Healthcare-associated Staphylococcus aureus bloodstream infection: length of stay, attributable mortality, and additional direct costs

This study aimed to determine the excess length of stay, extra expenditures, and attributable mortality to healthcare-associated S. aureus bloodstream infection (BSI) at a teaching hospital in central Brazil. The study design was a matched (1:1) case-control. Cases were defined as patients > 13 years old, with a healthcare-associated S. aureus BSI. Controls included patients without an S. aureus BSI, who were matched to cases by gender, age (± 7 years), morbidity, and underlying disease. Data were collected from medical records and from the Brazilian National Hospital Information System (Sistema de Informações Hospitalares do Sistema Único de Saúde - SIH/SUS). A Wilcoxon rank sum test was performed to compare length of stay and costs between cases and controls. Differences in mortality between cases and controls were compared using McNemar's tests. The Mantel-Haenzel stratified analysis was performed to compare invasive device utilization. Data analyses were conducted using Epi Info 6.0 and Statistical Package for Social Sciences (SPSS 13.0). 84 case-control pairs matched by gender, age, admission period, morbidity, and underlying disease were analyzed. The mean lengths of hospital stay were 48.3 and 16.2 days for cases and controls, respectively (p < 0.01), yielding an excess hospital stay among cases of 32.1 days. the excess mortality among cases compared to controls that was attributable to s. aureus bloodstream infection was 45.2%. Cases had a higher risk of dying compared to controls (OR 7.3, 95% CI 3.1-21.1). Overall costs of hospitalization (SIH/SUS) reached US$ 123,065 for cases versus US$ 40,247 for controls (p < 0.01). the cost of antimicrobial therapy was 6.7 fold higher for cases compared to controls. healthcare-associated s. aureus BSI was associated with statistically significant increases in length of hospitalization, attributable mortality, and economic burden. Implementation of measures to minimize the risk of healthcare-associated bacterial infections is essential.

Adesão à prática de higienização das mãos por profissionais de saúde de um hospital universitário / Adhesion to the practice of hand hygiene by professionals in the health area in a university hospital / Adhesión a la práctica de la higiene de las manos por los profesionales de salud de un hospital universitario

A higienização das mãos (HM) é a medida mais simples e efetiva e de menor custo no controle das infecções relacionadas à assistência à saúde. Este estudo tem como objetivo avaliar a adesão dos profissionais da área de saúde quanto à prática de higienização das mãos. Pesquisa descritiva do tipo quantitativa realizada por meio de um banco de dados do Serviço de Controle de Infecção Hospitalar de um hospital escola da região Centro-oeste. A análise foi realizada por meio do programa SPSS versão 16.0. Foram analisadas 1316 oportunidades de HM, dessas 951 (72,3%) não ocorreram à adesão a essa prática. Em relação às situações que não ocorreram à adesão, destaca-se antes da realização de procedimento não invasivo com o paciente com 24%. A adesão à HM, segundo as normas regulamentadas pelos órgãos competentes, não se apresenta incorporada à prática diária dos profissionais de saúde dessa instituição e, desta forma, ações educativas com vistas a orientar e motivar esses profissionais à prática correta e frequente de HM devem ser discutidas e implementadas.

The hand washing (HW) is the most simple and effective and less costly in the control of infections related to health care. This study aims to evaluate the adhesion of professional health care as the practice of hand hygiene. Quantitative research, descriptive type, conducted through a database of the Department of Infection Control from a teaching hospital in the Midwest region. The analysis was performed using SPSS version 16.0. Were analyzed 1316 opportunities HW, these 951 (72.3%) did not occur to the adhesion of this practice. For the situations that not occurred adhesion, stands before the completion of non-invasive procedure with the patient with 24%. The adhesion to HW in accordance with the standards regulated by the relevant authorities, it not incorporated into the daily practice of health professionals that institution and thus educational in order to guide and motivate these professionals to practice correctly and often must HW be discussed and implemented.

El lavado de manos (LM) es la más sencilla y eficaz y menos costosa en el control de las infecciones relacionadas con el cuidado de la salud. Este estudio tiene como objetivo evaluar la adhesión de los profesionales de la salud cuanto la práctica de la higiene de las manos. La investigación cuantitativa de tipo descriptivo, realizado a través de una base de datos del Departamento de Control de Infecciones de un hospital de enseñanza en la región del Medio Oeste. El análisis se realizó mediante SPSS versión 16.0. Se analizaron 1316 oportunidades de LM, de esas 951 (72,3%) no se le ocurrió a la adhesión a esta práctica. En las situaciones en que la adhesión no se produjo, se destaca antes de la realización del procedimiento invasivo con el paciente, con 24%. La adhesión a el LM, de conformidad con los estándares regulados por las autoridades competentes, no se presenta incorporada a la práctica diaria de los profesionales de la salud de la institución educativa y, por tanto, son necesarias acciones afirmativas a fin de orientar y motivar a estos profesionales a la práctica correcta y frecuente de LM para que sea discutido y aplicado.

Bacteremias em pacientes internados em hospital universitário / Bacteremias at a teaching hospital: etiology, antimicrobial susceptibiliy pattern and risk factors for mortality

OBJETIVO: Avaliar a incidência de bacteremias, seu perfil de suscetibilidade antimicrobiana, e fatores associados ao óbito, em hospital universitário, no período de 1° de janeiro de 2000 a 31 de dezembro de 2001. MÉTODOS: Coorte retrospectiva. Pacientes maiores de 1 ano de idade, com bacteremia laboratorialmente confirmada e clinicamente significativa foram incluídos no estudo. Realizada análise de sobrevida multivariada, seguindo o modelo de riscos proporcionais de Cox. RESULTADOS: Foram detectados 295 episódios de bacteremia. O patógeno mais freqüente foi o Staphylococcus aureus: 118 (40 por cento), com 55,9 por cento de MRSA. A letalidade pela bacteremia foi de 34,5 por cento. Os fatores de risco independentes para o óbito foram terapia inicial inadequada (HR ajustado 2,05 IC 95 por cento: 1,25-3,36) e gravidade da apresentação clínica (HR ajustado 5,52 IC 95 por cento: 3,15-9,69). CONCLUSÃO: Nosso estudo mostrou elevada letalidade associada a bacteremia, com alta freqüência de MRSA. A terapia inicial inadequada e a gravidade da apresentação clínica foram fatores de risco independentes para o óbito pela bacteremia.

OBJECTIVE: To evaluate the frequency and profile of bacteremia, its antimicrobial susceptibility and to analyze predictors of mortality in bloodstream infections (BSI) at this Teaching Hospital from January 1, 2000 to December 31, 2001. METHODS: Design: retrospective cohort. Patients over one year old with clinically significant episodes of BSI which were microbiologically documented were included in the study. The Cox proportional hazards risk model was applied to identify prognostic factors related to death by bacteremia. RESULTS: A total of 295 episodes of BSI were detected. The most common pathogen was S. aureus: 118 (40.0 percent), with 55.9 percent of MRSA. Mortality associated with bacteremia was 34.5 percent. Independent predictors of mortality were: inadequate initial therapy (HR adjusted 2.05 IC95 percent: 1.25-3.36) and severity of the clinical manifestations (HR adjusted 5.52 IC95 percent: 3.15-9.69). CONCLUSION: This study disclosed high mortality rates due to BSI and a high frequency of MRSA. Inadequate initial therapy and severity of clinical manifestations were significantly and independently associated with mortality.