ABSTRACT
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.
Subject(s)
Cross Infection/microbiology , Cross Infection/prevention & control , Equipment and Supplies, Hospital/microbiology , Hematopoietic Stem Cell Transplantation/adverse effects , Hospital Design and Construction/methods , Neoplasms/complications , Air Microbiology , Environmental Exposure/adverse effects , Humans , Immunocompetence , Infection Control/methods , Neoplasms/therapy , Risk Assessment , Risk Factors , Water MicrobiologyABSTRACT
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.
Subject(s)
Humans , Cross Infection/microbiology , Cross Infection/prevention & control , Hematopoietic Stem Cell Transplantation/adverse effects , Equipment and Supplies, Hospital/microbiology , Hospital Design and Construction/methods , Neoplasms/complications , Water Microbiology , Risk Factors , Infection Control/methods , Risk Assessment , Air Microbiology , Environmental Exposure/adverse effects , Immunocompetence , Neoplasms/therapyABSTRACT
INTRODUCTION: Acinetobacter baumannii causes severe infections that primarily affect intensive care unit (ICU) patients. It has a high prevalence of multidrug resistance, including carbapenems, and a high potential for intra-hospital and inter-hospital transmission. The aim of this study was to determine the origin of extensively drug-resistant (XDR) A. baumannii isolates in our hospital during 2009. METHODOLOGY: This was an observational retrospective study. Isolates of A. baumannii were obtained from patients hospitalized during 2009. XDR isolates were defined using criteria published by Magiorakos et al.. The isolates were classified as community acquired, hospital acquired, and inter-hospital transmission. RESULTS: A total of 48 isolates of A. baumannii were isolated during 2009, corresponding to 34 patients. Of these, 18 (53%) were susceptible, 6 (18%) were multidrug resistant (MDR), and 10 (29%) were XDR. Of the 10 XDR isolates, 9 were isolated from patients transferred from other hospitals. The median time of hospitalization in origin hospitals was 17 days, while the median time of hospitalization in the study hospital, previous to isolation of A. baumannii, was 1 day. A total of 6 out of 10 patients had a positive culture taken on the day of admission. None of the patients shared a clinical ward or time during hospitalization. Genotypic characterization demonstrated the existence of two clones (A and B) which were geographically associated with patients transferred from two different regions of the country. CONCLUSIONS: During 2009, all XDR A. baumannii isolates were recovered from patients coming from other hospitals, indicative of inter-hospital transmission.
Subject(s)
Acinetobacter Infections/microbiology , Acinetobacter Infections/transmission , Acinetobacter baumannii/drug effects , Acinetobacter baumannii/isolation & purification , Disease Transmission, Infectious , Drug Resistance, Multiple, Bacterial , Acinetobacter Infections/epidemiology , Acinetobacter baumannii/classification , Acinetobacter baumannii/genetics , Genotype , Hospitals, University , Humans , Molecular Epidemiology , Molecular Typing , Retrospective StudiesABSTRACT
UNLABELLED: Visual assessment of surfaces may not be enough to document the level of cleanliness in the hospital setting. It is necessary to introduce quantitative methods to document the results of this practice. OBJECTIVE: To evaluate the efficacy of hospital terminal cleaning procedures, using an adenosine triphosphate (ATP) bioluminescence method in a teaching hospital. METHOD: During 2008 we conducted an evaluation using ATP bioluminescence LIGHTNING MVP™ (Arquimed) of external and internal housekeeping service. After conducting an initial evaluation we implemented education of cleaning practices and finally we did a post intervention evaluation. Using chi-square method we compared prior versus after cleaning, quality of cleaning performed by external versus internal personnel, single versus double terminal cleaning procedures and prior versus after intervention. A finding of three RLU or less was considered a clean surface. RESULTS: We performed 198 evaluations in 33 patient units and nine OR. Internal personnel accomplished 25.37% of clean surfaces before and 80% after the education intervention (p=0.01). In contrast, external personnel obtained 68.8% before and 73.33% after intervention (p=0.3). CONCLUSIONS: This study suggests that visual assessment is not enough to ensure quality of the process and it is necessary to document the level of cleanliness by quantitative methods.
