Healthcare-associated infections: a threat to the survival of patients with COVID-19 in intensive care units.

BACKGROUND: Wide variation in mortality rates among critically ill patients with coronavirus disease 2019 (COVID-19) has been reported. This study evaluated whether healthcare-associated infections (HAI) are a risk factor for death among patients with severe COVID-19 in the intensive care unit (ICU). METHODS: This retrospective cohort study included patients with severe COVID-19 hospitalized in the ICU of four hospitals in the city of Curitiba, Brazil. Patients with COVID-19 who died during ICU hospitalization were compared with those who were discharged. A second analysis compared patients who developed HAI in the ICU with those who did not. Multiple logistic regression models were used to control for confounders. RESULTS: In total, 400 patients were included, and 123 (31%) patients developed HAI. The most common HAI was lower respiratory tract infection (67%). Independent risk factors for death were: age [odds ratio (OR) 1.75, 95% confidence interval (CI) 1.43-2.15; P<0.0001]; clinical severity score (OR 2.21, 95% CI 1.70-2.87; P<0.0001); renal replacement therapy (OR 12.8, 95% CI 5.78-28.6; P<0.0001); and HAI (OR 5.9, 95% CI 3.31-10.5; P<0.0001). A longer interval between symptom onset and hospital admission was protective against death (OR 0.93, 95% CI 0.88-0.98; P=0.017). The only independent factors associated with HAI were high C-reactive protein and low PaO2/FiO2 ratio. CONCLUSIONS: No factors that could point to a high-risk group for HAI acquisition were identified. However, age, dialysis and HAI increased the risk of death in ICU patients with severe COVID-19; of these, HAI is the only preventable risk factor.

CHALLENGES AND REFLECTIONS ON CULTURAL DIVERSITY IN THE CONTEXT OF PANDEMIC COVID-19

The study aimed to understand the pedagogical practices, involving cultural diversity, developed by Portuguese teachers during the pandemic period caused by COVID-19 in 2020. The research was carried out at the Federal Institute of Rondonia Science and Technology, in the Campi of Colorado do Oeste and Vilhena, with 04 (four) Portuguese Language teachers who work in Integrated High School. The methodological instruments used were documentary research, bibliographic research and semi -structured interview, anchored in the perspective of Candau (2008), Merleau-Ponty (2011) and Freire (1997;2007). The results point out the concern of the teachers in making possible an emancipatory and humanizing education through pedagogical practices that promote a dialogue of respect and valorization of multiculturalism. Limitations on access to technological resources were evidenced due to the social, political and economic inequalities that affect our country, being a great challenge to guarantee the constitutional right of access to a fair and integrative education.