Contemporary challenges for hospital epidemiology

Decréscimo nas notificações compulsórias registradas pela Rede Nacional de Vigilância Epidemiológica Hospitalar do Brasil durante a pandemia da COVID-19: um estudo descritivo, 2017-2020

Resumo Objetivo: Descrever as notificações compulsórias de doenças, agravos e eventos de saúde pública (DAEs) registradas pela Rede Nacional de Vigilância Epidemiológica Hospitalar (Renaveh) do Brasil antes e durante a pandemia de COVID-19. Métodos: Estudo ecológico descritivo, com registros do Sistema de Informação de Agravos de Notificação (Sinan) no período correspondente às Semanas Epidemiológicas (SEs) 1 de 2017 (1º de janeiro de 2017) a 52 de 2020 (26 de dezembro de 2020). Resultados: No período de 2017 a 2020, a Renaveh notificou 1.258.455 fichas de DAEs, das quais apenas 225.081 (17,9%) foram notificadas em 2020, representando um decréscimo de 146.340 registros em relação às notificações de 2019. Na análise temporal por SE, houve decréscimo maior que mil registros nas notificações a partir da SE 12. Conclusão: Houve decréscimo nas notificações compulsórias de DAEs registradas pela Renaveh em todo o período analisado, com destaque para o ano de 2020.

Infection control and changes in management of hospitals: the European experience

The general setting for the management of many European hospitals has undergone enormous changes during the last five to 10 years, especially with respect to economic, personnel and technical resources. This change has had a serious influence on the practice of infection control. To get an insight of the problems infection control practitioners in Europe today have to face, hospital epidemiologists representing nine European countries were asked to answer a questionnaire. In most countries, new laws on communicable disease prevention and infection control in hospitals have been implemented during the last few years. In conjunction with the widespread introduction of quality assurance and the accreditation of hospitals, organizational aspects of infection control have gained importance. However, budget restrictions and the growing competition between institutions are major challenges. In general, there has been a remarkable influence of the documented changes on the practice of infection control in European hospitals. Facing this situation, infection control practitioners should abandon unproven measures and implement those that are evidence-based, to prevent hospital acquired infection (HAI). Cost reducing initiatives, like the use of well designed multi-use devices and the reuse of disposables should be considered and scientifically assessed.

Molecular technology for hospital epidemiology

Hospital-acquired infections in the United States contribute to approximately 80,000 deaths per year, with an associated cost of > $4 billion. Some of these infections are associated with outbreaks and clusters occurring within the hospital. The hospital infection control team must respond quickly and decisively to recognize and curtail these outbreaks, but their response often depends on critical laboratory data that characterize or "fingerprint" suspected microbial isolates. This presentation summarizes the simple, easily performed tests and the more molecular approaches that a hospital laboratory may take in support of infection control efforts. In addition to phenotypic data, such as biotype and antibiograms, hospitals that elect to incorporate molecular protocols should limit their first experiences to plasmid analysis and plasmid restriction endonuclease profiles.

Continuous quality improvement in a hospital system: implications for hospital epidemiology

The purpose of this report is to describe the “Continuous Quality Improvement” (CQI) paradigm as adopted by one of the 30 largest hospital systems in the United States and to explore the implications for hospital epidemiology and infection control. Hospital epidemiology has its roots in the application of epidemiologic tools and principles to the problems of nosocomial infections. Key steps in the development of hospital epidemiology came from physicians in Great Britain and the United States who were part of the public health systems of those countries. In the United States, physicians trained in infectious diseases as a subspecialty occupy the position of hospital epidemiologist in most university, Veterans Affairs, and larger community teaching hospitals. Some of these individuals argue that hospital epidemiologists should continue to focus principally on infection control. Others are just as convinced that the premises and knowledge of epidemiology honed by experiences in infection control are very well suited to many other problems facing hospitals in the 1990s.

Year 2000 objectives for preventing nosocomial infections: how do we get there?

In the late 1970s, the United States Public Health Service (PHS), in collaboration with public and private sector individuals and organizations, for the first time formulated national objectives for the prevention and control of disease. The PHS Year 1990 Objectives and Year 2000 Objectives both contain plans for preventing and controlling nosocomial infections. The Year 2000 Objectives contain goals for reducing infections that have been judged achievable, using existing prevention and control strategies. The specific Year 2000 Objectives targeting nosocomial infections can be divided into two categories: a) protecting the health care worker and b) protecting the patient. The Occupational Safety and Health Administration will play a major role in the upcoming decade in attaining the health care worker objectives. Reductions in patient nosocomial infections focus on surgical wound infections and infections in intensive care patients. Considerable work needs to be done in developing suitable nosocomial infection rate measures that adjust for patient case mix in order to assess progress toward achieving the objectives. Educational efforts targeted at entry-level health care providers and hospital epidemiologists must be strengthened. Government agencies, academic centers, industry, and professional organizations each have unique strengths and talents that can be collectively brought to bear on the problem.