n = 31) participated in a point-prevalence survey on August 4, 1999. Data collected for all PICU inpatients included demographics, infections, therapeutic interventions, and outcomes. RESULTS: There were 512 patients in 35 PICUs. The median age was 2.2 years (range, <1 day-35.4 years). Seventy-five PICU-acquired infections occurred among 61 (11.9%) patients. The most frequently reported sites were bloodstream (31 [41.3%]), lower respiratory tract (17 [22.7%]), urinary tract (10 [13.3%]), or skin/soft tissue (6 [8.0%]). The most frequent pathogens were coagulase-negative staphylococci (in 16 [21.3%] infections), Candida spp. (13 [17.3%]), enterococci (10 [13.3%]), Staphylococcus aureus (9 [12.0%]), or Pseudomonas aeruginosa (8 [10.7%]). Age-adjusted risk factors for infection included central intravenous catheters (relative risk [RR], 4.1; 95% confidence intervals [CI], 2.4-7.1), arterial catheters (RR, 2.4; 95% CI, 1.5-3.9), total parenteral nutrition (RR, 5.5; 95% CI, 3.6-8.5), or mechanical ventilation (RR, 3.9; 95% CI, 2.2-6.8). Infection was associated with higher age-adjusted risk of death within 4 weeks of the survey (RR, 3.4; 95% CI, 1.7-6.5). CONCLUSIONS: This national multicenter study documented the high prevalence of PICU-acquired infections. Preventing these infections should be a national priority.