Navegando por Palavras-chave "infecção hospitalar"
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- ItemAcesso aberto (Open Access)Adesão à técnica de lavagem de mãos em Unidade de Terapia Intensiva Neonatal(Sociedade de Pediatria de São Paulo, 2009-06-01) Martinez, Mariana Reclusa; Campos, Luiz Alexandre Albuquerque Freixo; Nogueira, Paulo Cesar Koch [UNIFESP]; Unilus Faculdade de Ciências Médicas de Santos; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE:To evaluate the hand washing technique employed by health professionals and visitors of patients treated in a Neonatal Intensive Care Unit (NICU). METHODS: A prospective observational study was performed in the NICU of a teaching hospital in Santos, São Paulo, Brazil. The evaluation was made during seven months, with mornings and afternoons observations. Data were collected by two medical students. Observed people were not informed of the objective of the research. Two approaches were used to compare the hand washing technique: a) analysis by intention to treat, considering individuals who did not wash their hands as using an inadequate technique and b) by protocol analysis, considering only those who washed their hands. The chi-square or Fisher's exact tests were used to compare the groups and p<0.05 was adopted in all tests to reject the null hypothesis. RESULTS: 43 observations were performed, which lasted about 30 minutes each, being 20 in the morning and 23 in the afternoon. We observed six physicians (14%), 26 nurses (60%), three (7%) laboratory and X-ray technicians and eight (19%) relatives of patients. Among these, 24 (55.8%) washed their hands before entering the unit. The procedure was adopted more frequently during the morning (75%) than in the afternoon (39%). The correct technique was never adopted by any observed category. CONCLUSIONS: Hand washing techniques are rarely followed in hospitals and, therefore, educational programs to increase the compliance with health professionals are urgent.
- ItemAcesso aberto (Open Access)Caracterização fenotípica e molecular de amostras de Staphylococcus coagulase negativo isoladas de infecções da corrente sanguínea de pacientes de dois hospitais gerais da cidade de São Paulo(Universidade Federal de São Paulo (UNIFESP), 2009-04-29) Souza, Alinne Guimarães de [UNIFESP]; Pignatari, Antonio Carlos Campos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Coagulase negative staphylococci (CoNS) are important etiologic agents responsible for healthcare related infection (HCRI) in bloodstream infections. In a retrospective study we evaluate CoNS isolated from patients with HCRI in bloodstream infections admitted to two general hospitals at São Paulo city, from August 2005 to August 2007. The isolates were characterized at species level and antimicrobial susceptibility tested by the Vitek® system and ViteK® 2. Oxacillin resistance was evaluated by oxacillin and cefoxitin discs. The presence of mecA gene and the SCCmec type were determined by multiplex PCR. Staphylococcus epidermidis was the predominant specie followed by S. hominis, S. haemolyticus, S. simulans, S. warneri, S. capitis and S. auricularis. Oxacillin resistance was observed in 88.2% of the isolates with 100% concordance between oxacilin and cefoxitin discs confirmed by mecA gene. All isolates were susceptible to vancomycin and four isolates revealed intermediate resistance to teicoplanin by Etest®. One S. epidermidis showed resistance to linezolide. The predominant SCC type was the type III followed by the types IV, I, II and V. In 26.9% positive mecA isolates we did not characterize the SCCmec type by the molecular protocol utilized.
- ItemSomente MetadadadosInfecção do trato urinário associada à sonda vesical após cirurgia cardiovascular: impacto de um programa de prevenção(Universidade Federal de São Paulo (UNIFESP), 2014-10-31) Andrioli, Edivete Regina [UNIFESP]; Medeiros, Eduardo Alexandrino Servolo de Medeiros [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction: Urinary tract infection (UTI) is one of the most common hospital-acquired infections. Approximately 80% of these infections are associated to an indwelling urinary catheter (CAUTI). Despite the risk of infections and complications due to urinary catheter use to be known, few Brazilian studies have assessed the impact of interventions to reduce the length of stay of catheter, the CAUTI rate and the urinary catheter utilization ratio. Objectives: To assess the impact of a prevention program on CAUTI rate and urinary catheter utilization ratio in the Cardiovascular Surgery Intensive Care Unit at Hospital São Paulo; to evaluate the impact on adherence to recommendations of insertion, management and length of stay of urinary catheter; and to determine CAUTI rate and asymptomatic bacteremic Urinary Tract Infection rate. Methods: Prospective and intervencional study conducted at Hospital São Paulo, Universidade Federal de São Paulo / Escola Paulista de Medicina, from April 1st 2011 to September 30th 2012, and divided into three periods - pre-intervention, intervention and postintervention - with six-month duration each period. In the intervention period was carried out an observation of catheter insertion technique in the operating room, observation of catheter maintenance care in the Cardiovascular Surgery Intensive Care Unit, assessment of necessity of catheter staying, training to correct the mismatches and implement CAUTI prevention measures, evaluation of knowledge before and post training, dissemination of compliance rate and CAUTI rate. In the pre and postintervention periods was monitored CAUTI rate and urinary catheter utilization rate. The CDC/NHSN criteria, 2011, were adopted to identify UTI. In the statistical analysis was adopted a 5% significant level. Results: In the first phase we had 110 patients undergoing to cardiovascular surgery, 102 in the second phase and 118 in the third phase. There was no statistical difference among clinical and demographic variables of patients, length of stay in the ICU and in the hospital, and length of stay of invasive devices, in three phases of study. In the first period occurred six CAUTI, five in the second and two in the third, and no one Asymptomatic Bacteremic Urinary Tract Infection in three periods. The CAUTI rate was 11,42 infections/1000 catheter-days in the first phase, 7,83 in the second and 4,40 in the third, there was a 61,7% reduction, however no significant trend was observed (p=0.216). The urinary catheter utilization rate was 0.62, 0.72 and 0.61, respectively, there was a 1,4% reduction, without a significant tendency (p=0,881). The risk of infection in the pre-intervention phase was 2,60 times major than the postintervention phase (RR 2.60; CI95% 1.35 ? 5.00; p=0.004) and the men had risk of infection 3,80 times major than the women (RR 3.80; CI95% 2.06 ? 7.04; p<0.001). There was an improvement of hand hygiene compliance before bladder catheter insertion (p=0.001) and after (p=0.004), catheter fixation (p=0,001) and all maintenance care together (p=0.036). The assessment of reasons of catheter staying revealed no difference statistical, including when was inappropriate (p=0.247). The knowledge of professionals improved post training (p=0,015). Conclusion: With the program adopted, the CAUTI rate was reduced by 61,7% in the Cardiovascular Surgery Intensive Care Unit at Hospital São Paulo. The urinary catheter utilization ratio was not reduced. There was a meaningful improvement of practice with regard to hand hygiene before and after catheter insertion, catheter fixation and all maintenance care together, and also of knowledge of professionals.
- ItemAcesso aberto (Open Access)Papel da punção do seio maxilar no diagnóstico e no tratamento de pacientes com rinossinusite hospitalar(Associação Brasileira de Otorrinolaringologia e Cirurgia Cervicofacial, 2012-08-01) Mendes Neto, José Arruda [UNIFESP]; Guerreiro, Viviane Maria [UNIFESP]; Hirai, Elcio Roldan; Kosugi, Eduardo Macoto [UNIFESP]; Santos, Rodrigo de Paula [UNIFESP]; Gregório, Luiz Carlos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Rhinosinusitis is one of the most commom causes of fever of unknown origin in critically ill patients and should be systematically searched. OBJECTIVE: This study aims to evaluate the diagnostic and therapeutic effect of maxillary sinus puncture performed at the bedside in patients with infective rhinosinusitis hospitalized in an Intensive Care Unit of a high complexity care hospital. MATERIALS AND METHODS: This retrospective study looks into patients on mechanical ventilation with fever of unknown origin and signs of rhinosinusitis on CT images who were submitted to inferior meatus maxillary sinus puncture. RESULTS: The total study sample consisted of 27 patients (70.3% male; mean age 45.3 years). The most common Intensive Care Unit admission diagnoses were head trauma and stroke. CT scans revealed the maxillary (85.2%) and sphenoid (74.1%) sinuses were the most involved paranasal sinuses. Middle meatus purulent drainage was seen in 30.7% of the nasal cavities. Fever was reduced in 70.4% of the patients after puncture (p < 0.001). The most commonly found organisms in sinus aspirates were Pseudomonas aeruginosa and Acinetobacter baumannii. CONCLUSION: Maxillary sinus puncture performed at the bedside of the patients is an important diagnostic and theraupetic tool for critically ill patients.