Análise de desvios na desparamentação de equipamentos de proteção individual no contexto da pandemia de COVID-19: macacão versus avental longo / Analysis of deviations in the doffing of personal protective equipment in the context of the COVID-19 pandemic: overalls versus long apron

Introdução: a vulnerabilidade de profissionais de saúde em relação ao risco de autocontaminação por COVID-19 durante assistência clínica é agravada por desvios no uso de equipamentos de proteção individual (EPI). Objetivos: determinar a incidência dos desvios de procedimento na desparamentação dos EPI contendo macacão e avental longo; comparar a incidência dos desvios entre eles; além de analisar a associação a demais fatores levantados. Método: estudo de abordagem quantitativa, observacional e transversal, que levantou os desvios de procedimento em dois protocolos de desparamentação de EPI respectivamente contendo macacão e avental longo em dois hospitais públicos. Foram avaliados profissionais de diferentes faixas etárias e profissões, atuantes em unidade de terapia intensiva coorte coronavírus, sendo videogravadas 335 desparamentações, o que permitiu análise minuciosa dos desvios de procedimento cometidos. Resultados: a retirada da máscara N-95 exibiu taxa de desvio semelhante nos dois cenários (67,6% macacão versus 61,9% avental). A higiene das mãos obteve 87,7% de desvios (macacão) versus 55,5% (avental). Quanto à retirada do macacão e avental longo, a incidência foi de 73% de desvios (macacão) contra 6,5% (avental). Botas impermeáveis tiveram 79,7% de desvios, enquanto sapatilhas descartáveis 26,9%. Evidenciou-se que seguir exatamente a ordem dos procedimentos preconizados pelas instituições contribuiu para menor autocontaminação (macacão, p=0,03 e avental p=0,006). A desparamentação em tempo mais curto demonstrou maior número de desvios e autocontaminação, enquanto os profissionais que retiraram em tempo maior, tiveram menor número de desvios e, consequentemente, menor autocontaminação. Conclusão: observou-se que o conjunto mais complexo contendo macacão em sua composição exibiu maiores desvios, induzindo a maior autocontaminação dos profissionais em diversos quesitos, quando comparado com o conjunto com avental. Os resultados desta pesquisa dão subsídios para tomada de decisão de gestores quanto ao modelo a ser adotado, avaliando prós e contras, além de direcionar treinamento de profissionais de saúde visando sua maior segurança, especialmente em eventos com potenciais riscos biológicos.

Objective: to determine the incidence of procedure deviations in PPE containing coveralls and gown, comparing the insufficiency of deviations between them to study the association with other factors raised. Method: observational, cross-sectional study, quantitative, was raised the procedure deviations in two PPE doffing protocols, respectively coveralls and gown in two hospitals. Professionals of different age groups and professions, working in coronavirus cohort ICUs, were evaluated, and 335 undressings were recorded, which allowed a thorough analysis of the deviations of procedure committed. Results: removal of the N-95 mask exhibited a similar deviation rate across scenarios (67.6% overalls versus 61.9% apron). Hand hygiene obtained 87.7% of deviations (coveralls) versus 55.5% (apron). Regarding the removal of the coveralls and gown, the incidence was 73% of deviations (coveralls), against 6.5% (gown). Waterproof boots had 79.7% deviations, while disposable sneakers 26.9%. We showed that following exactly the order of the procedure recommended by the institutions contributed to less self-contamination (overalls, p=0.03 and apron p=0.006). The shorter doffing time showed a greater number of deviations and self-contamination, while the professionals who removed the clothes in a longer time had fewer deviations and consequently less self-contamination. Conclusion: we observed that the more complex set containing coveralls in its composition exhibited greater deviations, inducing greater self-contamination in several aspects when compared to the set with gown. The results of this research provide support for the decision of managers regarding the model to be adopted, evaluating pros and cons, in addition to directing training of health professionals aiming at their greater safety.

Encuesta sobre el manejo de injertos del ligamento cruzado anterior contaminados accidentalmente / Survey on management of accidentally contaminated anterior cruciate ligament grafts

OBJETIVO: Encuestar a cirujanos de rodilla en Chile, sobre su conducta en contaminaciones accidentales del injerto, en reconstrucciones de ligamento cruzado anterior (LCA). MÉTODOS: Se realizó una encuesta anónima en relación a la incidencia, tratamiento y resultados clínicos de los injertos de LCA contaminados, a todos los médicos pertenecientes al área de traumatología y ortopedia asistentes al congreso Ateneo de rodilla 2015. RESULTADOS: Se encuestaron 54 médicos, 33 (61%) especialistas en cirugía de rodilla y 21 (39%) médicos en formación. De los cirujanos de rodilla, 15 (45%) reportaron al menos un caso de contaminación, de los cuales 12 (80%) informaron un único evento, 3 (20%) indicaron la eventualidad en 2, 3 y 5 ocasiones respectivamente, para un total de 22 injertos contaminados. De los cirujanos que reportaron injertos contaminados, 11 (73%) realizan 50 o más reconstrucciones al año. La decisión tomada en los casos de contaminación fue en 13 oportunidades (59%), lavar el injerto y utilizarlo de acuerdo al plan inicial; en 6 casos (27%), utilizar aloinjerto; en 2 ocasiones (9%), utilizar autoinjerto alternativo; y en 1 oportunidad (5%); triplicar el semitendinoso. Ninguno de los casos de contaminación reportó infecciones. CONCLUSIONES: En casos de una contaminación accidental, la mayoría de los cirujanos encuestados prefieren optar por la descontaminación del injerto y su utilización en la reconstrucción de acuerdo al plan inicial; para lo cual la clorhexidina y antibióticos sería la solución a usar de preferencia. NIVEL DE EVIDENCIA: Nivel V, opinión de experto.

OBJECTIVE: To survey knee surgeons who perform anterior cruciate ligament (ACL) reconstruction in Chile, about the management when ACL graft contamination occurs. METHODS: An anonymous survey was conducted to all physicians belonging to the area of traumatology and orthopedics who attended the 2015 annual Chilean Knee Society meeting. The survey questioned the incidence, treatment, and outcomes of ACL graft contaminations. RESULTS: Fifty-four physicians were surveyed, of which 33 (61%) where knee surgeons and 21 (39%) physicians in training. Of the 33 knee surgeons, 15 (45%) reported at least one contamination during their career. Of those 15, 12 (80%) had one event, and three surgeons (20%) informed having 2, 3, and 5 episodes respectively, for a total of 22 reported contaminated grafts. Of the surgeons who reported a contaminated graft, 11 (73%) performed 50 or more ACL reconstructions annually. In 13 opportunities (59%) the management for a contaminated graft was cleansing the graft and proceeding as planned. In 6 cases (27%) an allograft was used, in 2 occasions (9%) a different graft was harvested, and in 1 opportunity (5%) a semitendinosus graft triplication was performed. No infections in any of the contaminated grafts were reported. CONCLUSIONS: In case of accidental graft contamination during an ACL reconstruction, knee surgeons most often preferred disinfecting the graft and using it as the initial plan. LEVEL OF EVIDENCE: Level V, expert opinion.

Microbiological contamination of nebulizers used by cystic fibrosis patients: an underestimated problem / Contaminação microbiológica de nebulizadores usados por pacientes com fibrose cística: um problema subestimado

ABSTRACT Objective: Home nebulizers are routinely used in the treatment of patients with cystic fibrosis (CF). This study aims to evaluate the contamination of nebulizers used for CF patients, that are chronically colonized by Pseudomonas aeruginosa, and the association of nebulizer contamination with cleaning, decontamination and drying practices. Methods: A cross-sectional, observational, multicenter study was conducted in seven CF reference centers in Brazil to obtain data from medical records, structured interviews with patients/caregivers were performed, and nebulizer's parts (interface and cup) were collected for microbiological culture. Results: overall, 77 CF patients were included. The frequency of nebulizer contamination was 71.6%. Candida spp. (52.9%), Stenotrophomonas maltophilia (11.9%), non-mucoid P. aeruginosa (4.8%), Staphylococcus aureus (4.8%) and Burkholderia cepacia complex (2.4%) were the most common isolated pathogens. The frequency of nebulizers' hygiene was 97.4%, and 70.3% of patients reported cleaning, disinfection and drying the nebulizers. The use of tap water in cleaning method and outdoor drying of the parts significantly increased (9.10 times) the chance of nebulizers' contamination. Conclusion: Despite the high frequency hygiene of the nebulizers reported, the cleaning and disinfection methods used were often inadequate. A significant proportion of nebulizers was contaminated with potentially pathogenic microorganisms for CF patients. These findings support the need to include patients/caregivers in educational programs and / or new strategies for delivering inhaled antibiotics.

RESUMO Objetivo: Nebulizadores caseiros são usados rotineiramente no tratamento de pacientes com fibrose cística (FC). Este estudo objetiva avaliar a contaminação de nebulizadores utilizados por pacientes de FC que estão cronicamente colonizados por Pseudomonas aeruginosa e a associação da contaminação do nebulizador com a higienização, esterilização e método de secagem. Métodos: Um estudo transversal, observacional, multicêntrico foi conduzido em sete centros de referência de FC no Brasil para obter dados de registros médicos; foram feitas entrevistas estruturadas com os pacientes/cuidadores e partes de nebulizadores (máscara e copo) foram coletados para cultura microbiológica. Resultados: No geral, 77 pacientes com FC foram incluídos. A frequência da contaminação do nebulizador foi de 71,6%. Candida spp. (52,9%), Stenotrophomonas maltophilia (11,9%), P. aeruginosa não mucoide (4,8%), Staphylococcus aureus (4,8%) e complexo Burkholderia cepacia (2.4%) foram os patógenos isolados mais comuns. A frequência de higienização dos nebulizadores foi de 97,4%, e 70,3% dos pacientes relata higienização, esterilização e secagem dos aparelhos. A lavagem com água da torneira e secagem das partes no tempo, em espaço aberto, aumentou significativamente (9 a 10 vezes) a chance de contaminação dos nebulizadores. Conclusões: Apesar dos relatos de frequente higienização dos nebulizadores, os métodos de limpeza e esterilização usados eram inadequados. Uma proporção significativa de nebulizadores foi contaminada com microrganismos potencialmente patogênicos para pacientes com FC. Estes resultados apoiam a necessidade de inclusão dos pacientes/cuidadores em programas educacionais e/ou novas estratégias para fornecimento de antibióticos inalatórios.

Microbiological analysis of contact lens cases: impact of the hospital environment / Análise microbiológica de estojos de lentes de contato: impacto do ambiente nosocomial

ABSTRACT Purpose: The aim of this study was to analyze the bacterial and fungal microbiota found in contact lens cases among two groups of patients to correlate the data on the habits of contact lens users and to evaluate whether there is a difference in the culture results between users of ridged and nonridged contact lens cases. Methods: Two groups (35 patients per group) were included, consisting of hospital workers and those who had not visited a hospital in the past 30 days, and a questionnaire regarding epidemiological data and habits related to contact lens and lens case use was administered. In addition, 140 samples collected from the right and left compartments of each lens case by swabbing the bottom of the wells were tested using bacterioscopy as well as fungal and bacterial cultures via computerized identification of the species. Results: No fungal growth was identified in any of the 70 contact lens cases; however, bacteria were found in 39 cases, and there was no statistical difference between the groups. Most bacteria (>85%) were gram-negative bacilli. Contamination inone compartment of the contact lens case elevated the risk of contamination of the other side (>80%). Moreover, contamination was statistically higher in the ridged cases than in nonridged cases (p=0.0149). Conclusion: The types of bacteria contaminating the cases are generally not seen in eye diseases associated with contact lens use, suggesting that other decisive variables are involved in eye infection from a contaminated lens or case. Fungal contamination of contact lens cases appears to be an exception. Ridged cases are commonly used by contact lens wearers and present a potential risk to eye health. In addition, the results of bacterial tests between hospital workers and those who did not visit a hospital were not significantly different.

RESUMO Objetivo: O objetivo deste trabalho foi analisar a microbiota bacteriana e fúngica encontrada em estojos de lentes de contato em dois grupos, correlacionar os dados sobre os hábitos de uso de lentes de contato e avaliar se há diferença na positividade das culturas entre os usuários estojos de lentes de contato com ranhuras e sem ranhuras. Métodos: Dois grupos foram formados, trabalhadores do hospital e pessoas que não visitaram o hospital (35 indivíduos por grupo), e um questionário foi aplicado sobre dados epidemiológicos e hábitos relacionados ao uso de lentes de contato e estojos de lentes. Além disso, 140 amostras, coletadas do compartimento direito e esquerdo de cada estojo de lente, esfregando o fundo dos mesmos, foram testadas por bacterioscopia e por culturas de fungos e bactérias, com identificação computadorizada da espécie. Resultados: Não houve crescimento fúngico em nenhum dos 70 estojos de lentes de contato, porém bactérias foram encontradas em 39; não houve diferença estatística entre os grupos. A maioria das bactérias (>85%) eram bacilos gram-negativos. Quando um compartimento estava contaminado, o risco de contaminação do outro compartimento era elevado (>80%). A contaminação foi estatisticamente maior nos estojos com ranhuras (p=0,0149). Conclusão: A contaminação dos estojos parece ocorrer por bactérias que, em geral, não são encontradas em doenças oculares associadas ao uso de lentes de contato, sugerindo que existem outras variáveis decisivas nas infecções oculares de uma lente ou estojo contaminado. Contaminação de estojos de lentes de contato com fungos parece ser uma exceção. O uso de estojos com ranhuras é uma prática comum e apresenta um risco potencial à saúde ocular. Não foram encontradas diferenças significativas nos resultados dos testes bacterianos entre trabalhadores hospitalares e pessoas que não visitaram o hospital.

Evaluación de la portación de cándida spp en pinzas ortodóncicas post utilización / Evaluation of candida spp carriage on orthodontic pliers, after using them

Objetivo: evaluar el nivel de contaminación por Candida spp, post uso del instrumental de ortodoncia que se utiliza intrabucalmente en pacientesColombianos y Argentinos. Materiales y métodos: Se incluyeron pacientesentre 16 y 65 años, de ambos sexos, con armado de brackets superior e inferior. Criterios de Exclusión: pacientes con brackets de autoligado, con enfermedades autoinmunes, con enfermedades sistémicas con manifestaciones en el periodonto, pacientes fumadores, menores de 16 años y con armado de brackets en un solo maxilar. Se analizaron los alicates de corte distal Hu Friedy luego de ser utilizados para seccionar el arco por distal del último tubo presente enboca. Se estudiaron 80 pacientes agrupados en: Grupo A 40 pacientesColombianos, Grupo B 40 pacientes argentinos. Se realizó una primer tomaintrabucal con un hisopo estéril y se llevó a un tubo con medio de Stuart. Se cortaron las 4 secciones distales de los arcos en boca tardando al menos 1 minuto. Con un segundo hisopo estéril se frota toda la superficie del alicate post uso y se llevaron a otro tubo. Se sembraron en Chromagar Candida y se realizaron pruebas microbiológicas convencionales. Resultados: Las pinzas estériles aparecen contaminadas post corte distal delos alambres en el 95% de los casos en ambos países. Hubo diferencia entrelos pacientes colombianos y los argentinos respecto a las especies, ya que enlos primeros la especie con mayor prevalencia fue Candida tropicalis tanto en lapinza como en la cavidad bucal, mientras que en los argentinos fue Candidaalbicans. Conclusión: las pinzas de ortodoncias se contaminan con Candidaspp post utilización en boca y son un fómite a partir del cual puede generarsediseminación sistémica así como infección cruzada.

Microbial investigation of biofilms recovered from endotracheal tubes using sonication in intensive care unit pediatric patients

Abstract Objectives To compare cultured microorganisms identified on endotracheal tubes biofilms through sonication technique with traditional tracheal aspirate collected at extubation of pediatric intensive care unit patients. Methods Demographic and epidemiological data were analyzed to identify factors possibly related with the microbiological profile of the two collection methods. Associations between categorical and continuous variables were analyzed using the chi-square or Fisher's exact test, or Student's t test. p-Value <0.05 were considered significant. Results Thirty endotracheal tubes and tracheal aspirates samples from 27 subjects were analyzed. Only one patient presented the clinical diagnosis of ventilator-associated pneumonia. Overall, 50% of bacteria were Gram-negative bacilli, followed by Gram-positive bacteria in 37%, and fungi in 10%. No statistically significant difference on the distribution of Gram-positive or Gram-negative bacteria (p = 0.996), and fungi (p = 0.985) were observed between the collection methods. Pseudomonas spp. was the most frequent microorganism identified (23.8%), followed by Streptococcus spp. (18.5%), Acinetobacter spp. (15.9%), coagulase-negative staphylococci (11.2%), and Klebsiella spp. (8.6%). Concordant results between methods amounted to 83.3%. Pseudomonas aeruginosa and Acinetobacter baumannii showed carbapenem resistance in 50% and 43.7% of the isolates, respectively. In general, cultures after endotracheal tubes sonication (non-centrifuged sonication fluid and centrifuged sonication fluid) yielded bacteria with higher rates of antimicrobial resistance compared to tracheal aspirates cultures. Additionally, in 12 subjects (40%), we observed discrepancies regarding microbiologic profiles of cultures performed using the collection methods. Conclusions Our study demonstrated that sonication technique can be applied to ET biofilms to identify microorganisms attached to their surface with a great variety of species identified. However, we did not find significant differences in comparison with the traditional tracheal aspirate culture approach.

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

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

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

Propofol inhibits burn injury-induced hyperpermeability through an apoptotic signal pathway in microvascular endothelial cells

Recent studies have revealed that an intrinsic apoptotic signaling cascade is involved in vascular hyperpermeability and endothelial barrier dysfunction. Propofol (2,6-diisopropylphenol) has also been reported to inhibit apoptotic signaling by regulating mitochondrial permeability transition pore (mPTP) opening and caspase-3 activation. Here, we investigated whether propofol could alleviate burn serum-induced endothelial hyperpermeability through the inhibition of the intrinsic apoptotic signaling cascade. Rat lung microvascular endothelial cells (RLMVECs) were pretreated with propofol at various concentrations, followed by stimulation with burn serum, obtained from burn-injury rats. Monolayer permeability was determined by transendothelial electrical resistance. Mitochondrial release of cytochrome C was measured by ELISA. Bax and Bcl-2 expression and mitochondrial release of second mitochondrial-derived activator of caspases (smac) were detected by Western blotting. Caspase-3 activity was assessed by fluorometric assay; mitochondrial membrane potential (Δψm) was determined with JC-1 (a potential-sensitive fluorescent dye). Intracellular ATP content was assayed using a commercial kit, and reactive oxygen species (ROS) were measured by dichlorodihydrofluorescein diacetate (DCFH-DA). Burn serum significantly increased monolayer permeability (P<0.05), and this effect could be inhibited by propofol (P<0.05). Compared with a sham treatment group, intrinsic apoptotic signaling activation - indicated by Bax overexpression, Bcl-2 downregulation, Δψm reduction, decreased intracellular ATP level, increased cytosolic cytochrome C and smac, and caspase-3 activation - was observed in the vehicle group. Propofol not only attenuated these alterations (P<0.05 for all), but also significantly decreased burn-induced ROS production (P<0.05). Propofol attenuated burn-induced RLMVEC monolayer hyperpermeability by regulating the intrinsic apoptotic signaling pathway.

Microbial contamination of single-and multiple-dose vials after opening in a pulmonary teaching hospital

OBJECTIVES: Intravenous therapy is a complex procedure usually requiring the preparation of the medication in the clinical area before administration to the patient. Breaches in aseptic technique may result in microbial contaminations of vials which is a potential cause of different avoidable infections. We aimed to investigate the prevalence and pattern of microbial contamination of single- and multiple-dose vials in the largest pulmonary teaching hospital in Iran. METHODS: In a period of 2 months, opened single- and multiple-dose vials from different wards were sampled by a pharmacist. The name of the medication, ward, labeling of the vials, the date of opening, and storing temperature were recorded for each vial. Remained contents of each vial were cultured using appropriate bacterial and fungal growth media. RESULTS: Microbial contamination was identified in 11 of 205 (5.36%) of vials. The highest contamination rate was 14.28% for vials used in interventional bronchoscopy unit. The most frequent contaminated medication was insulin. Gram-positive bacteria (81.82%) were more significantly involved than gram-negative ones (9.09%) and fungi (9.09%), with the highest frequency for Staphylococcus epidermidis . CONCLUSIONS: Our data demonstrate that repeated use of vials especially if basic sterility measures are disobeyed can cause microbial contamination of administered products to the patients. Infection preventionists are responsible to train health care workers regarding aseptic techniques and apply guidelines for aseptic handling of intravenous solutions.

Contaminação de equipamentos e superfícies de unidades de terapia intensiva de uma maternidade pública por staphylococcus coagulase negativa / Contamination of equipment and surfaces intensive care unit of a public maternity coagulase negative staphylococcus

As unidades de terapia intensiva são consideradas áreas críticas de um hospital, pois oferecem risco para infecções. O ambiente destas unidades representa um potencial reservatório de micro-organismos patogênicos, os quais podem ser veiculados a hospedeiros suscetíveis como recém-nascidos e crianças. O objetivo deste estudo foi detectar a presença de Staphylococcus coagulase negativa em equipamentos e superfícies de unidades de terapia intensiva de uma maternidade pública de Goiânia, Goiás. A pesquisa foi desenvolvida em três unidades, sendo duas pediátricas e uma neonatal. A coleta das amostras ocorreu no período de setembro de 2011 a julho de 2012. Foram avaliados 93 materiais, sendo 48 equipamentos e 45 superfícies. O procedimento de coleta das amostras foi realizado com a utilização de swab, o qual foi introduzido em meios de cultura específicos. Os isolados bacterianos foram identificados mediante análises microscópicas, macroscópicas e testes bioquímicos. Dentre os materiais analisados, 62 (66,7 por cento) estavam contaminadas por Staphylococcus coagulase negativa, sendo 32 (66,7 por cento) equipamentos e 30 superfícies (66,7 por cento). As incubadoras (90,9 por cento) e as bancadas (88,9 por cento) foram os materiais mais frequentemente contaminados. Foi isolado um total de 65 bactérias. Alguns materiais (n=3) apresentaram contaminação concomitante por duas cepas bacterianas fenotipicamente diferentes. Neste estudo, os equipamentos e superfícies investigados foram identificados como focos de contato de Staphylococcus coagulase negativa, apresentando risco para a transmissão destes micro-organismos a recém-nascidos e crianças hospitalizadas. A adoção de procedimentos de descontaminação mais efetivos é necessária para o controle da disseminação desta bactéria no ambiente hospitalar...

Ovos de enterobius vermicularis em salas de espera e banheiros de unidades básicas de saúde (UBS) do município de Nova Serrana-MG: contribuições para o controle / Enterobius vermicularis eggs in waiting rooms and bathrooms basic health units (BHU) in the municipality of Nova Serrana-MG: contributions to control

Neste trabalho, avaliou-se, utilizando a técnica de Graham (1941), a presença de ovos de helmintos intestinais em amostras coletadas em objetos de cinco Unidades Básicas de Saúde (UBS) da cidade de Nova Serrana-MG. No total de oito coletas, foram amostrados, nas recepções, 40 mesas de atendimento e 40 assentos de cadeiras e, nos banheiros, 64 maçanetas internas e 64 maçanetas externas de portas. Todas as lâminas foram analisadas por microscopia óptica nos aumentos de 10X e 40X no Laboratório de Microscopia da FUNEDI/UEMG e reexaminadas no Laboratório de Helmintologia e Malacologia Médica do Centro de Pesquisas René Rachou (FIOCRUZ-Minas). Os resultados indicaram a presença de ovos de Enterobius vermicularis, em sua maioria, viáveis, sendo os percentuais de ocorrência calculados por meio de proporção simples. Na recepção, a porcentagem de contaminação foi de 25,0 por cento nas mesas de atendimento e de 17,9 por cento no assento das cadeiras; nos banheiros, 35,7 por cento das maçanetas internas e 21,4 por cento das maçanetas externas apresentaram ovos. Não foram encontrados ovos e larvas de outros helmintos, apenas grãos de pólen, fibras vegetais e esporos de fungos. Foram realizadas palestras direcionadas aos funcionários destas UBS para apresentar-lhes os resultados e discutir medidas para evitar a contaminação de pessoas que frequentam e trabalham nestes locais. Os dados evidenciaram que as salas de espera das UBS podem ser importantes veículos de dispersão e contaminação de enteroparasitos. Medidas de educação em saúde são importantes e devem ser realizadas entre os usuários e funcionários dos postos, pois levam as pessoas a conhecer o problema, mudar seus hábitos e discutir soluções para prevenção e controle desta e de outras endemias...

In this study, the presence of intestinal helminth eggs was evaluated in samples collected from five Basic Health Units (BHU) using the Graham’s technique (1941), in the city of Nova Serrana (MG). In the total of 8 collections, 40 chair seats and 40 attendance tables were sampled in the reception and, on the toilet doors, 64 internal door handles and 64 external door handles. All the slides were analyzed by light optic microscopy with 10X and 40X magnifications in the Microscopy Laboratory FUNEDI / UEMG and re-examined in the Medical Malacology and Helminthology Laboratory of the Research Center René Rachou (FIOCRUZ-Minas). The results indicated the presence of Enterobius vermicularis eggs, mostly viable, with infection rates calculated by simple proportion. In the reception the contamination percentage was 25.0 percent on attendance tables and 17.9 percent on chair seats; in the toilets, 35.7 perecent of internal door handles and 21.4 percent of external door handles presented eggs. There were no eggs and larvae of other helminths, only pollen grains, vegetable fibers and fungal spores. Lectures were held with employees of BHU to present the results and discuss measures that can be taken to prevent contamination of people who attend and work at these sites. The data showed that the BHU toilets and waiting rooms can be important vehicles of dispersal and contamination with enteroparasites. Health education measures are important and must be undertaken among the health center users and employees as they lead people to understand the problem, change their habits and discuss solutions to prevent and control this and other diseases...

Avaliação da contaminação dos tubos de resina composta nas clínicas do Curso de Odontologia de uma universidade particular em Manaus-AM / Assessment of contamination of composite resins tubes in Dental School clinics in a private university at Manaus-AM

Objetivo - Avaliar a contaminação de tubos de resina manipulados nas clínicas de graduação do Curso de Odontologia da Universidade Paulista (UNIP) em Manaus-AM. Métodos - Realizou-se a detecção do crescimento bacteriano em culturas de amostras coletadas em 13 tubos de resina composta, escolhidos aleatoriamente e divididos em três grupos: Grupo 1 - tubos sem uso e lacrados (3 tubos); Grupo 2 - tubos de resina em uso na clínica odontológica 1 da UNIP (5 tubos); Grupo 3 - tubos de resina em uso na clínica odontológica 2 da UNIP (5 tubos). As coletas foram realizadas em fluxo laminar, por um único operador, utilizando swabs umedecidos em solução salina estéril, sendo em seguida as amostras semeadas em caldo BHI e incubados à temperatura de 37°C por 24-48 horas. Após 48 horas de incubação, foi considerado como positivo o tubo em que houve turvação do meio. Destes, foi realizada semeadura em Agar BHI, Sabouraud e Mac-Conkey. Após a semeadura, as placas foram incubadas em estufa bacteriológica a 37°C por 24 horas, a fim de se avaliar a morfologia das colônias e coloração de Gram. Resultados - Das amostras coletadas, em apenas uma não houve crescimento bacteriano, demonstrando que as paredes externas dos tubos de resina composta foram contaminadas após os procedimentos realizados pelos alunos da UNIP/Manaus. Observou-se ainda contaminação dos tubos lacrados pelo fabricante, e a desinfecção com álcool 70% não foi suficiente para descontaminar a superfície dos tubos. Conclusão - Existe a necessidade de educação priorizando a biossegurança em todos os procedimentos realizados em Odontologia, principalmente por alunos de graduação.

Objective - To evaluate the contamination of tubes of resin handled in clinics of Dental School, University Paulista (UNIP) at Manaus-AM. Methods - This was the detection of bacterial growth in cultures of samples collected in 13 tubes of composite resin, chosen at random and divided into three groups: Group 1 - unused and sealed tubes (3 tubes), Group 2 - tubes use of resin in a dental clinic UNIP 1 (5tubes), Group 3 - tubes of resin in use of dental clinic UNIP 2 (5 tubes) samples were collected in a laminar flow, by a single operator using swabs soaked in sterile saline, and then the samples grown in BHI broth and incubated at 37° C for 24-48 hours. After 48 hours of incubation was considered as positive when the tube was turbid medium. Of these, seeding was performed on BHI agar, Sabouraud and MacConkey. After seeding, the plates were incubated in a bacteriological incubator at 37°C for 24 hours in order to evaluate the colony morphology and Gram staining. Results - Of the samples collected in only one there was no bacterial growth, demonstrating that the outerwalls of the composite tubes were contaminated after the procedures performed by students of UNIP/ Manaus. It was also observed contamination of the tubes sealed by the manufacturer, and disinfection with 70% alcohol is not sufficient to decontaminate the surface of the tubes. Conclusion - There is a need to prioritize education in all biosafety procedures in dentistry, mainly for undergraduate students.

Contaminação de cassetes radiográficos em hospital privado: uma contribuição da enfermagem / Contamination of radiographic cassettes in private hospital: a nursing contribution

Objetivo - Investigar os cassetes radiográficos como fontes de contaminação cruzada entre pacientes internados e verificar como são realizadas as radiografias nos leitos das Unidades de Terapia Intensiva e apartamentos quanto à prevenção e controle de infecção hospitalar. Métodos - Trata-se de um estudo aplicado, quantitativo e descritivo realizado em um hospital privado do Piauí. Na pesquisa estiveram presentes dois tipos de populações distintas: sete cassetes radiográficos e sete técnicos ou tecnólogos em Radiologia. A realização das culturas e aplicação do checklist foram realizadas de março a abril de 2011. Resultados - Verificou-se que 91,42% das culturas laboratoriais apresentaram a presença de incontáveis unidades formadoras de colônias de microrganismos patogênicos, sendo 62,5% Bacilos Gram negativos. Não é realizada a descontaminação dos cassetes radiográficos antes dos exames nos leitos (100%). Conclusões - A Enfermagem, ao observar elementos que possibilitem a ocorrência de infecção hospitalar, deve cooperar para uma assistência hospitalar de maior qualidade.

Objective - To investigate the radiographic cassettes as sources of cross contamination between patients and see how X-rays are performed in the beds of Intensive Care Units and apartments on the prevention and control of hospital infection. It is an applied study, quantitative and descriptive conducted in a private hospital in Piauí. Methods - In the present study were two types of distinct populations: seven X-ray cassettes and seven technicians or tecnologists in Radiology. The completion of the checklist and application cultures were performed from March to April 2011. Results - It was found that 91.42% of laboratory cultures showed the presence of countless colony-forming units of pathogenic microorganisms, 62,5% Gram negative. Decontamination is not performed before the slides radiographic examinations of the beds (100%). Conclusions - Nursing, the elements that make it possible to observe the occurrence of hospital infection, should cooperate to a higher quality hospital care.

Análisis de la monitorización de cinco indicadores de calidad del hemocultivo en un hospital universitario en Chile 2009-2011 / Quality indicators for blood culture: three years of monitoring at a university hospital in Chile

Blood culture is considered the "gold standard" for the diagnosis of bacteremia, critical condition with high morbidity and mortality. Because of its importance, it is estimated that the blood culture is a critical test that requires close monitoring on the quality with which the process is performed. The objective of this work is to show the results of the monitoring carried out during the past three years, of 5 quality indicators of blood cultures in the laboratory of the Hospital Clínico de la Pontificia Universidad Católica de Chile, considering pre-analytical, analytical and post-analytical aspects. In the 3 years monitored the mean contamination was 0,7%, 46% of adult bottles had adequate volume, match between Gram stain with final identification was 99.4%, 100% of correct participations were achieved in surveys of external quality control and Gram staining notification before 1 hour was 88.7%. With regard to proposed aims, in 2011 the laboratory complies with all, except the percentage of bottles with appropriate volume of blood inoculated. This indicator is very low and should be corrected as soon as possible since it is known that it is an important condition for optimum performance of blood cultures.

El hemocultivo es el "estándar de oro" para el diagnóstico de bacteriemia, condición grave de alta morbi-mortalidad. Por esto, se estima que el hemocultivo es un examen crítico, que requiere monitorización de su calidad. El objetivo de este trabajo es mostrar los resultados de la monitorización de 3 años de 5 indicadores de calidad del hemocultivo implementados en nuestro hospital. El porcentaje promedio de contaminación de las botellas para hemocultivo fue 0,7%, el porcentaje de botellas de adultos con volumen adecuado fue 46%, la concordancia de la tinción de Gram con la identificación final correspondió a 99,4%, el 100% de las participaciones en encuestas de control de calidad externo fueron correctas y 88,7% de los avisos de valores de alerta de la tinción de Gram fueron realizados antes de 1 hora. En el año 2011 se cumplió con las metas propuestas por el laboratorio para todos los indicadores, excepto con el porcentaje de botellas con volumen apropiado de sangre. Este último, se encuentra muy por debajo de la meta y debe ser mejorado a la brevedad, ya que el volumen de sangre cultivada es el factor más importante para obtener un rendimiento óptimo del hemocultivo.

Contaminação por Bacillus cereus em superfícies de equipamentos e utensílios em unidade de alimentação e nutrição / Contamination by Bacillus cereus on equipment and utensil surfaces in a food and nutrition service unit

A constatação de que Bacillus cereus é um microrganismo que constitui problema especial em plantas de processamento de alimentos, dentre as quais se incluem restaurantes universitários, levou a realização deste trabalho, que teve como objetivo contribuir para a avaliação de riscos a que se expõem os usuários de cozinhas de grande porte, por meio da identificação de pontos do ambiente, a partir dos quais o microrganismo pode ser transferido aos alimentos. A presença de B. cereus foi detectada em 38,3 por cento das amostras de equipamentos e utensílios estudados. As contagens atingiram até 5,7x10² UFC/cm², sendo que os valores mais elevados foram obtidos a partir de amostras dos setores de distribuição, indicando a importância destes locais como fontes potenciais de transmissão do microrganismo para os alimentos.

The confirmation that Bacillus cereus is a microorganism that represents a special problem in food processing plants, such as university cafeterias, inspired this work, the scope of which was to evaluate the risks consumers are exposed to by identifying the contamination points from whence the microorganism can be transferred on to food. The presence of B. cereus was detected in 38.3 percent of the equipment and utensils studied. Counts of up to 5.7x10 ² CFU/cm² were found, with the highest values being found in samples from distribution sectors, indicating the importance of these areas as potential sources of microorganism transmission on to food.

Nebulizadores: fonte de contaminação bacteriana em pacientes com fibrose cística? / Nebulizers in cystic fibrosis: a source of bacterial contamination in cystic fibrosis patients?

OBJETIVO: Determinar se os nebulizadores de pacientes com fibrose cística são fonte de contaminação microbiana e verificar se a técnica e a frequência de desinfecção dos nebulizadores é apropriada. MÉTODOS: Estudo de corte transversal observacional, sem grupo controle. Foram coletadas amostras de 28 pacientes com fibrose cística, no domicílio do paciente, sem aviso prévio sobre o motivo da visita. Foram colhidas três amostras por paciente: do reservatório do nebulizador, da máscara/bocal e do próprio paciente (swab da orofaringe/escarro). As amostras foram acondicionadas adequadamente e levadas para análise. Os pacientes, seus pais ou responsáveis preencheram um questionário sobre métodos de limpeza e desinfecção dos nebulizadores. RESULTADOS: Foram obtidas 84 amostras dos 28 pacientes. Destes, 15 (53,5 por cento) eram do gênero masculino. A mediana de idade foi de 11 anos (variação: 1-27 anos). Dos 28 pacientes, 15 apresentaram culturas de escarro/orofaringe positivas. As bactérias encontradas com maior frequencia foram Streptococcus aureus (8/15) e Pseudomonas aeruginosa (4/15). A cultura obtida dos nebulizadores identificou diversos patógenos, sem nenhum predominante. Não houve associações entre os resultados das culturas obtidas dos nebulizadores e aquelas dos pacientes em 27 casos (96,7 por cento). A limpeza e a desinfecção não eram realizadas de forma adequada em 22 casos (78,6 por cento). CONCLUSÕES: Nesta amostra de pacientes, apesar das técnicas de desinfecção inadequadas, os nebulizadores não foram uma fonte de contaminação microbiana.

OBJECTIVE: To determine whether nebulizers are a source of microbial contamination in patients with cystic fibrosis, as well as whether the technique and frequency of disinfection of these devices is appropriate. METHODS: This was a cross-sectional, uncontrolled observational study. Samples were collected from 28 patients with cystic fibrosis. Samples were collected at the homes of the patients, who were not previously informed of the purpose of the visit. Three samples were collected from each patient: one from the nebulizer chamber, one from the mask/mouthpiece, and one from the patient (oropharyngeal swab /sputum). The samples were properly stored and taken for analyses. The patients, their parents, or their legal guardians completed a questionnaire regarding nebulizer cleaning and disinfecting methods. RESULTS: We collected 84 samples from the 28 patients. Of those 28 patients, 15 (53.5 percent) were male. The median age of the patients was 11 years (range, 1-27 years). Of the 28 patients, 15 presented with positive oropharyngeal swab /sputum sample cultures. The most common bacterial isolates were Staphylococcus aureus (in 8 patients) and Pseudomonas aeruginosa (in 4 patients). Although the samples obtained from the nebulizers presented with various pathogens in culture, no specific species predominated. In 27 cases (96.7 percent), there were no associations between the samples obtained from the nebulizers and those obtained from the patients in terms of the results of the cultures. Cleaning and disinfection of nebulizers were inappropriate in 22 cases (78.6 percent). CONCLUSIONS: In this sample of patients, despite the inappropriate disinfection techniques, nebulizers were not found to be a source of microbial contamination.

Contaminação bacteriana de estetoscópios das unidades de pediatria em um hospital universitário / Bacterial contamination of stethoscopes in pediatric units at a university hospital

A avaliação da contaminação, de estetoscópios utilizados em setores pediátricos de hospital e emergência, mostrou que 87 por cento dos estetoscópios apresentaram diafragmas contaminados. O microrganismo mais freqüentemente isolado foi Staphylococcus coagulase negativo. A resistência aos antibióticos mostra que o estetoscópio deve ser considerado um importante veículo de bactérias resistentes aos antibióticos.

Evaluation of the contamination of stethoscopes used in pediatric units of a hospital and emergency service showed that 87 percent of them presented contaminated diaphragms. Coagulase-negative Staphylococcus was the microorganism most frequently isolated. The resistance to antibiotics indicates that stethoscopes should be considered to be an important vehicle for disseminating bacteria resistant to antibiotics.

Etiology and pathogenesis of bloodstream infections associated with the use of long-term central vascular catheter (CVC) in patients who undergone gastrointestinal surgery

CVC is the main factor of risk of bloodstream infections. This study purpose was determining both etiology and pathogenesis of these infections in 80 patients who undergone gastrointestinal surgery and who worn long lasting CVC, in the institution HC-UFU. Cultures were made in nostril, skin of the insertion site, tip and catheter hub, in addition to hemoculture in those suspects of sepsis. The colonization incidence rate of the catheter tip was 12.5/ 1,000 catheter days and the CVC associate infection rate was 3.1/1,000 catheter days. Frequencies of skin, hub and catheter tip colonization were 13.8 percent, 8.9 percent and 13.3 percent, respectively. Coagulase-negative Staphylococci were the most found microorganisms in nostril (74 percent), skin (45.4 percent) and hub (75 percent) and Gram-negative bacilli (50 percent), followed by S. aureus (25 percent) the most common ones in catheter tip. Approximately 51 percent of patients received antibiotics and most of them (53.7 percent) had therapeutic purpose. The frequency of patients with clinical sepsis was 27.5 percent. Three cases of bacteremia associated with the use of CVC were detected (3.8 percent), with S. aureus in two of them and K. pneumoniae in the third one. There was not seen any association of skin and hub colonization with their presence in the catheter tip and in the blood of these patients, but S. aureus was recovered from nostril of those with sepsis by this pathogenic agent. A greater concern is suggested over preventive measures and control of these primary and secondary bloodstream, as well as catheter tip colonization.

Microbial contamination of antiseptics and disinfectants.

OBJECTIVE: To study the bacterial contamination of antiseptics and disinfections in-use and the risk factors for contamination. MATERIAL AND METHOD: Bacterial contamination of antiseptics and disinfectants was done by culturing in-use solutions. Eight commonly used solutions were studied: alcohol 70%, chlorhexidine 4%, and 0.5%, povidone iodine 7.5% and 10%, tincture iodine 1-2%, lysol 2% and sodium hypochlorite 0.5%. RESULTS: The following risk factors for contamination were found : preparation by unskilled personnel, improper containers and prolonged use. Contamination with bacteria were found in 1.8% of 16,142 samples tested Highest rate of contamination was found in Lysol 2%. There was no contamination of povidone iodine 10% and tincture iodine 1-2%. Bacterial contamination of antiseptics and disinfectants was highest in provincial hospitals and was not found in university hospitals. The rates of contamination correlated with the duration of use. Most bacteria isolated were those found in the environment. CONCLUSION: The contamination of in-use antiseptics and disinfectants was as high as 1.8%. Risk factors for contamination were improper preparation and prolonged use.