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1.
Article in English | WPRIM | ID: wpr-888609

ABSTRACT

BACKGROUND@#Regional disparities in the working conditions of medical doctors have not been fully assessed in Japan. We aimed to clarify these differences in hospital characteristics: doctors' workload, wages, and popularity among medical students by city population sizes.@*METHODS@#We targeted 423 teaching hospitals certified by the Japanese Society of Internal Medicine and assessed the working conditions of physicians specializing in internal medicine. We calculated their workload (the annual number of discharged patients per physician) and retrieved data on junior residents' monthly wages from the Resinavi Book which is popular among medical students in Japan to know the teaching hospital's information and each hospital's website. Furthermore, we explored the interim matching rate of each hospital as its popularity among medical students. Next, we classified cities in which all hospitals were located into eight groups based on their population size and compared the characteristics of these hospitals using a one-way analysis of variance.@*RESULTS@#The average workload was 110.3, while the average workload in hospitals located in most populated cities (≥ 2,000,000) was 88.4 (p < 0.05). The average monthly wage was 351,199 Japanese yen, while that in most populated cities was 305,635.1 Japanese yen. The average popularity (matching rate) was 101.9%, and the rate in most populated areas was 142.7%, which was significantly higher than in other areas.@*CONCLUSIONS@#Hospitals in most populated areas had significantly lower workloads and wages; however, they were more popular among medical students than those in other areas. This study was the first to quantify the regional disparities in physicians' working conditions in Japan, and such disparities need to be corrected.


Subject(s)
Cities/statistics & numerical data , Geography , Hospitals, Teaching/statistics & numerical data , Japan , Physicians/statistics & numerical data , Population Density , Salaries and Fringe Benefits/statistics & numerical data , Students, Medical/psychology , Workload/statistics & numerical data
2.
Rev. bras. enferm ; 72(2): 442-449, Mar.-Apr. 2019. graf
Article in English | LILACS, BDENF | ID: biblio-1003472

ABSTRACT

ABSTRACT Objective: To describe the social network of adolescents who need special health care. Method: A qualitative, descriptive and exploratory study conducted between 2016 and 2017 in the pediatric outpatient clinic of a teaching hospital in southern Brazil. Thirty-five semi-structured interviews were conducted with adolescents between 12 and 18 years of age, followed by the construction of genograms and ecomaps. After transcription, the enunciations were subjected to Pêcheux's method of discourse analysis. Results: The institutional network consists of health services, schools and religious entities, as well as adolescents' families and friends. In the family network, women family members—such as mothers, grandmothers and aunts—have a special role. Final Consideration: The adolescents' social network is composed of institutional and family circles. In the view of adolescents, the tertiary service is more capable of solving their problems, and for this reason used the most. In order to ensure these adolescents access to and continuity of care, the articulation between health policies and health services is suggested.


RESUMEN Objetivo: Describir la red social de los adolescentes que necesitan una atención especial a la salud. Método: Estudio cualitativo, descriptivo y exploratorio, realizado entre 2016 y 2017 en la clínica pediátrica de un hospital escuela en la región sur de Brasil. Se realizaron 35 entrevistas semiestructuradas con adolescentes de 12 a 18 años de edad, y después se elaboraron genogramas y ecomapas. Después de la doble transcripción, se sometieron los relatos a análisis de discurso pecheutiano. Resultados: En la red institucional constan de servicios de salud, escuelas y organismos religiosos, así como de familiares y amigos de los adolescentes. En la red de la familia, se elogian a las mujeres, representadas por las madres, las abuelas y las tías. Consideraciones Finales: La red social de los adolescentes se compone de círculos institucionales y familiares. En la perspectiva de los adolescentes, el servicio terciario es más resolutivo, por lo tanto, es lo más utilizado. Se recomienda articular las políticas con los servicios de salud para que se oferte a estos adolescentes el acceso a la salud y la continuidad del cuidado.


RESUMO Objetivo: Descrever a rede social de adolescentes que necessitam de atenção especial à saúde. Método: Estudo qualitativo, descritivo e exploratório realizado entre 2016 e 2017 no ambulatório pediátrico de um hospital de ensino no sul do Brasil. Foram realizadas 35 entrevistas semiestruturadas com adolescentes entre 12 a 18 anos de idade, seguidas pela construção de genogramas e ecomapas. Após a dupla transcrição, as enunciações foram submetidas à análise de discurso pechetiana. Resultados: A rede institucional é composta por serviços de saúde, escolas e entidades religiosas, além de familiares e amigos dos adolescentes. Na rede familiar, as mulheres são enaltecidas, representadas pelas mães, avós e tias. Considerações Finais: A rede social dos adolescentes é composta pelos círculos institucional e familiar. Na ótica dos adolescentes, o serviço terciário é mais resolutivo e por isso é o mais utilizado. Sugere-se articular as políticas e os serviços de saúde para o acesso e continuidade do cuidado desses adolescentes.


Subject(s)
Humans , Male , Female , Child , Adolescent , Chronic Disease/psychology , Adolescent Behavior/psychology , Social Networking , Professional-Patient Relations , Quality of Health Care/standards , Social Support , Brazil , Chronic Disease/nursing , Chronic Disease/rehabilitation , Interviews as Topic/methods , Qualitative Research , Ambulatory Care Facilities/organization & administration , Ambulatory Care Facilities/statistics & numerical data , Hospitals, Teaching/organization & administration , Hospitals, Teaching/statistics & numerical data
3.
Einstein (Säo Paulo) ; 17(1): eAO4432, 2019. tab
Article in English | LILACS | ID: biblio-984366

ABSTRACT

ABSTRACT Objective To investigate the use of fall-risk-increasing drugs among patients with falls reported to the Patient Safety Office of a hospital, and to identify the factors associated with high risk for fall. Methods A cross-sectional study, carried out in a teaching hospital. The study population was the universe of fall reports received by the Patient Safety Office. The dependent variable was a high risk for falls. The Medication Fall Risk Score was used to measure fall risk. Descriptive, univariate and multivariate analyses were performed. Results Of the 125 fall reports in the study, 38 (30.4%) were in 2014, 26 (20.8%) in 2015, and 61 (48.8%) in 2016. Half of the patients (63; 50.4%) were classified as high fall risk and 74 (59.2%) had two or more risk factors for the event. The most frequently used drug classes were opioids (25%), anxiolytics (19.7%), beta-blockers (9.9%), angiotensin II antagonists (7%) and vascular-selective calcium channel blockers (7%). After the adjusted analysis, the factors associated with falls were amputation (odds ratio: 14.17), female sex (odds ratio: 2.98) and severe pain (odds ratio: 5.47). Conclusion Medications are an important contributor to in-hospital falls, and the Medication Fall Risk Score can help identify patients at a high risk for falls.


RESUMO Objetivo Investigar o uso de medicamentos que aumentam o risco de queda entre pacientes que tiveram quedas notificadas ao Núcleo de Segurança do Paciente de um hospital, bem como identificar os fatores associados ao risco elevado de queda. Métodos Trata-se de estudo transversal realizado em hospital de ensino. A população do estudo foi composta pelo universo de notificações de queda enviadas para o Núcleo de Segurança do Paciente. A variável dependente foi alto risco para queda. A mensuração do risco de queda foi realizada de acordo com o Medication Fall Risk Score. Foram realizadas as análises descritiva, univariada e multivariada. Resultados Das 125 notificações de queda incluídas no estudo, 38 (30,4%) foram notificadas em 2014, 26 (20,8%) em 2015 e 61 (48,8%) em 2016. Metade dos pacientes (63; 50,4%) foram classificados na categoria alto risco de queda, e 74 (59,2%) apresentaram dois ou mais fatores de risco para o evento. As classes de medicamentos mais frequentes foram opioides (25%), ansiolíticos (19,7%), betabloqueadores (9,9%), antagonistas de angiotensina II (7%) e bloqueadores de canais de cálcio seletivos com efeitos principais vasculares (7%). Após a análise ajustada, os fatores associados com queda foram amputação (odds ratio: 14,17), sexo feminino (odds ratio: 2,98) e dor intensa (odds ratio: 5,47). Conclusão Os medicamentos são importante fator contribuinte para a queda intra-hospitalar, e o Medication Fall Risk Score contribui para a identificação de pacientes com alto risco de quedas.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Accidental Falls/statistics & numerical data , Patient Safety/statistics & numerical data , Inpatients , Professional Staff Committees , Cross-Sectional Studies , Retrospective Studies , Risk Factors , Hospitals, Teaching/statistics & numerical data , Middle Aged
4.
Rev. latinoam. enferm. (Online) ; 27: e2939, 2019. tab, graf
Article in Portuguese | LILACS, BDENF | ID: biblio-1043062

ABSTRACT

Objetivo estimar a prevalência e evitabilidade de eventos adversos cirúrgicos em hospital de ensino e classificar os eventos segundo o tipo de incidente e grau do dano. Método estudo transversal e retrospectivo realizado em duas fases. Na fase I, enfermeiros realizaram revisão retrospectiva em amostra aleatória simples de 192 prontuários de pacientes adultos, utilizando o formulário do Canadian Adverse Events Study para rastreamento de casos. A fase II objetivou a confirmação do evento adverso por comitê de especialistas composto por médico e enfermeiros. Os dados foram analisados por estatística descritiva univariada. Resultados a prevalência de eventos adversos cirúrgicos foi de 21,8%; em 52,4% dos casos, a detecção ocorreu no retorno ambulatorial. Dos 60 casos analisados, 90% (n=54) eram evitáveis e mais de dois terços resultaram em danos leves a moderados. Falhas técnicas cirúrgicas contribuíram em, aproximadamente, 40% dos casos. Houve prevalência da categoria infecção associada à atenção à saúde (50%;n=30). Destacaram-se os eventos adversos relacionados à infecção de sítio cirúrgico (30%;n=18), deiscência de sutura (16,7%;n=10) e hematoma/seroma (15%;n=9). Conclusão a prevalência e evitabilidade dos eventos adversos cirúrgicos são desafios a serem enfrentados pela gestão hospitalar.


Objective to estimate the prevalence and avoidability of surgical adverse events in a teaching hospital and to classify the events according to the type of incident and degree of damage. Method cross-sectional retrospective study carried out in two phases. In phase I, nurses performed a retrospective review on a simple randomized sample of 192 records of adult patients using the Canadian Adverse Events Study form for case tracking. Phase II aimed at confirming the adverse event by an expert committee composed of physicians and nurses. Data were analyzed by univariate descriptive statistics. Results the prevalence of surgical adverse events was 21.8%. In 52.4% of the cases, detection occurred on outpatient return. Of the 60 cases analyzed, 90% (n = 54) were preventable and more than two thirds resulted in mild to moderate damage. Surgical technical failures contributed in approximately 40% of the cases. There was a prevalence of the infection category associated with health care (50%, n = 30). Adverse events were mostly related to surgical site infection (30%, n = 18), suture dehiscence (16.7%, n = 10) and hematoma/seroma (15%, n = 9). Conclusion the prevalence and avoidability of surgical adverse events are challenges faced by hospital management.


Objetivo estimar la prevalencia y evitación de eventos adversos quirúrgicos en el hospital de enseñanza y clasificar los eventos según el tipo de incidente y grado del daño. Método estudio transversal y retrospectivo realizado en dos fases. En la fase I, los enfermeros realizaron una revisión retrospectiva en una muestra aleatoria simple de 192 prontuarios de pacientes adultos, utilizando el formulario del Canadian Adverse Events Study para el seguimiento de casos. En la fase II, el objetivo tuvo la confirmación del evento adverso por comité de especialistas compuesto por médico y enfermeros. Los datos fueron analizados por estadística descriptiva univariana. Resultados la prevalencia de eventos adversos quirúrgicos fue del 21,8%; en el 52,4% de los casos la detección ocurrió en el retorno al ambulatorio. De los 60 casos analizados, 90% (n=54) eran evitables y más de dos tercios resultaron en daños leves a moderados. Las fallas técnicas quirúrgicas contribuyeron en aproximadamente el 40% de los casos. La prevalencia de la categoría de infección asociada a la atención de la salud (50%, n=30). Se destacan los eventos adversos relacionados a la infección del sitio quirúrgico (30%, n=18), la dehiscencia de sutura quirúrgica (16,7%, n=10) e hematoma/seroma (15%, n=9). Conclusión la prevalencia y evitación de los eventos adversos quirúrgicos son desafíos a ser enfrentados por la gestión hospitalaria.


Subject(s)
Humans , Male , Female , Adult , Postoperative Complications/epidemiology , Surgical Procedures, Operative/adverse effects , Hospitals, Teaching/statistics & numerical data , Postoperative Complications/prevention & control , Postoperative Period , Surgical Procedures, Operative/standards , Surgical Wound Dehiscence/epidemiology , Surgical Wound Infection , Brazil/epidemiology , Cross-Sectional Studies , Retrospective Studies , Patient Safety , Middle Aged
5.
Clin. biomed. res ; 39(4): 266-278, 2019.
Article in Portuguese | LILACS | ID: biblio-1053319

ABSTRACT

Este artigo ilustra o desenvolvimento das atividades de pesquisa ao longo dos 48 anos do Hospital de Clínicas de Porto Alegre (HCPA). Fundado em 1971, o HCPA começa a atuar em pesquisa em 1974, data dos primeiros artigos indexados nas bases internacionais. O estudo abrange um período de 44 anos, de 1974 a 2018, para o qual foram levantados os artigos científicos publicados em periódicos indexados na base Web of Science por pesquisadores do próprio hospital, da Faculdade de Medicina e de outras unidades da UFRGS associados aos projetos de pesquisa do HCPA. O artigo resulta de um estudo cientométrico, sendo para tanto realizadas análises de indicadores bibliográficos, como produção total de artigos científicos experimentais, artigos de revisão e artigos completos em eventos (proceedings papers). Para facilidade de informação, os termos utilizados pelas bases foram mantidos em inglês ao longo do texto e nas tabelas e figuras. Um total de 6.383 documentos desses três tipos de artigos foi publicado no período. Mostra-se também a evolução temporal dessa produção. Foram ainda levantadas as principais áreas de pesquisa, as palavraschave dos artigos, as revistas, a colaboração internacional e menção aos trabalhos mais citados. Ao longo do estudo foi possível verificar que alguns pesquisadores, autores de trabalhos significativos, não indicam nos artigos sua vinculação ao HCPA e recomenda-se uma orientação do GPPG sobre o assunto. (AU)


This article illustrates the development of research activities over the 48 years of the Hospital de Clínicas de Porto Alegre (HCPA). Founded in 1971, the HCPA begins its research activities in 1974, date of the first articles published in indexed journals. The study covers a period of 44 years, from 1974 to 2018 for which the scientific articles in journals indexed in the Web of Science database, published by researchers of the hospital including the Faculty of Medicine and other UFRGS units associated with the research projects of the HCPA were considered for this study. The article results from a scientometric study, and for this purpose analyzes of bibliographic indicators were carried out, covering: total production of experimental scientific articles, review articles and complete papers published in the proceedings of scientific events. For ease of information, the terms used by the bases were maintained in English throughout the text and in the tables and figures. A total of 6,383 documents of these three types of articles were published in the period. The temporal evolution of this production is also shown. The main research areas, the keywords of the articles, the journals, the international collaboration and the most cited papers were also raised. It was identified at the end that several authors though working in the hospital, do not indicate in the articles their linkage to the HCPA and thus, it is recommended to GPPG to develop some orientation to the researchers concerning to this subject. (AU)


Subject(s)
Humans , Bibliometric Indicators , Scientific Publication Indicators , Periodicals as Topic/statistics & numerical data , Scholarly Communication/statistics & numerical data , Hospitals, Teaching/statistics & numerical data
6.
Braz. j. infect. dis ; 22(4): 273-277, July-Aug. 2018. tab
Article in English | LILACS | ID: biblio-974228

ABSTRACT

ABSTRACT Background Candidemia is the most frequent invasive fungal disease in hospitalized patients, and is associated with high mortality rates. The main objective of this study was to evaluate changes in the epidemiology of candidemia at a tertiary care hospital in a 21-year period. Methods We evaluated all episodes of candidemia diagnosed between 1996 and 2016 at a University-affiliated tertiary care hospital in Brazil. We arbitrarily divided the study period in 3: 1996-2002 (period 1), 2003-2009 (period 2) and 2010-2016 (period 3). Incidence rates were calculated using hospital admissions as denominator. Results We observed 331 episodes of candidemia. The incidence was 1.30 episodes per 1000 admissions, with no significant change over time. Candida albicans (37.5%), C. tropicalis (28.1%), C. parapsilosis (18.4%) and C. glabrata (6.9%) were the most frequent species. The proportion of patients receiving treatment increased (65.5%, 79.4% and 74.7% in periods 1, 2 and 3, respectively, p= 0.04), and the median time from candidemia to treatment initiation decreased from 4 days in period 1 (range 0-32 days) to 2 days in period 2 (range 0-33 days) and 2 days in period 3 (range 0-14 days, p< 0.001). We observed a significant decrease in the use of deoxycholate amphotericin B (47.4%, 14.8% and 11.9%), and an increase in the use of echinocandins (0%, 2.8% and 49.1%; p< 0.001). The APACHE II score increased over time (median 16, 17.5, and 22, p< 0.001). The overall 30-day mortality was 58.9%, and did not change significantly over the study period. Conclusions There was an improvement in patient care, with an increase in the proportion of patients receiving treatment and a decrease in the time to treatment initiation, but no improvement in the outcome, possibly because the proportion of sicker patients increased over time.


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Candida/classification , Candidemia/epidemiology , Patient Admission/trends , Brazil/epidemiology , Candida/isolation & purification , Incidence , Hospital Mortality/trends , Candidemia/mortality , Candidemia/drug therapy , Tertiary Care Centers/statistics & numerical data , Hospitals, Teaching/statistics & numerical data , Antifungal Agents/therapeutic use
7.
Arch. Health Sci. (Online) ; 25(1): 61-64, 23/04/2018.
Article in Portuguese | LILACS | ID: biblio-1046656

ABSTRACT

Introdução: Plasmocitoma é um tumor maligno, originado da proliferação irreversível e autônoma dos plasmócitos, podendo se apresentar como massa circunscrita ou infiltração difusa. Quando há mais de um tumor de células plasmáticas, ocorre o chamado Mieloma Múltiplo. Essa neoplasia maligna de células B apresenta produção exagerada de uma das imunoglobulinas de cadeias leves Kappa ou Lambda. Objetivo: Avaliar possíveis associações entre dados epidemiológicos e a carga tumoral em pacientes com Mieloma Múltiplo. Material eMétodos: Trata-se de um estudo transversal, quantitativo, descritivo, realizado em prontuários de pacientes diagnosticados com Mieloma Múltiplo no Laboratório de Patologia do Hospital de Base do município de São José do Rio Preto, São Paulo, entre 2010 e 2014. Foram consideradas as variáveis: sexo, idade, presença de cadeia leve (Kappa, Lambda, ambas e não especificada), carga tumoral (leve, moderada e acentuada). Resultados:Analisamos 42 laudos de pacientes diagnosticados com Mieloma Múltiplo, sendo que 69% dos pacientes apresentaram idade igual ou superior a 60 anos, presença de imunoglobulina de cadeia leve Kappa em 59% e carga tumoral acentuada em 67% dos casos. Em relação ao sexo, observamos que o nível de carga tumoral acentuada ocorreu de maneira similar entre homens e mulheres. As mulheres diagnosticadas com carga tumoral leve ou moderada configuraram 71% dos pacientes, do estudo. Conclusão: A idade e sexo não constituem fator de risco para o Mieloma Múltiplo na amostragem avaliada, este fato pode estar relacionado ao tamanho amostral.


Introduction: Plasmocytoma is a malignant tumor, originated from the irreversible and autonomous proliferation of the plasmacytes, being able to present as circumscribed mass or diffuse infiltration. When there is more than one plasma cell tumor, the so-called Multiple Myelomas occurs. This malignant B cell neoplasm exhibits overproduction of one of the Kappa or Lambda light chain. Objective: To evaluate possible ssociation of epidemiological data with tumor burden in patients with multiple myelomas. Patients and Methods:It is a cross-sectional study conducted with medical records of patients diagnosed with multiple myeloma by the Pathology Laboratory in Hospital de Base in the city of São José do Rio Preto, São Paulo, between 2010 and 2014. We considered the variables gender, age, light chain presence (Kappa, Lambda, both and unspecified), and tumor burden (mild, moderate or severe). Results: We analyzed 42 medical records of patients diagnosed with multiple myelomas. Of these, 69% of patients were aged 60 and over. Immunoglobulin Kappa light chain was found in 59% patients, and severe tumor burden in 67% of them. Regarding sex, we observed that severe tumor burden level occurred in a similar manner in men and women, without significant associations. Women diagnosed with mild to moderate tumor burden corresponded to 71% of patients, but no significant association was found. Conclusion: Age and sex were not a risk factor for multiple myelomas in this evaluated sample. This may be due to the sample size evaluated.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Plasma Cells , Plasmacytoma/epidemiology , Multiple Myeloma/epidemiology , Hospitals, Teaching/statistics & numerical data
8.
Braz. j. infect. dis ; 22(1): 55-59, Jan.-feb. 2018. tab
Article in English | LILACS | ID: biblio-1039208

ABSTRACT

ABSTRACT To characterize methicillin-resistant Staphylococcus aureus isolates from an intensive care unit of a tertiary-care teaching hospital, between 2005 and 2010. A total of 45 isolates were recovered from patients admitted to the intensive care unit in the study period. Resistance rates higher than 80% were found for clindamycin (100%), erythromycin (100%), levofloxacin (100%), azithromycin (97.7%), rifampin (88.8%), and gentamycin (86.6%). The SCCmec typing revealed that the isolates harbored the types III (66.7%), II (17.8%), IV (4.4%), and I (2.2%). Four (8.9%) isolates carried non-typeable cassettes. Most (66.7%) of the isolates were related to the Brazilian endemic clone from CC8/SCCmec III, which was prevalent (89.3%) between 2005 and 2007, while the USA100/CC5/SCCmec II lineage emerged in 2007 and was more frequent in the last few years. The study showed high rates of antimicrobial resistance among methicillin-resistant S. aureus isolates and the replacement of Brazilian clone, a well-established hospital lineage, by the USA100 in the late 2000s, at the intensive care unit under study.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Intensive Care Units/statistics & numerical data , Reference Values , Brazil , Microbial Sensitivity Tests , Interspersed Repetitive Sequences , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Methicillin-Resistant Staphylococcus aureus/drug effects , Hospitals, Teaching/statistics & numerical data , Anti-Bacterial Agents/pharmacology
9.
Rev. bras. enferm ; 70(2): 400-406, Mar.-Apr. 2017. tab
Article in English | LILACS, BDENF | ID: biblio-843650

ABSTRACT

ABSTRACT Objective: investigate the understanding of nurses on nurse prescribing conformity to the care needs of hospitalized patients and factors associated with that conformity. Method: a descriptive study, with a quantitative approach, was conducted at 20 in-patient units of a teaching hospital in the state of São Paulo. The participants (N=139) answered a semi-structured questionnaire. Results: For 43 (30.9%) nurses, nurse prescribing is always in line with patients' care needs. The fields of body care and elimination, skin and mucosa care and investigation and monitoring were the most frequently addressed. Conclusion: in the perception of most nurses, nurse prescribing does not conform with patients' health heeds. The establishment of strategies to improve prescribing quality is recommended, as well as the development of permanent qualification programs and the systematic use of instruments for assessment of patients' care demands regarding nursing.


RESUMEN Objetivo: investigar la concepción de enfermeros sobre conformidad de prescripción de enfermería a necesidades de atención de pacientes hospitalizados y factores asociados a tal conformidad. Método: estudio descriptivo, con abordaje cuantitativo, realizado en 20 unidades de internación de hospital de enseñanza del estado de São Paulo. Los participantes (N=139) completaron cuestionario semiestructurado. Resultados: para 43 (30,9%) enfermeros, las prescripciones de enfermería estuvieron siempre alineadas a las necesidades de cuidado de los pacientes. Las áreas de Cuidado Corporal y Eliminaciones, Cuidado de Piel y Mucosas e Investigación y Monitoreo fueron las más abordadas. Conclusión: según visión de la mayoría de enfermeros, no hay conformidad de prescripción de enfermería con necesidades de atención de los pacientes. Se recomienda implementación de estrategias para mejorar la calidad de las prescripciones, cualquier otro desarrollo de programas de calificación continuada y utilización sistemática de instrumentos de evaluación de demanda de atención del paciente referentes a enfermería.


RESUMO Objetivo: investigar a concepção de enfermeiros sobre a conformidade da prescrição de enfermagem às necessidades de cuidados de pacientes hospitalizados e fatores associados a esta conformidade. Método: estudo descritivo, com abordagem quantitativa, realizado em 20 unidades de internação de um hospital de ensino do estado de São Paulo. Os participantes (N=139) responderam a um questionário semiestruturado. Resultados: para 43 (30,9%) enfermeiros, as prescrições de enfermagem encontram-se, sempre, alinhadas às necessidades cuidativas dos pacientes. As áreas de Cuidado Corporal e Eliminações, Cuidados com Pele e Mucosas e Investigação e Monitoramento foram as mais abordadas. Conclusão: na percepção da maioria dos enfermeiros não há conformidade da prescrição de enfermagem com as necessidades de cuidados dos pacientes. Recomenda-se a implementação de estratégias para aprimorar a qualidade das prescrições, bem como o desenvolvimento de programas de qualificação contínua e a utilização sistemática de instrumentos de avaliação da demanda de atenção do paciente em relação à enfermagem.


Subject(s)
Humans , Male , Female , Adult , Drug Prescriptions/standards , Clinical Competence/standards , Nurse's Role , Nurses/standards , Nurses/statistics & numerical data , Drug Prescriptions/nursing , Drug Prescriptions/statistics & numerical data , Quality of Health Care/standards , Quality of Health Care/statistics & numerical data , Patients' Rooms/organization & administration , Patients' Rooms/statistics & numerical data , Brazil , Hygiene/standards , Surveys and Questionnaires , Professional Autonomy , Clinical Competence/statistics & numerical data , Skin Care/nursing , Hospitals, Teaching/organization & administration , Hospitals, Teaching/statistics & numerical data , Middle Aged
10.
Rev. bras. enferm ; 70(1): 96-103, jan.-fev. 2017. tab, graf
Article in Portuguese | LILACS, BDENF | ID: biblio-843627

ABSTRACT

RESUMO Objetivo: verificar os fatores associados e o nível de adesão às precauções padrão dos profissionais de enfermagem do setor de clínica médica de um hospital de ensino. Método: estudo quantitativo, transversal, analítico, realizado com 54 profissionais de enfermagem, por meio da aplicação da Escala Psicométrica de Adesão às Precauções Padrão, traduzida e validada para o português do Brasil. Resultados: o escore global de adesão foi intermediário (4,41); não houve correlação estatisticamente significativa entre adesão e categoria profissional (p=0,404) e com o tempo de exercício profissional (p= 0,612). Verificou-se correlação do item Lava as mãos após a retirada de luvas descartáveis (p=0,026) com profissionais com tempo de trabalho, na área, superior a 10 anos. Conclusão: a adesão às medidas de precaução padrão pela equipe de enfermagem foi intermediária, não tendo diferença estatisticamente significativa em relação à categoria profissional e ao tempo de exercício profissional.


RESUMEN Objetivo: verificar los factores asociados y el nivel de adhesión a precauciones estándar en profesionales de enfermería del sector de clínica médica de un hospital de enseñanza. Método: estudio cuantitativo, transversal, analítico, realizado con 54 profesionales de enfermería, a través de la aplicación de la Escala Psicométrica de Adhesión a las Precauciones Estándar, traducida y validada al portugués brasileño. Resultados: el puntaje global de adhesión fue intermedio (4,41); no hubo correlación estadísticamente significativa entre adhesión y categoría profesional (p=0,404) ni con tiempo de ejercicio profesional (p=0,612). Se verificó correlación del ítem Lava sus manos luego de quitarse los guantes descartables (p=0,026) en profesionales con tiempo de actuación en el área mayor a 10 años. Conclusión: la adhesión a medidas de precaución estándar del equipo de enfermería fue intermedia, sin diferencia estadísticamente significativa respecto de categoría profesional y tiempo de actuación profesional.


ABSTRACT Objective: analyze related factors and the level of adherence to standard precautions of nursing professionals from the clinical medical division of a teaching hospital. Method: a quantitative, cross-sectional, analytical study was conducted with 54 nursing professionals using the Psychometric Scale of Adherence to Standard Precautions, translated and validated to Brazilian Portuguese. Results: the global score of adherence was intermediate (4.41); no statistically significant correlation was observed between adherence and professional category (p=0.404) and length of professional practice (p= 0.612). A correlation was observed between 'Washes hands after removing disposable gloves' (p=0.026) and professionals with nursing practice above 10 years. Conclusion: adherence to standard precautions by the nursing team was intermediate, with no statistically significant difference in relation to the professional category and length of professional practice.


Subject(s)
Humans , Male , Female , Adult , Infection Control/standards , Guideline Adherence/standards , Nurses/standards , Brazil , Cross-Sectional Studies , Surveys and Questionnaires , Infection Control/statistics & numerical data , Clinical Competence/standards , Clinical Competence/statistics & numerical data , Guideline Adherence/statistics & numerical data , Hospitals, Teaching/organization & administration , Hospitals, Teaching/statistics & numerical data , Middle Aged , Nurses/statistics & numerical data
11.
Braz. j. med. biol. res ; 50(6): e5797, 2017. tab
Article in English | LILACS | ID: biblio-839307

ABSTRACT

Candida species are the leading cause of invasive fungal infections, and over the past decade there has been an increased isolation of drug resistant Candida species. This study aimed to identify the species distribution of Candida isolates and to determine their unique antifungal susceptibility and resistance patterns. During a cross-sectional study, 209 Candida isolates (recovered from 206 clinical samples) were collected and their species distribution was determined using ChromAgar Candida. The Vitek-2 system (Biomerieux, South Africa) was used to determine minimum inhibitory concentrations (MICs) to azoles (fluconazole, voriconazole), echinocandins (caspofungin, micafungin), polyenes (amphotericin B) and flucytosine. Four species of Candida were isolated, of which C. albicans was the most frequent, isolated in 45.4% (95/209) of the isolates, followed by C. glabrata: 31.1% (65/209). The MICs of the different antifungal drugs varied amongst the species of Candida. From the 130 isolates tested for MICs, 90.77% (112/130) were susceptible to all antifungal drugs and 6.9% (9/130) of the isolates were multi-drug resistant. C. dubliniensis (n=2) isolates were susceptible to all the above mentioned antifungal drugs. There was no significant difference in species distribution amongst clinical specimens and between patients' genders (P>0.05). An increase in MIC values for fluconazole and flucytosine towards the resistance range was observed. To our knowledge, this is the first report on surveillance of Candida species distribution and antifungal susceptibility at a public tertiary teaching hospital in Eastern Cape, South Africa.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Antifungal Agents/pharmacology , Candida/drug effects , Urine/microbiology , Vagina/microbiology , Candida/classification , Candida/isolation & purification , Cross-Sectional Studies , Drug Resistance, Fungal , Hospitals, Teaching/statistics & numerical data , Microbial Sensitivity Tests , South Africa , Tertiary Care Centers/statistics & numerical data
12.
Rev. Soc. Bras. Med. Trop ; 49(6): 763-767, Dec. 2016. tab
Article in English | LILACS | ID: biblio-1041390

ABSTRACT

Abstract INTRODUCTION: Despite the therapeutic benefits of drugs, adverse drug reactions (ADRs) occur. Method: We assessed a series of suspected ADRs identified from notifications and intensive monitoring of inpatients from March 2013 to March 2014. RESULTS: Skin reactions predominated (31%). Systemic anti-infective agents were implicated in 16 (72%) reactions. Fifteen (68%) ADRs were classified as possible. The implicated drug was not correctly identified by the healthcare team in 12 cases. CONCLUSIONS: Some reactions were not correctly attributed to the causative drug(s), suggesting that the use of a validated evaluation method can promote successful identification of causal links between ADRs and drugs.


Subject(s)
Humans , Male , Female , Adult , Communicable Diseases/drug therapy , Drug-Related Side Effects and Adverse Reactions/epidemiology , Brazil/epidemiology , Hospitals, Teaching/statistics & numerical data , Middle Aged
13.
Clinics ; 71(7): 387-391, tab
Article in English | LILACS | ID: lil-787434

ABSTRACT

OBJECTIVES: Physician compliance with standard precautions is important in the specialty of gynecology and obstetrics because of the high frequency of invasive procedures. The current study investigated compliance with standard precautions among resident physicians working in gynecology and obstetrics. METHOD: A cross-sectional study was conducted among resident physicians in gynecology and obstetrics in their first (R1), second (R2) and third (R3) years of residency at a teaching hospital in a city in São Paulo. A structured questionnaire that included demographic and professional aspects and the Standard Precautions Adherence Scale were used to collect data. Statistical analysis was performed using IBM® SPSS version 20. Ethical aspects were considered. RESULTS: Fifty-eight resident physicians participated in the study. Of the enrolled participants, 27 (46.6%) were in R1, 12 (20.7%) were in R2 and 19 (32.8%) were in R3. The standard precautions compliance score was 4.1, which was classified as intermediate. There were no significant differences in the compliance scores of the resident physicians across the three years of residency (H=2.34, p=0.310). CONCLUSION: Compliance with standard precautions among resident physicians was intermediate. Preventive measures in clinical practice are not fully adopted in the specialty of gynecology and obstetrics. More important, many professionals claimed lack of sufficient training in standard precautions in the workplace. Such circumstances should draw the attention of hospital management with regard to occupational health risks.


Subject(s)
Humans , Male , Female , Adult , Young Adult , Advance Directive Adherence/standards , Gynecology/education , Internship and Residency/standards , Obstetrics/education , Practice Patterns, Physicians'/standards , Advance Directive Adherence/statistics & numerical data , Brazil , Cross-Sectional Studies , Guideline Adherence , Health Knowledge, Attitudes, Practice , Hospitals, Teaching/statistics & numerical data , Practice Patterns, Physicians'/statistics & numerical data , Surveys and Questionnaires , Universal Precautions
14.
Einstein (Säo Paulo) ; 14(1): 41-46, Jan.-Mar. 2016. tab
Article in English | LILACS | ID: lil-778502

ABSTRACT

ABSTRACT Objective To analyze the process of recording transfusion monitoring at a public teaching hospital. Methods A descriptive and retrospective study with a quantitative approach, analyzing the instruments to record transfusion monitoring at a public hospital in a city in the State of Minas Gerais (MG). Data were collected on the correct completion of the instrument, time elapsed from transfusions, records of vital signs, type of blood component more frequently transfused, and hospital unit where transfusion was performed. Results A total of 1,012 records were analyzed, and 53.4% of them had errors in filling in the instruments, 6% of transfusions started after the recommended time, and 9.3% of patients had no vital signs registered. Conclusion Failures were identified in the process of recording transfusion monitoring, and they could result in more adverse events related to the administration of blood components. Planning and implementing strategies to enhance recording and to improve care delivered are challenging.


RESUMO Objetivo Analisar o processo de registro de monitorização do ato transfusional em um hospital público de ensino. Métodos Estudo descritivo, retrospectivo, de abordagem quantitativa. Foram analisados os instrumentos de registro de monitorização do ato transfusional em um hospital público do interior de Minas Gerais (MG). Foram coletados dados relativos a correto preenchimento do instrumento, tempo decorrido das transfusões, registros dos sinais vitais, tipo de hemocomponente mais frequentemente transfundido e setor de ocorrência da transfusão. Resultados Foram analisados 1.012 instrumentos, dos quais 53,4% apresentaram falhas no preenchimento, 6% das infusões foram iniciadas após o tempo preconizado e 9,3% dos pacientes não tiveram os sinais vitais registrados. Conclusão Foram identificadas falhas no processo de registro da monitorização transfusional, que podem gerar maior ocorrência de eventos adversos relacionados à administração de hemocomponentes. É um desafio elaborar e implementar estratégias que possibilitem aprimorar os registros, assim como a assistência prestada.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Blood Transfusion/statistics & numerical data , Monitoring, Physiologic/statistics & numerical data , Brazil , Medical Records/statistics & numerical data , Retrospective Studies , Practice Guidelines as Topic , Erythrocyte Transfusion/statistics & numerical data , Hospitals, Public/statistics & numerical data , Hospitals, Teaching/statistics & numerical data , Intensive Care Units/statistics & numerical data , Monitoring, Physiologic/nursing
15.
Einstein (Säo Paulo) ; 12(3): 282-286, Jul-Sep/2014. tab, graf
Article in English | LILACS | ID: lil-723932

ABSTRACT

Objective To analyze the profile of patients with microorganisms resistant to carbapenems, and the prevalence of the enzyme Klebsiella pneumoniae carbapenemase in interobacteriaceae. Methods Retrospective descriptive study. From the isolation in bacteriological tests ordered by clinicians, we described the clinical and epidemiological characteristics of patients with enterobacteria resistants to carbapenems at a university hospital, between March and October 2013. Results We included 47 isolated patients in this study, all exhibiting resistance to carbapenems, including 9 patients who were confirmed as infected/colonized with K. pneumoniae carbapenemase. Isolation in tracheal aspirates (12; 25.5%) predominated. The resistance to ertapenem, meropenem, and imipenem was 91.5%, 83.0% and 80.0%, respectively. Aminoglycosides was the class of antimicrobials that showed the highest sensitivity, 91.5% being sensitive to amikacin and 57.4% to gentamicin. Conclusion The K. pneumoniae carbapenemase was an important agent in graun isotaling in hospital intection. The limited therapeutic options emphasize the need for rapid laboratory detection, as well as the implementation of measures to prevent and control the spread of these pathogens. .


Objetivo Analisar o perfil dos pacientes que apresentaram microrganismos com resistência aos carbapenêmicos, e a prevalência da enzima Klebsiella pneumoniae carbapenemase em enterobactérias. Métodos Estudo retrospectivo descritivo. A partir do isolamento em exames bacteriológicos solicitados pelos clínicos, descrevemos as características clínicas e epidemiológicas dos pacientes que apresentaram enterobactérias resistentes aos carbapenêmicos entre março e outubro de 2013 em um hospital universitário. Resultados Foram incluídos 47 pacientes isolados, todos apresentando resistência aos carbapenêmicos, dos quais 9 tiveram confirmação de infecção/colonização por K. pneumoniae carbapenemase. Ocorreu predomínio de isolamento em aspirados traqueais (12; 25,5%). A resistência ao ertapenem, meropenem e imipenem foi de 91,5%, 83,0% e 80,0%, respectivamente. Os aminoglicosídeos foram a classe de antimicrobianos que apresentou maior sensibilidade, sendo 91,5% sensível a amicacina e 57,4% a gentamicina. Conclusão A K. pneumoniae carbapenemase constituiu um importante patógeno hospitalar em isolamento crescente nesse nosocômio. As limitadas opções terapêuticas reforçam a necessidade de uma rápida detecção laboratorial, assim como a implementação de medidas de prevenção e controle da disseminação desses patógenos. .


Subject(s)
Adolescent , Adult , Child , Female , Humans , Male , Young Adult , Bacterial Proteins/biosynthesis , Cross Infection/microbiology , Drug Resistance, Bacterial , Enterobacteriaceae/enzymology , Klebsiella Infections/enzymology , Klebsiella pneumoniae/enzymology , beta-Lactamases/biosynthesis , Carbapenems/therapeutic use , Enterobacteriaceae Infections/enzymology , Enterobacteriaceae Infections/microbiology , Enterobacteriaceae/drug effects , Enterobacteriaceae/isolation & purification , Hospitals, Teaching/statistics & numerical data , Klebsiella Infections/microbiology , Klebsiella pneumoniae/drug effects , Klebsiella pneumoniae/isolation & purification , Microbial Sensitivity Tests , Polymerase Chain Reaction , Retrospective Studies
16.
Rev. saúde pública ; 48(2): 314-321, abr. 2014. graf
Article in Portuguese | LILACS | ID: lil-711859

ABSTRACT

OBJETIVO Analisar os motivos de atraso na alta hospitalar de pacientes internados em enfermarias de clínica médica. MÉTODOS Foram analisados 395 prontuários de pacientes consecutivos das enfermarias de clínica médica de dois hospitais públicos de ensino: Hospital das Clínicas da Universidade Federal de Minas Gerais e Hospital Odilon Behrens. Foi utilizado o Appropriateness Evaluation Protocol para definir o momento a partir do qual as anotações do prontuário permitiam concluir que a permanência no hospital não mais era adequada. O intervalo entre esse momento e a data da alta hospitalar efetivada definiu o total de dias de atraso na alta hospitalar. Foi utilizado, sistematicamente, instrumento para categorizar os motivos de atraso da alta hospitalar, tendo sido realizada análise de frequências. RESULTADOS O atraso na alta hospitalar ocorreu em 60,0% das 207 internações do Hospital das Clínicas e em 58,0% das 188 internações do Hospital Odilon Behrens. O atraso por paciente foi em média de 4,5 dias no primeiro e 4,1 dias no segundo, o que corresponde à taxa de ocupação de 23,0% e 28,0% em cada hospital, respectivamente. Os principais motivos de atraso nos dois hospitais foram, respectivamente: espera para realização de exames complementares (30,6% e 34,7%) ou para liberação dos laudos dos exames (22,4% e 11,9%) e os relacionados à responsabilidade médica (36,2% e 26,1%), compreendendo a demora na discussão do caso clínico e na tomada de decisão clínica e dificuldades nas interconsultas, respectivamente (20,4% e 9,1%). CONCLUSÕES Foi constatado percentual elevado de atraso na alta hospitalar nos dois hospitais. O atraso foi devido principalmente a fatores relacionados a processos, que podem ser melhorados por intervenções da equipe assistencial e dos ...


OBJECTIVE To analyze the causes of delay in hospital discharge of patients admitted to internal medicine wards. METHODS We reviewed 395 medical records of consecutive patients admitted to internal medicine wards of two public teaching hospitals: Hospital das Clínicas of the Universidade Federal de Minas Gerais and Hospital Odilon Behrens. The Appropriateness Evaluation Protocol was used to define the moment at which notes in the medical records indicated hospital stay was no longer appropriate and patients could be discharged. The interval between this estimated time and actual discharge was defined as the total number of days of delay in hospital discharge. An instrument was used to systematically categorize reasons for delay in hospital discharge and frequencies were analyzed. RESULTS Delays in discharge occurred in 60.0% of 207 hospital admissions in the Hospital das Clínicas and in 58.0% of 188 hospital admissions in the Hospital Odilon Behrens. Mean delay per patient was 4.5 days in the former and 4.1 days in the latter, corresponding to 23.0% and 28.0% of occupancy rates in each hospital, respectively. The main reasons for delay in the two hospitals were, respectively, waiting for complementary tests (30.6% versus 34.7%) or for results of performed tests to be released (22.4% versus 11.9%) and medical-related accountability (36.2% versus 26.1%) which comprised delays in discussing the clinical case and in clinical decision making and difficulties in providing specialized consultation (20.4% versus 9.1%). CONCLUSIONS Both hospitals showed a high percentage of delay in hospital discharge. The delays were mainly related to processes that could be improved by interventions by care teams and managers. The impact on mean length of stay and hospital occupancy rates was significant and troubling in a scenario of relative shortage of beds and long waiting lists for hospital admission. .


Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Length of Stay , Patient Discharge , Brazil , Hospitals, Teaching/statistics & numerical data , Length of Stay/statistics & numerical data
17.
Clinics ; 69(3): 163-167, 3/2014. tab
Article in English | LILACS | ID: lil-703602

ABSTRACT

OBJECTIVES: Drug safety problems can lead to hospital admission. In Brazil, the prevalence of hospitalization due to adverse drug events is unknown. This study aims to estimate the prevalence of hospitalization due to adverse drug events and to identify the drugs, the adverse drug events, and the risk factors associated with hospital admissions. METHOD: A cross-sectional study was performed in the internal medicine ward of a teaching hospital in São Paulo State, Brazil, from August to December 2008. All patients aged ≥18 years with a length of stay ≥24 hours were interviewed about the drugs used prior to hospital admission and their symptoms/complaints/causes of hospitalization. RESULTS: In total, 248 patients were considered eligible. The prevalence of hospitalization due to potential adverse drug events in the ward was 46.4%. Overprescribed drugs and those indicated for prophylactic treatments were frequently associated with possible adverse drug events. Frequently reported symptoms were breathlessness (15.2%), fatigue (12.3%), and chest pain (9.0%). Polypharmacy was a risk factor for the occurrence of possible adverse drug events. CONCLUSION: Possible adverse drug events led to hospitalization in a high-complexity hospital, mainly in polymedicated patients. The clinical outcomes of adverse drug events are nonspecific, which delays treatment, hinders causality analysis, and contributes to the underreporting of cases. .


Subject(s)
Female , Humans , Male , Middle Aged , Drug-Related Side Effects and Adverse Reactions/epidemiology , Hospitalization/statistics & numerical data , Patient Admission/statistics & numerical data , Age Distribution , Brazil/epidemiology , Cross-Sectional Studies , Hospitals, Teaching/statistics & numerical data , Logistic Models , Prevalence , Risk Factors , Sex Distribution , Statistics, Nonparametric
18.
Rev. chil. infectol ; 30(2): 129-134, abr. 2013. ilus
Article in Spanish | LILACS | ID: lil-673993

ABSTRACT

Objectives: To report the results of 13 years worth of epidemiologic surveillance of ventilator-associated pneumonia (VAP) following heart surgery and the main interventions applied in order to reduce VAP incidence. Methods: This is a retrospective and descriptive study of active epidemiologic surveillance of VAP. National diagnostic criteria were used. Interventions associated with a decrease in VAlP incidence in adults who underwent heart surgery are described. Results: A significant and sustained reduction was observed in the rate of VAP; being 56.7 per 1,000 ventilator-days in 1998 vs 4.7 per 1,000 ventilator-days in 2010 (p < 0.001). The strongest reduction was observed following 2003 (34.4 to 14.8 per 1,000 ventilator-days in 2004, p < 0.001). The interventions with greatest impact were the implementation of an early-weaning protocol, the introduction of trained nurses to perform the mechanical ventilator equipment management and the routine use of alcohol-based hand rubs. Conclusion: Epidemiologic surveillance associated with the establishment of a multifactorial intervention program applied in collaboration with the attending team, have demonstrated a significant reduction of VAP incidence after heart surgery.


Objetivos: Comunicar los resultados de 13 años de vigilancia epidemiológica de neumonía asociada a ventilación mecánica (NAVM) post cirugía cardíaca y las principales intervenciones implementadas para reducir su incidencia. Metodología: Estudio retrospectivo, descriptivo, de vigilancia epidemiológica activa de NAVM utilizando los criterios del ]Ministerio de Salud (MINSAL) y de las intervenciones asociadas con una disminución de la tasa de NAVM en adultos operados de cirugía cardíaca. Resultados: Se observó una reducción significativa y sostenida de la tasa de NAVM, siendo 56,7 por 1.000 días de ventilación mecánica (VM) en 1998 vs 4,7 por 1.000 días de VM en 2010 (p < 0,001). La mayor reducción fue observada a partir de 2003 (desde 34,4 a 14,8 por 1.000 días de VM en 2004, p < 0,001). Las intervenciones con mayor impacto fueron la implementación de un protocolo de extubación precoz, la incorporación de enfermeras capacitadas en el manejo de los equipos de VM y el uso rutinario de alcohol gel. Conclusión: La vigilancia epidemiológica asociada a un programa de intervención multifactorial aplicado en conjunto con el equipo tratante permitió reducir significativamente la incidencia de NAVM post cirugía cardíaca.


Subject(s)
Adult , Humans , Cardiac Surgical Procedures , Epidemiological Monitoring , Hospitals, Teaching/statistics & numerical data , Infection Control/methods , Pneumonia, Ventilator-Associated/prevention & control , Cardiac Surgical Procedures/adverse effects , Cardiac Surgical Procedures/statistics & numerical data , Chile/epidemiology , Hospitals, Teaching/standards , Incidence , Intensive Care Units , Pneumonia, Ventilator-Associated/epidemiology , Retrospective Studies
19.
Braz. j. infect. dis ; 17(1): 48-53, Jan.-Feb. 2013. ilus, tab
Article in English | LILACS | ID: lil-665774

ABSTRACT

OBJECTIVES: This study aimed to analyze the pattern of surgical chemoprophylaxis, surgical site infection rate, and to check rationality of surgical chemoprophylaxis based on Kunin's criteria. MATERIALS AND METHODS: A prospective, observational study was performed on patients undergoing surgery, in a tertiary care teaching hospital. Data were collected in a pro-forma which included the patients' details, prescriptions from date of admission to discharge or any other outcome and operative notes. Surgical site infection as defined by Centre for Disease Control criteria was recorded. Rationality was assessed based on Kunin's criteria. RESULTS: Total 220 patients were enrolled over a period of one year. Mean hospital stay was 8.67 ± 5.17 days. A total of 2294 drugs were prescribed out of which 840 (36.61%) were antimicrobials. Mean duration for pre-operative intravenous antimicrobial therapy was 0.75 ± 0.45 day and for post-operative intravenous antimicrobial therapy was 3.33 ± 2.24 days while post-operative oral antimicrobial therapy was 4.58 ± 3.34 days. Third generation cephalosporins were prescribed most frequently 64.74% and 64.40% pre-operatively and post-operatively respectively. Antimicrobial prescribing was inappropriate in 52.28%. Total of 19 patients developed surgical site infection. Surgical site infection rate was significantly higher (13.04%) in patients receiving inappropriate chemoprophylaxis (p < 0.01). Surgical site infection adds 9.98 days of hospital stay (p < 0.0001) and 3.57 extra drugs (p < 0.0001) compared to group without surgical site infection. CONCLUSION: Inappropriate use of antimicrobials is highly prevalent in surgical chemoprophylaxis leading to higher surgical site infection rate. Adoption of international standard and formulation of locally feasible guidelines can help overcome this situation.


Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Anti-Bacterial Agents/therapeutic use , Inappropriate Prescribing/statistics & numerical data , Surgical Wound Infection/prevention & control , Hospitals, Teaching/statistics & numerical data , Length of Stay , Prospective Studies , Surgical Wound Infection/epidemiology , Tertiary Healthcare
20.
Braz. j. infect. dis ; 16(6): 503-509, Nov.-Dec. 2012. ilus, tab
Article in English | LILACS | ID: lil-658918

ABSTRACT

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


Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Bacteremia , Cross Infection , Hospital Mortality , Staphylococcal Infections , Staphylococcus aureus , Bacteremia/economics , Bacteremia/microbiology , Bacteremia/mortality , Brazil/epidemiology , Case-Control Studies , Cross Infection/economics , Cross Infection/microbiology , Cross Infection/mortality , Hospital Costs , Hospitals, Teaching/economics , Hospitals, Teaching/statistics & numerical data , Length of Stay , Staphylococcal Infections/economics , Staphylococcal Infections/mortality
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