Improving water quality and using standard operating procedures for reprocessing catheters can prevent pyrogenic reactions in hospitalized patients.
Background Surgical site infections (SSIs) can account for 25% of all nosocomial infections and contribute significantly to the economic burden resulting from infectious complications. To control this problem, an active surveillance program with the feedback of SSI rates to surgeons can reduce subsequent rates by up to 40%, since 19% to 65% of these infections are diagnosed after patient discharge. However, there is no standard method for conducting surveillance outside the hospital and the best methodology is still unknown. For many hospitals, SSI surveillance has three main objectives: to feedback surgeons with their SSI rates; to evaluate SSI rates over time, identifying outbreaks; and to compare data among different institutions. This study aims to answer the crucial question: is surveillance after patient discharge worthwhile? Methods Prospective surveillance according to the National Healthcare Safety Network (NHSN) protocol of the Centers for Disease Control and Prevention (CDC) at Hospital Lifecenter, Hospital Madre Teresa and Hospital Universitário Ciências Médicas, tertiary care centers, which serve the metropolitan area of Belo Horizonte, Brazil. The data were collected between Jan/2017 and Dec/2019. Results In almost three years of study, the infection rate data were calculated with and without surveillance. The monthly analysis by clinic showed that the inclusion of post-discharge patients in the computed rates increases its value, but not significantly. Of 22.009 patients analyzed, in Lifecenter Hospital, 229(1%) had SSI. This percentage refers to the infection rate with the post-discharge survey, while the rate of surgical infection without vigilance corresponds to 202(0,9%) (Table 1). The surveillance for Madre Teresa, those numbers were: 29.770, 382(1,3%) and 351(1,2%), respectively (Table 2). In Hospital Universitário Ciências Médicas: 20.286, 447 (2,2%) and 215(1,1%) (Table 3). Table 1 - Surgical site infection: data with and without post-discharge surveillance. Hospital Lifecenter (Jan/ 2017 to Jul/2019): month-by-month analysis. Table 2 - Surgical site infection: data with and without post-discharge surveillance. Hospital Madre Teresa (Jan/ 2017 to Dec/2019): month-by-month analysis. Table 3 - Surgical site infection: data with and without post-discharge surveillance. Hospital Universitário Ciências Médicas (Jan/ 2017 to Dec/2019): month-by-month analysis. Conclusion SSI post-discharge surveillance is indicated only for specific procedures. However, once the endemic curve with the infection rate did not change with the inclusion of post-discharge SSI, the study strongly suggests that surveillance after the discharge of the surgical patient is not necessary. Graph 1 - Surgical site infection: rates with and without post-discharge surveillance. Hospital Lifecenter (Jan/2017 to Jul/2019): endemic curve. Graph 2 - Surgical site infection: rates with and without post-discharge surveillance. Hospital Madre Teresa (Jan/2017 to Jul/2019): endemic curve. Graph 3 - Surgical site infection: rate with and without post-discharge surveillance. Hospital Universitário Ciências Médicas (Jan/2017 to Jul/2019): endemic curve. Disclosures All Authors: No reported disclosures
Background: Ventilator-associated lower respiratory infections (LRIs) and pneumonia (VAP) are important healthcare-associated infections and are among the leading causes of death worldwide. Prevention of these infections are often based on care bundles. We investigated the incidence of VAP+LRI and the preventive efficacy of each component of our ventilator bundle. Methods: Our ventilator bundle includes 6 components that are daily checked by an infection control practitioner. These 6 evidence-based practices were implemented in 3 ICUs from a general tertiary-care private hospital in Belo Horizonte City (Brazil): (1) daily oral care with chlorhexidine; (2) elevate the head of the bed to between 30 and 45; (3) avoid scheduled ventilator circuit change; (4) monitor cuff pressure; (5) use subglottic secretion drainage; and (6) daily sedation interruption and daily assessment of readiness to extubate. VAP and ventilator-LRI definitions were obtained from the CDC NHSN. The impact of adherence rate to items in the ventilator bundle (%) on the incidence rate of VAP+LRI was assessed using linear regression and scatterplot analyses. Results: Between January 2018 and April 2019, 1,888 ventilator days were observed in the 3 ICUs, with 42 VAP and LRI events, an overall incidence rate of 22.2 cases per 1,000 ventilator days. After September 2018, the infection control service started a campaign to increase the ventilator bundle compliance (Fig. 1). Adherence rates to all 6 bundle components increased between January–August 2018 and September 2018–April 2019 from 25% to 55% for daily oral care, from 34% to 79% for elevating the head of the bed, 28% to 86% for avoiding scheduled ventilator circuit change, from 32% to 83% for cuff pressure monitoring, from 32% to 83% for subglottic secretion drainage, and from 33% to 85% for daily sedation interruption. PAV and LRI incidence decreased from 41 to 16 in ICU A, from 22 to 14 in ICU B and from 24 to 18 in ICU C. The impact of each bundle component was identified by linear regression, calculating the percentage of PAV+LRI incidence rate that is explained by bundle item adherence (r2) and correlation coefficient (r): daily sedation interruption (r2 = 48%; r = 0.69; P = .004) (Fig. 2), cuff pressure monitorization (r2 = 0.3721; r = 0.61; P = .016), subglottic secretion drainage (r2 = 36%; r = 0.60; P = .017), avoidance of scheduled ventilator circuit change (r2 = 34%; r = 0.58; P = .023), daily oral care (r2 = 25%; r = 0.50; P = .050), and elevate the head of the bed (r2 = 25%; r = 0.48; P = .067). Conclusions: The impact of each bundle component on preventing PAV+LRI was identified by the study. An educational intervention performed by the infection control service increased the adherence to the ventilator bundle, and the PAV and LRI incidence decreased.Funding: NoneDisclosures: None
Background: The infection control service of a private hospital in Belo Horizonte, Brazil, performs continuous surveillance of surgical patients according to the CDC NHSN protocols. In a routine analysis of the neurosurgical service, we identified a subtle increase in the incidence of surgical site infection (SSI): in 5 months (June–October 2018), 6 patients developed an SSI. From January 2017 until May 2018, there were no cases of infection in neurosurgery, which led us to suspect an outbreak. Methods: A cohort study was used to investigate the factors associated with risk of SSI. We investigated the following variables: ASA score, number of hospital admissions, age, preoperative hospital length of stay, duration of surgery, wound class, general anesthesia, emergency, trauma, prosthesis, surgical procedures, surgeon. Furthermore, 9 key steps were followed to investigate the outbreak: case definition (step 1), search for new SSI cases (step 2); confirmation of the outbreak (step 3); analysis of SSI cases by London Protocol (step 4); analysis of the cohort data (step 5); inspections in the surgical ward (step 6); qualitative and quantitative reports sent to the neurosurgical departments (step 7); continuing with active surveillance (stage 8); announcement of research findings (step 9). Results: The outbreak was confirmed: SSI incidence in the pre-epidemic period (January–May 2018) was 0 of 218 (0%); in the epidemic period (June–October 2018), SSI incidence was 6 of 94 (6.4%) (P < .001). We identified 3 SSI etiologic agents: 2 Klebsiella pneumoniae, 2 S. aureus, and 1 Serratia marcescens. It was unlikely that there was a common source for the outbreak. We identified the following risk factors: second or third hospital admissions (RR, 3.7; P = .041), and preoperative hospital length of stay: SSI patients (4.3±5.7 days) versus control patients (0.7 ± 2.1 days) (P = .048). None of the surgeons presented an SSI rate significantly different from each other. We used the London protocol to identify antibiotic prophylaxis failures in most cases. Conclusions: New cases of infections can be prevented if the length of preoperative hospital stay becomes as short as possible and, most importantly, if antibiotic prophylaxis does not fail.Funding: NoneDisclosures: None
Devido à crescente relevância das infecções hospitalares em UTI torna-se fundamental o conhecimento epidemiológico, seu mecanismo de resistência e as manifestações clínicas associado ao Acinetobacter baumannii. Este microrganismo é a bactéria mais recorrente nas infecções em UTI acometendo pacientes imunodeprimidos, apresentando um grave problema de saúde pública por vários casos de infecção hospitalar. O objetivo deste estudo foi analisar fatores associados às frequentes infecções bacterianas por Acinetobacter baumannii em pacientes internados nas unidades de terapia intensiva. Esta revisão bibliográfica foi realizada a partir de quatro bases de dados: Medline, Lilacs, Decs e SciELO, considerando-se artigos publicados no período de 2008 a 2015, nos idiomas português, inglês e espanhol. “Foram pesquisadas as palavras-chaves “infecção hospitalar”, ‘‘Acinetobacter” e "Acinetobacter baumannii". As infecções por Acinetobacter baumannii adquirida pelos pacientes internados em unidade de terapia intensiva é essencial à detecção precoce deste patógeno, de modo a adotar medidas preventivas para minimizar a disseminação bacteriana e evitar a contaminação cruzada entre os profissionais da saúde, os quais são a sua principal rota de contaminação. A incorreta intervenção determina a presença deste microrganismo no âmbito hospitalar. A infecção nosocomial pelo Acinetobacter baumannii está associada à predisposição do individuo e a submissão deste a procedimentos invasivos. Para o controle da infecção o antimicrobiano de escolha deve ser avaliado de duas formas: a resistência bacteriana na unidade hospitalar e o fármaco de escolha deve apresentar atividade intrínseca compatível com os carbapenêmicos.
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