Carga y tipología microbiana relacionada con infecciones asociadas a la asistencia sanitaria en servicios clínicos / The microbial weight and type and its relationship with associated infections in health care

RESUMEN Introducción: Las infecciones asociadas a la asistencia sanitaria repercuten en la calidad de los servicios de salud, causando prolongación en la estancia hospitalaria, aumento en costos de atención, riesgo para la vida de los pacientes. A pesar de los intentos por mejorar esta situación, la problemática aún persiste. Objetivo: Determinar la carga y tipología microbiana relacionada con las infecciones asociadas a la asistencia sanitaria en servicios clínicos. Métodos: Estudio cuantitativo, descriptivo, correlacional, diseño no experimental, realizado en servicios Quirúrgica y Unidad de Cuidados Intensivos de un Hospital de Santa Marta, Colombia, durante abril a septiembre de 2014. De manera intencional se tomaron muestras de laboratorio a pacientes, trabajadores, espacios físicos y equipos. El análisis de la información se realizó mediante frecuencias absolutas y relativas, así como correlación de Pearson. Resultados: Quirúrgica reportó infección de herida quirúrgica (100 por ciento), aislando Pseudomona aeruginosa en 66,66 por ciento de casos; cinco espacios positivos (60,00 por ciento Staphylococcus albus coagulasa negativo y 40,00 por ciento Streptococcus ssp). Dos equipos resultaron positivos para Staphylococcus albus (coagulasa negativo). Unidad de Cuidados Intensivos reportó infecciones urinarias (40,00 por ciento), neumonía (40,00 por ciento) y de herida quirúrgica (20,00 por ciento), siendo Acinetobacter baumannii (40,00 por ciento) el microorganismo más frecuente. En el 100,00 por ciento espacios positivos se aisló Streptococcus ssp; ningún germen fue aislado en instrumental y equipos. Conclusiones: Quirúrgica tuvo mayor carga microbiana que la Unidad de Cuidados Intensivos. El germen predominante fue Acinetobacter baumanii. La correlación entre germen causal de las Infecciones Asociadas a la Asistencia Sanitaria, espacios físicos y equipos biomédicos resultó débil; entre germen causal e instrumental quirúrgico no existió relación(AU)

ABSTRACT Introduction: Health care-associated infections have an impact on the quality of health care services, thus causing longer stay at hospitals, rise in assistance costs and risks for the patient's life. Despite the attempts at improving this situation, the problem still remains. Objective: To determine the microbial burden and typing related to health care-associated infections in the clinical services. Methods: A quantitative, descriptive, correlative and non-experimental design-type study conducted in the Surgery services and in the Intensive Care Unit of a hospital located in Santa Marta, Colombia, from April to September, 2014. The lab samples were intentionally taken from patients, workers, physical spaces and equipment. The information analysis was based on absolute and relative frequencies as well as Pearson's correlation coefficient. Results: The Surgery Services reported surgical wound infection (100 percent), isolation of Pseudomona aeruginosa in 66.66 percent of cases; five bacteria-positive physical spaces (60 percent to coagulase-negative Staphylococcus albus and 40 percent to Streptococcus spp). Two pieces of equipment were positive to coagulase-negative Staphylococcus albus. The Intensive Care Unit reported urinary infections (40 percent), pneumonia (40 percent) and surgical wound (20 percent), being Acinetobacter baumannii (40 percent) the most frequent. In all the positive physical spaces, Streptococcus spp was isolated, but not a single germ was found in the medical instruments or in the equipment. Conclusions: Surgical Service had higher microbial burden than the Intensive Care Unit. The predominant germ was Acinetobacter baumanni. The correlation among the causative germ of health care-associated infections, the physical spaces and the biomedical equipment was poor whereas the correlation of the causative germ and the surgical instruments was non-existent(AU)

Prevalence and antibiogram of methicillin resistant Staphylococcus aureus isolated from medical device-related infections; a retrospective study in Lahore, Pakistan

Abstract INTRODUCTION: With the advancement of medicine and surgery, various types of medical devices have become part of treatment strategies. METHODS: Identification and antimicrobial sensitivity testing were done according to CLSI guidelines following standard microbiological practices. RESULTS: Urinary catheter infections (31%) were most frequent followed by central venous catheter (18%) and orthopedic implants (15%). Methicillin resistant Staphylococcus aureus (MRSA) was a major cause of device-related infection after Escherichia coli (21%); other pathogens were Klebsiella pneumoniae (14%), Pseudomonas spp. (10%), Acinetobacter spp. (8%) and Candida species (7%). None of MRSA was resistant to vancomycin (MIC ≥16µg/mL). Resistance rates were 98% and 97% for ofloxacin and ciprofloxacin, respectively. CONCLUSIONS Escherichia coli and MRSA are major pathogens of medical device-related infections.

Comparative analysis of ampoules and vials in sterile and conventional packaging as to microbial load and sterility test / Análise comparativa de ampolas e frascos-ampolas em embalagens estéreis e convencionais quanto a carga microbiana e teste de esterilidade

ABSTRACT Objective To compare sterility and microbial (bacteria and fungi) load in the outer part of hyperbaric bupivacaine (Neocaína®) in ampoule and bupivacaine in vial, in conventional and sterile pack formulations. Methods The sterile packs were divided into two groups: G1 (n=16) with ampoules and G2 (n=16) with vials. Conventional formulations were divided into two groups, being G3 (n=16) with ampoules and G4 (n=16) with vials. The ampoules and vials were opened and had their content drawn. The empty bottles were then placed in sterile plastic bags and sent for analysis of microbial load (bacteria and fungi) and sterility testing. Data were analyzed using the χ2 test with Yates correction, and 95% confidence interval. Results G1 and G2 showed no bacterial growth when compared to conventional groups (p<0.001). The most common agent in conventional microbiological samples was Staphylococcus aureus. There was no fungal growth in both groups. Conclusion The use of (sterile pack) reduces the microbial load of bottles, and would decrease the chance of exposure to potential contamination of the anesthetic solution.

RESUMO Objetivo Comparar a esterilidade e a carga microbiana (bactérias e fungos) da parte externa dos frascos de envasamento de bupivacaína hiperbárica (Neocaína®) em ampola e bupivacaína em frasco-ampola das apresentações convencional e estéril (sterile pack). Métodos As apresentações estéreis (sterile pack) foram distribuídas em dois grupos, sendo que o G1 (n=16) continha as ampolas e o G2 (n=16), os frascos-ampola. As apresentações convencionais foram distribuídas em dois grupos, a saber G3 (n=16) com as ampolas e G4 (n=16) com os frascos-ampola. As ampolas e os frascos-ampolas eram abertos e tinham seu conteúdo aspirado. Os frascos vazios eram, então, acondicionados em sacos plásticos estéreis e enviados para análise quanto à carga microbiana (bactérias e fungos), bem como para o teste de esterilidade. Os dados foram analisados por meio do teste χ2 com correção Yates com intervalo de confiança de 95%. Resultados Os grupos G1 e G2 não apresentaram crescimento bacteriano quando comparado aos grupos convencionais (p<0,001). O microbiano mais comum nas amostras convencionais foi o Staphylococcus aureus. Não houve crescimento de fungos em nenhum dos grupos. Conclusão O uso de embalagens estéreis (sterile pack) diminui a carga microbiana dos frascos de envasamentos, o que diminuiria a chance de exposição a uma potencial contaminação da solução anestésica.

Stability of antimicrobial activity of peracetic acid solutions used in the final disinfection process

The instruments and materials used in health establishments are frequently exposed to microorganism contamination, and chemical products are used before sterilization to reduce occupational infection. We evaluated the antimicrobial effectiveness, physical stability, and corrosiveness of two commercial formulations of peracetic acid on experimentally contaminated specimens. Stainless steel specimens were contaminated with Staphylococcus aureus, Escherichia coli, Candida albicans, blood, and saliva and then immersed in a ready peracetic acid solution: 2% Sekusept Aktiv (SA) or 0.25% Proxitane Alpha (PA), for different times. Then, washes of these instruments were plated in culture medium and colony-forming units counted. This procedure was repeated six times per day over 24 non-consecutive days. The corrosion capacity was assessed with the mass loss test, and the concentration of peracetic acid and pH of the solutions were measured with indicator tapes. Both SA and PA significantly eliminated microorganisms; however, the SA solution was stable for only 4 days, whereas PA remained stable throughout the experiment. The concentration of peracetic acid in the SA solutions decreased over time until the chemical was undetectable, although the pH remained at 5. The PA solution had a concentration of 500-400 mg/L and a pH of 2-3. Neither formulation induced corrosion and both reduced the number of microorganisms (p = 0.0001). However, the differences observed in the performance of each product highlight the necessity of establishing a protocol for optimizing the use of each one.

Risk Stratification-based Surveillance of Bacterial Contamination in Metropolitan Ambulances

We aimed to know the risk-stratification-based prevalence of bacterial contamination of ambulance vehicle surfaces, equipment, and materials. This study was performed in a metropolitan area with fire-based single-tiered Basic Life Support ambulances. Total 13 out of 117 ambulances (11.1%) were sampled and 33 sites per each ambulance were sampled using a soft rayon swab and aseptic containers. These samples were then plated onto a screening media of blood agar and MacConkey agar. Specific identification with antibiotic susceptibility was performed. We categorized sampling sites into risk stratification-based groups (Critical, Semi-critical, and Non-critical equipment) related to the likelihood of direct contact with patients' mucosa. Total 214 of 429 samples showed positive results (49.9%) for any bacteria. Four of these were pathogenic (0.9%) (MRSA, MRCoNS, and K. pneumoniae), and 210 of these were environmental flora (49.0%). However, the prevalence (positive/number of sample) of bacterial contamination in critical, semi-critical airway, semi-critical breathing apparatus group was as high as 15.4% (4/26), 30.7% (16/52), and 46.2% (48/104), respectively. Despite current formal guidelines, critical and semi-critical equipments were contaminated with pathogens and normal flora. This study suggests the need for strict infection control and prevention for ambulance services.

Guías de práctica clínica para la prevención de infecciones intrahospitalarias asociadas al uso de dispositivos médicos / Clinical practice guidelines for the prevention of nosocomial infections associated with the use of medical devices

Las infecciones asociadas a la atención en salud representan un problema de salud pública y son un indicador de la calidad en prestación y gestión en salud. En este contexto, los programas de vigilancia y control epidemológico de estas enfermedades, y la adaptación e implementación de guías para su prevención son estrategias que pueden mejorar la seguridad del paciente y deben ser una prioridad para las instituciones. Un panel de expertos de las áreas de infectología, cuidados intensivos, neumología, enfermería, terapia respiratoria y farmacia, preparó una guía de práctica clínica para la prevención de las infecciones asociadas a dispositivos médicos, mediante un proceso de adaptación de otras guías por medio de una estrategia de búsqueda sistemática basada en la "evidencia". Se propone que estas guías sean utilizadas por los trabajadores de la salud con el fin de establecer estrategias que prevengan la aparición de infecciones hospitalarias relacionadas con dispositivos de uso prioritario durante el cuidado intensivo. Se hacen recomendaciones basadas en información científica y adaptadas a nuestro medio en temas generales, como la introducción de listas de chequeo, el lavado de manos y los sistemas de vigilancia y supervisión; se formulan recomendaciones específicas para la prevención de las infecciones del torrente sanguíneo asociadas a dispositivos intravasculares, de las infecciones respiratorias asociadas al uso de asistencia respiratoria mecánica y de las infecciones urinarias asociadas al uso de catéteres urinarios.

Healthcare associated infections (HAI) are an important public health problem and an indicator of the quality of healthcare and management. In this scenario, surveillance and epidemiologic control programs and the adaptation and implementation of clinical guidelines for HAI prevention are estrategies that can improve the safety of patient care and should be prioritized in the institutions. Evidence based clinical practice guidelines for the prevention of infections asociated with invasive medical devices were prepared by an expert panel in infectious diseases, critical care, pulmonary care, nursery, respiratory therapy and pharmacy by means of a process of adaptation of other guidelines available through a systematic review of the literature. These guidelines are intended to be used by healthcare workers with the aim of establishing estrategies to prevent HAI related to invasive medical devices. Recommendations based of scientific evidence adapted to our setting are made related to general estrategies such as checklists, hand washing, surveillance and supervision systems. Specific recommendations to prevent bloodstream infections related to intravascular catheters, respiratory infections related to mechanical ventilation and urinary tract infections related to urinary catheters are made.

Micro-scale surface-patterning influences biofilm formation

The formation of biofilms on indwelling/implanted medical devices is a common problem. One of the approaches used to prevent biofilm formation on medical devices is to inhibit bacterial attachment by modification of the synthetic polymers used to fabricate the device. In this work, we assessed how micro-scale features (patterns) imprinted onto the surface of silicone elastomer similar to that used for medical applications influenced biofilm formation by Staphylococcus aureus, Staphylococcus epidermidis, and Pseudomonas aeruginosa. Patterns were transferred from a multi-patterned oxidized silicon-wafer master-template to silicone elastomer. Features consisted of bars, squares, and circles each extending 0.51 µm above the surface. Feature sizes ranged between 1.78 and 22.25 µm. Distances separating features ranged between 0.26 and 17.35 µm. Bacterial biofilm formation on discs cut from imprinted silicone elastomer was assessed by direct microscopic observation and quantified as the surface area covered by biofilm. Unpatterned silicone elastomer served as a control. Several of the micro-scale patterns imprinted into the silicone elastomer significantly reduced biofilm formation by each bacterium and interrupted biofilm continuity. Although there were differences in detail among strains, bacteria tended to attach in the area between features more than to the surface of the feature itself.

Device-associated infections in a Colombian neonatal intensive care unit

Objective: The present study was aimed at determining device-associated infection rates, device use rates and the microbiologic profile of nosocomial infections in a tertiary neonatal intensive care unit (ICU) in Bogotá, Colombia. Methods: Prospective nosocomial infection surveillance was implemented in a neonatal intensive care unit for 11 months in line with the High Risk Nursery component of the Colombian Nosocomial Infection Surveillance programme. Patient-days, length of stay, device use rates and device-associated nosocomial infection rates were calculated. Results: 1 998 device days were observed among 2 890 patient days during the 11 months' surveillance. Central venous catheter-related bloodstream infection was the most common device-associated infection for all birth-weight categories. 69,2 percent and 100 percent of all coagulase negative staphylococci and Staphylococcus aureus infections were methicillin resistant strains and all gram negative rods were susceptible to third generation cephalosporins, carbapenems, ciprofloxacin and piperacillin-tazobactam. Device-associated infection and device use rates in the ICU were higher than Colombian Nosocomial Infection Surveillance reports for October 2004 and reports from Colombia and other Latin-American countries. Conclusions: This surveillance identified blood-stream infection as being the most common infection in the ICU in question. Efforts should thus be directed at establishing suitable infection-control practices.

Objetivo: El objetivo del presente estudio fue determinar las tasas de infección asociadas a dispositivos médicos, las tasas de utilización y el perfil microbiológico de las infecciones hospitalarias en una unidad de terapia intensiva neonatal en Bogotá-Colombia. Métodos: Un sistema de vigilancia de infección hospitalaria fue implementado en la unidad de terapia intensiva neonatal de un hospital de tercer nivel durante un periodo de 11 meses de acuerdo al componente neonatal del sistema de vigilancia de infección hospitalaria de los estados unidos. Se calcularon los días pacientes, los días de estancia, las tasas de utilización y de infección asociadas a dispositivos invasivos. Resultados: Un total de 1 998 días dispositivos fueron observados entre 2 890 días paciente durante los 11 meses de vigilancia. La infección asociada a catéter central fue la infección más frecuente entre las diferentes categorías de peso neonatal. El 69,2 por ciento y el 100 por ciento de todos los Staphylococos coagulasa negativa y Staphylococcus aureus fueron resistentes a meticilina respectivamente, y todos los bacilos gram negativos fueron susceptibles a las Cefalosporinas de tercera generación, Carbapenemicos, Ciprofloxacina y a Piperacilina-Tazobactam. Las tasas de infección asociada a dispositivos invasivos y las tasas de utilización en nuestra unidad fueron superiores al reporte de octubre del 2004 del sistema de vigilancia de infección hospitalaria de los estados unidos y de otros trabajos realizados en Colombia y en Latinoamérica. Conclusiones: Este proceso de vigilancia ha permitido identificar que las infecciones del torrente sanguíneo comprende el principal problema de nuestra unidad y por tal motivo la necesidad de implementar adecuadas medidas de control de infecciones para disminuir la ocurrencia de esta infección debe ser la prioridad de nuestra institución.

Bacteriological evaluation of conjunctiva, contact lens storage cases and solutions during contact lens wear.

A total of 90 subjects were investigated in this study, out of which 51 constituted the contact lens wearing group and 39 constituted the control group who had never worn contact lenses. Out of 51 contact lens wearing group, 41 were asymptomatic lens wearer subjects and 10 were symptomatic lens wearer subjects having some complications. All the subjects of contact lens wearing group had worn soft contact lenses on daily wear basis for a duration of 7 days to one year. In total 33 subjects were culture positive and remaining 57 culture negative. Staphylococcus epidermidis was isolated equally from asymptomatic and control group, however, significantly more gram negative organisms such as Pseudomonas aeruginosa and Serratia marcescens were isolated from the symptomatic lens wearers. P. aeruginosa and S. marcescens could also be isolated from lens storage cases. S. marcescens was the organism most commonly isolated from the contact lens solutions. Further, the results showed that both P. aeruginosa and S. marcescens adhere to injured cornea only and not to normal cornea when microscopic study of adherence of bacteria to uninjured and injured ex vivo mouse corneas was done.

Developing nursing blood borne pathogen control plan for Mansoura university hospital

Blood borne infections pose a serious threat to health and well-being of health care workers in Egypt. Hepatitis B, Hepatitis C and HIV have in common the blood borne pathway of transmission and severity of their outcome Occupational health and safety aims at prevention of such transmission at different levels eg. vaccination prevention for Hepatitis, post exposure prophylaxis and follow up after exposure. Also OSHA's final rule made it mandatory that health care facilities assumed responsibility for protection of their employees from exposure to Blood borne pathogen by eight components such as person protective equipment, universal precaution engineering control, work practice control, Hepatitis B prophylaxis training and education record keeping. The aim of this study was to design a blood borne pathogen control plan for Mansoura University hospital through assessing nurses knowledge and awareness related to Blood borne pathogen control, assessing the viability of equipment and supplies in various department in the designated hospital, designing the blood borne pathogen control plan based on the assumed data, and examining the validity of the designated plan. The study was conducted in Surgical and Obstetric units at Mansoura University hospital in ten departments. The subjects of this study were composed of two groups, namely a nursing group, and a jury group. Nursing group included 104 subjects were chosen from the above mentioned hospital departments. Jury group consisted of 50 subjects, divided into two subgroups which include 25 medical and 25 nurses Study tools included, questionnaire format aimed to assessing nurse's knowledge related to blood borne pathogen control. Checklist aimed to checking the Blood borne pathogen control plan in the studied hospital and opinionative sheet aimed to test the validity of the developing Blood borne pathogen control plan. The results revealed that nurses knowledge about the blood borne pathogen control plan was low Meanwhile, nurses knowledge was high [59 %] in relation to getting and staying vaccinated while the knowledge was low [34 %] in relation to report and get help with any needle stick accidents. Whereas nurse leaders, awareness about the Blood borne pathogen control plan was very low in addition to all the nurses leader [100.0%] were aware about the absence of training programs and an explanation of exposure control plan. All the nurses [100%] were aware about the lack of clear duties and responsibility for nursing staff in the Blood borne pathogen department. Equipments and supplies for Blood borne Pathogen control as observed in various departments were mostly observed to be available, and in a working state, and good storage. As far as the validation of the blood borne pathogen control plan presented in the study, the majority of the members of the two groups of jury agreed upon all items regarding form of the plan and upon the general evaluation items of the plan. No statistically significant differences could be detected between the two groups. It is concluded from the study that health care workers are at risk of exposure to different occupational hazards especially blood borne infection which may have a direct or cumulative deleterious effect on their health as a result of many factors such as lack of staff nurses knowledge related to blood borne pathogen prevention, lack of hospital policy and system related to blood borne prevention, lack of nurses adherence to blood borne prevention and absence of Blood borne pathogen control plan. The study recommend that report the percentage of Blood borne infection among health care working in Egypt, increase nurses' knowledge related to Blood borne infection prevention, apply control plan in different departments in different hospitals and governorate, develop policies and regulations adherent to Blood borne prevention, mandatory testing of health care workers is not justified on the basis of current scientific evidence strategies for preventing transmission of blood borne pathogens should be reviewed as new information becomes available and re-evaluated as to their effectiveness and standards for infection control practices in health care settings and mechanisms to implement and evaluate these standards should be developed

Avaliaçäo bacteriológica da açäo do glutaraldeído utilizado como desinfetante em esofagogastroduodenofibroscopia / Bacteriological evaluation of the action of glutaraldehyde used as disinfecting agent in esophagogastroduodescopy

Foi estudado o efeito bacteriológico do glutaraldeído a 2 por cento, usado como desinfetante, em um esofagogastroduodenofibroscópio modelo Olympus GIFXQ. Realizaram-se culturas do material colhido na superfície externa e no canal operatório, antes do início da jornada de trabalho, imediatamente após uso no paciente e após limpeza e desinfecçao. Concluiu-se que, quando imerso em glutaraldeído a 2 por cento por dez minutos, fazendo-se também a aspiraçao do desinfetante pelo canal de biópsias e enxaguadura com soro fisiológico, nao houve crescimento bacteriano nem na superfície externa nem no canal operatório do aparelho, constituindo-se em procedimento eficaz para limpeza e desinfecçao.