ABSTRACT Objective: to perform a situational diagnosis of the behavior of health professionals concerning hand hygiene practices in highly-complex sectors. Methods: this quantitative and retrospective study was based on reports (2016 and 2017) of Adult and Pediatric ICUs of a Federal hospital in Rio de Janeiro. Results: one thousand two hundred fifty-eight opportunities for hand hygiene were analysed. The chance of professionals sanitizing hands in Pediatric ICUs is 41.61% higher than in Adult ICUs. Concerning proper hand hygiene, the medical team had a 39.44% lower chance than the nursing team. Others had a 30.62% lower chance when compared to the nursing team. The moment “after contact with the patient” presented 4.5275 times the chance in relation “before contact with the patient”. Conclusion: in front of hand hygiene recommendations to control COVID-19, diagnostic assessment and previous analysis of the behavior of professionals proved to be positive.

Introduction: The use of antibiotics in humans, animal husbandry and veterinary activities induces selective pressure leading to the colonization and infection by resistant strains.Objective: We evaluated water samples collected from rivers of the Guanabara Bay, which have suffered minor and major environmental degradation, and clinical samples of hospital origin to detect evidence of the presence of resistance genes to aminoglycosides, beta-lactam antibiotics and fluoroquinolones in strains of Klebsiella pneumoniae subsp. pneumoniae, K. pneumoniae subsp. ozaenae and Escherichia coli.Materials and methods: For isolation of the water strains we employed culture media containing 32 μg/ml cephalotin and 8 μg/ml gentamicin. The strains from clinical materials were selected using culture media containing 8 μg/ml gentamicin. The strains were identified and subjected to antimicrobial susceptibility testing (AST), plasmid DNA extraction and polymerase chain reaction (PCR) to detect genes encoding enzymes modifying aminoglycosides (EMA), extended-spectrum beta-lactamases (ESBL) and plasmid mechanisms of quinolone resistance (PMQR).Results: The AST of the isolates recovered from water samples showed multidrugresistance profiles similar to those found in isolates recovered from clinical materials. All isolates from water samples and 90% of the isolates from clinical samples showed at least one plasmid band. In the PCR assays, 7.4% of the isolates recovered from water samples and 20% of those from clinical materials showed amplification products for the three antimicrobial classes.Conclusion: We believe that the detection of microorganisms presenting genetic elements in environments such as water is necessary for the prevention and control of their dissemination with potential to infect humans and other animals in eventual contact with these environments.

Objetivo: apresentar o estado do conhecimento científico sobre os cuidados de enfermagem relacionados à prevenção e controle de infecções relacionadas ao cateter venoso central não implantado de curta permanência. Conteúdo: destaca-se a importância dos cuidados de enfermagem baseados em evidências e amparados pela legislação do exercício profissional vigente: identificação de sinais e sintomas sugestivos de colonização e/ou infecção, cuidados relacionados ao óstio de inserção e à manutenção do dispositivo, incluindo uso de antissépticos, coberturas e infusão de soluções para manutenção da permeabilidade e prevenção de infecções. Conclusão: para evitar as complicações decorrentes da inserção e manutenção do cateter é necessário que a equipe de saúde possua capacitação técnico-científica baseada em evidências quanto às práticas de cuidado e trabalhem de forma sincronizada e consistente com o objetivo de garantir assistência efetiva e segura.ABSTRACTObjective: to present the state of scientific knowledge about nursing care in prevention and control of infections relating to the short-term, non-implanted, central-line catheter. Content: the study highlighted the importance of evidence-based nursing care supported by current legislation on professional practice: identification of signs and symptoms of colonization and/or infection, care for the insertion site and maintenance of the device, including use of antiseptics, topical products and infusion solutions for maintaining permeability and preventing infection. Conclusion: prevention of complications resulting from catheter insertion and maintenance requires that the health team have evidence-based technical and scientific training in care practices, and work in a synchronized and consistent manner for the purpose of ensuring effective, safe care.RESUMENObjetivo: presentar el estado de conocimiento científico sobre la atención de enfermería en cuanto a la prevención y el control de infecciones relacionadas con el catéter venoso central no implantado de corta permanencia. Contenido: se destaca la importancia de la atención de enfermería basada en evidencia y respaldada por la legislación actual de la práctica profesional: identificación de signos y síntomas de colonización y/o infección, cuidado relacionado con la apertura de inserción y el mantenimiento del dispositivo, incluyendo el uso de antisépticos, productos tópicos e infusión de soluciones para el mantenimiento de la permeabilidad y la prevención de infecciones. Conclusión: para evitar las complicaciones derivadas de la inserción y el mantenimiento del catéter es necesario que el equipo de salud tenga capacitación técnico-científica basada en evidencias en cuanto a las prácticas de atención y trabaje de forma sincronizada y consistente con el objetivo de garantizar una atención efectiva y segura.

Trata-se de um estudo documental que foi realizado no período entre os meses de março a dezembro de 2019, em um Hospital Federal localizado no município do Rio de Janeiro. Os dados foram coletados nos documentos oficiais arquivados no setor de Comissão de Controle de Infecções Hospitalar do hospital em estudo. O estudo tem como objetivo: Avaliar os indicadores de adequação e inadequações dos cateteres vesicais de demora em um Hospital Federal na cidade do Rio de Janeiro. Como objetivo: Avaliar os indicadores de adequação e inadequações dos cateteres vesicais de demora em um Hospital Federal na cidade do Rio de Janeiro. A análise dos dados mostrou inadequação a fixação do cateter e, em relação a manutenção do coletor abaixo do nível do paciente longe do piso, e capacidade da bolsa coletora menor que 2/3. Temos como conclusão: Os dados mostram a importância de reflexão para o cuidado de enfermagem, a observação das normas e orientações para controle de infecções, qualidade de assistência e segurança dos pacientes.

Introduction: Healthcare is recognized as a condition of high selective pressure (SP) due to the use of antimicrobials. The emergence of community bacterial species resistant to the antimicrobials mostextensively used in hospitals is of concern, as is the case with Gram-negative rods producing extended-spectrum beta-lactamases (ESBL). Hospital colonization by carbapenem-resistant Enterobacteria (CRE) can persist for many months after hospital discharge, and their encoding genes can be transferred among different species. Methodology: Because of the scarcity of options due to resistance to carbapenems, we sought to evaluate the occurrence of CRE in stool samples from outpatients and inpatients of a University Hospital, for whom clinical and epidemiological data were obtained from the analysis of medical records. After parasitological examination, stool samples from outpatients and inpatients were diluted in saline (1:20, 1:1000 and 1:2000) solution and 0.1 mL seeding was performed on MacConkey Agar (MA) containing gentamicin 8 μg/mL and MA containing cephalexin 32 μg/mL. Once isolated, strains were identified by biochemical tests and AST (with imipenem, ertapenem, and meropenem) was performed according to CLSI (2020). Results: We isolated carbapenem-resistant strains of enterobacteria in 13 (43.3%) of the 30 inpatients and in 13 (29%) of the 31 outpatients (p>0.05). In 7 (23.3%) of the 30 inpatients and in 5 (16.1%) of the 31 outpatients, we isolated CRE at 1:1000 or 1:5000 dilutions of stool samples, which correspond to “microbial loads”. Ten bacterial species were isolated in the CRE related to the 13 inpatients and 13 outpatients, among whom we identified two or more species in 9 (69.2%) and 10 (76.9%), respectively. Even taking into account the limitations of the study due to the possibility of bias arising from the absence of data in the medical records, the detection of intestinal colonization with CRE in non-hospitalized individuals is of concern and may jeopardize the implementation of rational empirical therapy in patients of that community. Conclusion: It is possible that, as was the case of ESBL-producing strains decades ago, infections by carbapenem-resistant strains have become endemic in the community.In general, this development is a cause of concern, for plasmid-associated antimicrobial resistance strains, due to the fact that an often-recognized plasmid-associated fitness of bacterial cell favors persistence of the strains, even in the absence of antimicrobial (co-)selective pressures.

Objetivo: descrever a implementação de rotina de rastreamento de germes multirresistentes em uma enfermaria de cirurgia geral. Metodologia: trata-se de um relato de experiência realizado por residentes em Enfermagem Clínica Cirúrgica, a partir de uma abordagem educativa acerca do rastreio de germes multirresistentes, em um hospital universitário no Rio de Janeiro. Resultados: a atividade educativa foi realizada durante 4 dias subsequentes do mês de novembro de 2019, na enfermaria de Cirurgia Geral. Teve como público alvo a equipe de enfermagem composta por enfermeiros e técnicos em enfermagem. Foi planejada a aplicação de pré e pós-teste, para a avaliação do conhecimento adquirido pelos profissionais, porém não foi possível devido à demanda assistencial do setor. Conclusão: a intervenção proporcionou melhorias para rotina da enfermaria, além de contribuir para a melhor assistência dos pacientes e conhecimento dos profissionais. Entretanto a avaliação da atividade foi prejudicada pela grande demanda de trabalho do setor.

viii FONSECA, B. O. Selection and transport of tools to crack open nuts by semifree-ranging capuchin monkeys (Sapajus sp): experimental manipulation of the costs of the distance between "hammers" and "anvils" and efficiency of the tool. 2012. ix+109p. Master Thesis

Multidrug resistance is a public health problem. Enterobacteriaceae strains may be reservoirs of antimicrobial and potassium tellurite (PT) resistance genes, which is a determinant of bacterial escape to intraphagocytic killing mechanisms. The mobility of resistance genes and their genetic rearrangements are significantly involved in the dissemination of these genes. Mobile genetic elements such as integrons and transposons, as well as IS26 (considered among the predominant ISs), facilitate the formation and mobilization of sets of resistance genes in plasmids capable of transferring these determinants of resistance and virulence horizontally. There is evidence of associations, in plasmids, of genes encoding adhesins, toxins and antimicrobial resistance, possibly related to PT resistance. In the present work, 342 samples were collected for bacteriological culture in different units of a University Hospital in Rio de Janeiro, Brazil (Hospital Kitchen, Medical and Surgical Clinics Wards, and Intensive Care Unit): 98 samples from hands of professionals, 85 hand samples from food handlers, 104 stool samples (rectal swab) from patients and 55 food samples. We isolated 27 strains of Enterobacteriaceae through selective media containing cephalothin (32µg/mL). Bacterial identification was performed by conventional phenotypic methods. Antimicrobial susceptibility tests, as well as the phenotypic test for Extended-Spectrum Beta-lactamases (ESBLs) production, were performed by disk diffusion. PT resistance was also tested by direct seeding in media with 25µg/mL and 112 µg/mL of the compound. Plasmids were visualized by agarose gel electrophoresis of bacterial DNA extracts. Additionally, antimicrobial resistance genes and IS26 were detected by PCR assays. From a total of 27 strains of Enterobacteriaceae isolated, eight strains of Enterobacteriaceae were selected, considering phenotypes indicative of ESBLs production, resistance to aminoglycosides and presence of plasmids of high and low molecular weight (from the hands of food handlers, food and feces from hospitalized patients).  Three strains 3/8 (37.5%) were resistant to aminoglycosides and cephalosporins, concomitantly. Four 4/8 strains (50.0%) were positive for the phenotypic test for ESBL production and six 6/8 strains (75.0%) were resistant to PT. Strains with resistance to aminoglycosides and producing ESBL showed amplification product for the genes tested. We consider that these antimicrobial resistance genes, also the determinants for resistance to PT (as a bacterial virulence factor), as well as IS26, may contribute to the plasticity and fitness of R plasmids, in different environments, favoring the circulation of relevant pathogenic strains.