Effectiveness of ultraviolet C-light in eliminating microbial pathogens from stethoscopes used in the Neonatal Intensive Care Unit of East Avenue Medical Center

Background@#Instruments used to examine infected patients may be contaminated by disease- causing microorganisms during contact. If these instruments are not sterilized properly prior to being used on other patients, pathogen transfer may occur via this route. Stethoscopes are the most commonly used equipment by healthcare providers. Microbes and viruses may be transmitted from one patient to another and from healthcare worker to patient via stethoscope membranes.@*Objective@#To determine the effectiveness of ultraviolet c-light in eliminating microbial pathogens from stethoscopes used in the Neonatal Intensive Care Unit of East Avenue Medical Center.@*Methodology@#This is a two-arm, double blind, randomized controlled trial. The minimum sample size computed for this study was 26 stethoscopes. Thirteen (13) stethoscopes each were randomly allocated to Ultraviolet C (Group A) and standard of care (Group B) groups.@*Data Analysis@#Summary statistics were reported in tables as means, standard deviations, percentages and frequencies min-max for quantitative discrete outcome measures or percentages for qualitativemeasures.@*Results@#The predominant microbial pathogens colonized in the stethoscopes were different species of Coagulase Negative Staphylococcus (CONS) namely: Staphylococcus Heamolyticus (34.62%), Staphyloccocus Epidermidis (26.92%) and Staphylococcus Hominis (19.23%). Both UVC light and standard of care were equally effective in decreasing the CFUS on the stethoscopes. There was no significant difference in the post-test colony-forming units (CFUs) between the two groups (t = .594, p >.05).@*Conclusion@#UVC light sterilization is comparative to the standard of care in eliminating microbial pathogens. It works faster and is more reliable, durable and cost-effective. It is recommended as an alternative method for decontaminating stethoscopes used at the EAMC-NICU due to its numerous advantages.Keywords: ultraviolet c light, neonatal intensive care unit, stethoscope

Instrumentos para captação e análise acústica dos sinais de ausculta cervical na prática clínica fonoaudiológica: uma revisão integrativa de literatura / Instruments for acoustic capture and analysis of cervical auscultation signals in speech-language pathology clinic practice: an integrative literature review

RESUMO Objetivo Descrever os instrumentos utilizados para captação e análise acústica dos sinais de ausculta cervical e identificar aqueles com maior potencial para aplicação na clínica fonoaudiológica. Estratégia de pesquisa Trata-se de uma revisão integrativa de literatura. As buscas foram realizadas nas bases de dados MEDLINE/PubMed, Scopus e Web of Science, a partir da combinação de termos de relevância e operadores booleanos, durante o mês de novembro de 2020. Critérios de seleção Artigos científicos publicados nos idiomas português, espanhol ou inglês, nos últimos cinco anos (2016-2020) e que apresentassem estudo da ausculta cervical. Resultados Foram encontrados 98 artigos. Após a aplicação dos critérios de seleção, 26 artigos foram selecionados para esta revisão. Para captação dos sinais de ausculta cervical, o microfone foi o instrumento mais utilizado, seguido pela técnica de ausculta cervical de alta resolução, que combina sinais acústicos e vibratórios registrados por um microfone e um acelerômetro, respectivamente. Softwares e/ou algoritmos foram selecionados para análise acústica dos sinais, de acordo com o objetivo de cada estudo. Conclusão O método de ausculta cervical de alta resolução e a análise acústica por meio de algoritmos de aprendizado de máquina apresentaram grande potencial para utilização na prática clínica fonoaudiológica para avaliação e monitoramento da deglutição.

ABSTRACT Purpose Describe the instruments used to capture and analyze the acoustic signals obtained from cervical auscultation, and identify those with the greatest potential for application in the speech pathology clinic. Research strategy This is an integrative literature review. Searches were performed in the MEDLINE/PubMed, Scopus and Web of Science databases in November 2020, using relevant keywords combined with Boolean operators. Selection criteria Scientific articles published in Portuguese, Spanish or English in the last five years (2016-2020) and that presented a study of cervical auscultation. Results Ninety-eight articles were found. After the application of selection criteria, 26 articles were selected for this review. Microphones were the most common instruments used to perform cervical auscultation, followed by high-resolution cervical auscultation techniques, which combine acoustic and vibrational signals recorded by a microphone and an accelerometer, respectively. Acoustic analysis was performed using different software packages and/or algorithms depending on the goals of each study. Conclusion The combination of high-resolution cervical auscultation and machine learning for acoustic analysis has great potential for utilization in the clinical assessment and monitoring of swallowing in speech pathology.

Contaminación microbiana en estetoscopios utilizados por proveedores de salud / Microbial contamination in stethoscopes used by health care providers

Introducción: El estetoscopio se ha descrito como un fómite capaz de transmitir patemas de tipo infeccioso a los trabajadores de la salud Objetivo: Caracterizar la presencia de contaminación microbiana en estetoscopios utilizados por proveedores de salud. Métodos: Estudio transversal en 50 muestras microbiológicas obtenidas de estetoscopios pertenecientes a proveedores de salud que laboran en el Hospital Pediátrico Cerro, de junio-octubre de 2019. Se aplicó una encuesta para evaluar variables demográficas y epidemiológicas de sus titulares relacionadas con la aplicación de medidas descontaminantes. Se examinaron los resultados mediante el análisis porcentual y prueba de Ji-cuadrada para buscar asociación significativa (p≤0,05) con los hábitos higiénicos. Resultados: El 100 por ciento de los estetoscopios están contaminados. Los aislamientos más frecuentes fueron: Staphylococcus alba 40,3 por ciento, Staphylococcus aureus 32,6 por ciento y Klebsiella pneumoniae 3,8 por ciento. Las áreas de mayor contagio fueron las de misceláneas (44,2 por ciento) y de respiratorio (36,5 por ciento). El personal con notable contaminación en sus equipos fueron los alumnos (81,4 por ciento) y los especialistas (14,8 por ciento). Las causas que determinaron no practicar la desinfección en los alumnos fue la falta de enseñanza (45,4 por ciento); en los especialistas, la carencia de hábitos (33,3 por ciento) y la falta de desinfectante (66,3 por ciento). Las bacterias gramnegativas fueron sensibles en su mayoría a los aminoglucósidos y Staphylococcus aureus a la clindamicina, vancomicina, ciprofloxacino y cloranfenicol. Conclusiones: Existe alta frecuencia de contaminación en los estetoscopios utilizados por los proveedores de salud motivado por la falta de hábito de desinfección en médicos y su desconocimiento en alumnos(AU)

Introduction: Stethoscopes has been described as a fomite which is able to transmit infectious agents to health care workers. Objective: To describe the presence of microbial contamination in stethoscopes used by health care providers. Methods: Cross-sectional study in 50 microbiological samples obtained from stethoscopes belonging to health care providers whom worked in Cerro Pediatric Hospital from June to October, 2019. It was applied a survey to evaluate demographic and epidemiologic variables of the owners related with the implementation of disinfection measures. The results were examined through percentage analysis and the Ji-square test to look for significative relation (p≤0,05) with hygene habits. Results: 100 percent of the stethoscopes were contamined. The most frequent isolated agents were: Staphylococcus alba 40.3 percent, Staphylococcus aureus 32.6 percent and Klebsiella pneumoniae 3.8 percent. The hospital areas with more contagion were: Miscellany (44.2 percent) and Respiratory (36.5 percent). The personnel with more contamination in their equipments were: students (81.4 percent) and specialists (14.8 percent). The cause of not doing the disinfection processes in the students was the lack of knowledge (45.4 percent); and in the specialists was the lack of hygene habits and the lack of disinfectant solutions (66.3 percent). Negative Gran bacteria were mostly sensitive to aminoglycosides and Staphylococcus aureus to clindamycin, vancomycin, ciprofloxacin and cloramphenicol. Conclusions: There is high frequency of contamination in the stethoscopes used by health care providers, mainly motived by the lack of disinfection habits in physicians and lack of knowledge on it in the students(AU)

René Théophile Hyacinthe Laënnec (1781-1826). Doscientos años del uso del estetoscopio. Una breve reseña / René Théophile Hyacinthe Laënnec (1781-1826). Two hundred years of the stethoscope. A brief overview

Se han cumplido doscientos años desde la publicación en la que se dio a conocer la aplicación clínica del estetoscopio. Esta fue realizada en 1819 por René Théophile Hyacinthe Laënnec. El Dr. Laënnec vivió su infancia en la efervescencia social de la Revolución francesa y estudió Medicina en París, donde se graduó en 1804. Su experiencia clínica en el Hospital Necker culminó con la invención del estetoscopio en 1816. Tres años después, la publicación de su obra maestra De l'auscultation médiate enfatizó un enfoque clínico-patológico más racional, en especial, para el entendimiento de las enfermedades cardiorrespiratorias. Sin duda, el Dr. Laënnec revolucionó la medicina al perfeccionar el arte de la semiología torácica, que permitió al médico transformar los sonidos que escuchaba en una imagen, la cual podía visualizar.Con ocasión del bicentenario de este trascendental hito de la medicina moderna, se recuerda su historia

Two hundred years have passed since the publication that revealed the clinical use of the stethoscope. René Théophile Hyacinthe Laënnec published it in 1819. Laënnec spent his childhood in the social effervescence of the French Revolution and studied medicine in Paris, where he graduated in 1804. His clinical experience at Necker Hospital peaked with the invention of the stethoscope in 1816. Three years later, he published his masterpiece De L'Auscultation Médiate, which underlined a more rational clinical-pathological approach, especially in the understanding of cardiopulmonary diseases. Undoubtedly, Laënnec revolutionized medicine by perfecting the art of thoracic semiology, which allowed him to translate the sounds he heard into an image that could be visualized.In the bicentennial of the invention of such fundamental milestone in modern medicine, the purpose of this article is to go over its history

On stethoscopes, patient records, artificial intelligence, and zettabytes: A glimpse into the future of digital medicine in Mexico / Sobre estetoscopios, expedientes clínicos, inteligencia artificial y zettabytes: una mirada al futuro de la medicina digital en México

Abstract Science and technology are modifying medicine at a dizzying pace. Although access in our country to the benefits of innovations in the area of devices, data storage and artificial intelligence are still very restricted, the advance of digital medicine offers the opportunity to solve some of the biggest problems faced by medical practice and public health in Mexico. The potential areas where digital medicine can be disruptive are accessibility to quality medical care, centralization of specialties in large cities, dehumanization of medical treatment, lack of resources to access evidence-supported treatments, and among others. This review presents some of the advances that are guiding the new revolution in medicine, discusses the potential barriers to implementation, and suggest crucial elements for the path of incorporation of digital medicine in Mexico.

Resumen La ciencia y la tecnología han modificado la medicina a un ritmo vertiginoso. Si bien el acceso en México a los beneficios de las innovaciones en el área de dispositivos, almacenamiento de datos e inteligencia artificial aún es muy restringido, el avance de la medicina digital ofrece la oportunidad de solventar algunos de los problemas más grandes que enfrenta la práctica médica y la salud pública en este país. Las potenciales áreas en las que la medicina digital puede resultar innovadora son la accesibilidad a cuidados médicos de calidad, la centralización de las especialidades en grandes urbes, la deshumanización del trato médico, la falta de recursos para acceder a tratamientos avalados por evidencia, entre otros. Esta revisión presenta algunos de los avances que guían la nueva revolución en la medicina, revisa el potencial y las posibles barreras para su aplicación, además de sugerir elementos cruciales para el trayecto de incorporación de la medicina digital en México.

Auscultação dos sons da deglutição de crianças com bronquiolite / Auscultation of swallowing sounds of children with bronchiolitis

RESUMO Objetivo verificar as características acústicas dos sons de deglutição de lactentes com bronquiolite. Métodos estudo retrospectivo por análise de banco de dados aprovado pelo CEP sob o número 1499.911. Os sinais acústicos foram coletados por meio dos estetoscópios eletrônicos da marca Littmann®, modelo 4100. A amostra foi composta por sons da deglutição de lactentes com diagnóstico de bronquiolite viral aguda, internados em um hospital infantil do Sul do país. Os sons armazenados em arquivo digital foram abertos e rodados no software Deglutisom®, sendo verificados e confirmados por dois avaliadores independentes. Estabeleceu-se o pico de frequência, intensidade e intervalos de deglutição. Resultados a amostra de sons da deglutição de 22 crianças, sendo 31,8% do gênero feminino e 68,2% do masculino, apresentou mediana de idade de 81 dias. Encontrou-se diferença entre as características acústicas da deglutição comparadas ao gênero, com maior número de deglutições no gênero feminino (p=0,033). Não houve associação entre as variáveis pico de frequência (m=744 Hz), intensidade (m=52 dB) e tempo de deglutição (5,3s). Conclusão as características acústicas da deglutição da auscultação cervical de lactentes com bronquiolite, analisadas neste estudo, são de pico de frequência grave, intensidade forte, média de duas deglutições por sucção e tempo de deglutição de 5,3 s, havendo diferença entre os gêneros, em relação ao número de deglutições, maior no feminino.

ABSTRACT Purpose To verify the acoustic characteristics of swallowing noise in an infant with bronchiolitis. Methods A retrospective study was performed by database analysis approved by the ERC under the number 1499.911; the acoustic signals were collected through Littmann® model 4100 electronic stethoscopes. The sample was composed of a bank of infants swallowing sounds, diagnosed with acute viral bronchiolitis, children under 12 months-old, hospitalized in a children's hospital in the south of the Country. The sound file storage was opened, and it was rotated in the Deglutisom® software, being verified and confirmed by two independent judges. The peak of frequency, intensity, and swallowing intervals were established. Results The sample totalized a group of 22 babies, 31.8% of the female gender, and 68. 2% of males with a median age of 81 days. There was a difference between the acoustic characteristics of swallowing compared to the gender, regarding the number of swallows, with the highest number of swallows in the female gender (p=0.033). There was no association between the peak frequency (m=744 Hz), intensity (m=52 dB), and swallowing time (5.3s). Conclusion The acoustic characteristics of cervical auscultation swallowing of Infants with bronchiolitis are bass frequency peak, a strong intensity, a mean of two swallows, and a swallowing time of 5.3 s, with the difference between genders concerning the number of swallows, highest in the female.

Swallowing sounds profile of a post stroke group using electronic stethoscope software / Perfil dos sons da deglutição de um grupo pós-AVC fazendo uso de software de estetoscópio eletrônico / Perfil de los sonidos de deglutición de un grupo pós-AVC que hace uso del software del estetoscopio electrónico

Introduction: Cervical auscultation is a complementary evaluation to dysphagia clinical evaluation. Objective: To establish the swallowing sounds profile in post-stroke patients' group. Methods: Clinical cross-sectional study, whose collection and acoustic analysis was performed through the electronic stethoscope of the Littman brand (model 4100) and clinical evaluation of dysphagia, with the collection of 45 swallows of liquids and 9 swallows dried. Results: Sample composed of nine post stroke individuals with an average age of 54.33-year-old; 55.6% of patients with swallowing disease. The frequency varies between 20-500 Hz; the dry swallowing frequencies occurred in 250 Hz in swallowing without alteration, and between 20 Hz and 249 Hz in disease. For the swallowing of liquids, between 20Hz and 249 Hz without alteration, and 250 in Hz disease. The average dry swallowing time was given in 110.3 ms (SD ± 38. 6 ms) and with liquids in 111.6 ms (SD ± 36.5 ms). The average time between the dry swallowing events was 125 ms (SD ± 54.74 ms) in swallowing without alteration and of 98.60 ms (SD ± 18. 66 ms) in disease; in liquid swallowing it was 100.20 ms (DP ± 31.01 ms) without alteration, and 120.68 ms (SD ± 38.52 ms) in the swallowing disease. Conclusion: The digital stethoscope showed itself as an instrumental possibility for the collection, but for the acoustic analysis it is not productive. The results of the dry and liquid swallowing were: average time around 110 ms and at low frequency, varying between 20 Hz and 500 Hz for both consistencies, with post stroke patients.

Introdução: A ausculta cervical caracteriza-se como um exame complementar à avaliação clínica da disfagia. Objetivo: Estabelecer o perfil sonoro dos ruídos da deglutição de um grupo de pacientes pós-AVC. Método: Estudo clínico de caráter transversal, cuja coleta e análise acústica foram realizadas através do estetoscópio eletrônico da marca Littman (modelo 4100) e avaliação clínica da disfagia, com a coleta de 45 deglutições de líquidos e nove deglutições secas. Resultados: Amostra composta por nove sujeitos pós-AVC com idade média de 54,33 anos; 55,6% dos pacientes com alteração de deglutição. As frequências variaram entre 20-500 Hz, as frequências da deglutição seca ocorreram em 250 Hz na deglutição sem alteração e entre 20 Hz a 249 Hz na alterada; para a deglutição de líquidos entre 20 Hz a 249 Hz sem alteração e de 250 Hz na alterada. O tempo médio da deglutição seca se deu em 110,3 ms (dp ±38,6 ms) e com líquidos em 111,6 ms (dp ± 36,5 ms). O tempo médio entre os eventos de deglutição seca foi de 125 ms (dp ± 54,74 ms) na deglutição sem alteração e de 98,60 ms (dp ± 18,66 ms) na alterada; na deglutição líquida foi de 100,20 ms (dp ± 31,01 ms) sem alteração e de 120,68 ms ± 38,52 ms na deglutição alterada. Conclusão: O estetoscópio digital mostrou-se como uma possibilidade instrumental para a coleta, contudo para a análise acústica se mostrou pouco objetivo. Os resultados encontrados com a deglutição seca e com a consistência líquida foram: tempo médio em torno de 110 ms e em frequência baixa, variando entre 20 Hz e 500 Hz para ambas as consistências, junto aos pacientes pós-AVC.

Objetivo: establecer el perfil sonoro de los sonidos de deglución después de um accidente cerebrovascular. Método: estudio clínico de carácter transversal, cuya colección y análisis acústico se realizó a través del estetoscopio electrónico de la marca Littman (modelo 4100) y evaluación clínica de la disfagia, con la recolección de 45 degluticiones de líquidos y nueve degluticiones secas. Resultados: muestra compuesta por nueve sujetos después de um accidente cerebrovascular, con una edad promedio de 54,33 años; 55,6% con cambio de deglución. Las frecuencias variaram entre 20-500 Hz, de la deglución seca ocurrieron en 250 Hz en tragar sin alteración y entre 20 Hz el 249 Hz en alterada; la deglución de líquidos entre 20 Hz el 249 Hz sin alteración y 250 Hz en la deglución alterada. El tiempo medio de deglución en seco se dio en 110,3ms y con líquidos en 111,6ms. El tiempo promedio entre los eventos de deglución seca fue 125 ms en la deglución sin alteración y de 98,60 ms en la deglución alterada. En la deglución líquida fue 100,20 ms sin alteración y 120,68 ms en la deglución alterada. Conclusión: el estetoscopio digital se demostró como posibilidad instrumental de la colección, pero para el análisis acústico demostró poca meta. Los resultados de la deglución seca y com líquidos encontrados fueron: tiempo promedio en la deglución alterada de 110 ms y a baja frecuencia, variando entre 20 Hz y 500 Hz para ambos consistencias, con pacientes después de um accidente cerebrovascular.

Will ultrasound replace the stethoscope?: a case report on neonatal one-lung ventilation / O ultrassom substituirá o estetoscópio?: relato de caso sobre ventilação monopulmonar neonatal

Abstract Background and objectives: One-lung ventilation and selective intubation in neonates can be challenging due to intrinsic physiological specificities and material available. Ultrasound (US) is being increasingly used in many extents of anaesthesiology including confirmation of endotracheal tube position. Case report: We present a case report of a neonate proposed for pulmonary lobectomy by thoracoscopy in which lung exclusion was confirmed by ultrasound. Conclusion: US is a rapid, more sensitive and specific method than auscultation to evaluate tracheal intubation and lung exclusion.

Resumo Justificativa e objetivos: A ventilação monopulmonar e a intubação seletiva em recém-nascidos podem ser um desafio devido às especificidades fisiológicas intrínsecas e ao material disponível. O aparelho de ultrassom tem sido cada vez mais usado em muitas situações no campo da anestesia, incluindo a confirmação da posição do tubo endotraqueal. Relato de caso: Apresentamos o relato do caso de um recém-nascido proposto para lobectomia pulmonar por toracoscopia em que a exclusão pulmonar foi confirmada por ultrassom. Conclusão: O ultrassom é um método rápido, mais sensível e específico do que a ausculta para avaliar a intubação traqueal e a exclusão pulmonar.

Design and Implementation of Heart Sound Detection Device Based on MEMS MIC / 中国医疗器械杂志

The paper describes how to develop a digital heart sound signal detection device based on high gain MEMS MIC that can accurately collect and store human heart sounds. According to the method of collecting heart sound signal by traditional stethoscope, the system improves the traditional stethoscope, and a composite probe equipped with a MEMS microphone sensor is designed. The MEMS microphone sensor converts the sound pressure signal into a voltage signal, and then amplifies, converts with Sigma Delta, extracts and filters the collected signal. After the heart sound signal is uploaded to the PC, the Empirical Mode Decomposition (EMD) is carried out to reconstruct the signal, and then the Independent Component Analysis (ICA) method is used for blind source separation and finally the heart rate is calculated by autocorrelation analysis. At the end of the paper, a preliminary comparative analysis of the performance of the system was carried out, and the accuracy of the heart sound signal was verified.

Contaminação Microbiana de Estetoscópios em Duas Unidades Hospitalares do Estado de Minas Gerais / Microbial Contamination of Stethoscopes in Two Hospitals of Minas Gerais State

Introdução: As Infecções Relacionadas à Assistência à Saúde (IRAS) representam importante problema de saúde pública. Vários fatores favorecem o aumento dos casos de IRAS, entre eles a incorreta higienização das mãos e falta de desinfecção de equipamento utilizados no ambiente hospitalar, que contribuem para disseminação de microrganismos no ambiente hospitalar. Objetivos: Analisar a prevalência da contaminação microbiana de estetoscópios de duas Unidades de Terapia Intensiva. Métodos: Foram coletadas 22 amostras de estetoscópios utilizados em duas unidades hospitalares públicas de Minas Gerais, uma de Juiz de Fora e outra de São João Del Rei, sendo a coleta realizada através de swabs estéreis. Resultados: Foram avaliados o total de 22 estetoscópios. Dos 16 avaliados em Juiz de Fora, 11(68,75%) apresentaram crescimento microbiano, sendo 7(54%) Staphylococcus sp coagulase negativa, 3(23%) Klebsiella pneumoniae, 1(7,6%) Acinetobacter baumanni, 1(7,6%) de Enterococcus sp e 1(7,6%) de Staphylococcus aureus. Na unidade de São João Del Rei, dos 6 leitos, cada um com estetoscópio próprio, ocorreu crescimento microbiano em 100% das análises, sendo 4(44,4%) cepas de Staphylococcus sp coagulase negativa, 1(11,1%) de Klebsiella pneumoniae, 1 cepa (11,1%) de Enterobacter sp e 3(33,3%) de Staphylococcus aureus. Conclusões: Foi observado a presença de microrganismos patogênicos em grande parte das amostras de estetoscópios analisados em ambas instituições, sendo de grande importância a Comissão de Infecção Hospitalar insistir e promover programas de re-educação e incentivo às boas práticas dentro das unidades hospitalares. (Au)

Introduction: The Healthcare-associated infections (HAI) became concerning to the public health system. Several factors favor the increase of HAI cases, among them the wrong hand hygiene and disinfection of smaller medical equipment, such as stethoscope used by health professionals, contribute to the propagation of microorganisms. Objectives: Analyse the prevalence of microbial contamination of stethoscopes of two Intensive Care Unit (ICU) throughout swabs. Methods: Were collected 22 samples of two public hospitals from Minas Gerais, one from Juiz de Fora and the other from São João Del Rei, being collected through sterile swabs. Results: A total of 22 stethoscopes were evaluated. Out of the 16 evaluated in Juiz de Fora, 11 (68.75%) presented microbial growth, 7 (54%) of which were coagulase-negative Staphylococci, 3 (23%) Klebsiella pneumoniae, 1 (7.6%) Acinetobacter baumanni, 1(7,6%) de Enterococcus sp and 1 (7.6%) Staphylococcus aureus. However, in the unit of São João Del Rei, out of the 6 beds, each one with their own stethoscope, there was microbial growth in 100% of the samples, 4 (44.4%) of which were coagulase-negative Staphylococci, 1 (11.1%) Klebsiella pneumonia, 1 bacterial strain (11.1%) Enterobacter sp and 3 (33.3%) Staphylococcus aureus. Conclusions: The presence of pathogenic microorganisms was observed in most of the samples of stethoscopes analysed in both institutions, resulting in the utterly important insistence from the Hospital Infection Commission in promoting re-education programmes and incentive to better practices in hospitals. (AU)

Tarjeta de adquisición de datos para el sistema integrado de estetoscopio digital y ECGAR del proyecto SEDAR / Data acquisition card for integrated system of digital stethoscope and ECGAR of SEDAR Project

El artículo presenta el desarrollo de una tarjeta de adquisición de datos (TAD) para uso biomédico. Este diseño forma parte de un sistema que permite realizar un análisis comparativo entre los sonidos cardiopulmonares (SC) y el electrocardiograma de alta definición (ECGAR). La TAD reportada digitaliza simultáneamente tres señales adquiridas. Los dos primeros canales digitalizan las señales correspondientes a las derivaciones dI y dIII del ECGAR. El tercer canal digitaliza la señal captada del SC. El instrumento consta de dos partes, una etapa de hardware para adquirir la señal y un software para la manipulación de datos en la computadora. El hardware está compuesto por un microcontrolador de alto rendimiento, una interfaz de comunicación con la computadora vía USB y los circuitos de seguridad eléctrica inherentes a un equipo médico. El software permite la adquisición de las señales transmitidas desde el hardware, su visualización gráfica y el almacenamiento de la información en una base de datos. Las pruebas de funcionamiento demostraron errores inferiores al 0,1 % en las mediciones de amplitud y no se registró perdida de información en la comunicación con la computadora

The paper reports the development of a data acquisition card (TAD) for biomedical use. This design is part of a system that allows a comparative analysis between cardiopulmonary sounds (SC) and the high-definition electrocardiogram (ECGAR). The reported TAD simultaneously digitizes three acquired signals. The channels 1 and 2 digitize the ECGAR signals corresponding to leads dI and dIII. The channel 3 digitizes to SC captured signal. The instrument consists of two parts, a hardware for acquire the signal and a software for data manipulation in the computer. The hardware consists of a high performance microcontroller, a USB communication interface with the computer and the electrical safety circuits inherent to medical equipment. The software allows the signals acquisition transmitted from the hardware, its graphic visualization and the information storage in a database. The performance tests showed errors less than 0.1 % in amplitude measurements and no loss of information in the communication with the computer

Bacterias patógenas multidrogoresistentes aisladas en estetoscopios de médicos en un hospital de nivel III / Multi-drug resistant bacteria isolated from medical stethoscopes in a level III hospital

Objetivos: Determinar el perfil de susceptibilidad de bacterias patógenas aisladas en estetoscopios usados por médicos de un hospital de nivel III en Lima, Perú. Material y métodos: Estudio observacional, descriptivo y transversal, realizado en el Hospital Nacional Arzobispo Loayza. Ciento veintitrés bacterias aisladas se guardaron congeladas a - 20 °C. Posteriormente se sembró en placas de agar TSA, manitol salado y se procedió a incubar 24 horas a 37 °C. Se preparó una suspensión ajustada a 0,5 McFarland de turbidez, se procedió a inocular en placas de agar Mueller - Hinton (disco difusión); se determinó concentración mínima inhibitoria (MIC) en algunos casos y se utilizó antibióticos según la CLSI (Clinical and Laboratory Standards Institute). Resultados: Todas las cepas de Staphylococcus spp. coagulasa negativa, presentaron sensibilidad a ERI, DA, CIP, NF, LZD, VAN (100%); tres bacterias dieron resistencia a PEN, OXA, FOX (2,8%). Las cinco cepas de Staphylococcus aureus aisladas, presentaron sensibilidad a GE, AK, NF, LZD (100%); sin embargo, una cepa de Staphylococcus aureus presentó resistencia a FOX, VAN (20%). Las dos cepas de Acinetobacter spp. presentaron sensibilidad a IMI, MER, COL (100%). De las cuatro cepas de Pseudomonas aeruginosa, dos presentaron resistencia a FEP, IMI, MER (50%). La cepa de Escherichia coli presentó resistencia a IMI, MER. Conclusiones: Se tipificaron cepas de Staphylococcus coagulasa negativa y Staphylococcus aureus con resistencia a meticilina y vancomicina; Pseudomonas aeruginosa con resistencia a carbapenemasas y enterobacterias resistentes a cefalosporinas. (AU)

Objectives: To determine the susceptibility profile of pathogenic bacteria isolated from medical stethoscopes in a level II hospital in Lima. Methods: Cross-sectional study carried-out in Hospital Nacional Arzobispo Loayza. One hundred and twenty-three bacteria were stored at -20C to be cultured in TSA agar and salt mannitol agar to be further incubated for 24 hours at 37C. A suspension adjusted at 0,5 McFarland turbidity was done to be cultured at Mueller - Hinton agar to determine minimal inhibitory concentration (CIM) following CLSI (Clinical and Laboratory Standard Institute) recommendations. Results: All coagulase-negative Staphylococcus spp. were susceptible to ERI, DA, CIP, NF, LZD, VAN (100%); three strains were resistant to PEN, OXA, FOX (2,8%). All five Staphylococcus aureus strains were susceptible to GE, AK, NF, LZD (100%); however, one strain was resistant to FOX, VAN (20%). The two Acinetobacter spp. strains were susceptible to IMI, MER, COL (100%). Two out of four strains of Pseudomonas were resistant to IMI, MER. Conclusions: The study reports strains of methicillin resistant coagulase negative Staphylococcus and Staphylococcus aureus; carbapenem resistant Pseudomonas aeruginosa, and cephalosporin resistant enterobacteria. (AU)

Heated wire humidification circuit attenuates the decrease of core temperature during general anesthesia in patients undergoing arthroscopic hip surgery / 대한마취과학회지

BACKGROUND: Intraoperative hypothermia is common in patients undergoing general anesthesia during arthroscopic hip surgery. In the present study, we assessed the effect of heating and humidifying the airway with a heated wire humidification circuit (HHC) to attenuate the decrease of core temperature and prevent hypothermia in patients undergoing arthroscopic hip surgery under general anesthesia. METHODS: Fifty-six patients scheduled for arthroscopic hip surgery were randomly assigned to either a control group using a breathing circuit connected with a heat and moisture exchanger (HME) (n = 28) or an HHC group using a heated wire humidification circuit (n = 28). The decrease in core temperature was measured from anesthetic induction and every 15 minutes thereafter using an esophageal stethoscope. RESULTS: Decrease in core temperature from anesthetic induction to 120 minutes after induction was lower in the HHC group (–0.60 ± 0.27℃) compared to the control group (–0.86 ± 0.29℃) (P = 0.001). However, there was no statistically significant difference in the incidence of intraoperative hypothermia or the incidence of shivering in the postanesthetic care unit. CONCLUSIONS: The use of HHC may be considered as a method to attenuate intraoperative decrease in core temperature during arthroscopic hip surgery performed under general anesthesia and exceeding 2 hours in duration.

Contaminación con bacterias patógenas de estetoscopios del personal médico en un hospital de nivel III en Lima, Perú / Contamination of medical stethoscopes with pathogenic bacteria in a level III hospital in Lima, Peru

Objetivos: Determinar el grado de contaminación bacteriana con bacterias patógenas de los estetoscopios del personal médico en un hospital general de Lima, Perú. Material y métodos: Estudio de tipo observacional,descriptivo y transversal, realizado en el Hospital Nacional Arzobispo Loayza, entre los meses de enero y juniodel 2013. Se estudiaron 124 muestras de estetoscopios del personal médico en las siguientes áreas: UCI 20; neonatología 13; quemados 3; medicina 52; emergencia 36. Se recolectaron las muestras con hisopos humedecidos,en condiciones estériles (En presencia de un mechero de vidrio para alcohol) y luego fueron introducidos en tuboscon preparado de caldo BHI (Infusión cerebro corazón) para ser incubados por 24 horas a 37°C; se cultivó en Agarsangre, Agar MacConkey, Agar manitol y Agar cetrimidepara su posterior determinación de bacterias patógenaspor procedimientos bioquímicos ,luego se identificó la susceptibilidad bacteriana con la técnica de Kirby- Bauer...

Objectives: To determine the degree of contamination with pathogenic bacteria by stethoscopes used for medical personnel in a general hospital in Lima, Peru. Methods: Cross sectional study carried-out at Hospital Nacional Arzobispo Loaya between January and June 2013. A total of 124 samples were evaluated from the following areas: 20 from the ICU, 13 from the neonatology service, 3 from the burn unit; 52 from medicine wards, and 36 from the emergency room. The samples were collected using a moist cotton swab in sterile conditions (using a alcohol bunser burner) and introduced in tubes containing brain-heart infusion to be incubated at 37C for 24 hours. The determination of pathogenic bacteria used MacConkey and manitol agar with specific biochemical methods. The Kirby-Bauer method was used to determine the antibiotic susceptibility pattern...

¿Estetoscopio o estafiloscopio?: Potencial vector en las infecciones asociadas a la atención de la salud / Stethoscope or staphyloscope?: Potential vector in nosocomial infections

Healthcare-associated infections (HCAI) are a problem worldwide. In our country, the estimated incidence of HCAI is 70,000 per year. This results in an increase in the average length of hospital stay by 10 days per patient, an estimated annual cost of US $ 70 million and an overstay of 700 thousand bed days a year. For over 30 years stethoscopes have been considered as potential HCAI vectors, since pathogens like methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus strains adhere and colonize them. These organisms can be transmitted between patients if the instruments are not sanitized. Several studies conclude that disinfecting the stethoscope with isopropyl alcohol eliminates up to 99% of bacteria. Simple, economic measures such as implementation of guidelines for stethoscope disinfection are a clear opportunity for preventing infections.

Las infecciones asociadas a la atención de la salud (IAAS) son un problema a mundial. Sólo en nuestro país se estima una incidencia de 70.000 al año, lo que se traduce en un aumento de la estadía hospitalaria en 10 días promedio por paciente, un costo anual estimado en 70 millones de dólares y una sobre-estadía de 700 mil días cama al año. La evidencia señala que diferentes instrumentos de uso hospitalario resultan contaminados por patógenos; entre ellos, el estetoscopio se ha identificado como potencial vector de IAAS hace más de 30 años y adquiere gran relevancia al ser de uso generalizado. Microorganismos patógenos, incluyendo cepas de Staphylococcus aureus resistente a meticilina y cepas de Enterococcus resistente a vancomicina se adhieren y contaminan los estetoscopios, pudiendo transmitirse a otros pacientes si no son desinfectados. Diversos estudios concluyen que la desinfección del estetoscopio con alcohol isopropílico elimina hasta 99% de estas y otras bacterias, por lo que existe una clara oportunidad para aportar a la prevención de las IAAS, interviniendo a través de la implementación de medidas sencillas, económicas y operativas al corto plazo, normando por ejemplo la limpieza del estetoscopio.

RSV Outbreak at a Single Postpartum Care Center in Gyeongsangbukdo / 대한주산의학회잡지

PURPOSE: We performed an analysis of the RSV outbreak in a postpartum center in Gyeongsangbukdo to provide preliminary data for health and hygiene management of postpartum care centers. METHODS: All of 22 newborns who were transferred to our hospital from a postpartum care center from December 2014 to January 2015 showed positive for RSV by viral culture and enrolled in the study group. To identify early symptoms in RSV infected newborn in the nursery 31 infants (1 month to 24 month of age) who were hospitalized in our hospital due to RSV infection during the same period were selected as control group and clinical symptoms were compared with the study group. A retrospective study was also performed on the newborns who were cared and not transferred to our hospital in the postpartum care center, as well as the facilities offered by the center. RESULTS: All of 22 neonatal patients who were transferred to our hospital had early symptoms of rhinorrhea and cough compared to control group. Rhinorrhea appeared 4.2±2.0 days before the admission, and cough occurred 1.0±1.1 days after rhinorrhea. The level of infection control specified by the law for general facilities relating to postpartum care centers was applied to the postpartum center, RSV infection was not controlled. Strict hand washing, individual equipment such as stethoscopes and exclusion of visitors with respiratory symptoms were done and infected neonates were segregated in separate air circulation system and cared by nurse-infant ratios from 1:1 to 1:2 depending on the needs of the individual neonates. Additional transmission was not observed after transfer to our hospital CONCLUSION: Neonates with cough and rhinorrhea were initial symptom for RSV infection in the postpartum center and should be evaluated for RSV infection during high risk season. Current guideline or support for infection control in postpartum center should be reevaluated for RSV infection control.