[Healthcare associated infections and severity of illness index of patients in intensive care units]

Staphylococcus spp. Causatives of Infections and Carrier of blaZ, femA, and mecA Genes Associated with Resistance

Staphylococcus spp. have been associated with cases of healthcare associated infections due to their high incidence in isolates from the hospital environment and their ability to cause infections in immunocompromised patients; synthesize biofilms on medical instruments, in the case of negative coagulase species; and change in genetic material, thus making it possible to disseminate genes that code for the acquisition of resistance mechanisms against the action of antibiotics. This study evaluated the presence of blaZ, femA, and mecA chromosomal and plasmid genes of Staphylococcus spp. using the qPCR technique. The results were associated with the phenotypic expression of resistance to oxacillin and penicillin G. We found that the chromosomal femA gene was present in a greater proportion in S. intermedius when compared with the other species analyzed, while the plasmid-borne mecA gene was prevalent in the S. aureus samples. The binary logistic regression performed to verify the association among the expression of the genes analyzed and the acquisition of resistance to oxacillin and penicillin G were not significant in any of the analyses, p > 0.05.

Identification and resistance profile of bacteria isolated on stethoscopes by health care professionals: Systematic review

BACKGROUND

Evaluate the presence of bacteria and resistance profile in stethoscopes used by health care professionals and its consequences within the hospital environment.

METHODS

It is a systematic review, in which articles indexed in the BVS, CAPES-Periódicos, Cochrane Library, PubMed, Scientific Electronic Library Online, and ScienceDirect databases were searched.

RESULTS

Twenty-two articles were selected for this study. The significant majority of professionals does not perform hygiene of the stethoscope, either due to the lack of instructions or the lack of knowledge about the contamination's risks. In addition, over these 22 articles evaluated, only 10 demonstrated that more than 50% of the analyzed samples were contaminated with some type of bacteria. Coagulase-negative Staphylococcus spp., Staphylococcus aureus, Acinetobacter spp., Pseudomonas spp., and Klebsiella pneumoniae were the most recurrent pathogens. Besides that, multiresistant strains were also isolated, highlighting resistance to Ampicillin and Clindamycin.

CONCLUSIONS

Indeed, the stethoscope is a potential disseminator of bacterial infections. The contamination is explained by the possible cross reactions that make the transmission of infectious agents possible. Cleaning before and after each auscultate is an efficient alternative to minimize these pathogens.

Factors Associated with Mortality in Critically Ill Patients Diagnosed with Hospital Acquired Infections

Objective

Evaluate host and pathogen factors associated with mortality in those with hospital acquired infections (HAI) in a tertiary intensive care unit in Brazil.

Methods

Observational and analytical cohort single center study in a general intensive care unit (ICU) in Northeastern Brazil between January 2016 and August 2018, including those over 18 years of age admitted to the ICU found to have a HAI.

Results

A total of 165 patients were included, with a mean age of 72 years and male predominance (53.3%) and observed mortality of 46%. Mortality in those with HAI was significantly associated with older age, increased ICU length of stay and readmission to the ICU in univariate analysis. Multivariate analysis revealed that development of septic shock and obtundation during ICU admission was significantly associated with an increased risk of death (OR: 6.94, 95% CI 1.23–39.27, OR: 2.48, 95% CI 1.17–5.29, respectively). A trend towards mortality risk was noted in those with increased age and prior cardiovascular disease. Surprisingly, mortality risk was independent of site of infection, type of pathogen and antibiotic resistance. Furthermore, having more than one HAI over the course of the ICU admission did not impact mortality.

Conclusion

Risk of death in those with HAI is associated with obtundation and septic shock, in addition to vasopressor use. Host factors, rather than pathogen-specific characteristics or infecting site, impact risk of death related to HAI in the ICU.

Nursing Care in Healthcare-Associated Infections: A Scoping Review

OBJECTIVE

To identify and map nursing care to the adult patient with Healthcare-Associated Infections admitted to the Intensive Care Unit.

METHOD

Scoping Review, conducted in January 2018, through the search of studies in national and international databases, journals, catalogs of theses and dissertations, and websites of Brazilian health institutions. We included full surveys published in the Portuguese, Spanish or English language; which had as object of study the researched subject, besides manuals and protocols. We analyzed the type of material, year, country, population, method, Level of Evidence, and nursing care. The final sample consisted of 33 publications.

RESULTS

Among the nursing care to the patient, hand hygiene was identified, general care in nursing procedures, use of protocols, effective communication and periodic training.

CONCLUSION

Identifying patient care with infection was important in order to list methods and reorient nursing activities.

INFECÇÕES RELACIONADAS À ASSISTÊNCIA À SAÚDE E FATORES ASSOCIADOS NO PÓS-OPERATÓRIO DE TRANSPLANTE HEPÁTICO

RESUMO Objetivo: identificar a incidência das infecções relacionadas à assistência à saúde e seus fatores associados, durante o primeiro mês do pós-operatório de pacientes adultos submetidos ao transplante hepático em um hospital público de Fortaleza. Método: estudo retrospectivo, descritivo com abordagem quantitativa, realizado com 53 receptores de fígado no primeiro semestre do ano de 2015. Os dados foram coletados através dos prontuários, fichas ambulatoriais e de notificação de infecções. Resultados: dos pacientes avaliados, 15 (28,3%) apresentaram infecção durante o primeiro mês, em que o mais prevalente foi a sepse clínica (n=6; 37,4%), seguida de infecção do trato respiratório (n=3; 18,8%), trato urinário (n=3;18,8%), sítio cirúrgico (n=3; 18,8%) e por último, infecção de corrente sanguínea (n=1; 6,2%). Os que apresentaram associação estatística em relação a não ocorrência de infecções foram o grupo dos pacientes casados e a indicação de cirrose por hepatite C. A média dos dias de internação no pós-operatório, o uso do imunossupressor micofenolato de mofetil e a média do uso de alguns dispositivos invasivos, foram identificados como os fatores associados à ocorrência de infecções, sendo estatisticamente significativos para p=<0,05. Conclusão: a identificação da incidência das infecções relacionadas à assistência à saúde e seus fatores associados em pacientes submetidos ao transplante hepático, poderá subsidiar o direcionamento das ações de saúde, com a finalidade de diminuir a morbimortalidade associada às infecções e otimizando a recuperação desses pacientes.

RISK FACTORS ASSOCIATED WITH TEMPORARY CATHETER-RELATED INFECTION IN PATIENTS ON DIALYSIS TREATMENT

ABSTRACTThis study aims to identify risk factors associated with temporary hemodialysis catheter-related infection, in patients on dialysis treatment in a teaching hospital. This is a prospective study performed from November of 2012 to May of 2013, with 129 patients. Sociodemographic, clinical and biochemical data were collected from patient charts. In patients with a catheter,, 48.8% had catheter-related infection, 65% were male, 65% were 60 years of age or older, 85.3% had the catheter because they were diagnosed with acute renal failure, and 88% were hospitalized in an intensive care unit. There was a significant correlation between the independent variables and the outcome of infection. The risk factors associated with temporary hemodialysis catheter-related infection were: length of time of catheter use, the change of device, death, and complications during a hemodialysis session.