ABSTRACT
Justification and Objectives: despite the importance of companions/visitors for hospitalized patients under specific precautions, it is noted that risks of exposure and dissemination of microorganisms in health services by this population are still incipient in the literature. Thus, the objective was to characterize the current recommendations on specific precautions for companions and visitors of hospitalized patients and to analyze the barriers to their implementation from infection preventionists' perspective. Methods: a descriptive and exploratory study with a quantitative approach, with 89 infection preventionists, between March and June 2020. Data collected by electronic questionnaire, "snowball" sampling and analyzed according to frequency of responses. Results: hand hygiene was the most recommended recommendation (>95.0%). As for non-conformities, staying in the room without attire (78.6%), going to other rooms (53.9%) and keeping doors open as aerosol precaution (51.7%) stood out. Regarding the strategies adopted to guide companions/visitors, there was a predominance of individual verbal guidance (92.4%). The main barrier cited was the lack of institutional policy (56.2%). Conclusion: there was no uniformity in the recommendations, and non-conformities and barriers were listed. The importance of specific prevention guidelines for this public and effective educational strategies for its implementation are highlighted.(AU)
Justificativa e Objetivos: apesar da importância dos acompanhantes/visitantes para pacientes hospitalizados em precauções específicas, nota-se que os riscos de exposição e disseminação de microrganismos nos serviços de saúde por essa população ainda são incipientes na literatura. Dessa forma, objetivou-se caracterizar as recomendações vigentes sobre precauções específicas para acompanhantes e visitantes de pacientes hospitalizados e analisar as barreiras para a sua implementação sob a ótica de prevencionistas de infecção. Métodos: estudo descritivo e exploratório, de abordagem quantitativa, com 89 prevencionistas de infecção, entre março e junho de 2020. Dados coletados por questionário eletrônico, com amostragem tipo "bola de neve" e analisados segundo frequência das respostas. Resultados: a higienização das mãos foi a recomendação mais indicada (>95,0%). Quanto às não conformidades, destacou-se permanecer no quarto sem paramentação (78,6%), frequentar outros quartos (53,9%) e manter portas abertas em precaução para aerossóis (51,7%). Referente às estratégias adotadas para a orientar os acompanhantes/visitantes, houve predomínio da orientação verbal individual (92,4%). A principal barreira citada foi a falta de política institucional (56,2%). Conclusão: não houve uniformidade nas recomendações, e não conformidades e barreiras foram elencadas. Destaca-se a importância de diretrizes de prevenção específicas para esse público e estratégias educativas efetivas para sua implementação.(AU)
Justificación y Objetivos: a pesar de la importancia de los acompañantes/visitantes para pacientes hospitalizados bajo precauciones específicas, se advierte que los riesgos de exposición y diseminación de microorganismos en los servicios de salud por parte de esta población son aún incipientes en la literatura. Así, el objetivo fue caracterizar las recomendaciones vigentes sobre precauciones específicas para acompañantes y visitantes de pacientes hospitalizados y analizar las barreras para su implementación desde la perspectiva de los preventivos de infecciones. Métodos: estudio descriptivo y exploratorio con enfoque cuantitativo, con 89 prevencionistas de infecciones, entre marzo y junio de 2020. Datos recolectados por cuestionario electrónico, muestreo "bola de nieve" y analizados según frecuencia de respuestas. Resultados: la higiene de manos fue la recomendación más recomendada (>95,0%). En cuanto a las no conformidades, se destacó permanecer en la habitación sin atuendo (78,6%), ir a otras habitaciones (53,9%) y mantener las puertas abiertas como precaución contra los aerosoles (51,7%). En cuanto a las estrategias adoptadas para orientar a los acompañantes/visitantes, hubo predominio de la orientación verbal individual (92,4%). La principal barrera citada fue la falta de política institucional (56,2%). Conclusión: no hubo uniformidad en las recomendaciones, y se enumeraron las no conformidades y las barreras. Se destaca la importancia de pautas de prevención específicas para este público y estrategias educativas efectivas para su implementación.(AU)
Subject(s)
Humans , Visitors to Patients/education , Cross Infection/prevention & control , Infection Control , Patients , Epidemiology, Descriptive , Patient SafetyABSTRACT
Objetivo: apresentar um diagnóstico situacional sobre o conhecimento dos profissionais de saúde sobre precauções específicas. Métodos: estudo transversal, realizado em um hospital filantrópico mineiro, com 127 profissionais de saúde de nível superior. Para a coleta de dados, utilizou-se o instrumento "Conhecimento dos profissionais de saúde sobre Precauções Específicas" com 29 questões de múltipla escolha, distribuídas em cinco eixos temáticos. Para a análise dos dados, foram executados procedimentos descritivos e diferentes testes estatísticos. Resultados: a média geral de acertos das questões foi 64,7%. O eixo temático "Acomodação e estrutura" apresentou mediana de acertos (43,6%) significativamente menor (p<0,001) que os demais eixos. O eixo "Cadeia epidemiológica de transmissão de microrganismos" apresentou mediana de 60% e os eixos "Cuidado com ambiente" e "Comunicação" tiveram mediana de 66,7%. A maior mediana de acertos ocorreu no eixo "Equipamento de proteção individual (80%)". Conclusão: a assertividade foi baixa em todos os eixos temáticos, o que pode comprometer a qualidade e a segurança da assistência prestada. Assim, verifica-se a necessidade de promover ações educativas com estratégias inovadoras, sensibilizando estes profissionais quanto à adesão dessas medidas de precaução. (AU)
Objective: to present a situational diagnosis about the knowledge of health professionals about specific precautions. Methods: cross-sectional study, conducted in a philanthropic hospital in Minas Gerais, with 127 health professionals of higher education. For data collection, was used the instrument "Knowledge of health professionals on Specific Precautions" with 29 multiple choice questions, distributed in five thematic axes. Descriptive procedures and different statistical tests were performed for the analysis of the data. Results: the overall average number of correct answers was 64.7%. The thematic axis "Accommodation and structure" presented a significantly lower median number of correct answers (p<0.001) than the other axes. The axis "Epidemiological chain of transmission of microorganisms" presented a median of 60% and the axes "Environment Care" and "Communication" had a median of 66.7%. The highest median of correct answers occurred in the axis "Personal protective equipment (80%)". Conclusion: assertiveness was low in all thematic axes, which can compromise the quality and safety of the care provided. Thus, there is a need to promote educational actions with innovative strategies, sensitizing these professionals about the adoption of these precautionary measures. (AU)
Objectivo: presentar un diagnóstico situacional sobre el conocimiento de los profesionales de la salud sobre precauciones específicas. Métodos: estudio transversal realizado en un hospital filantrópico de Minas Gerais, con 127 profesionales de la salud de nivel superior. Para la recopilación de datos, se utilizó el instrumento "Conocimiento de los profesionales de la salud sobre Precauciones Específicas", con 29 preguntas objetivas de múltiple elección, distribuidas en cinco ejes temáticos. Para el análisis de los datos, se realizaron procedimientos descriptivos y diferentes pruebas estadísticas. Resultados: la media general de respuestas correctas fue del 64,7%. El eje temático "Acomodación y estructura" mostró una mediana de respuestas correctas (43,6%) significativamente menor (p<0,001) que los otros ejes. El eje "Cadena epidemiológica de transmisión de microorganismos" tuvo una mediana del 60% y los ejes "Cuidado del medio ambiente" y "Comunicación" tuvieron una mediana del 66,7%. La mediana más alta de respuestas correctas se dio en el eje "Equipo de protección personal (80%)". Conclusión: el asertividad fue baja en todos los ejes temáticos, lo que puede comprometer la calidad y la seguridad de la atención prestada. Así, se comprueba la necesidad de promover acciones educativas con estrategias innovadoras, sensibilizando a estos profesionales en cuanto a la aplicación de las medidas de precaución. (AU)
Subject(s)
Precautionary Principle , Patient Isolation , Health Knowledge, Attitudes, Practice , Health Personnel , KnowledgeABSTRACT
@#Problem: From April to September 2021, Fiji experienced a second wave of coronavirus disease (COVID-19) precipitated by the Delta variant of concern, prompting a need to strengthen existing data management of positive COVID-19 cases. Context: With COVID-19 cases peaking at 1405 a day and many hospital admissions, the need to develop a better way to visualize data became clear. Action: The Fiji Ministry of Health and Medical Services, the World Health Organization and the United Nations Office for the Coordination of Humanitarian Affairs collaborated to develop an online clinical dashboard to support better visualization of case management data. Outcome: The dashboard was used across Fiji at national, divisional and local levels for COVID-19 management. At the national level, it provided real-time reports describing the surge pattern, severity and management of COVID-19 cases across the country during daily incident management team meetings. At the divisional level, it gave the divisional directors access to timely information about hospital and community isolation of cases. At the hospital level, the dashboard allowed managers to monitor trends in isolated cases and use of oxygen resources. Discussion: The dashboard replaced previous paper-based reporting of statistics with delivery of trends and real-time data. The team that developed the tool were situated in different locations and did not meet physically, demonstrating the ease of implementing this online tool in a resource-constrained setting. The dashboard is easy to use and could be used in other Pacific island countries and areas.
ABSTRACT
Objetivo: Avaliar o conhecimento dos enfermeiros recém-formados sobre as medidas das Precauções Específicas (PE). Método: Estudo transversal descritivo-exploratório, com abordagem quantitativa, realizado em um hospital privado de São Paulo, em fevereiro de 2019. Os enfermeiros foram abordados para participar da pesquisa enquanto aguardavam o início do processo seletivo para "Enfermeiro Junior". Para avaliar o conhecimento, foi utilizado um instrumento validado, contendo 29 questões de múltipla escolha, divididas em cinco eixos temáticos, sendo definida como ponto de corte a média 7,0 (de zero a 10). Para análise dos dados, foi usado o pacote estatístico R Core, e o lme4 para os modelos mistos generalizados, sendo adotado nível de significância de 5%. Resultados: Participaram do estudo 190 enfermeiros recém-formados com nota geral de 5,82, sendo a maior média (7,9) no eixo "Equipamento de Proteção Individual". Nos demais eixos, as médias foram abaixo de 7,0, tendo a menor pontuação (4,35) no eixo "Cuidados com o Ambiente". Conclusão e Implicações para a prática: O estudo evidenciou déficit de conhecimento sobre as PE entre os enfermeiros recém-formados, com implicações para a segurança dos pacientes e dos profissionais de saúde, desde a prática assistencial na graduação (estágios) ao início da carreira profissional
Objective: To assess the knowledge of newly graduated nurses about Specific Precautions/Isolation measures. Method: A cross-sectional descriptive-exploratory study with a quantitative approach was conducted in a private hospital in São Paulo in February 2019. The researcher approached the nurses waiting for the "Junior Nurse" position selection process to participate in the survey. The participants answered a validated instrument with 29 multiple-choice questions, divided into five thematic categories. A score of 7.0 (from zero to 10) was defined as the cut-off point. The R Core statistical package and the lme4 for generalized mixed models were used for data analysis, with a significance level of 5%. Results: 190 newly graduated nurses participated in the study, with an overall knowledge of Specific Precautions score of 5.82, with the highest mean (7.9) in the "Personal Protective Equipment" category. In the other four categories, the nurses scored below 7.0, with the lowest score (4.35) in the "Care for the environment". Conclusion and Implications for the practice: The study showed a deficiency of Specific Precautions knowledge among newly graduated nurses, with implications for the patients' and healthcare professionals' safety from graduation practice (internship) to the beginning of their professional career
Objetivo: Evaluar los conocimientos de los enfermeros recién graduados sobre las medidas de Precauciones Específicas/aislamiento. Método: Se realizó un estudio transversal descriptivo-exploratorio con enfoque cuantitativo en un hospital privado de São Paulo en febrero/2019. El investigador abordó a los enfermeros que esperaban el proceso de selección del puesto de "Enfermero Junior" para que respondieran a la encuesta. Se utilizó un instrumento validado con 29 preguntas de opción múltiple, divididas en cinco categorías temáticas, y definió como punto de corte 7,0 (de cero a 10). Se utilizó el paquete estadístico R Core y el lme4 para modelos mixtos generalizados, y nivel de significación del 5%. Resultados: Participaron 190 enfermeros recién graduados con una puntuación global de 5,82, con la media más alta (7,9) en "Equipos de protección personal". En las demás categorías, las puntuaciones fueron inferiores a 7,0, siendo la más baja (4,35) la de "Cuidado del ambiente". Conclusión e implicaciones para la práctica: El estudio mostró una deficiencia de conocimientos sobre Precauciones Específicas entre los enfermeros recién graduados, lo que tiene implicaciones para la seguridad de los pacientes y de los profesionales de la salud desde la práctica de graduación (pasantía) hasta el inicio de la carrera profesional
Subject(s)
Humans , Adult , Young Adult , Communicable Disease Control , Health Knowledge, Attitudes, Practice , COVID-19/prevention & control , Nurses , Cross-Sectional Studies , Personal Protective Equipment , COVID-19/transmissionABSTRACT
Objetivo: Analisar a associação entre as características sociodemográficas e a adesão aos cuidados domésticos de casos suspeitos de Covid-19 em isolamento domiciliar. Método: Estudo transversal, analítico. A coleta de dados ocorreu em unidade mista de saúde do Ceará, com 50 participantes suspeitos de Covid-19. Aplicou-se formulário de caracterização sociodemográfica, clínica e de avaliação dos cuidados em relação ao isolamento domiciliar. Para análise estatística, foram utilizados os testes Mann-Whitney e a razão de verossimilhança. Os princípios éticos das pesquisas com seres humanos foram seguidos. Resultados: A maioria dos homens (57,9%; p = 0,010) e das pessoas que conheciam alguém, pessoalmente, que teve/tem diagnóstico de Covid-19 (92,1%; p = 0,040) evitou aglomerações; 65,4% dos participantes com companheiro (a) descartaram o lixo adequadamente (p = 0,047); e 81,6% das pessoas com menor escolaridade aderiram à lavagem de roupas pessoais, de cama e toalhas com sabão comum e água (p = 0,043). Conclusão e implicaçoÌes para a praÌtica: As características sociodemográficas influenciaram a adesão a cuidados específicos, como evitamento de aglomerações, tratamento de lixo contaminado e lavagem de roupas pessoais, de cama e toalhas. Os cuidados domiciliares precisam ser mais enfatizados em consultas e pelos veículos de divulgação
Objective: To analyze the association between sociodemographic characteristics and adherence to home care of suspected COVID-19 cases in home isolation. Method: This is a cross-sectional, analytical study, and data collection took place in a health unit in Ceará, with 50 suspected COVID-19 participants. A sociodemographic, clinical characterization, and care evaluation form regarding home isolation was applied. For statistical analysis, the Mann-Whitney and likelihood ratio tests were used. The ethical principles of research with human beings were followed. Results: Most men (57.9%; p = 0.010) and people who personally knew someone diagnosed with COVID-19 (92.1%; p = 0.040) avoided crowded places, 65.4% of the participants with a partner discarded the garbage properly (p = 0.047), and 81.6% of people with less education adhered to washing personal clothes, bedding, and towels with common soap and water (p = 0.043). Conclusions and implications for practice: Sociodemographic characteristics influenced adherence to specific care, such as avoiding crowded places, treating contaminated waste, and washing personal clothes, bedding, and towels. Home care needs to be more emphasized in consultations and by means of dissemination
Objetivo: Analizar la asociación entre características sociodemográficas y adhesión a la atención domiciliaria de casos sospechosos de Covid-19 en aislamiento domiciliario. Método: Estudio transversal, analítico. La recolección de datos se llevó a cabo en una unidad de salud mixta en Ceará, con 50 participantes sospechosos de Covid-19. Se aplicó una forma de caracterización y evaluación sociodemográfica y clínica de los cuidados en relación al aislamiento domiciliario. Para el análisis estadístico se utilizaron pruebas de Mann-Whitney y de razón de verosimilitud. Se siguieron los principios éticos de la investigación con seres humanos. Resultados: La mayoría de los hombres (57,9%; p=0,010) y las personas que conocían a alguien personalmente que tenía/tiene un diagnóstico de Covid-19 (92,1%; p=0,040) evitaron los clusters; el 65,4% de los participantes con pareja (a) descartó la basura correctamente (p=0,047); el 81,6% de las personas con menor nivel educativo se adhirió a lavar la ropa personal, la ropa de cama y las toallas con agua y jabón común (p=0,043). Conclusión e implicaciones para la práctica: Las características sociodemográficas influyeron en la adhesión a cuidados específicos, como evitar aglomeraciones, tratar residuos contaminados y lavar ropa, sábanas y toallas personales. Es necesario hacer más hincapié en la atención domiciliaria en las consultas y mediante la difusión de información
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Patient Isolation , Patient Compliance/statistics & numerical data , Social Determinants of Health/statistics & numerical data , COVID-19/therapy , Cross-Sectional Studies , COVID-19/prevention & controlABSTRACT
RESUMEN Bajo las actuales circunstancias de la pandemia por COVID-19, y dada la posibilidad de colapso de los sistemas de salud debido al aumento de contagios a nivel mundial, es necesario establecer el tiempo en el que un paciente infectado con SARS-CoV-2 mantiene la condición de contagiante. Determinar con mayor precisión la fase de transmisibilidad del agente infeccioso servirá para estandarizar el periodo de aislamiento del paciente y evitará la diseminación del virus a nivel comunitario y su reincorporación a la actividad laboral de forma segura. Mediante pruebas moleculares se ha establecido que el ARN viral es detectable en el tracto respiratorio desde 2 a 3 días antes de la manifestación de síntomas; alcanza su máximo nivel al inicio de los síntomas y disminuye progresivamente en los siguientes 7 u 8 días en la mayoría de pacientes. Sin embargo, la detección persistente del ARN viral mediante RT-PCR no necesariamente significa que el paciente conserve su capacidad infectante. Se ha reportado que en casos leves y moderados de COVID-19, la capacidad replicativa del virus perdura hasta el día 9 desde el inicio de síntomas, mientras que, en casos severos y críticos, se prolonga hasta el día 20 desde la aparición de síntomas. Actualmente, las estrategias propuestas por la OMS y los CDC para definir el tiempo de aislamiento de los contagiados se basan en el tiempo de manifestación de síntomas y la evolución clínica del paciente.
ABSTRACT Under the current circumstances of the COVID-19 pandemic and given the possibility of collapse of health systems due to the increase in infections worldwide, it is necessary to establish the time in which a patient infected with SARS-CoV-2 maintains the contagious condition. Determining the infectious agent's transmissibility phase with greater precision will serve to standardize the isolation period of the patient and will prevent the spread of the virus at the community level and its safe return to work. Through molecular tests it has been established that viral RNA is detectable in the respiratory tract from 2 to 3 days before the manifestation of symptoms, reaching its maximum level at the onset of symptoms and decreasing progressively in the following 7 or 8 days in most of patients. However, persistent detection of viral RNA by RT-PCR does not necessarily mean that the patient remains infectious. It has been reported that in mild and moderate cases of COVID-19, the replicative capacity of the virus lasts until day 9 from the onset of symptoms, while, in severe and critical cases, it lasts until day 20 from the onset of symptoms. Currently, the strategies proposed by the WHO and the CDC to define the isolation time of those infected are based on the time of manifestation of symptoms and the clinical evolution of the patient.
ABSTRACT
RESUMEN Fundamento: la pandemia de COVID-19 es la crisis sanitaria que define nuestro tiempo y que ha puesto a prueba los sistemas de salud en todo el mundo. Objetivo describir las características clínico epidemiológicas de pacientes sospechosos de COVID-19, en aislamiento durante el primer cuatrimestre del 2021. Métodos estudio observacional, descriptivo, transversal. El universo de estudio fue de 2 631 pacientes contactos y sospechosos de la enfermedad ingresados en dos centros de aislamiento en la Universidad de Ciencias Médicas de Cienfuegos, desde enero hasta abril 2021. Se analizaron las variables: edad, sexo, ocupación, municipio de residencia, antecedenetes epidemiológicos, comorbilidades y confirmación por la prueba de cadena de polimerasa en tiempo real. Se confeccionó una encuesta epidemiológica e historia clínica individual durante el aislamiento. Resultados: el 78,3 % de los pacientes en aislamiento fueron contacto de casos confirmados, los pacientes en edad laboral representaron el mayor porciento, con predominio del sexo femenino. El municipio de Cienfuegos aportó el mayor número de pacientes. El 59,2 % de estos tenía al menos una comorbilidad, más del 50 % eran hipertensos. El 8 % de los sospechosos fueron positivos a la COVID-19. Conclusiones el aislamiento de contacto y sospechosos como medida de contención de la pandemia representa una estrategia de impacto. Conocer las características de los pacientes aislados sirve como línea de base para el desarrollo de nuevas medidas sanitarias.
ABSTRACT Background: The COVID-19 pandemic is the defining health crisis of our time that has put health systems to the test around the world. Objective: to describe the clinical epidemiological characteristics of patients in isolation, during the first four months of 2021. Methods: observational, descriptive, cross-sectional study. The study universe consisted of 2 631 patients who were contacts and suspected of the disease admitted to two isolation centers at the University of Medical Sciences of Cienfuegos, from January to April 2021. The variables were analyzed: age, sex, occupation, municipality of residence, epidemiological antecedents, comorbidities and confirmation by the real-time polymerase chain test. An epidemiological survey and individual medical history were prepared during isolation. Results: 78.3% of the patients in isolation were contacts of confirmed cases, the patients of working age represented the highest percentage, with a predominance of the female sex. The municipality of Cienfuegos contributed the largest number of patients. 59.2% of these had at least one comorbidity, more than 50% were hypertensive. 8% of the suspects were positive for COVID-19. Conclusions: the isolation of contact and suspects as a measure to contain the pandemic represents an impact strategy. Knowing the characteristics of isolated patients serves as a baseline for the development of new health measures.
ABSTRACT
Introducción: La prevención de infecciones intrahospitalarias es uno de los aspectos más inquietantes en enfermería en los últimos años. Para esto, se han establecido diversas estrategias, entre ellas, los aislamientos hospitalarios. Sin embargo, se encuentra gran diAcultad para el cumplimiento de las medidas de aislamiento. Objetivo: Determinar los factores sociodemográAcos y de la atención en salud relacionados con el cumplimiento de las precauciones de contacto por parte de los visitantes en un hospital de alta complejidad de la ciudad de Medellín. Método: Se realizó un estudio descriptivo de corte trasversal a un total de 126 visitantes de pacientes aislados por contacto. Se identiAcaron factores asociados al cumplimiento del aislamiento mediante una encuesta, se analizó la información en el programa SPSS mediante una regresión logística y se asumió signiAcancia estadística si valor P menor a 0,05. Resultados: La adherencia total al aislamiento fue de un 40,5% y está asociada principalmente con dos factores: disponibilidad de los elementos de protección y estar de acuerdo con el uso de estos. Conclusiones: Los factores mejor asociados con el cumplimiento del aislamiento hacen necesario que las instituciones garanticen suAcientes insumos para los visitantes y que tanto el personal de salud como los visitantes reciban una mayor sensibilización en este tema.
Introduction: Preventing the intra-hospital infections is one of the major concerns in the last year. To that end, different strategies have been set such as hospital isolation. However, there is a grate default in order to comply with the isolation measures Objective: To determine the sociodemographic and healthcare factors related to how to comply with the contact warnings by the visitors coming into a high complexity hospital in Medellín. Methods: It is a cross-sectional descriptive study including in total 126 visitors who were isolated aÆer a contact. Factors associated with the isolation compliance were identiAed based on a survey. Information was analyzed with SPSS soÆware by doing a logistic regression and statistical signiAcance was assumed as P<0.05. Results: Total adherence to isolation was 40.5%, which is mainly associated with two factors: availability of protective garments and to agree with their use. Conclusions: Ǽe factors deemed as best associated with the isolation compliance required that the institutions provided enough protective garments to the visitors and that both the visitors and the hospital staff can receive a better awareness-rising communication on this topic.
Introdução: A prevenção de infeções intrahospitalares é um dos aspectos mais preocupantes nos últimos anos. Para isso, tem se estabelecido várias estratégias, entre elas, o isolamento hospitalar. No entanto, há grande diAculdade para a adesão as medidas de isolamento. Objetivo: Determinar os fatores sociodemográAcos e da atenção em saúde relacionados com o cumprimento das precauções de contato por parte dos visitantes em um hospital de alta complexidade na cidade de Medellín. Método: Foi realizado um estudo descritivo transversal com um total de 126 visitantes de pacientes isolados por contato. IdentiAcaram-se fatores associado ao cumprimento do isolamento mediante inquérito, analisou-se a informação no programa SPSS mediante regressão logística e foi assumida signiAcância estatística se o valor P fosse menor a 0,05. Resultados: A adesão total ao isolamento foi de 40,5% e está associada principalmente com dois fatores: disponibilidade dos elementos de proteção e concordância com seu uso. Conclusões: Os fatores mais bem associados ao cumprimento do isolamento tornam necessário que as instituições garantam suprimentos suAcientes para os visitantes e que tanto o pessoal de saúde quanto os visitantes recebam maior conscientização sobre essa questão.
Subject(s)
Humans , Patient Isolation , Universal Precautions , Treatment Adherence and ComplianceABSTRACT
ABSTRACT Objective: to analyze the COVID-19 pandemic and what we have (re)learned from the world experience of adopting prevention measures recommended by the World Health Organization as well as the epidemiological overview in the world, in Latin America and in Brazil. Results: the World Health Organization has pointed out that the path to reduce the speed of circulation of the virus, control and decrease in the number of cases and deaths resulting from this pandemic can only be accomplished with mass adoption of fundamental measures that include hand hygiene, alcohol gel use, cough etiquette, cleaning surfaces, avoiding agglomerations and social distancing. The epidemiological curve of the disease clearly shows the devastating proportions in Italy, Spain and the United States, surpassing China in death records, due to the delay in adopting the aforementioned measures. In Brazil, the rapid progression in relation to the world and Latin America points to an important increase in the number of cases. Conclusion: this is possibly the most serious pandemic in recent human history, and its course can be influenced by the rigor in adopting individual and collective behavioral measures.
RESUMEN Objetivo: analizar la pandemia de COVID-19 y lo que hemos (re)aprendido de la experiencia mundial para la adopción de las medidas de prevención recomendadas por la Organización Mundial de la Salud, así como el panorama epidemiológico en el mundo, en América Latina y en Brasil. Resultados: la Organización Mundial de la Salud ha señalado que el camino hacia la reducción de la velocidad de circulación del virus, el control y la reducción del número de casos y muertes resultantes de esta pandemia solo se puede lograr con la adopción masiva de medidas fundamentales que incluyan la higiene de las manos, uso de alcohol en gel, etiqueta respiratoria, limpieza de superficies, evitando hacinamiento y distancia social. La curva epidemiológica de la enfermedad muestra claramente las proporciones devastadoras en Italia, España y Estados Unidos, superando a China en los registros de defunciones, debido a la demora en la adopción de estas medidas. En Brasil, la rápida progresión en relación con el mundo y América Latina apunta a un aumento importante en el número de casos. Conclusión: esta pandemia es posiblemente la más grave en la historia humana reciente y su curso puede verse influenciado por el rigor en la adopción de medidas de comportamiento individuales y colectivas.
RESUMO Objetivo: analisar a pandemia da Covid-19 e o que temos (re)aprendido com a experiência mundial para adoção das medidas de prevenção preconizadas pela Organização Mundial de Saúde bem como o panorama epidemiológico no mundo, na América Latina e no Brasil. Resultados: a Organização Mundial de Saúde tem apontado que o caminho para a redução da velocidade de circulação do vírus, o controle e queda do número de casos e óbitos decorrentes dessa pandemia só poderá ser alcançado com adoção em massa de medidas fundamentais que incluem higienização das mãos, uso do álcool em gel, etiqueta respiratória, limpeza de superfícies, evitar aglomerações e distanciamento social. A curva epidemiológica da doença mostra claramente as proporções devastadoras na Itália, Espanha e nos Estados Unidos, superando a China em registros de óbitos, devido ao atraso na adoção dessas medidas. No Brasil, a progressão rápida em relação ao mundo e à América Latina aponta um importante aumento do número de casos. Conclusão: essa pandemia possivelmente é a mais grave da história recente da humanidade e seu curso pode ser influenciado pelo rigor na adoção de medidas comportamentais individuais e coletivas.
Subject(s)
Humans , Coronavirus Infections , Disease Prevention , Pandemics , Personal Protective Equipment , Betacoronavirus , Patient Isolation , Psychological Distance , Behavior , Health EducationABSTRACT
Introduction: Since December 2019, the SARS-CoV2 virus has propagated throughout the world at great speed. Multiple studies describe its behavior in Intensive Care Units, but there is little information about its impact on a Critical Care Recovery Center (CCRC). Objective: To show if the use of a contingency protocol could reduce virus dissemination among patients hospitalized in a CCRC. Materials and Methods: Observational, retrospective, cross-sectional study. The study included patients older than 18 years on respiratory isolation for being a suspected case of SARS-CoV2, or close contact of a confirmed case or for their admission to theinstitution, during May 2020.The values were expressed as median and interquartile range or frequency and percentage, according to the variable. The differences between positive and negative SARS-CoV2 cases were evaluated with the median test and the Fisher' s Exact Test. Results: During the study period, 30 patients were placed in respiratory isolation (53% suspected cases, 13% close contact and 34% admission to the institution). 5 of them tested positive for SARS-CoV2, with a median of 61 years (18-71), mostly males (4/5), 80% tracheostomized and 33% with invasive mechanical ventilatory assistance. One patient died from complications associated withSARS-CoV2. No significant differences were found in the number of positive cases according to the isolation cause (p = 0.37) or the clinicaldemographic characteristics between positive and negative cases. Conclusion: The use of a contingency protocol for patients potentially infected with SARS-CoV2 in a CCRC could reduce the virus dissemination inside the institution.
Subject(s)
Humans , Betacoronavirus , Patient Isolation , Rehabilitation , Respiration, Artificial , TracheostomyABSTRACT
RESUMEN La enfermedad por coronavirus 2019 SARS-CoV2 es una infección emergente, hasta la fecha no es completamente claro el potencial patogénico ni la dinámica de transmisión. Por esta razón es necesario mantener y fortalecer las medidas de bioseguridad dentro de los establecimientos de salud. Los mismos incluyen delineamientos sobre la circulación de personas dentro del hospital desde su llegada hasta su destino final, ya sean funcionarios, personal de salud, pacientes y acompañantes de los mismos, con la única finalidad de protegernos entre todos y evitar la diseminación del SARS-CoV2. El objetivo de esta revisión es resumir la vasta bibliografía disponible para determinar los puntos claves en la protección y circulación de los pacientes internados en salas de Clínica Médica del Hospital Nacional a fin de evitar la diseminación del SARS-CoV2.
ABSTRACT The 2019 SARS-CoV2 coronavirus disease is an emerging infection, to date the pathogenic potential and transmission dynamics are not completely clear. For this reason it is necessary to maintain and strengthen biosecurity measures within health facilities. They include guidelines on the movement of people within the hospital from their arrival to their final destination, whether they are officials, health personnel, patients and their companions, with the sole purpose of protecting each other and preventing the spread of SARS- CoV2. The objective of this review is to summarize the extensive bibliography available to determine the key points in the protection and circulation of patients hospitalized in the rooms of the Medical Clinic Service of the National Hospital in order to avoid the spread of SARS-CoV2.
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RESUMEN INTRODUCCIÓN. El tiempo es un factor importante en el tratamiento del ACV agudo, con la pandemia de covid-19 se puede ver afectada la adherencia a las guías. Se han reportado tasas de ACV en presencia de covid-19 alrededor del 5%, además un aumento en el tiempo de consulta de los pacientes en otras regiones del mundo y una mayor ocupación de camas de UCI para patologías respiratorias que usualmente se destinan a pacientes con ACV. Este documento recoge las recomendaciones del comité de Enfermedad Cerebrovascular de la Asociación Colombiana de Neurología basados en la literatura y votadas por consenso. OBJETIVOS. Proporcionar una guía rápida adaptada a los diferentes escenarios de atención de ACV en Colombia, divididos en centro listo, primario y avanzado incluyendo una ruta de atención para paciente con sospecha de covid-19 denominada Código ACV protegido, que incluye el uso de elementos de protección personal para pacientes y personal de salud. PUNTOS PRINCIPALES. Dentro de las recomendaciones principales está el cuestionario de tamizaje al ingreso a urgencias, uso de tapabocas para el paciente, considerar todo Código ACV sospechoso de covid-19, toma de PCR para covid-19 en todos los ACV y llevar a zona buffer. En sospecha de oclusión proximal incluir tomo-grafía de tórax a la evaluación de imágenes. CONCLUSIONES. Establecer pautas de atención durante la pandemia covid-19 permite optimizar protección para pacientes y personal de salud, disminuir retrasos y tratar de evitar que pacientes no reciban el tratamiento adecuado en los diferentes niveles de atención del sistema de salud.
SUMMARY INTRODUCTION. Time is an important factor in the treatment of acute stroke, with the COVID-19 pandemic adherence to guidelines can be affected. Stroke rates in the presence of COVID-19 have been reported around 5%, in addition to an increase in the consultation time of patients in other regions of the world and a greater occupation of ICU beds for respiratory pathologies that are usually intended for patients with stroke. This document contains the recommendations of the Cerebrovascular Disease Committee of the Colombian Neurology Association based on the literature and voted by consensus. OBJECTIVES. Provide a quick guide adapted to the different stroke care scenarios in Colombia, divided into ready, primary and advanced centers, including a care route for a patient with suspected COVID-19 called the protected stroke code, which includes the use of protection elements for the patient and the healthcare team. MAIN FACTS. Among the main recommendations are the screening questionnaire on admission to the emergency department, the use of face masks for the patient, considering all suspected stroke code as COVID-19, taking the PCR for COVID-19 in all strokes and taking them to the buffer zone. In suspected large vessel occlusion, include chest tomography to image evaluation. CONCLUSIONS. Establishing guidelines of care during the COVID-19 pandemic allows optimizing protection for patients and health care personnel, reducing delays and trying to avoid patients not receiving adequate treatment at different levels of attention in the health system.
Subject(s)
Transit-Oriented DevelopmentABSTRACT
RESUMEN Ante el número cada vez mayor de pacientes con covid-19 y los rápidos cambios que ha traído consigo la pandemia en los estilos de vida, se redactó el presente documento, con el objetivo de proveer una recomendación a los neurológos y médicos en general para el abordaje del paciente con cefalea. Inicialmente, se realiza el abordaje de la cefalea como uno de los síntomas del covid-19, revisando las series de casos y proponiendo posibles clasificaciones diagnósticas para explicar su presencia en estos pacientes. Posteriormente, se evaluará la cefalea secundaria a otros trastornos neurológicos también reportados en pacientes con covid-19 y los signos de alarma para realizar estudios complementarios. Por último se revisará como ha cambiado el seguimiento de los pacientes con cefalea primaria en medio de la pandemia, recomendaciones sobre ajustes que se deben hacer durante este tiempo en su manejo y formulación, y finalmente recomendaciones sobre interacciones en sus medicamentos en caso de enfermar por covid-19.
SUMMARY Given the increasing number of patients with COVID-19 and the rapid changes that the pandemic has brought about in lifestyles, this document was developed with the aim of providing a recommendation to neurologists and doctors in general for the approach of the patient with headache. Initially, the headache was treated as one of the symptoms of COVID-19, reviewing the case series and proposing possible diagnostic classifications to explain its presence in these patients. Subsequently, headache secondary to other neurological disorders also reported in patients with COVID-19 and the warning signs will be evaluated to carry out complementary studies. Finally, it will be reviewed how the follow-up of patients with primary headache in the midst of the pandemic has changed, recommendations on adjustments to be made during this time in its management and formulation, and finally recommendations on drug interactions in case of illness due to COVID-19.
Subject(s)
Transit-Oriented DevelopmentABSTRACT
Objetivo: Descrever a experiência vivenciada pelo familiar de paciente crítico em isolamento de contato. Métodos: Estudo com metodologia qualitativa, realizado em 2019, em uma unidade de transplante de uma instituição hospitalar pública, em Fortaleza, Ceará, Brasil, cujos participantes foram 17 familiares de pacientes que se encontravam internados na Unidade Pós-operatória de Alta Complexidade em isolamento de contato. A coleta de dados ocorreu por meio de entrevista semiestruturada, sendo realizada a análise temática, a partir da qual emergiram três categorias: A experiência do familiar no momento da visita; A fé como suporte para o enfrentamento na espera da recuperação do seu familiar; Os sentimentos vivenciados pela necessidade de isolamento. Resultados: Os achados revelaram a necessidade da precaução por isolamento, que assusta muito os familiares, e a importância do uso de aparelhos, de medidas de prevenção e de proteção, contexto em que a fé e a esperança acabam dando vez para o desânimo e tristeza. O medo do desconhecido e de contrair a doença de seu familiar traz um sentimento ambíguo. Conclusão: Percebeu-se nas falas que a religião, espiritualidade, crença, tem papel fundamental no dia a dia dos familiares e na recuperação dos pacientes em hospitalização, trazendo mais segurança e força em todo processo. A reação dos entrevistados diante da necessidade da utilização de equipamento de proteção individual, tanto pelos profissionais como por eles mesmos no período da visita, mostrou que foi interpretada como "nojo" para tocar em seus familiares.
Objective: To describe the experience of a family member of a critical patient in contact isolation. Methods: This is a qualitative study, carried out in 2019, in a transplant unit of a public hospital in Fortaleza, Ceará, Brazil, whose participants were 17 relatives of patients who were hospitalized in the High Complexity Postoperative Unit in contact isolation. Data collection took place through semi-structured interviews, with thematic analysis being carried out, from which three categories emerged: The family member's experience at the time of the visit; Faith as support for coping while waiting for your family member to recover; and The feelings experienced by the need for isolation. Results: The findings revealed the need for precaution for isolation, which greatly scares family members and the importance of using devices, preventive and protective measures, a context in which faith and hope end up giving way to discouragement and sadness. The fear of the unknown and of contracting the illness of your relative brings an ambiguous feeling. Conclusion: It was perceived in the statements that religion, spirituality, and belief have a fundamental role in the daily lives of family members and the recovery of patients in hospitalization, bringing more security and strength in the whole process.
Objetivo: Describir la experiencia vivenciada por el familiar de paciente critico en aislamiento de contacto. Métodos: Estudio con metodología cualitativa realizado en 2019 en una unidad de trasplante de una institución hospitalaria pública de Fortaleza, Ceará, Brasil, cuyos participantes fueron 17 familiares de pacientes ingresados en la unidad postoperatoria de alta complejidad de aislamiento de contacto. La recogida de datos se dio a través de entrevista semiestructurada y se realizó el análisis temático de lo cual emergieron tres categorías: La experiencia del familiar durante la visita; El apoyo de la fe para el afrontamiento de la espera de la recuperación de su familiar; Los sentimientos vividos debido el aislamiento. Resultados: Los hallazgos revelaron la necesidad de precaución por el aislamiento que asusta mucho los familiares y la importancia del uso de aparatos, de medidas de prevención e de protección, contexto en el cual se cambia la fe y la esperanza por el desánimo y la tristeza. El miedo del desconocido y de tener la enfermedad de su familiar lleva a un sentimiento ambiguo. Conclusión: Se percibió en las hablas que la religión, la espiritualidad y la creencia tienen el papel fundamental en el cotidiano de los familiares y para la recuperación de los pacientes ingresados que tienen más seguridad y fuerza en todo el proceso. La reacción de los entrevistados ante la necesidad de la utilización de aparato de protección individual por los profesionales y por ellos mismos durante la visita ha sido interpretada como "aversión" de tocar sus familiares.
Subject(s)
Patient Isolation , Nursing , Critical Care OutcomesABSTRACT
OBJECTIVE@#To determine the environmental contamination degree of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in corona virus disease 2019 (COVID-19) wards, to offer gui-dance for the infection control and to improve safety practices for medical staff, by sampling and detecting SARS-CoV-2 nucleic acid from the air of hospital wards, the high-frequency contact surfaces in the contaminated area and the surfaces of medical staff's protective equipment in a COVID-19 designated hospital in Wuhan, China.@*METHODS@#From March 11 to March 19, 2020, we collected air samples from the clean area, the buffer room and the contaminated area respectively in the COVID-19 wards using a portable bioaerosol concentrator WA-15. And sterile premoistened swabs were used to sample the high-frequency contacted surfaces in the contaminated area and the surfaces of medical staff's protective equipment including outermost gloves, tracheotomy operator's positive pressure respiratory protective hood and isolation clothing. The SARS-CoV-2 nucleic acid of the samples were detected by real-time fluorescence quantitative PCR. During the isolation medical observation period, those medical staff who worked in the COVID-19 wards were detected for SARS-CoV-2 nucleic acid with oropharyngeal swabs, IgM and IgG antibody in the sera, and chest CT scans to confirm the infection status of COVID-19.@*RESULTS@#No SARS-CoV-2 nucleic acid was detected in the tested samples, including the 90 air samples from the COVID-19 wards including clean area, buffer room and contaminated area, the 38 high-frequency contact surfaces samples of the contaminated area and 16 surface samples of medical staff's protective equipment including outermost gloves and isolation clothing. Moreover, detection of SARS-CoV-2 nucleic acid by oropharyngeal swabs and IgM, IgG antibodies in the sera of all the health-care workers who participated in the treatment for COVID-19 were all negative. Besides, no chest CT scan images of medical staff exhibited COVID-19 lung presentations.@*CONCLUSION@#Good ventilation conditions, strict disinfection of environmental facilities in hospital wards, guidance for correct habits in patients, and strict hand hygiene during medical staff are important to reduce the formation of viral aerosols, cut down the aerosol load, and avoid cross-infection in isolation wards. In the face of infectious diseases that were not fully mastered but ma-naged as class A, it is safe for medical personnel to be equipped at a high level.
Subject(s)
Humans , Betacoronavirus , COVID-19 , China , Coronavirus Infections , Medical Staff , Pandemics , Pneumonia, Viral , Protective Devices , SARS-CoV-2 , Severe Acute Respiratory Syndrome/prevention & controlABSTRACT
Aim: Infection control is crucial in any clinical setting. It is vital that all dentists must follow the infection control protocols in their clinics to prevent cross-infection. In a dental clinic, even simple dental procedures including extractions, scaling and root planning, dental crown preparations and root canal treatment, have a high risk of exposure to blood, which may cause transmission blood-borne diseases. Dentist’s compliance with these guidelines and recommendations have been recently studied in different parts of the world. Hence this study was performed to evaluate the knowledge, attitude, and practice regarding infection control measures among private dental practioners in Karachi, Pakistan.Study Design:Cross-sectional study.Place and Duration of Study:This study was conducted for a period of four months in Karachi, Pakistan. Materialsand Methods: Present cross–sectional study was performed by interviewing 234dentists via a questionnaire based upon various questions regarding infection control. Sample were collected using convenience sampling, from private dental clinics in Karachi, Pakistan. Setting:Questionnaire were sent to 400 general dentist in Karachi,out of which 234 replied.Results: Mostly (69%) dentists who took part in the study were males. Regarding infection control, most of the individuals had a comprehensive understanding of infection control techniques. Isolation was considered to play a vital role in cross-infection prevention by 97.3% of the dentists. 93.2% used autoclave for sterilization and majority had thorough knowledge of the process involved. Regarding preventive measures, 66.7% of the dentists were vaccinated against major infectiousagents in our society and 92.2% took protective measures required to prevent cross-infection.Conclusion: Knowledge, attitudes and practices regarding infection control of dentists in private clinic of Karachi, Pakistan are satisfactory.
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ABSTRACT Objective: To know the perception, meanings and repercussions of specific precautions for hospitalized patients. Methods: Qualitative study with qualitative clinical methodology according to the vulnerability theoretical reference. The semi-directed interview and the Bardin content analysis were used. Results: Identification of three thematic units: (1) guidelines received, in which there was lack of information and misunderstandings about the reason for precautionary implementation; (2) perceptions about private rooms, there with both positive and negative perceptions; and (3) stigma related to the isolation condition, given patients felt constraint for being in a unit of infectious diseases and fear of being separated from the others. Final considerations: Situations of vulnerability were evidenced, both related to hospitalization and feelings aroused. The study can contribute to health services by broadening their vision beyond infection control.
RESUMEN Objetivo: Conocer la percepción, los significados y repercusiones de la precaución específica para el paciente internado. Métodos: Estudio cualitativo con metodología clínica cualitativa bajo referencial teórico de vulnerabilidad. Se utilizó la entrevista semidirigida y el análisis de contenido de Bardin. Resultados: Se identificaron tres unidades temáticas: (1) directrices recibidas, en que se observó la información insuficiente y los conceptos erróneos acerca del por qué la aplicación de precaución; (2) percepciones sobre el cuarto privado, fueron verificadas tanto percepciones positivas, como negativas; y (3) estigma relacionado a la condición de aislamiento, en la cual se identificó constreñimiento por estar en una unidad de enfermedades infecciosas y miedo por estar separados de los demás. Consideraciones finales: Las situaciones de vulnerabilidad fueron evidenciadas, relacionadas tanto a la internación ofrecida, en cuanto a los sentimientos despertados. El estudio puede contribuir con los servicios de salud, ampliando su visión más allá del control de infecciones.
RESUMO Objetivo: Conhecer a percepção, significados e repercussões da precaução específica para o paciente internado. Métodos: Estudo qualitativo com metodologia clínica qualitativa sob referencial teórico de vulnerabilidade. Utilizou-se a entrevista semidirigida e análise de conteúdo de Bardin. Resultados: Identificaram-se três unidades temáticas: (1) orientações recebidas, em que se observou insuficiência de informações e equívocos sobre o motivo da implementação da precaução; (2) percepções sobre o quarto privativo, verificou-se tanto percepções positivas, quanto negativas; e (3) estigma relacionado à condição de isolamento, na qual identificou-se constrangimento por estar em uma unidade de doenças infecciosas e medo por estarem separados dos demais. Considerações finais: Situações de vulnerabilidades foram evidenciadas, tanto relacionadas à internação ofertada, quanto aos sentimentos despertados. O estudo pode contribuir com os serviços de saúde, ampliando sua visão para além do controle de infecções.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Patient Isolation/psychology , Hospitalization , Life Change Events , Social Support , Interviews as Topic/methods , Universal Precautions/methods , Qualitative Research , Middle AgedABSTRACT
PURPOSE: The purpose of this study was to explore uncertainty, depression, and anxiety in isolated inpatients and to identify associations between them, with specific focus on state anxiety. METHODS: Data were collected using structured questionnaires and semi-structured interviews, administered to isolated inpatients at an acute care hospital (N=92). The structured questionnaires consisted of the State-Trait Anxiety Inventory, Mishel Uncertainty in Illness Scale, and the Center for Epidemiologic Studies Depression Scale. Multiple linear regression and content analysis were conducted. RESULTS: Isolated inpatients showed significant differences in uncertainty, depression, trait anxiety, and state anxiety according to gender, perception of sufficient information about isolation, and the type of isolation. State anxiety scores increased when sufficient information about isolation was not provided (β=.23, p=.005), with higher levels of depression (β=.24, p=.020) and trait anxiety (β=.49, p<.001). Through the content analysis, three themes were identified regarding patient's information needs about isolation specifically for disease, explanation, and environment. CONCLUSION: Based on the findings, it is crucial to improve the awareness of emotional responses of isolated patients experiencing uncertainty, depression, and anxiety. Our study findings are expected to support the development of nursing interventions to provide proper information and mental health support when caring for isolated inpatients.
Subject(s)
Humans , Anxiety , Depression , Epidemiologic Studies , Information Seeking Behavior , Inpatients , Linear Models , Mental Health , Nursing , Patient Isolation , UncertaintyABSTRACT
Justificativa e Objetivos: Infecções Relacionadas à Assistência à Saúde (IRAS) são consideradas um problema de saúde pública cujo controle pode minimizar a morbimortalidade dos pacientes. A instituição precoce de isolamento de contato para pacientes possivelmente colonizados por microrganismos multirresistentes (MR), pode reduzir sua disseminação os casos de IRAS e custos hospitalares. O objetivo deste estudo foi avaliar a frequência e impacto de culturas de vigilância positivas com microrganismos multirresistentes (MR) após um surto de Enterococcus spp. resistentes à vancomicina (VRE). Métodos: Foram implementadas rotinas de coleta de culturas de vigilância a partir de abril de 2014 para pacientes procedentes de outras unidades de saúde via Central de Regulação do Estado e Município em um hospital filantrópico em SalvadorBA. Resultados: Foram avaliados 663 pacientes no período de dezembro de 2014 a dezembro de 2015, sendo que 42 destes apresentaram cultura de vigilância positiva para microrganismos gram positivos e negativos MR. Após a implementação da rotina de realização de culturas de vigilância, não foram mais detectados surtos na nossa unidade. Conclusão: A rotina de culturas de vigilância pode funcionar como um importante instrumento na prevenção da disseminação de MR.(AU)
Background and Objectives: Health Care Related Infections (IRAS) are considered a public health problem whose control can minimize patients' morbidity and mortality. The early institution of contact isolation for patients possibly colonized by multiresistant (MR) microorganisms can reduce their spread in cases of IRAS and hospital costs. This study aimed to evaluate the frequency and impact of positive surveillance cultures with multiresistant (MR) microorganisms following an outbreak of vancomycin resistant Enterococcus spp. (VRE). Methods: Surveillance cultures collection routines were implemented since April / 14 for patients referred from other health to a philanthropic hospital in Salvador Bahia via state and municipal referral center. Results: A total of 663 patients were evaluated in the period from December / 14 to December / 15, and 42 of them had a positive surveillance culture for gram positive and negative MR microorganisms. After the routine implementation of surveillance cultures, no outbreaks were detected in our unit. Conclusion: Despite the high cost, the study showed that routine surveillance cultures are an important tool in preventing MR dissemination.(AU)
Justificación y objetivos: Infecciones Relacionadas a la Asistencia sanitaria (IRAS) se consideran un problema de salud pública cuyo control puede minimizar la morbimortalidad de los pacientes. La institución precoz de aislamiento de contacto para pacientes posiblemente colonizados por microrganismos multirresistentes (MR), puede reducir su diseminación de los casos de IRAS y costos hospitalarios. El objetivo del estudio fue evaluar la frecuencia e impacto de cultivos de vigilancia positivos con microrganismos multirresistentes (MR) después de un brote de Enterococcus spp. resistentes a la vancomicina (VRE). Métodos: Se implementaron rutinas de recolección de cultivos de vigilancia a partir de abril / 14 para pacientes procedentes de otras unidades de salud vía Central de Regulación del Estado y Municipio en un hospital filantrópico en Salvador - BA. Resultados: Se evaluaron 663 pacientes en el período de diciembre / 14 a diciembre / 15, siendo que 42 de ellos presentaron un cultivo de vigilancia positiva para microrganismos gram positivos y negativos MR. Después de la implementación de la rutina de realización de cultivos de vigilancia, ya no se detectaron brotes en nuestra unidad. Conclusión: La rutina de cultivos de vigilancia puede ser un importante instrumento en la prevención de la diseminación de MR.(AU)
Subject(s)
Humans , Patient Isolation , Drug Resistance, Microbial , Epidemiological MonitoringABSTRACT
RESUMEN El Staphylococcus sciuri es un estafilococo coagulasa negativo presente en animales de granja que en raras ocasiones se puede encontrar como microorganismo colonizador en humanos. Su importancia radica en que se ha asociado con infecciones graves como la endocarditis, peritonitis e infección del tracto urinario; constituyendo el 0,79% del número total de estafilococos coagulasa negativos aislados en muestras clínicas. Presentamos el caso de una primigesta de 22 años, con un embarazo de 17,5 semanas. La exploración física inicial evidenció taquicardia y temperatura de 39.3 ° C. Los estudios de laboratorio informaron leucocitos de 25,000, neutrófilos de 83%, plaquetas en 350,000, uroanálisis con marcada piuria, con más de 500 células/uL, nitritos negativos; tinción de Gram de orina con cocos Gram positivos. Después de tres días de tratamiento con Ceftriaxona un gramo cada doce horas intravenosamente, se obtienen informes positivos para S.sciuri multiresistente. Finalmente, se inició manejo con Clindamicina 600 mg cada seis horas intravenosamente, más Gentamicina a dosis de 1 mg/kg cada ocho horas intravenosamente. S.sciuri es una bacteria que se ha encontrado en el ambiente hospitalario y ocasionalmente es aislada en humanos, produciendo infecciones graves. Países como Colombia continúan tratando las infecciones sin tener en cuenta su propio entorno, en el cual los patógenos silvestres son causa frecuente de infecciones, debido al estrecho rango de coexistencia entre animales y humanos en las regiones rurales. Conclusión. Este caso pone de manifiesto la necesidad de considerar como agenta causal aquellos patógenos presentes en animales de granja que pueden causar infecciones en humanos, sobretodo en pacientes que proceden de las áreas lejanas a los centros urbanos.
SUMMARY Staphylococcus sciuri is a negative coagulase staphylococcus present in farm animals that can rarely be found as a colonizing microorganism in humans. Its importance is that it has been associated with serious infections such as endocarditis, peritonitis and urinary tract infection; constituting 0.79% of the total number of coagulase-negative staphylococci isolated in clinical samples. We present the case of a woman in her first pregnancy of 22 years, with a pregnancy of 17.5 weeks. The initial physical examination showed tachycardia and temperature of 39.3 ° C. Laboratory studies reported leukocytes of 25,000, neutrophils of 83%, platelets in 350,000, urinalysis with marked pyuria, with more than 500 cells / uL, negative nitrites; Gram stain of urine with Gram positive cocci. After three days of treatment with Ceftriaxone one gram every twelve hours intravenously, positive reports for multiresistant S. sciuri are obtained. Finally, management was started with Clindamycin 600 mg every six hours intravenously and Gentamicin at a dose of 1 mg / kg every eight hours intravenously. S.sciuri is a bacterium that has been found in the hospital environment and is occasionally isolated in humans, causing serious infections. Countries such as Colombia continue to treat infections without taking into account their own environment, in which wild pathogens are a frequent cause of infections, due to the narrow range of coexistence between animals and humans in rural regions. Conclusion. This case highlights the need to consider as a causal agent those pathogens present in animals that can cause infections in humans, especially in patients who come from areas far away from urban centers.