Background: Healthcare-associated infection (HAI) control programs have improved patient care all over the world. Our program was implemented in 1997 in a general intensive care unit (ICU) based upon surveillance of HAI with regular infection rates feedback to the ICU team and implementation of best practices such as hand hygiene (HH) and oral care for ventilated patients, optimal care, and early removal of invasive devices. Objective: To report our decreasing HAI rates in the past 22 years. Methods: Hospital Sao Francisco 20-bed ICU admits 120–140 surgical and clinical patients monthly, with 90% occupancy. The HAI infection control team implemented HAI surveillance and developed several protocols for HAI prevention. In the past 5 years, ICU personnel initiated the collection of several indicators using random direct observations of HH compliance, central venous catheter correct care, and appropriated oral care, among others. HAI definitions followed Brazilian Health Ministry HAI definitions and were expressed as infections per 1,000 patient days (total HAI rate) and device-related infections per 1,000 device days. Catheter-associated urinary tract infection (CAUTI), central-line–associated blood stream infection (CLABSI) and ventilator-associated pneumonia (VAP) rates are reported here. The study period spanned January 1997 to August 2019. Measurement of antibiotic utilization (ie, meropenem, vancomycin, and piperacillin-tazobactam) was calculated by dividing the of antibiotic consumed vials by the daily defined dose and patient days. Results: The total HAI, CAUTI, CLABSI, and VAP rates dropped 70%, 85%, 84%, and 87%, respectively, from 1997 to 2019 (Table 1). From 2009 to 2019, we detected decreases in hospital use of meropenem from 52 to 38, in vancomycin from 50 to 40, and in piperacillin-tazobactam from 144 to 88. Conclusions: HAI control programs can be effective in ICUs, with impressive results, but it requires time and considerable effort. Data on compliance with basic infection control measures should accompany HAI data and should be shared with the ICU team because ICU team participation is essential to keeping the program alive. Broad-spectrum antibiotics use also decreased, with potential benefits to the hospital flora.Funding: NoneDisclosures: None
Background: Measles was considered eradicated in Brazil in 2016, but the virus reemerged in the country in 2018, causing large outbreaks. Ribeirao Preto has been measles free since 1997, but the outbreak in Sao Paulo City, 180 miles away in June 2019, alerted us to the possibility of measles patients coming to our emergency room (ER). The preparedness challenge was considerable: most healthcare workers (HCWs) had never seen a measles case before, and confirmatory measles laboratory tests were not readily available to us. Objective: To describe the hospital preparedness for the coming community measles outbreak. Methods: Hospital So Francisco is a 170-bed, general, tertiary-care hospital with 10,000 ER visits monthly. Measles preparedness consisted of measles training classes for HCWs, and flow charts with pictures and measles information in every ER office, also sent to HCW cell phones. We also designated areas for suspected measles patients for prompt medical evaluation; and we implemented mass measles vaccination for all hospital HCWs regardless of vaccination status, excluding pregnant or immunosuppressed HCWs. We considered a measles suspected case any person with fever, 1 of 3 symptoms (cough, coryza or conjunctivitis), and a generalized maculopapular rash with head-to-toe distribution. All contacts for suspected cases were recommended to obtain a measles vaccination. Detection of viral RNA in a biological sample and or a positive IgM result in serum was used to confirm a clinically suspected case. The study period spanned July 2019 to September 2019. Results: Measles training occurred for 3 weeks in July–August and reached 200 HCWs. The measles vaccination was offered July 23 to August 15; 1,362 HCWs were already vaccinated (93% of target population). In total, 35 clinical suspected measles cases were seen in the ER, and 3 of these were HCWs who had received the measles vaccine in their incubation period. Also, 3 patients were admitted to the hospital and 1 to the intensive care unit; there were no deaths. Overall, 8 patients had laboratory-confirmed measles, and 1,343 community contacts of these patients were vaccinated. We did not detect measles transmission to inpatients or to other HCWs after mass vaccination began. In the same period, Sao Paulo state had >7,000 laboratory-confirmed measles cases and 12 deaths. Conclusions: Community measles outbreaks are a challenge for the hospital infection control team, and they can potentially disrupt the daily activities in the hospital. We were able to adequately prepare for the largest state outbreak in 20 years without secondary cases or deaths.Funding: NoneDisclosures: None
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