Assessment of patients'knowledge, attitude and practice of cross-infection control in the dental clinic during COVID-19 pandemic

Background:The emergence of coronavirus disease 2019 (COVID-19), a highly contagious disease that causes viral respiratory illness, has changed the lifestyle of humans worldwide. Dental practitioners and patients are at high risk of infection during their routine practice due to their exposure to saliva, blood, and droplet production.Aim:To gain insight into the patient's viewpoint regarding the practice, altitude, and knowledge of COVID-19 and its transmission and cross-infection in dental clinics.Methods:This was cross­sectional analytic survey in dentistry during the COVID-19 pandemic. Aself-administered close-ended questionnaire consisting of 32 variables was distributed among the study participants. The data were analysed using the Statistical Package for the Social Sciences (SPSS) version 25. The level of significance was p ≤ 0.05. Results:The age of the participants varied from 20 - 58 years, with a mean age of 34.6 ±5. The majority (89.3%) felt COVID-19 was a highly contagious disease, while 50.0% of the respondents believed that the most common route of COVID-19 transmission in dentistry is through aerosols. The majority, 78.6%, recorded good knowledge of infection control following the COVID-19 outbreak. The number of married patients who had good knowledge of cross-infection control was 118, which was statistically significant.Conclusion:From the study, it is evident that the patients possess a good range of knowledge in both preventive and cross-infection protocols to follow during the COVID-19 pandemic. However, the same cannot be said about the practice

The effect of interventional program underpinned by health belief model on awareness, attitude, and performance of nurses in preventing nosocomial infections: A randomized controlled trial study / Efecto de un programa de intervención basado en el modelo de creencias en salud sobre el conocimiento, la actitud y el desempeño del personal de enfermería en la prevención de las infecciones intrahospitalarias. Ensayo controlado aleatorizado / Efeito de um programa de intervenção baseado no modelo de crenças em saúde no conhecimento, atitude e atuação da equipe de enfermagem na prevenção de infecções hospitalares. Teste controlado e aleatório

Objective. The present study examined the effect of an interventional program underpinned by the Health Belief Model (HBM) on nurses' awareness, attitude, and performance in preventing nosocomialinfections.Methods. This randomized controlled trial study was performed on 60 clinical nurses in lar, Iran. Nurses were selected using the simple random sampling method and assigned to two experimental (n=30) and control (n=30) groups. Data collection tool included the valid and reliable questionnaire was developed by Soleimani et al. The research intervention consisted of five 90-min sessions based on the health belief model in preventing hospital infection for experimental group. Before the intervention, immediately and two months after the intervention, the two groups completed the questionnaire. The control group received no intervention. Results. Data analysis showed that the differences between the two groups was statistically significant immediately and two months after the intervention (p<0.05). In experimental group the changes in the mean score of knowledge, attitude and performance of nurses before, immediately and two months after the intervention were significant (p<0.05), but in the control group, only the changes in the mean score of performance were significant (p<0.05). Conclusion. The results showed that the HBM-based intervention is effective in promoting nurses' knowledge, attitude, and performance in preventing nosocomialinfections. hence, periodical and in-service HBM-based training programs on preventing nosocomialinfections are recommended to be held for nurses.

Objetivo. El presente estudio examinó el efecto de un programa de intervención basado en el modelo de creencias en salud (Health Belief Model -HBM-, en inglés sobre el conocimiento, la actitud y el desempeño de las enfermeras en la prevención de las infecciones intrahospitalarias. Métodos. Este ensayo controlado aleatorizado se realizó en 60 enfermeras clínicas de lar, Irán. Las enfermeras fueron seleccionadas mediante el método de muestreo aleatorio simple y asignadas a dos grupos experimental (n=30) y de control (n=30). La herramienta para la recogida de datos incluyó el cuestionario válido y fiable desarrollado por Soleimani et al.La intervención consistió en cinco sesiones de 90 minutos basadas en el modelo de creencias de salud para prevenir la infección intrahospitalaria en el grupo experimental. Antes de la intervención, inmediatamente y dos meses después de la intervención, los dos grupos completaron el cuestionario. El grupo de control no recibió ninguna intervención. Resultados. El análisis de los datos mostró diferencias estadísticamente significativas entre los dos grupos en los momentos inmediatamente y dos meses después de la intervención (p<0.05). En el grupo experimental, los cambios en la puntuación media de conocimientos, actitudes y rendimiento de las enfermeras se observaron en los momentos de antes, inmediatamente y dos meses después de la intervención (p<0.05); mientras que en el grupo de control solamente los cambios en la puntuación media de desempeño fueron significativos (p<0.05). Conclusión. Los resultados mostraron que la intervención basada en HBM fue eficaz para promover el conocimiento, la actitud y el rendimiento de las enfermeras en la prevención de las infecciones intrahospitalaria, por lo que se recomienda impartir a las enfermeras programas de formación periódicos y en servicio basados en HBM sobre la prevención de las infecciones intrahospitalarias.

Objetivo. Examinar o efeito de um programa de intervenção baseado no Modelo de Crenças em Saúde (MBH) no conhecimento, atitude e desempenho dos enfermeiros na prevenção de infecções hospitalares. Métodos. Este ensaio clínico randomizado foi conduzido em 60 enfermeiras clínicas de lar, Irã. Os enfermeiros foram selecionados pelo método de amostragem aleatória simples e distribuídos em dois grupos experimental (n=30) e controle (n=30). O instrumento de coleta de dados incluiu o questionário válido e confiável desenvolvido por Soleimani et al. A intervenção consistiu em cinco sessões de 90 minutos baseadas no modelo de crenças em saúde para prevenir infecção hospitalar no grupo experimental. Antes, imediatamente e dois meses após a intervenção, ambos os grupos responderam ao questionário. O grupo controle não recebeu nenhuma intervenção. Resultados.A análise dos dados mostrou diferenças estatisticamente significativas entre os dois grupos imediatamente e dois meses após a intervenção (p<0.05). No grupo experimental foram observadas alterações na pontuação média de conhecimentos, atitudes e desempenho dos enfermeiros antes, imediatamente e dois meses após a intervenção (p<0.05); enquanto no grupo controle apenas as alterações na pontuação média de desempenho foram significativas (p<0.05). Conclusão.Os resultados demonstraram que a intervenção baseada no HBM foi eficaz na promoção do conhecimento, atitude e desempenho dos enfermeiros na prevenção de infecções hospitalares, pelo que se recomenda proporcionar aos enfermeiros este tipo de programas de formação em serviço baseados no HBM.

The burden of healthcare-associated infection in Moroccan hospitals: systematic review and meta-analysis

Healthcare-associated infections (HAI), also referred to as nosocomial infections, is defined as an infection acquired in a hospital setting. This infection is considered a HAI if it was not present or incubating at the time of admission. This includes infections acquired in the hospital but appearing after discharge, and also occupational infections among staff of the facility. HAI are a major patient safety measure to be considered in hospitals.

Semiautomated disinfection of ophthalmic contact lenses

The ophthalmic lenses that come in contact with the eyes pose a high risk for the transmission of bacterial and viral infections in eye clinics. Disinfecting these lenses does not happen stringently in a busy practice. We describe a novel method of disinfecting ophthalmic contact lenses using a semiautomated lens disinfector equipment, semiautomated lens disinfector. The equipment has motors to pump in and pump out water and disinfecting solution into a reservoir bath. The used ophthalmic lenses will be placed in a tray that partially dips into the bath for disinfection. Microbiology tests that were done to check the quality of the disinfection cycle showed good outcomes. Disinfection of ophthalmic contact lenses with the new equipment appeared to effectively eliminate contaminant microorganisms. This equipment can be used in busy ophthalmic clinics to alleviate the chances of cross-infection.

Horizontal unidirectional airflow for reducing cross-infection of COVID-19: A narrative review

Recent decades have witnessed the emergence of many airborne diseases such as severe acute respiratory syndrome, Middle East respiratory syndrome, and COVID-19, which have highlighted the importance of effective ventilation in residential, work, or hospital premises. Ventilation which plays an essential role in reducing or diluting the airborne contaminants. However, it is not always easy to achieve by natural ventilation as it depends on many other factors such as temperature and climatic conditions. (wind velocity, wind direction, and housing pattern/design). Horizontal unidirectional airflow (HUAF) is one such method that can be achieved at low cost and can reduce cross-infection of COVID-19 to much extent. Hence, this narrative review aims to bring some insight into what is HUAF, how it can be achieved, and what are its possible implications in preventing COVID-19 transmission.

Factores pronósticos de mortalidad por agente infeccioso en un hospital de alta complejidad de Cartagena-Colombia / Prognostic factors for mortality caused by an infectious agent in a high complexity hospital in Cartagena-Colombia

Introducción: La identificación de los principales factores clínico-epidemiológicos que determinan causas de mortalidad en pacientes hospitalizados es una necesidad apremiante, principalmente cuando los esfuerzos realizados en la actualidad no permiten asumir acciones fundamentadas en la identificación de las causas de dicho evento. Objetivo: Establecer cuáles son los factores pronósticos de mortalidad por agente infeccioso en un hospital de alta complejidad de la ciudad de Cartagena- Colombia. Material y Métodos: Se realizó un estudio de casos y controles retrospectivo, con muestra proyectada de 86 casos y 258 controles, en una relación 1:3, que cumplieron con los criterios de elegibilidad respectivos y en los que realizaron análisis bivariados y posteriormente un análisis multivariado que incluyó métodos de regresión logística binaria. Resultados: El riesgo de mortalidad en el análisis multivariado está determinado por variables como sexo masculino (ORa 1,695 IC 95 por ciento: 1,005-2,856); Cáncer (ORa 2,389 IC 95 por ciento 1,230-4,642); inmunosupresión (ORa 3,211 IC 95 por ciento 1,004-10,26); Ventilación mecánica (ORa 2,541 IC 95 por ciento 1,128-5,722); Estancia en la UCI (ORa 2,331 IC 95 por ciento1,227-4,425) e Infección por bacterias productoras de carbapenemasas (ORa 4,778 IC95 por ciento 1,313-17,38). Conclusiones: En pacientes masculinos con cáncer o cualquier otra forma de inmunosupresión, en los que se requiera el uso del ventilador mecánico o estancia en la unidad de cuidado intensivo y que además desarrollen infecciones por bacterias productoras de carbapenemasas existe mayor riesgo de muerte por agente infeccioso(AU)

Introduction: The identification of the main epidemiological clinical factors that determine the causes of mortality in hospitalized patients is a pressing need, mainly when the efforts made at present do not allow us to take actions based on the identification of the causes of the aforementioned event. Objective: To identify the prognostic factors for mortality caused by infectious agents in a high complexity hospital in the city of Cartagena, Colombia. Material and Methods: A retrospective case-control study was conducted in 86 cases and 258 control samples that met the eligibility criteria, at the 1: 3 ratio. Bivariate analyses and a subsequent multivariate analysis that included binary logistic regression methods were also performed. Results: In the multivariate analysis, the risk of mortality is determined by variables such as male sex (ORa 1,695 95 percent CI: 1.005-2.856); cancer (ORa 2,389 95 percent CI 1,230-4,642); immunosuppression (ORa 3.211 95 percent CI 1.004-10.26); mechanical ventilation (ORa 2.541 95 percent CI 1.128-5.722); stay in the ICU (ORa 2,331 95 percent CI 1,227-4,425) and infection caused by carbapenemase-producing bacteria (ORa 4,778 95 percent CI 1,313-17.38). Conclusions: Male patients with cancer or any other form of immunosuppression who require the use of a mechanical ventilator or admission to the intensive care unit who also develop infections caused by carbapenemase-producing bacteria, are at greater risk of death from an infectious agent(AU)

Infecção relacionada à assistência à saúde e sepse na hospitalização em pediatria / Infección relacionada con la atención a la salud y sepsis en hospitalización en pediatría / Infection related to health care and sepsis in hospitalization in pediatrics

RESUMO Introdução: as infecções em pediatria são entraves no tratamento da criança hospitalizada, pois surgem com maior frequência, sendo um fator desencadeante de complicações no tratamento da criança hospitalizada. Objetivo: investigar a frequência das infecções relacionadas à assistência à saúde e sepse em crianças hospitalizadas. Método: trata-se de um estudo quantitativo prospectivo e descritivo. A coleta de dados ocorreu de julho a dezembro de 2015, por meio de 173 prontuários físicos e eletrônicos dos pacientes. Os dados foram analisados via Microsoft Office Excel® e análise descritiva. Resultados: identificou-se uma alta prevalência de infecções relacionadas à assistência à saúde com 31% (n= 54), tendo como principal causa a pneumonia, e destas 55% evoluíram para sepse (n=32). Conclusão: os achados permitem uma visão sobre a gravidade da ocorrência de infecções em crianças hospitalizadas, destacando a necessidade de capacitação da equipe de saúde para o reconhecimento precoce, com vistas à diminuição dos índices de infecção dentro dos serviços de saúde e melhoria na qualidade da assistência ofertadaà população pediátrica.

RESUMEN Introducción: las infecciones en pediatría son obstáculos en el tratamiento del niño hospitalizado, pues surgen con mayor frecuencia, siendo un factor desencadenante de complicaciones en el tratamiento del niño hospitalizado. Objetivo: investigar la frecuencia de las infecciones relacionadas con la atención a la salud y sepsis en niños hospitalizados. Método: se trata de un estudio cuantitativo prospectivo y descriptivo. La recolección de datos tuvo lugar de julio a diciembre de 2015, a través de 173 registros médicos, físicos y electrónicos, de los pacientes. Los datos fueron analizados vía Microsoft Office Excel® y análisis descriptivo. Resultados: se identificó una alta prevalencia de infecciones relacionadas con la atención a la salud con 31% (n=54), teniendo como principal causa la neumonía, y de estas 55% evolucionaron para sepsis (n=32). Conclusión: los hallazgos permiten una visión sobre la gravedad de la ocurrencia de infecciones en niños hospitalizados, destacando la necesidad de capacitación del equipo de salud para el reconocimiento precoz, con vistas a reducir los índices de infección dentro de los servicios sanitarios y mejorar la calidad de la atención ofrecida a la población pediátrica.

ABSTRACT Introduction: cross-infections are obstacles in the treatment of hospitalized children, as they are more frequently, and may be a triggering factor for complications in the treatment of hospitalized children. Objective: to investigate the frequency of healthcare-related infections and sepsis in hospitalized children. Method: this is a prospective and descriptive quantitative study. The data collection took place from July to December 2015, using 173 physical and electronic patient records. The data were analyzed using Microsoft Office Excel® and descriptive analysis. Results: a high prevalence of cross-infections was identified with 31% (n=54), having pneumonia as the main cause, and out of these 55% have progressed to sepsis (n=32). Conclusion: the findings allow an insight into the severity of the occurrence of infections in hospitalized children, highlighting the need for training the health team for early recognitionfor reducing infection rates within health services, and improving the quality of assistance offered to the pediatric population.

Design and application of auxiliary isolation device of cupping therapy for cross-infection prevention / 中国针灸

An auxiliary isolation device of cupping therapy for cross-infection prevention is designed to reduce the disinfection steps and be against cross transmission. This device is composed of a disposable isolation unit made of fire proof plastic material and a disposable cup-mouth fixator made of elastic material. The disposable isolation unit includes two parts, the cup neck isolation unit and the inner isolation unit of fire cup. These two parts connect with the disposable cup-mouth fixator. All of those three sections of the device are center-connected ring-like structure. This device can well prevent the direct contact of fire cup with the patient's skin surface, characterized as safety protection, simple operation and saving time and manpower.

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

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

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

O uso de checklist como estratégia para redução de pneumonia associada à ventilação mecânica em uma unidade de terapia intensiva adulto / Using a checklist as a strategy for the reduction of mechanical ventilator-associated pneumonia in an adult intensive care unit / El uso de una lista de verificación como estrategia para reducir la Neumonía Asociada a la Ventilación Mecánica en una unidad de cuidados intensivos para adultos

Objetivo: Avaliar a efetividade do instrumento fast-checklist, desenvolvido por uma equipe interdisciplinar como estratégia de redução de tempo de ventilação mecânica (VM) e pneumonia associada à ventilação mecânica (PAV) em uma unidade de terapia intensiva adulto. Métodos: Estudo quantitativo, longitudinal, observacional, realizado entre os meses de janeiro de 2018 e junho de 2019 em uma unidade de terapia intensiva adulto no Paraná. Os dados foram analisados pelo teste t-student. Resultados: Foram avaliados 759 internamentos, destes, 283 utilizaram VM. Os dados mostraram que antes do fast-checklist havia uma média de 3,22 casos de PAV, e após a instituição do instrumento, o valor reduziu significativamente para 0,33 (p=0,001); condição igualmente observado para os dias de VM. A média de VM era de 157 dias e passou para 133 (p=0,037) e a densidade de PAV era de 21,62 e passou para 2,82 (p=0,003). Através da análise do teste de t, dá para inferir uma redução dos casos de PAV de 4,9% ao mês. Conclusão: O uso de instrumentos como o checklist para redução de PAV, acompanhado da mudança de cultura e participação ativa de equipes interdisciplinares, são de extrema relevância na redução deste tipo de infecção e infecções relacionadas à assistência à saúde.(AU)

Objectives: To evaluate the effectiveness of using the Fast-Check List instrument developed by an interdisciplinary team as a strategy to reduce the time of mechanical ventilation (MV) and Mechanical Ventilator-associated Pneureamonia (VAP) in an Intensive Care Unit ­ Adult. Methods: Quantitative, longitudinal, observational study, carried out between the months of January 2018 and June 2019 in one adult Intensive Care Unit in Paraná. The data were analyzed by the T test. Results: 759 hospitalizations between January 2018 and June 2019 were evaluated, of these 283 used mechanical ventilation (VM). The data showed that before the Fast-CheckList there was an average of 3.22 VAP and after the institution of the instrument, the value significantly decreased to 0.33 (p = 0.001). Condition also observed for MV days. The mean MV was 157 days, and went to 133 (p = 0.037) and the VAP Density (DIPAV) was 21.62 and went to 2.82 (p = 0.003). Through the analysis of the t test, it is possible to infer a 4.9% month-on-month reduction in VAP cases. Conclusion: The use of instruments such as the checklist to reduce pneumonia associated with mechanical ventilation, accompanied by a change in culture and the active participation of interdisciplinary teams are extremely important in reducing this type of infection and infections related to healthcare.(AU)

Objetivos: Evaluar la efectividad del instrumento fast-checklist desarrollado por un equipo interdisciplinario como estrategia para reducir el tiempo de ventilación mecánica (VM) y la neumonía asociada con ventilación mecánica (PAV) en una Unidad de Cuidados Intensivos Adulta. Métodos: Estudio cuantitativo, longitudinal, observacional, realizado entre enero de 2018 y junio de 2019 en una unidad de cuidados intensivos para adultos en Paraná (Brasil). Los datos se analizaron mediante la prueba t student. Resultados: Se evaluaron 759 hospitalizaciones, de estas 283 utilizaron VM. Los datos mostraron que antes de la fast-checklist había un promedio de 3,22 casos de PAV y que después del uso del instrumento el valor disminuyó significativamente a 0,33 (p = 0,001). Esta condición también se observó para días de VM. El promedio de VM era de 157 días y pasó para 133 (p = 0,037) y la densidad de PAV que era de 21,62 pasó para 2,82 (p = 0,003). Por medio del análisis de la prueba t, es posible inferir una reducción de los casos de PAV de un 4,9% mes a mes. Conclusión: El uso de instrumentos como la lista de verificación para reducir la neumonía asociada con la ventilación mecánica, acompañado de un cambio en la cultura y la participación activa de equipos interdisciplinarios, son muy importantes para reducir este tipo de infección e infecciones relacionadas con la atención médica.(AU)

O novo normal da Odontologia: revisão das recomendações para retomada da assistência odontológica durante a pandemia da COVID-19 / The New Normal of Dentistry: Review of Recommendations for the Resumption of Dental Care during the COVID-19 Pandemic

Objetivo: este artigo tem como objetivos identificar as recomendações para a retomada dos atendimentos odontológicos eletivos após surto epidêmico da COVID-19 e identificar os consensos e controvérsias entre as sugestões encontradas nos documentos. Material e Métodos: foi realizada uma pesquisa documental comparativa sobre as recomendações para o retorno do atendimento odontológico eletivo após o surto epidêmico da COVID-19. Secundariamente, foi realizada uma revisão da literatura a partir de busca nas bases: Portal Regional da Biblioteca Virtual em Saúde (BVS), que incorpora Lilacs, SciELO, MEDLINE, a partir da estratégia de busca ("COVID-19" AND "dentistry"). Resultados: foram analisados documentos oficiais do Ministério da Saúde ou de órgãos correspondentes e de entidades de classe de onze diferentes países do mundo e encontrados seis artigos que abordavam as recomendações para o retorno aos atendimentos eletivos. Conclusão: há um consenso quanto aos requisitos para as instalações do consultório, à indicação de realização de triagem antes do agendamento e atendimento e quanto aos cuidados recomendados durante o atendimento. Não há consenso quanto ao uso de bochechos antissépticos prévios ao procedimento, ao uso sistemático de testes rápidos antes do atendimento, ao tipo de proteção respiratória que deve ser utilizada pela equipe odontológica e ao tempo mínimo de pausa antes da realização da higienização da sala de trabalho quando são realizados procedimentos geradores de aerossol

Objective: This paper aims to identify the recommendations for the resumption of elective dental care after the epidemic outbreak of COVID-19 and to identify consensus and disagreements among the suggestions found in the documents. Materials and Methods: a comparative documentary research was carried out on the recommendations for the resumption of elective dental care after the outbreak of COVID-19. Additionally, a literature review was carried out based on a search in the Brazilian Regional Portal of the Virtual Health Library (VHL), which incorporates Lilacs, SciELO and MEDLINE databases, using the search query: ("COVID-19" AND "dentistry"). Results: government documents from the Ministry of Health or corresponding bodies and professional associations from eleven different countries in the world were analyzed and six articles were found addressing the recommendations for the resumption of elective dental care. Conclusion: there is a consensus about the requirements for dental facilities, the recommendation of screening patients before scheduling and appointments and the procedures performed during dental care. There is no consensus on the use of preprocedural antiseptic mouth rinses, the systematic use of rapid tests before the appointment, the type of respiratory protection that should be used by the dental team and the minimum interval to be allowed before cleaning the patient room when aerosol-generating procedures are performed

Aerosol transmission prevention of novel coronavirus in dental clinics / 上海交通大学学报（医学版）

Corona virus disease 2019 (COVID-19), which broke out in Wuhan, HuBei in December, 2019, spread around the country in a short term. Some infected patients suffered from severe acute respiratory syndrome. It has become a major public health event of international concern. COVID-19 patients are the main source of transmission and most people get infection easily, so the current main prevention method is interrupting the pathway of transmission. The dental treatments are very special because these operations produce substantial aerosols and lead a high risk of cross-infection, which brings challenge for epidemic prevention and control. In this paper, the characteristics of aerosols and prevention methods of aerosol transmission in dental clinics are mainly discussed.

Establishment of a system for control of cross-infection and workflow in endoscopy center during the pandemic of coronavirus disease 2019 / 中南大学学报(医学版)

OBJECTIVES@#To establish a system for control of cross-infection and workflow for preventing severe acute respiratory syndrome coronavirus 2 spread and ensuring the safety of medical staffs and patients in endoscopy center during the pandemic of the coronavirus disease 2019 (COVID-19).@*METHODS@#Based on the national publication of relevant documents and relevant guidance of Digestive Endoscopy Branch of Chinese Medical Association, we explored and optimized the workflow, staff protection and sterilization of endoscope in digestive endoscopy center during the pandemic of the COVID-19.@*RESULTS@#The prevention system of cross-infection and workflow in endoscopy during the pandemic of the COVID-19 were developed. The optimized workflow in endoscopy was conducted in 106 patients with necessary endoscopy from the Department of Gastroenterology, Third Xiangya Hospital, Central South University between January 24, 2020 and February 26, 2020, and no case of cross-infection was presented among the medical staffs, patients and family members.@*CONCLUSIONS@#Measures on control of cross-infection and workflow in digestive endoscopy center during the pandemic of the COVID-19 are effective, which are beneficial to preventing cross-infection in hospital and provide a scientific guidance for the general work in the digestive endoscopy centers during the pandemic of the COVID-19.

Cross infection after a difficult intubation of a COVID-19 confirmed patient

@#Coronavirus Disease 2019 (COVID-19) is a new infectious disease with no definitive treatment and subsequently became a global pandemic. It has a reported morbidity rate of 19% among health care workers. Patients infected with COVID-19 are at risk for developing respiratory failure requiring intubation. Careful infection control measures to prevent cross-infection to healthcare providers are necessary. While exact mechanisms of transmission are unknown, person to person horizontal transmission arise, and the risk of spread during aerosol-generating procedures is a major concern. This is a case of an anesthesiologist who developed cough, ageusia, and loose bowel movement after performing an intubation to a patient with difficult airway. She was diagnosed with COVID-19 and eventually made a full recovery. It highlights the clinical course of the illness from onset to recuperation and the need to understand optimal use of PPE in healthcare settings.

Fatores de risco do diagnóstico de enfermagem: risco de infecção em pacientes com a Síndrome da Imunodeficiência Adquirida hospitalizados / Factores de riesgo del diagnóstico de enfermería: riesgo de infección en pacientes con el Síndrome de Inmunodeficiencia Adquirida hospitalizados / Risk factors of nursing diagnosis: risk of infection in patients with Acquired Immune Deficiency Syndrome hospitalized

Resumo O objetivo desta investigação é fue identificar na literatura os fatores de risco do diagnóstico de enfermagem Risco de Infecção presentes em pacientes com Síndrome da Imunodeficiência Adquirida hospitalizados. Trata-se de uma revisão integrativa, realizada nas bases de dados PubMed, SCOPUS, Cumulative Index to Nursing and Allied Health Literature, Literatura Latino-Americana em Ciências de Saúde, Scientific Electronic Library Online. Foram selecionados 10 artigos que atenderam aos critérios de inclusão. Identificaram-se estudos de casocontrole, ensaio clínico, transversal, coorte e descritivo. Os resultados evidenciaram cinco dos 19 fatores presentes no diagnóstico de enfermagem "Risco de infecção", indicados na North American Nursing Diagnosis Association, sendo eles: imunossupressão (considerado o mais prevalente, presente em 70% dos estudos), desnutrição, alteração do peristaltismo, procedimento invasivo e enfermidade crônica. Conclui-se que o conhecimento sobre os fatores de risco que uma população estudada está suscetível, oferece um norteamento para uma assistência direcionada e eficaz, uma série de riscos diferentes.

Resumen El objetivo de esta investigación fue identificar en la literatura los factores de riesgo del diagnóstico de enfermería Riesgo de Infección presentes en pacientes con Síndrome de Inmunodeficiencia Adquirida hospitalizados. Se trata de una revisión integrativa, realizada en las bases de datos PubMed, SCOPUS, Cumulative Index to Nursing and Allied Health Literature, Literatura Latinoamericana en Ciencias de la Salud, Scientific Electronic Library Online. Se seleccionaron 10 artículos que atendieron a los criterios de inclusión. Se identificaron estudios de caso-control, ensayo clínico, transversal, cohorte y descriptivo. Los resultados evidenciaron cinco de los 19 factores presentes en el diagnóstico de enfermería "Riesgo de infección", indicados en la North American Nursing Diagnosis Association, siendo ellos: inmunosupresión (considerado el más prevalente, presente en 70% de los estudios), desnutrición, alteración del peristaltismo, el procedimiento invasivo y la enfermedad crónica. Se concluye que el conocimiento sobre los factores de riesgo en la población estudiada es susceptible, por lo que se ofrece una guía para la asistencia dirigida y eficaz, a fin de reducir riesgos.

Abstract The aim of this research was to identify in the literature the risk factors of the Nursing Risk Assessment of Infection present in patients with Acquired Immune Deficiency Syndrome hospitalized. This is an integrative review, carried out in the PubMed, SCOPUS, Cumulative Index to Nursing and Allied Health Literature databases, Latin American Literature in Health Sciences, Scientific Electronic Library Online. We selected 10 articles that met the inclusion criteria. Case-control studies, clinical, transverse, cohort and descriptive studies were identified. Five of the 19 factors present in the nursing diagnosis "Risk of infection", indicated in the North American Nursing Diagnosis Association, were: immunosuppression (considered the most prevalent present in 70% of the studies), malnutrition, peristalsis, invasive procedure and chronic disease. It is concluded that the knowledge about the risk factors in the studied population is susceptible, so a guide is offered for targeted and effective assistance in order to reduce risks.

Tecidos de poliéster e suas implicações para confecção de jalecos / Polyester cloths and their implications for making white coats

A literatura científica reporta a contaminação microbiana dos jalecos utilizados por profissionais da saúde, no entanto não há consenso relacionando seu uso com a redução da exposição microbiana por risco ocupacional. O objetivo desta pesquisa foi avaliar tecidos de poliéster (oxford e microfibra) utilizados na confecção de jalecos, quanto à função de barreira física contra fluido e bactérias, nas perspectivas e desafios do controle de infecção na área da saúde. Trata-se de um estudo do tipo experimental / laboratorial in vitro realizado em três etapas. Na primeira etapa, os tempos de passagem do fluido através dos tecidos foram cronometrados e registrados em segundos desde o início do escoamento do fluido até as formações e quedas das últimas gotas. Na segunda etapa (microbiológica), inóculos padronizados das bactérias padrão de Staphylococcus aureus (ATCC 25923) e Pseudomonas aeruginosa (ATCC 27853) foram adicionadas ao fluido. Decorrida a passagem do fluido através dos tecidos, alíquotas de 50µL in natura e diluídas (10-1 a 10-5) foram semeadas na superfície de placas de Petri (60x15mm) com meios de cultura seletivos, incubadas a 37°C por 24h e o número de unidades formadoras de colônia das bactérias expresso por mililitro do fluido (UFC/mL). Na terceira etapa, as características estruturais dos tecidos e a retenção bacteriana foram analisadas por meio de microscopia eletrônica de varredura (MEV). Os dados obtidos foram submetidos aos testes de normalidade (Kolmogorov-Smirnov e Shapiro-Wilk) e, posteriormente, ao teste de U de Mann-Whitney por meio do software IBM SPSS Statistics (versão 25) e nível de significância ?=5%. A comparação entre as medianas dos tempos de passagem do fluido através dos tecidos de oxford e microfibra demonstrou diferença estatisticamente significante (p<0,001) independente das variáveis envolvidas (tecidos limpo ou limpo e passado, e tecidos autoclavado ou não autoclavado). Na etapa microbiológica, não foi observada diferença entre as medianas das cargas bacterianas dos tecidos de oxford e microfibra após a passagem do fluido com S. aureus (p=0,056) e P. aeruginosa (p=0,320). As análises por MEV permitiram evidenciar estruturas com formas irregulares e de cristal, bem como espaços (macroporos) entre os fios dos tecidos de oxford, que permitiram um menor tempo de passagem do fluido através do tecido. No entanto, não foi constatada a presença bacteriana na superfície dos tecidos. Em conclusão, diante dos dois tipos de tecidos utilizados na confecção de jalecos, o de microfibra apresentou maior tempo de passagem do fluido comparado ao de oxford, em decorrência das diferenças estruturais desses tecidos. Entretanto, a função de barreira física bacteriana após a passagem do fluido através dos tecidos não foi observada, o que reforça a necessidade de substituição do jaleco quando esse entra em contato com fluidos biológicos, visando à biossegurança: controle de contaminação/infecção na área da saúde

Scientific literature reports contamination of white coats used by health professionals, but there is not a consensus relating its usage to reduction of microbial exposure by occupational risk. The objective of this study was to evaluate Oxford and microfiber cloths used for making white coats, regarding its function as physical barrier to fluid and bacteria, in perspectives and challenges of infection control in health field. It is an in vitro experimental / laboratory study carried out in three stages. In the first stage, fluid passage times through the pieces of cloths were measured and registered in seconds since the beginning of fluid flow until formations and falls of the last drops. In the second stage (microbiological), standardized inocula of standard bacteria of Staphylococcus aureus (ATCC 25923) and Pseudomonas aeruginosa (ATCC 27853) were added to the fluid. After the passage of fluid through the pieces of cloths, in natura and diluted 50µL aliquots (10-1 to 10-5) were seeded on the surface of Petri dishes (60x15mm) with selective culture mediums, incubated at 37°C for 24h and the number of colony forming units of bacteria expressed by milliliter of fluid (CFU/mL). In the third stage, structural characteristics of cloths and bacterial retention were analyzed through scanning electron microscopy (SEM). The obtained data were submitted to normality tests (Kolmogorov-Smirnov and Shapiro-Wilk) and, later, to Mann-Whitney U test through IBM SPSS Statistics (version 25) software and ?=5% significance level. Comparison between medians of the fluid passage time through oxford and microfiber cloths showed statistically significant difference (p<0.001) independent of the involved variables (clean or clean and ironed cloths, and autoclaved or non-autoclaved cloths). In the microbiological stage, difference was not observed between medians of bacterial loads of Oxford and microfiber cloths after the passage of the fluid with S. aureus (p=0.056) and P. aeruginosa (p=0.320). The analyses by SEM allowed evidence structures with irregular and crystal shapes as well as gaps (macropores) between the threads of pieces of Oxford cloth, that allowed a shorter fluid passage time through the cloth. However, bacterial presence on the surface of cloths were not noticed. In conclusion, before the two types of cloths used for making white coats, the microfiber one presented longer fluid passage time compared to the Oxford one, due to the structural differences of these cloths. However, the functionality as bacterial physical barrier after fluid passage through the pieces of cloths were not observed, which reinforces the need to replace the white coat when it comes in contact with biological fluids, aiming at biosafety: contamination/infection control in health field

Características microbiológicas das mãos e anéis de trabalhadores de saúde - revisão integrativa

As infecções cruzadas na assistência à saúde são reconhecidas como o evento adverso que mais ocorre durante o processo de internação de pacientes em hospitais; assim a adoção de medidas preventivas é legalmente recomendada pela Norma Regulamentadora 32, que estabelece a necessidade de higienização das mãos e a proibição do uso de adornos pelos trabalhadores de saúde, inclusive anéis. Objetivo: Sumarizar as evidências científicas sobre as características microbiológicas das mãos e anéis de trabalhadores de saúde e o risco de infecção cruzada. Material e Método: Revisão integrativa da literatura estruturada nas etapas: questão norteadora, busca, categorização dos estudos, avaliação, interpretação dos resultados e síntese do conhecimento. Foram selecionados artigos originais e revisões, publicados em inglês, português, espanhol e francês, em revistas indexadas nas principais bases de dados internacionais da área da Saúde, por meio dos descritores aplicados de acordo com as particularidades de cada base de dados e obtidos por consulta nos Descritores de Ciências em Saúde (DeCS) e Medical Subject Headings (MeSH). Resultados: Sete estudos foram analisados e evidenciaram que os principais microrganismos encontrados nas mãos e anéis de profissionais de saúde foram S. aureus, Enterococcus spp, S. epidermides, Klebsiella spp e E. colli. Conclusão: A contaminação das mãos com e sem anel ocorreu de modo semelhante, não podendo dizer com exatidão se o uso de anéis foi o responsável pelo aumento na quantidade de microrganismos encontrados e se essa prática interfere na infecção cruzada.

Cross-infections in health care are recognized as being the most frequent adverse event during the hospitalization process of patients. Therefore, the adoption of preventive measures is legally recommended by the Brazilian Regulatory Standard 32, which establishes the need for hand hygiene and the ban on the use of adornments by health workers, including rings. Objective: To summarize the scientific evidence on the microbiological characteristics of hands and rings of health workers and the risk of cross-infection. Materials and Methods: Integrative review of the literature structured in the following stages: guiding question, search, categorization of studies, evaluation, interpretation of results and synthesis of knowledge. Original articles and reviews published in English, Portuguese, Spanish and French, found in indexed journals of the main international databases of the health area, were selected using applied descriptors for each database and consulting the Health Sciences Descriptors (DeCS) and Medical Subject Headings (MeSH). Results: Seven studies were analyzed and showed that the main microorganisms found in the hands and rings of health professionals were S. aureus, Enterococcus spp, S. epidermides, Klebsiella spp and E. coli. Conclusion: Contamination of hands with and without rings occurred in a similar way. Nevertheless, it cannot be claimed that the use of rings is responsible for the increase in the number of microorganisms found and if this practice interferes in the cross infection.

Las infecciones cruzadas en la asistencia a la salud son reconocidas como el evento adverso que más ocurre durante el proceso de internación de pacientes en hospitales. Es por esto que la adopción de medidas preventivas es legalmente recomendada por la Norma Reguladora 32, que establece la necesidad de higienización de las manos y la prohibición del uso de adornos por los trabajadores de salud, incluso anillos. Objetivo: Resumir las evidencias científicas sobre las características microbiológicas de manos y anillos de trabajadores de salud y el riesgo de infección cruzada. Material y Método: Revisión integradora de la literatura estructurada en pasos: pregunta orientadora, búsqueda, categorización de los estudios, evaluación, análisis e interpretación de los resultados y síntesis de los conocimientos. Fueron seleccionados artículos originales y revisiones publicadas en inglés, portugués, español y francés, de acuerdo con las descripciones de las principales bases de datos internacionales del área de la salud, a través de los descriptores aplicados de acuerdo con las particularidades de cada base de datos y obtenidos por consulta en los Descriptores de Ciencias en Salud (DeCS) y Medical Subject Headings (MeSH). Resultados: Siete estudios fueron analizados y evidenciaron que los principales microorganismos encontrados en las manos y anillos de profesionales de salud fueron S. aureus, Enterococcus spp, S. epidermides, Klebsiella spp y E. coli. Conclusión: La contaminación de manos con y sin anillo ocurrió de modo semejante, no pudiendo decir con exactitud si el uso de anillos fue el responsable por el aumento en la cantidad de los microorganismos encontrados y si esa práctica interfiere en la infeción cruzada.

Feasibility of developing HAP risk warning model in critically ill patients based on genomic copy number polymorphisms of DEFA1/DEFA3 / 中华麻醉学杂志

Objective To evaluate the feasibility of developing hospital acquired pneumonia (HAP) risk warning model in critically ill patients based on genomic copy number polymorphisms (CNPs) of the genes encoding human neutrophil peptides 1-3 (DEFA1/DEFA3).Methods Seventy-seven HAP patients (group HAP) and 109 non-HAP patients of matched age and sex in intensive care unit (ICU) (group NHAP) were enrolled in the study.The genomic CNPs of DEFA1/DEFA3 was determined by realtime quantitative polymerase chain reaction after extracting DNA from peripheral blood samples.The source of patients,condition of endotracheal intubation within 24 h after admission to ICU,Acute Physiology Score,Acute Physiology and Chronic Health Evaluation Ⅱ score,Sequential Organ Failure Assessment score,mechanical ventilation time,length of hospital and ICU stay and outcomes were obtained.The predictive model was developed using logistic regression through combining DEFA1/DEFA3 copy numbers and clinical characteristics (Acute Physiology Score and source of emergency) within 24 h after admission to ICU.The receiver operating characteristic curve was used to evaluate the predictive efficacy of the model.Results The copy numbers of DEFA1/DEFA3 were significantly lower in HAP group than in NHAP group (P ＜0.05).The area under the receiver operating characteristic curve of the predictive model developed through combining the DEFA1/DEFA3 copy numbers with clinical characteristics was 0.789 (95％ CI 0.724-0.854) when the model was used for predicting HAP.Conclusion CNPs of DEFA1/DEFA3 can be used to develop the HAP risk warning model in critically ill patients.

Is Alcohol Swabbing Sufficient to Clean Otoscopes in Hospitals? / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: An otoscope is a basic instrument used by otorhinolaryngologists. An inappropriately sterilized otoscope has been reported to be a possible bacterial vector for infection. In this regard, we decided to investigate contaminated otoscopes for possible bacterial contamination and evaluate the efficacy of the otoscope disinfection methods. MATERIALS AND METHOD: We randomly drew 22 otoscope cones from university hospitals and 10 from private hospitals. Cones were divided into three groups accordingly to their sterilization methods: group 1 was wiped with 70% isopropyl alcohol, group 2 was soaked for 20 min in 70% isopropyl alcohol, and group 3 was soaked in CIDEX solution. The samples were cultured twice, first before the disinfection process and then after the disinfection process. Otoscopes were cleaned for a week by employing these techniques. RESULTS: Most of the pre-sterilized otoscopes (20/22) were obtained from the hospitals which demonstrated contamination with microorganisms. Staphylococcus was the most common bacteria found (16/22). After a week of cleansing, no bacteria were seen in group 1 (0%, 0/8), whereas group 2 (14.3%, 1/7), and group 3 (28.6%, 2/7) still showed remaining microorganisms. The three methods were significantly effective on sterilizing microorganisms. CONCLUSION: An otoscope can be a vector for spreading infection. We found that disinfection by alcohol-swabbing alone is sufficient for sterilizing otoscope cones. Clinically, this information may be useful to otorhinolaryngologists. However, further studies are required to establish the most appropriate disinfection protocol to prevent infection from microorganisms.

USE OF CLINICAL INDICATORS IN THE EVALUATION OF PREVENTION AND CONTROL PRACTICES FOR BLOODSTREAM INFECTION / EL USO DE INDICADORES EN LA EVALUACIÓN DE LAS PRÁCTICAS CLÍNICAS PARA LA PREVENCIÓN Y CONTROL DE LA INFECCIÓN DEL TORRENTE SANGUÍNEO / O USO DE INDICADORES CLÍNICOS NA AVALIAÇÃO DAS PRÁTICAS DE PREVENÇÃO E CONTROLE DE INFECÇÃO DE CORRENTE SANGUÍNEA

ABSTRACT The aim of this study was to evaluate the compliance of the implemented prevention and control practices for central venous catheter-related bloodstream infection, through clinical indicators. An observational study, with a quantitative approach, was conducted. The case series was based on 2064 evaluations, conducted through direct observation and medical records, using a manual for evaluating the quality of cross-infection control practices. The results showed that the indicator for the registrations of the insertion and dwell time of the catheter had the highest overall compliance rate (62.5%). The indicator related to hand hygiene, on the other hand, showed a null overall compliance rate. Strategies must be developed to ensure adherence to the prevention and control practices for central venous catheter-related bloodstream infection and periodic evaluations of working conditions must be implemented, in order to raise compliance rates.

RESUMEN El estudio pretende evaluar el cumplimiento de las prácticas para la prevención y control de la infección del torrente sanguíneo, relacionadas con el catéter venoso central a través de indicadores clínicos. Este es un estudio observacional, con un enfoque cuantitativo. La serie fue basada en las evaluaciones realizadas por 2064 observación directa y registro en registros médicos, utilizando el manual de evaluación de la calidad de las prácticas de control de infecciones hospital. Los resultados mostraron que el indicador en el insertar registro y tiempo de catéter mostró el mayor índice de cumplimiento global (62,5%). El indicador relacionado con la higiene de las manos demostró ya índice general cumplimiento nulo. Hay que elaborar estrategias para garantizar el cumplimiento de las prácticas de control de la infección y prevención de la circulación sanguínea central venosa relacionada con el catéter, así como instituir las evaluaciones periódicas de las condiciones de trabajo, a fin de elevar las tasas de cumplimiento.

RESUMO O estudo objetivou avaliar a conformidade da realização das práticas de prevenção e controle de infecção de corrente sanguínea relacionada ao cateter venoso central, através de indicadores clínicos. Trata-se de um estudo observacional, com abordagem quantitativa. A casuística baseou-se em 2064 avaliações, realizadas através da observação direta e registro em prontuários, utilizando o manual de avaliação de qualidade das práticas de controle de infecção hospitalar. Os resultados mostraram que o indicador relativo ao registro de inserção e tempo de permanência do cateter apresentou maior índice de conformidade geral (62,5%). Já o indicador relacionado à higienização das mãos apresentou índice de conformidade geral nulo. Existe a necessidade de elaborar estratégias que assegurem a adesão às práticas de controle e prevenção de infecção de corrente sanguínea relacionada ao cateter venoso central, bem como instituir avaliações periódicas das condições de trabalho, no sentido de elevar os índices de conformidade.