Parte II. Variables del ambiente hospitalario que inciden en el riesgo de infecciones de pacientes con cáncer y receptores de trasplante de precursores hematopoyéticos: Diseño, procesos asistenciales, calidad microbiológica del aire y agua / Hospital environment variables that affect the risk of infections of cancer patients and recipients of hematopoietic precursor transplants: Design, care processes, microbiological quality of air and water

Resumen El ambiente hospitalario es una fuente potencial de exposición a patógenos como bacterias, hongos y parásitos, que pueden provocar infecciones en pacientes con cáncer incluyendo receptores de trasplante de precursores hematopoyéticos. Para aminorar este riesgo, se deben tener en cuenta los elementos de diseño, construcción y emplazamiento del área de atención de pacientes. Se entregan recomendaciones para proveer ambientes seguros, incluyendo características y uso de ambiente protegido, la definición de procesos críticos, equipos clínicos destinados a la atención de pacientes, sugerencias de ámbitos a supervisar y aspectos relativos a la calidad microbiológica del aire y agua.

The hospital environment is a potential source of exposure to pathogens such as bacteria, fungi and parasites that can cause infections in patients with cancer including transplanted hematopoietic precursors. To mitigate this risk, the design, construction and location elements of the patient care area must be taken into account. Recommendations are given to provide safe environments, including aspects related to characteristics and use of a protected environment, the definition of critical processes, clinical teams dedicated to the care of patients, suggestions of areas to be monitored, the microbiological quality of air and water.

Molecular characteristics of methicillin-resistant Staphylococcus aureus isolates from hospital and community environments in northeastern Brazil

ABSTRACT This study characterized 30 MRSA isolates from intensive care unit (ICU) environment and equipment surfaces and healthy children. The SCCmec types I, IVa and V were detected in HA-MRSA isolates while CA-MRSA showed the SCCmec type IVa and V. Most isolates were classified as agr group II. All isolates presented the sei gene, and only HA-MRSA were positive for etb e tst genes. Three genotypes were related to Pediatric (ST5/SCCmecIV) and Berlin (ST45/SCCmecIV) clones. The present study showed molecular similarity between CA- and HA-MRSA isolates in hospital and community settings in a Brazilian region.

Carbapenem-resistant Acinetobacter baumannii contamination in an intensive care unit

Abstract INTRODUCTION: Acinetobacter baumannii is a major pathogen causing infections in intensive care units (ICUs). In this study, we aimed to evaluate the presence of A. baumannii in an ICU environment and gloves from ICU workers and to characterize the antimicrobial resistance of the isolates in comparison with those isolated from ICU patients at the same hospital. METHODS: ICU samples were collected from March to November 2010. Isolates biochemically characterized as Acinetobacter calcoaceticus-Acinetobacter baumannii complex were evaluated by PCR targeting the 16S rDNA and bla OXA-51 genes. Antimicrobial susceptibility was determined using the disk diffusion method, and carbapenem-resistant isolates were also evaluated for the minimum inhibitory concentration of imipenem using broth microdilution. The presence of the bla OXA-23 gene was evaluated in isolates with reduced susceptibility to carbapenems. RESULTS: A. baumannii was detected in 9.5% (84) of the 886 samples collected from the ICU environment, including from furniture, medical devices, and gloves, with bed rails being the most contaminated location (23.8%; 20/84). Multidrug-resistant (MDR) A. baumannii was found in 98.8% (83/84) of non-clinical and 97.8% (45/46) of clinical isolates. Reduced susceptibility to carbapenems was detected in 83.3% (70/84) of non-clinical and 80.4% (37/46) of clinical isolates. All isolates resistant to carbapenems harbored bla OXA-23. CONCLUSIONS: We found a strong similarity between the antimicrobial susceptibility profiles of non-clinical and clinical A. baumannii isolates. Such data highlight the ICU environment as a potential origin for the persistence of MDR A. baumannii, and hence the ICU may be a source of hospital-acquired infections caused by this microorganism.

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.

Candida glabrata among Candida spp. from environmental health practitioners of a Brazilian Hospital

Abstract The incidence of the species Candida albicans and non-albicans Candida was evaluated in a Brazilian Tertiary Hospital from the environment and health practitioners. In a 12-month period we had a total positivity of 19.65% of Candida spp. The most recurring non-albicans Candida species was C. glabrata (37.62%), generally considered a species of low virulence, but with a higher mortality rate than C. albicans. Subsequently, C. parapsilosis (25.74%) and C. tropicalis (16.86%) were the second and third most commonly isolated species. Considering the total samples collected from the emergency room and from the inpatient and the pediatric sector, 19.10% were positive for Candida spp., with the predominance of non-albicans Candida species (89.42%). The high percentage of positivity occurred in the hands (24.32%) and the lab coats (21.88%) of the health care assistants. No sample of C. albicans presented a profile of resistance to the drugs. All the non-albicans Candida species presented a decreased susceptibility to miconazole and itraconazole, but they were susceptible to nystatin. Most of the isolates were susceptible to fluconazole and amphotericin B. As expected, a high resistance rate was observed in C. glabrata and C. krusei, which are intrinsically less susceptible to this antifungal agent. The contamination of environmental surfaces by Candida spp. through hand touching may facilitate the occurrence of Candida infections predominantly in immunocompromised patients. In addition to that, the antifungal agents used should be carefully evaluated considering local epidemiologic trends in Candida spp. infections, so that therapeutic choices may be better guided.

Validação do processo de selagem em embalagens de produtos reprocessados na central de esterilização / Validation of sealing process for medical devices reprocessed in central supplies sterilization departments

Em função da complexidade e da necessidade de se estabelecerm rotinas e procedimentos operacionais padrão, que são interligados desde a limpeza até o armazenamento de materisis e produtos em centrais de esterilização, a validação de processos de selagem parece ser algo pouco divulgado e até certo ponto um ato que passa despercebido. Neste cenário, o presente artigo tem como objetivo servir de guia para enfermeiros de centrais de esterilização quanto ao conhecimento do processo de validação de embalagens e a obtenção de um guia simplificado para execução dos processos de validação de selagem de materiais esterelizados...

Bacterial contamination of some hospital equipments in Kano, Nigeria

One hundred swabs of some hospital equipments that come in contact with patients were collected and analysed at five [5] different hospitals in Kano State, Nigeria. These were cultured on selective and enrichment media for the purpose of isolation and identification of bacterial pathogens. Plates with growth were Gram-stained and subjected to biochemical analysis. The results showed that 76% of the swabs were positive for bacterial growth. The isolated bacteria were Corynebacterium spp. [10%], Lactobacillus spp. [8%], Staphylococcus spp. [52%] and Streptococcus spp. [6%]. Isolation of potential pathogens on surface of hospital equipments indicated that these equipment predispose the patients to nosocomial infections, sometimes with lethal repercussion to both patients and healthcare providers

Legionella in clinical specimens and hospital water supply facilities: molecular detection and genotyping of the isolates

To evaluate genus- and species-specific polymerase chain reactions [PCRs] for the detection of the genus Legionella and the species Legionella pneumophila in clinical specimens and hospital water supplies, and to establish a simple and reproducible random amplification of polymorphic DNA [RAPD]-PCR technique for genotyping of Legionella. A total of 70 respiratory tract specimens [bronchoalveolar lavage: n = 46; endotracheal secretions: n = 9; sputum: n = 15] from patients with atypical pneumonia, and 283 environmental samples [water: 20; swabs: 263] collected from water storage and supply facilities of the Mubarak Al-Kabeer Hospital, Kuwait, were tested by culture and genus-specific PCR for the detection of Legionella. The L pneumophila isolates were subsequently typed by serology and RAPD-PCR using serotype-specific sera and arbitrary primers, respectively. Of the 70 clinical samples, culture yielded 2 [2.9%] whereas genus-specific PCR detected Legionella in 20 [28.6%] samples. The 2 culture-positive specimens were also positive for L.-pneumophila-specific PCR. Testing of swab and water samples by culture and genus-specific PCR yielded 61 [21.6%] and 67 [23.7%] positive samples, respectively. All of the 61 culture-positive samples were also positive by genus-specific PCR and 45 of them were positive for L.-pneumophila-specific PCR. Serological typing of 43 L pneumophila isolates showed that 8 of these belonged to serotype 1 and 35 to serotype 3; however, RAPD-PCR analyses demonstrated polymorphisms among the isolates of both serotypes. A higher association between PCR and culture was observed for the environmental samples than for the clinical samples. The application of genus- and species-specific PCRs and RAPD is useful in the detection and typing of Legionella in clinical and environmental samples

A study on the application of pasteurization of medical equipment.

OBJECTIVES: To study the need of pasteurization of medical equipment and the possibility of production of pasteurizer in Thailand. MATERIAL AND METHOD: The need of pasteurization of medical equipment was studied by a set of questionnaires to heads of the central sterile supply department (CSSD) and head ward nurses in 29 hospitals across Thailand. Efficacy of pasteurization was demonstrated by disinfection with an imported pasteurizer. A pasteurizer was later produced by the researchers and had it tested for efficacy in disinfection. RESULTS: There were 26 items of medical equipment that could be disinfected by pasteurization. The number of the equipment was 6.2 pieces per bed per week. Disinfection of the equipment was done in C.S.S.D. as well as in patient's wards. The imported pasteurizer was efficacious in disinfection. The pasteurizer made by researchers was convenient for use, not expensive to manufacture and the operating cost for disinfection was 2 to 6 folds less than that done by ethylene oxide gas. CONCLUSION: Pasteurization is effective in disinfection and is applicable to certain heat labile medical equipments. A pasteurizer is not difficult to produce, cheap and the operating cost is low. Pasteurization should be more widely applied in Thailand

Characterization of Acinetobacter from clinical isolates at Gandhi memorial and associated hospitals, Lucknow.

The study was conducted in 4140 clinical samples sent to Microbiology department from different department of G.M. and associated hospitals. The samples included 2270 urine, 960 pus, 300 blood, 210 sputum, 180 CSF, 20 intercostal drainage tubes and 150 other swabs like vaginal and urethral, conjunctival smear 30, 10 ascitic fluids and 10 gastric aspirates. Apart from this, 30 specimens were collected from hospitals environment, like linen and trolley. From clinical samples, 43 acinetobacter strains (1.04%) were isolated. 17 strains (0.41%), were from pus, 12 (0.28%), from respiratory tract, 1, was (0.02%) from intercostal drainage secretions, urine 9 (0.22%), blood 1 (0.2%) and CSF 3 (.72%). From environmental samples, 7 strains (23.33%) were isolated. All the isolated strains were identified by routine biochemical tests. They were preserved in 1 % agar media for characterization. Characterization was done on the basis of growth at 37 degrees c, 41 degrees c and 44 degrees c, hemolysis, gelatin hydrolysis, acid from glucose, utilization of citrate, L-phenyl alanine, malonate, B-alanine, L-arginine, L-ornithine and L-aspartate. Among species identified Acinetobacter baumannii was 30 (69.67%), from clinical specimens and 5 (71.42%) from environment, Acinetobacter lwoffi was 10 (23.25%) from clinical specimen and 2 from environmental specimen, Acinetobacter hemolyticus was 3 (6.97%) and none from the environment. All the strains were resistant to penicillin. The sensitivity pattern showed gentamycin 64% sensitive, cotrimaxazole 42% cefotoxin 32% ciprofloxacine 26% and tetracycline 16%.