Characterization of the health-care-associated urinary tract infections at the Hospital das Clínicas de Ribeirão Preto, São Paulo, Brazil / Caracterização das infecções do trato urinário relacionadas à assistência médica no Hospital de Ribeirão Preto - SP

Urinary tract infections (UTIs) are the most common health-care-associated infections (HCAIs) and one of the top-ranking microbial infections. In the community, about 80% of UTIs are caused by uropathogenic Escherichia coli (UPEC), but there is a high variability of etiological agents involved in hospital-acquired UTIs. With this context in mind, the current study aimed to evaluate the prevalence of the main etiological agents responsible for UTIs and their susceptibility profile at the Hospital das Clínicas de Ribeirão Preto, a high complexity reference hospital in the Southeast region of Brazil. This retrospective and descriptive study analyzed all positive inpatient cultures [100,000 colony-forming unit (CFU)/mL] from November 2016 to April 2017. The most prevalent microorganism was Kleb-siella pneumoniae (23 isolates), equivalent to 37.7% of positive urocultures. The second most prevalent agent was UPEC, with 19 isolates (31.1%). The risk factors evaluated in these inpatients showed that 17.5% underwent a uro-logical procedure on admission, 31.6% were using a urinary catheter; 26.2% were using immunosuppressive drugs during the period in which the clinical diagnosis was made. Our results demonstrate the prevalence of UTI causes in the hospital context and the main risk factors for them and will be pretty helpful in guiding empirical treatment in severe UTIs inside the hospital as well as reflect on the actual need and time duration of invasive procedures in the hospital environmen (AU)

As infecções do trato urinário (IU) são a terceira causa principal de infecções associadas ao ambiente hospitalar, logo após as infecções pulmonares e da corrente sanguínea. Na comunidade, cerca de 80% das IU são causadas por E. coli, mas há uma alta variabilidade de agentes etiológicos envolvidos nas IU hospitalares. Este estudo visa avaliar a prevalência dos principais agentes etiológicos e perfil de suscetibilidade envolvidos em IU em um am-biente hospitalar de referência de alta complexidade no sul do Brasil. Este é um estudo retrospectivo e descritivo que analisou todas as culturas positivas (100.000 ufc/ml) de pacientes nas enfermarias de um hospital terciário no período entre novembro de 2016 a abril de 2017. O microorganismo mais prevalente foi Klebsiella pneumoniae (23 isolados), o que equivale a 37,7% das uroculturas. O segundo agente mais prevalente foi Escherichia coli, com 19 isolados (31,1%). Os fatores de risco avaliados nestes pacientes mostraram que 17,5% foram submetidos a um procedimento urológico na admissão, 31,6% estavam usando um cateter urinário; 26,2% estavam usando drogas imunossupressoras no período em que o diagnóstico clínico foi feito. Nossos resultados demonstram uma mudança importante na prevalência das causas de IU no contexto hospitalar e os principais fatores de risco para elas e serão bastante úteis para orientar o tratamento empírico em IU grave dentro do hospital, bem como refletir sobre a real necessidade e a duração dos procedimentos invasivos no ambiente hospitalar (AU)

Prevención de infecciones asociadas a la atención de salud: conocimientos y prácticas en médicos residentes / Prevention of health care-associated infections: knowledge and practices in resident physicians

RESUMEN Objetivos. Determinar el nivel de conocimientos y prácticas sobre las medidas de prevención de las infecciones asociadas a la atención de salud (IAAS) y sus factores asociados en médicos residentes ingresantes 2018 de una universidad de Lima, Perú. Métodos. Estudio transversal en el cual se aplicó un cuestionario validado a 171 médicos residentes. Las variables estudiadas fueron edad, sexo, tiempo como profesional, capacitaciones previas, procedencia, tipo de universidad de procedencia, entre otras. Resultados. 52% de los participantes fueron de sexo femenino, el 49% tenía 2 o menos años de tiempo como profesional médico, el 49% provenía de una universidad del interior del país, solo el 34% ocupó una vacante cautiva y el 71,9% tuvo capacitaciones previas sobre medidas de prevención de IAAS. El 83% de los médicos residentes ingresantes estudiados mostró poco conocimiento sobre medidas de prevención de las IAAS mientras que el 68,4% mostró prácticas no adecuadas sobre medidas de prevención de las IAAS. El ingreso a una especialidad de medicina estuvo asociado a un menor riesgo de tener poco conocimiento (OR: 0,32, IC 95%: 0,11-0,93). El mayor tiempo como profesional se relacionó a un menor riesgo de tener prácticas inadecuadas (OR: 0,936, IC 95%: 0,89-0,99). Conclusiones. Existe un bajo nivel de conocimientos sobre medidas de prevención de IAAS y una elevada proporción de los residentes ingresantes 2018 tuvo prácticas no adecuadas sobre medidas de prevención de IAAS. Se observó que el tipo de especialidad fue un factor asociado al nivel de conocimientos y el tiempo de experiencia profesional fue un factor asociado al tipo de práctica.

ABSTRACT Objectives. To determine level of knowledge and practices on the measures of prevention of infections associated with health care (HAI) and factors associated with in incoming resident physicians 2018 of a university of Lima, Peru. Methods. A validated questionnaire was applied to 171 resident physicians in a cross-sectional study. Variables studied were age, sex, time as a professional, previous training, origin, type of university of origin, among others. Results. It was observed that 52% are female, 49% had 2 or less years as a medical professional, 49% came from a university in the interior of the country, only 34% occupied a captive vacancy and 71.9% had previous training on HAI prevention measures. 83% of the incoming resident physicians studied showed a low level of knowledge about HAI prevention measures while 68.4% of the incoming resident physicians studied showed inappropriate practices on HAI prevention measures. When performing the multivariate analysis, it showed that entering a medicine specialty was associated with a lower risk of having low level of knowledge (OR: 0.32, 95% CI: 0.11-0.93). The bivariate analysis showed that the longest time as a professional was related to lower risk of having inappropriate practices, this being confirmed when performing the multivariate analysis (OR: 0.936, 95% CI: 0.89-0.99). Conclusions. There is a low level of knowledge about HAI prevention measures and a high proportion with inappropriate practices in incoming residents 2018 on HAI prevention measures. It was observed that the type of specialty is a factor associated with the level of knowledge and the time of professional experience is a factor associated with the type of practice.

Role of prophylactic antibiotics in elective surgeries and postoperative surgical infections

Background: Health care associated infections (HAIs) present a significant source of preventable morbidity and mortality. More than 30% of all HAIS are represented by surgical site infections (SSIs) making them most common sub types between 1.9% and 2.7% of all surgical patients. Joseph Lister “the man who made surgery safe” introduced antiseptic method for safe surgeries. As many are now considering antibiotics “wonder drug” which covers the surgical techniques and having asepsis. Extensive indiscriminate use of antibiotics has resulted in developing resistance.Methods: Study conducted in about 100 cases in various surgical units having various surgical procedures. Only clean cases are taken. A single stat dose of first generation cephalosporin 1gm given IV at the time of giving anesthesia. Postoperative any signs and symptoms like infections, fever with chills, wound discharge are observed. If any evidence of wound infection is present, accordingly sent for culture and sensitivity and suitable antibiotics are given.Results: In our study 5 patients had fever with serous discharge 2 patients showed no growth, 3 patients had got growth positive (2- staphylococcus aurous, 1- pseudomonas). Hence our infection rate is 3%.Conclusions: Single dose prophylaxis has got definite advantage to overcome the postoperative wound sepsis. Prolonged antibiotic therapy should be avoided as it has got no added advantages over single dose antibiotic.

Contaminación ambiental por microorganismos multirresistentes y el efecto de la limpieza y desinfección en una unidad de cuidados intensivos / Environmental contamination by multi-resistant microorganisms and the effect of cleaning and disinfection in an intensive care unit / Contaminação ambiental por micro-organismos multirresistentes e o efeito de limpeza e desinfecção em unidade de terapia intensiva

Conocer el rol del medio ambiente es fundamental para evitar las infecciones intra-hospitalarias. Con ese objetivo, se planteó evaluar la prevalencia de contaminación ambiental por microorganismos multirresistentes (MMR) antes y después de la limpieza terminal de habitaciones de pacientes colonizados y establecer si la aparatología de uso común actuaba como reservorio de estos en la unidad de cuidados intensivos (UTI). Se obtuvieron muestras ambientales de las habitaciones, 48 h posteriores a la detección de colonización y luego de las limpiezas. Los resultados mostraron que luego de ambos procedimientos de limpieza se logró reducir de 28,2% a 2,6% la contaminación por Acinetobacter spp. multirresistente (AMR). También, se tomaron muestras de aparatología de uso común encontrándose entre 1,8 y 5,4% de contaminación por MMR. La limpieza y desinfección reducen significativamente la contaminación ambiental. Sin embargo, la colonización de equipos por MMR y el incumplimiento de precauciones universales representan una posibilidad de transmisión cruzada.

It is essential to understand the role of the environment in order to avoid intrahospital infections. To achieve this objective, this research proposes to assess the prevalence of the environmental contamination caused by multi-resistant microorganisms (MRM) before and after terminal disinfection in rooms with colonized patients, but also to establish whether the commonly used device acts as a reservoir of those micro-organisms in an intensive care unit (ICU). Environmental samples were obtained from the rooms, 48 hours after detecting colonization and also after the first and second final cleaning. The results showed that after both procedures, there was a reduction from 28.2% to 2.6% of contamination caused by multi-resistant Acinetobacter spp. (AMR). Samples from appliances and supplies were taken as well, in which case, between 1.8 and 5.4% of contamination levels induced by MMR were found. Cleaning and disinfecting significantly reduce environmental contamination. However, both MMR bacterial colonization and the lack of universal precautions enforcement represent a possibility of cross-transmission.

É essencial conhecer o papel do meio ambiente para evitar as infecções intra-hospitalares. Com esse objetivo, planejou-se avaliar a prevalência de contaminação ambiental por microorganismos multirresistentes (MMR) antes e depois da limpeza final dos quartos de pacientes colonizados e estabelecer se os aparelhos de uso comum atuavam como um reservatório deles na unidade de terapia intensiva (UTI). Obtiveram-se amostras ambientais dos quartos 48 horas após a detecção da colonização e logo após as limpezas finais. Os resultados mostraram que depois dos dois procedimentos de limpeza se obteve uma redução de 28,2% para 2,6% da contaminação por Acinetobacter spp. multirresistente (AMR). Foram obtidas também amostras de aparelhos de uso comum onde se encontraram entre 1,8% e 5,4% de contaminação por MMR. A limpeza e a desinfecção reduzem significativamente a contaminação ambiental. Contudo, a colonização de equipamentos por MMR e o não cumprimento de providências universais representam uma possibilidade de transmissão cruzada.

Knowledge, attitude and practices of hand hygiene among nurses and nursing students in a tertiary health care center of Central India: a questionnaire based study

Background: Health care associated infections and emerging multi drug resistance in nosocomial pathogens is perceived as a serious public health threat with grievous concerns. Hand hygiene if practiced properly is cheapest, simplest and most effective tool in tackling this problem. The objective of this study was conducted to assess levels of knowledge, attitude and practice in various aspects of hand hygiene in nurses and nursing students in the study area for identifying gaps for planning necessary corrective measures.Methods: A cross sectional study involving self-administered pre-structured anonymous questionnaires administered to 50 staff nurses and 80 nursing students posted at a tertiary health care center of Central India. Z test of proportions was used to compare the percentages for each of the appropriate responses between the two study groups.Results: Most of the study participants exhibited moderate levels of knowledge and practice with marginal difference between two study groups. While nursing students were found to exhibit a remarkably higher level of attitude than staff nurses, difference being statistically significant.Conclusions: This study stresses upon the growing need for prompt interventions at institutional level for addressing the gaps evident from the study.

Assessment of hand hygiene practices among health care providers in a government tertiary care hospital

Background: Hand hygiene practices either by hand rub by disinfectant or hand washing by soap and water are very important for preventing Health care-associated infections (HCAIs). WHO have devised guidelines for hand rub and hand wash and advocated “My five moments for hand hygiene” as the approach for appropriate performance, teaching and evaluation of hand hygiene. The objective of this study is to observe hand hygiene practices, among health care providers in a tertiary care govt. hospital and document facilities available at the point of patient care for hand hygiene practices.Methods: A cross sectional observation study was conducted in 8 departments of a Government Tertiary care Hospital for observation of hand hygiene practices as Per WHO Guideline on “5 Moment of Care”. Total of 600 observations were made and one Health care provider was observed once at a point of time. Data Entry was done in MS excel and was analysed in Open Epi software.Results: Among 600 moments observed, 354 (59%) moments were those where hand hygiene practices were missed by HCPs. Among various HCPs 63% Doctors, 62% Nurses, 52% Medical students and 59% nursing students missed the hand hygiene practices. Lack of antimicrobial soap, alcohol based agents, sterile towel and hand drier were perceived barriers for hand hygiene Practices.Conclusions: There lies a huge gap in practice of hand hygiene among all cadres of health care providers. The study is able to identify the lack of infrastructure which can be improved to promote hand hygiene in wards.

Prolonged Urinary Catheterization – A Risk Factor for Intensive Care Unit Infections and Mortality: A Clinical Study in Tertiary Teaching Hospital of Northern Kerala

Background: The major cause of mortality and morbidity in intensive care units (ICUs) are health care-associated infection(HCAI), especially nosocomial infection (NCI). HCAI and NCI are key factors determining the clinical outcome among patientsadmitted in critical care areas. Few hospitals in India perform regular surveillance for HCAI and NCI in ICUs.Aim of the study: This study aims to study the incidence of HCAI and NCI as risk factors associated with mortality and morbidityICUs.Materials and Methods: A total of 624 patients hospitalized in six different ICUs of a large teaching hospital in Northern Keralawere assessed between April 2016 and March 2018. NCI was defined as the presence of clinical signs and symptoms of infectionin patients at least 48 h after their hospitalization, confirmed by positive cultures of specimens taken from the patients’ blood,urine, wounds, respiratory secretions, and other body fluids. A checklist comprising 109 questions were used to assess thepresence of HCAI and NCI as factors of increased mortality and morbidity.Observations and Results: Among the 624 patients, 364 (58.33%) were male and 260 were female (41.66%). The youngestpatient was aged 16 years and the eldest one was aged 87 years with a mean age of 49.78 ± 11.30. The mean age of patientswho had NCIs was 57.68 ± 09.45 when compared to the mean age of 52.39 ± 8.20 in patients without NCIs with P = 0.781(statistically not significant). The mean age of patients who died with NCIs was 76.15 ± 6.29 and the mean age of patientswith NCIs who survived was 63.20 ± 7.70 with P = 0.021 (statistically significant). Culture positivity of specimens collected andanalyzed was observed in 195 (31.25%) patients. The overall rate of confirmed NCI in the studied patients was 241/624 (38.61%)(confidence interval 95% = 13.25–21.50). General ICU was the most crowded ward consisting of 237/624 admissions (37.98%)and had the highest rate of NCIs 72/159 (38.81%).Conclusions: The patients with prolonged urinary catheterization were prone to NCIs and deaths in ICUs, and hence, theyshould be treated intensively

Susceptibilidad antimicrobiana en muestras clínicas de pacientes con infecciones asociadas a la atención de salud / Antimicrobial susceptibility in clinical samples of patients with health care associated infections

Introducción: Las infecciones asociadas a la atención de salud (IAAS) son uno de los principales problemas que afecta a los pacientes en las unidades hospitalarias, tanto en países desarrollados como carentes de recursos. Objetivo: Identificar los tipos de IAAS reportadas, microorganismo causal y susceptibilidad antimicrobiana en el Servicio de Medicina Interna del Hospital Clínico-Quirúrgico "Manuel Fajardo". Material y método: Estudio descriptivo, retrospectivo y transversal de 105 pacientes con IAAS, quienes ingresaron en el Servicio de Medicina Interna del Hospital Clínico-Quirúrgico Manuel Fajardo, desde enero 2013 hasta diciembre 2015. Se analizaron distintas variables. Se utilizó la estadística descriptiva y se relacionó la información nacional e internacional con los resultados obtenidos. Resultados: Predominaron los pacientes con edad superior a los 60 años. El diagnóstico más común fue la bronconeumonía en 58 pacientes (55.2 por ciento). El principal microorganismo causal para la bronconeumonía, la traqueobronquitis y las úlceras de presión fue Pseudomona spp.; mientras que para la infección del tracto urinario y flebitis-celulitis y absceso fueron E. coli y S. aureus respectivamente. Pseudomona spp. y E. coli mostraron alta resistencia a las cefalosporinas de primera, segunda y tercera generaciones testadas y a otros tipos de antibióticos; sin embargo, para los aminoglucósidos y Cefepime la sensibilidad fue favorable. La susceptibilidad de S. aureus mostró resultados muy adversos, pues solo para la Amikacina y Vancomicina tuvo aceptable sensibilidad. Conclusiones: Las IAAS predominaron en una población envejecida y fueron ocasionadas por una diversidad de microorganismos, principalmente Pseudomona spp., E. coli y S. aureus, los cuales mostraron elevada resistencia antimicrobiana(AU)

Introduction: The health care associated infections (HCAI) are one of the major problems which affect the patients in the hospital units, both in developed countries and in countries with low resources. Objective: To identify what kind of HCAI were reported, causal microorganism and antimicrobial susceptibility in the Internal Medicine Service at the "Manuel Fajardo" clinical-surgical hospital. Material and method: Descriptive, retrospective and transversal study of 105 patients with HCAI, who were admitted in the Internal Medicine Service at the Manuel Fajardo clinical-surgical hospital, from January 2013 to December 2015. It was analyzed different variables. It was used descriptive statistics and it was related the national and international information with the obtained results. Results: It were predominated the patients with age over 60 years. The more common diagnosis was broncho-pneumonia in 58 patients (55.2 percent). The principal causal microorganism for broncho-pneumonia, the tracheo-bronchitis and the pressure ulcers was Pseudomona spp.; while for urinary tract infection and flebitis-cellulitis and abscess were E. coli and S. aureus respectively. Pseudomona spp. and E. coli showed high resistance to cephalosporins of the first, second and third generation tested and other kinds of antibiotics; however, for the amynoglucosides and for Cefepime the sensibility was favourable. The susceptibility of S. aureus showed very adverse results, because only for Amikacin and Vancomicin had acceptable sensibility. Conclusions: The HCAI predominated in an aged population and were caused by a diversity of microorganisms, principally Pseudomona spp., E. coli and S. aureus, which showed high antimicrobial resistance(AU)

White coats: how much safe are they.

Various studies have suggested that health care workers'(HCW) clothing, including white coats, are potential reservoirs for microorganisms causing health care associated infections, reinfecting the hands of HCWs and may be a vector for transmission of nosocomial pathogens. Hence the present study was undertaken to detect the incidence of pathogenic microorganisms that contaminate nurses white coats. Methods: Total 324 swabs, collected by swabbing the three sites of the surface of the Nurses’ white coat (pockets, abdominal zone and the sleeve ends) were inoculated on blood agar, Mac-Conkey’s agar and incubated at 37°C overnight. Microbial growth was identified by standard methods. Antibiotic sensitivity test was carried out by Kirby-Baur disc diffusion method as per CLSI guidelines. Results: Non-pathogenic bacteria (skin flora) were isolated from all white coat culture and pathogenic bacteria from 76 (70.3%) white coats (45 from Surgery & allied departments, 31 from Medicine & allied departments). From total 324 samples, 85 (26.2%) samples were positive for pathogenic bacteria and total 94 pathogenic bacteria were isolated which includes 33 (35.1%) Staphylococcus aureus (6 MRSA, 27 MSSA), 56 gram negative bacilli (17 ESBL producers). The rate of contamination with pathogens, was higher on pockets (57.4%) compared with abdominal zone (27.6%) and sleeve ends (14.8%). Conclusions: The study highlights the importance of white coats as potential source of cross infection. A strict protocol should be followed for preventing cross-contamination from the white coats.

Microbiological characterization of the surface contamination in surgical room areas in a Hospital in Sao Paulo (Brazil) / Caracterización microbiológica de la contaminación de la superficie de áreas del quirófano en un hospital de Sao Paulo (Brasil)

Objective: To describe the microorganisms present on surface areas of surgical rooms, in a medium-sized hospital in Sao Paulo state (Brazil). Materials and method: Sixty samples were collected with the aid of sterile swabs soaked in peptone water and rubbed into quadrants of 20 cm 2 . The surfaces investigated were: medication tables, surgical tables, marble countertops and air conditioning grilles. Results: Staphylococcus aureus , coagulase negative, was the microorganism most frequently found on the surgical tables and on the medication tables (50.7% of the samples). This microorganism is also the most frequent cause of post-surgical infection at the same hospital. Conclusions: Prophylactic measures should include proper hand washing, the use of personal protective equipment, appropriate uniforms, and cleaning and sterilization of surface and medical and hospital equipment.

Objetivo: Describir los microorganismos presentes en las superficies del área de quirófanos de un hospital de tamaño medio en el estado de Sao Paulo (Brasil). Materiales y métodos: Se recolectaron y cultivaron 60 muestras con la ayuda de hisopos estériles en agua peptonada y aplicadas sobre cuadrantes de 20 cm 2 . Las superficies investigadas fueron: tabla de medicamentos, mesa operatoria, terminaciones de mármol de la sala y grillas del aire acondicionado. Resultados: El organismo aislado de manera más frecuente fue Staphylococcus aureus coagulasa negativa y se encontró sobre la mesa operatoria y en la mesa de drogas (50,7% de las muestras). Este es el microorganismo reportado como la causa más frecuente de infecciones post-quirúrgicas en el mismo hospital. Conclusiones: Las medidas profilácticas deben incluir un apropiado lavado de manos, uso de equipo personal protector y limpieza y esterilización del equipo médico y hospitalario y de las superficies de trabajo.

Hosting the Unwanted: Stethoscope Contamination Threat.

Aims: Stethoscopes represent a vehicle of bacteria and other microorganisms and may play a role in the spread of health-care associated infections (HAIs). We aimed to evaluate the contamination levels of stethoscopes before and after use of a disinfecting technique (DT). Study Design: Matched cross-over study. Place and Duration of Study: The study was conducted in July 2012 and involved three hospitals in Siena Province (Italy). Two were public hospitals with about 750 and 140 beds, and the other was private with 40 beds. Methodology: We evaluated: i) contamination on 74 shared and non shared stethoscopes; ii) bacterial load before and after use of a DT. Total bacterial count (TBC) at 36ºC and 22ºC, Staphylococcus spp., molds, Enterococcus spp., Pseudomonas spp., Escherichia coli and total coliforms bacteria were evaluated. Mann Whitney and Wilcoxon tests were used for comparisons (p<0.05). Results: Before DT, 49 stethoscopes were positive for TBC at 36ºC, 48 for TBC at 22ºC, 40 for Staphylococcus spp., 18 for methicillin-resistant Staphylococcus aureus, 33 for coliforms (9 for Escherichia coli), 5 for Enterococcus spp. and 2 for molds. After cleaning, the percentage reduction in CFUs was close at 100% in most comparisons. Shared stethoscopes proved to be less contaminated than non shared ones (p<0.05). Conclusion: Our results suggest that stethoscopes may be potential vehicles of HAIs. The DT was effective in reducing bacterial contamination.

Factores de riesgo para el desarrollo de Infecciones asociadas al cuidado de la salud (IACS) en pacientes quemados. Unidad de Quemados. Hospital del Niño, 2009-2013

Introducción: Las infecciones intrahospitalarias se denominan Infecciones Asociadas a Cuidados de la Salud (IACS). Los pacientes quemados tienen un alto riesgo de infección como resultado del inmunocompromiso, estancias intrahospitalarias prolongadas y los procedimientos diagnósticos/terapéuticos requeridos para su manejo. La Unidad de Quemados en 2012 fue el segundo área con mayor tasa de IACS del Hospital del Niño (incidencia 21.2%). Objetivo: Determinar los factores de riesgo para el desarrollo de IACS en pacientes de la Unidad de Quemados del Hospital del Niño de Panamá atendidos desde el año 2009 al 2013. Material y método: Estudio observacional analítico retrospectivo con muestreo probabilístico. Se determinó la frecuencia y fuerza de asociación entre las variables a estudiar y el desarrollo de IACS mediante la prueba de desigualdad relativa (OR) con su intervalo de confianza correspondiente, un nivel de significancia del 95% y precisión de 0.05, previa verificación de la significancia estadística a través de la prueba X2. Resultados: los lactantes, quemaduras de III grado, extensión >10% de SCTQ, número de segmentos corporales quemados, días de estancia hospitalaria, uso de dispositivos invasivos y la realización de procedimientos quirúrgicos son factores de riesgo para el desarrollo de IACS en pacientes quemados. Por otra parte, el uso de coberturas biosintéticas confiere un factor protector. Conclusión: los quemados poseen características endógenas y exógenas para el desarrollo de IACS. Conocer su comportamiento representa una herramienta útil para su control y prevención.

Introduction: Healthcare-associated infections (HAIs) are infections that developed during a hospitalization. Burned patients are at high risk of infection as a result of the immune suppression, long hospital stays and diagnostic / therapeutic procedures required for its management. The Burn Unit on 2012 was the second area with the highest rate of HAIs of the institution (incidence 21.2%). Objective: Determine the risk factors for the development of HAIs in patients in the Burn Unit of Panama Children Hospital since 2009 to 2013. Material and method: A retrospective analytical and observational study with a probabilistic sampling. We determined the frequency and correlations between the variables and the development of HAIs by Odds Ratio (OR) with its corresponding confidence interval, a level of significance of 95% and a precision of 0.05, upon verification of statistical significance through X2. Results: infants, III degree burns, extension above 10% of Burned Body Surface Area, number of compromised body segments, length of hospital stay, use of invasive devices and surgical procedures are risk factors for the development of HAIs in burned patients. On the other hand, the use of burn wound dressings confers a protective factor for them. Conclusion: burned patients have endogenous and exogenous features that allow the development of HAIs. Knowing their behavior represents a useful tool in the control and prevention of them.

Implementación de la estrategia "Atención Limpia es Atención Segura" en un hospital de tercer nivel en Medellín, Colombia / Implementation of the strategy "Clean Care is Safer Care" in a third level hospital in Medellín, Colombia

Introduction: Hand hygiene is the most cost-effective and simple measure of preventing healthcare associated infections (HAI). The approach to improve low compliance must be through multimodal interventions such as the "Clean Care is Safer Care" strategy (WHO). Aim: To estimate the efficacy of a multimodal strategy in improving hand hygiene in five wards of a tertiary care hospital in Medellín, Colombia (2008-2010). Methods: Quasi-experimental before-after study. Results: Hand hygiene compliance significantly increased after the intervention (82 to 89%, p = 0.007). The knowledge score increased from a median of 26 (IQR=22-28) to 30 (IQR=26-32, p = 0.001). Alcohol-based hand rub consumption increased significantly from 10.5 liters to 58.1 liters per 1000 patient-days [incidence ratio (IR) = 2.39, 95% CI = 1.99; 2.88]. Monthly HAI rates showed no significant variations during the same period [IR = 0.90, 95% CI = 0.71; 1.13]. Discussion: This and other recent studies demonstrate that implementing a multimodal strategy for hand hygiene significantly increases compliance with this measure, irrespective of type of health worker or hospital department. Conclusions: Implementing a multimodal strategy we achieved significant increases in hand hygiene compliance but mild or no significant variations in monthly HAI rates.

Introducción: La higiene de manos es una medida costo-efectiva para prevenir las infecciones asociadas a la atención de salud (IAAS). Para mejorar el cumplimiento se recomienda implementar estrategias multimodales como "atención limpia es atención segura" de la OMS. Objetivo: Estimar el efecto de la estrategia multimodal en cinco unidades de un hospital de tercer nivel en Medellín, Colombia (2008-2010). Métodos: Estudio cuasi-experimental antes y después. Resultados: El cumplimiento general con la higiene de manos aumentó de forma significativa en el período posterior a la implementación (82 a 89%, p = 0,007). El puntaje de conocimientos aumentó entre los dos períodos de tiempo (Mediana = 26, RIC = 22-28 vs Mediana = 30, RIC = 26-32; p = 0,001). El consumo de alcohol aumentó de 10,5 litros a 58,1 litros por 1.000 pacientes/día [razón de incidencias (RI) = 2,39; 95% CI = 1,99; 2,88]. Las tasas mensuales de IAAS no mostraron variaciones [RI = 0,90; 95% CI = 0,71; 1,13]. Discusión: Este estudio demuestra que la implementación de una estrategia multimodal para la higiene de manos aumenta significativamente el cumplimiento con esta medida, independientemente del tipo de trabajador y el servicio hospitalario. Conclusión: Con la estrategia multimodal se aumentó significativamente el cumplimiento con la higiene de manos.

Caracterización del gen mecA de Staphylococcus aureus resistentes a meticilina aislados de tres grupos poblacionales de la ciudad de Medellín / Characterization of mecA gene of methicillin-resistant Staphylococcus aureus Isolated from three population groups in Medellín

Introducción: Staphylococcus aureus resistente a la meticilina (SARM) es responsable de infecciones intrahospitalarias, las que constituyen una importante causa de morbilidad y mortalidad en nuestro medio, por lo cual la rápida identificación y tipificación molecular de la resistencia como el complejo SSCmec es esencial para entender la epidemiología de la infección. Objetivo: Caracterizar fenotípicamente la resistencia a meticilina y genotípicamente el casete cromosomal SSCmec en cepas de S. aureus aislados de individuos de la ciudad de Medellín mediante PCR múltiple. Materiales y métodos: A 41 aislamientos (hospitalarios y de la comunidad) de S. aureus se les estableció la resistencia a cefoxitin mediante la técnica de Kirby-Bauer y la concentración inhibitoria mínima para oxacilina. Mediante PCR convencional se les confirmó la presencia del gen mecA. Para la tipificación del complejo SSCmec se utilizó PCR múltiple para amplificar 6 loci diferentes de este gen. Resultados: A todos los aislamientos se les confirmó resistencia a meticilina y la presencia del gen mecA, de los cuales 17 fueron clasificados como SSC mec I, 1 como SSC mec II, 21 como SSC mecIV; dos aislamientos no fue posible clasificarlos. Conclusiones: Con el uso de esta técnica clasificamos el 95% de los aislamientos del estudio, encontrando una mayor prevalencia de los SSCmec I y IV. La implementación de esta técnica permite una fácil caracterización de los aislamientos SARM y un apropiado manejo de la información de los integrantes de los comités de infecciones hospitalarios, lo cual podría impactar positivamente en el tratamiento a los pacientes y el control de enfermedades infecciosas intrahospitalarias.

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) is involved in nosocomial infections, representing an important cause of morbidity and mortality. The rapid identification and molecular classification of resistance, such as the SSCmec complex, is essential to understanding the epidemiology of infection. Objective: To phenotypically characterize methicillin resistance and to genotype the SSCmec complex in S. aureus isolates collected from a cohort of patients from Medellín, Colombia. Materials and Methods: Cefoxtin resistance was evaluated in 41 S. aureus isolates, using the Kirby-Bauer method and determining the minimal bactericidal concentration of oxacillin. To confirm the presence of the mecA gene, conventional PCR was performed. The classification of the SSCmec complex was carried out by multiple PCR, amplifying 6 different loci in this gene. Results: Methicillin resistance and the presence of the mecA gene were confirmed in all isolates. A total of 17 were classified as SSCmec I, one as SSCmec II, and 21 SSCmec IV (only two isolates were not classified). Conclusions: Using this method, it was possible to classify 95% of the studied isolates, with a higher prevalence of SSCmec I and IV. The implementation of this technique allows the characterization of MRSA isolates and an appropriate management of the information by the members of the Hospital Infection Committee. Altogether, this method may have a positive impact on the treatment of patients with MRSA infections.

Risk Factors for Surgical Site Infections in Patients Undergoing Craniotomy

PURPOSE: The objectives of this study were to determine the prevalence, incidence, and risk factors for postoperative surgical site infections (SSIs) after craniotomy. METHODS: This study was a retrospective case-control study of 103 patients who had craniotomies between March 2007 and December 2008. A retrospective review of prospectively collected databases of consecutive patients who underwent craniotomy was done. SSIs were defined by using the Centers for Disease Control criteria. Twenty-six cases (infection) and 77 controls (no infection) were matched for age, gender and time of surgery. Descriptive analysis, t-test, chi-square-test and logistic regression analyses were used for data analysis. RESULTS: The statistical difference between cases and controls was significant for hospital length of stay (>14 days), intensive care unit stay more than 15 days, Glasgrow Coma Scale (GCS) score (< or =7 days), extra-ventricular drainage and coexistent infection. Risk factors were identified by logistic regression and included hospital length of stay of more than 14 days (odds ratio [OR]=23.39, 95% confidence interval [CI]=2.53-216.11) and GCS score (< or =7 scores) (OR=4.71, 95% CI=1.64-13.50). CONCLUSION: The results of this study show that patients are at high risk for infection when they have a low level of consciousness or their length hospital stay is long term. Nurses have to take an active and continuous approach to infection control to help with patients having these risk factors.