The impact of tooth brushing versus tooth brushing and chlorhexidine application to avoid postoperative pneumonia in children.

BACKGROUND: The pathogenesis of postsurgical pneumonia is a complicated and multifactorial process, in which elements like oral bacteria, orotracheal intubation, and dental hygiene play an important role. The objective of this study was to evaluate the efficacy of 2 types of oral hygiene interventions in decreasing cases of postsurgical pneumonia. METHODS: In pediatric patients scheduled for surgery, a quasi-experimental study was carried out over a 2-year period to evaluate the efficacy of 2 types of oral hygiene interventions. There were 2 groups of intervention with 1 group for comparison. Intervention groups were tooth brushing by a dentist (intervention group 1) and dental brushing by parents + chlorhexidine gluconate (intervention group 2). Data from the year with no oral hygiene interventions were used as the baseline group. RESULTS: A total of 2,535 surgical procedures were followed. Baseline group incidence of postoperative pneumonia was 10 per 1,000 surgeries, 0.2 per 1,000 surgeries in the intervention group 1 (P = .04), and 0.8 per 1,000 surgeries in the intervention group 2. Intervention group 1 was protective against postoperative pneumonia (odds ratio, 0.06; P = .02; 95% confidence interval, 0.033-0.079), but there was no benefit with intervention group 2 (odds ratio, 0.87; P = .599; 95% confidence interval, 0.52-1.46). CONCLUSIONS: Dental brushing performed before surgery by a pediatric dentist was effective in reducing the incidence of postoperative pneumonia in pediatric patients.

Healthcare-Associated Pneumonia: Don't Forget About Respiratory Viruses!

Introduction: Healthcare-associated infections are an important cause of morbidity and mortality, are among the most common adverse events in healthcare, and of them, pneumonia is the most commonly reported. Our objective was to evaluate the incidence and clinical outcome of respiratory viruses in hospital-acquired pneumonia (HAP). Methods: This was a prospective cohort study, include patients aged between 0 and 18 who fulfilled Centers for Diseases Control and Prevention (CDC) criteria for HAP. Demographic and clinical data were obtained, and a nasopharyngeal swab specimen was taken for the detection of respiratory viruses. All included patients were monitored until discharge to collect data on the need for mechanical ventilation, intensive care unit (ICU) admission, and mortality. All-cause 30-day mortality was also ascertained. Results: Four thousand three hundred twenty-seven patients were followed for 42,658 patient-days and 5,150 ventilator-days. Eighty-eight patients (2.03%) met the CDC criteria for HAP, 63 patients were included, and clinical and epidemiological characteristics showed no statistically significant differences between patients with virus associated healthcare-associated pneumonia (VAHAP) and those with non-viral healthcare-associated pneumonia (NVHAP). At least one respiratory virus was detected in 65% [95% CI (53-77)] of episodes of HAP, with a single viral pathogen observed in 53.9% and coinfection with 2 viruses in 11.1% of cases. The outcome in terms of ICU admission, mechanical ventilation and the 30-day mortality did not show a significant difference between groups. Conclusions: In two-thirds of the patients a respiratory virus was identified. There was no difference in mortality or the rest of the clinical outcome variables. About half of the patients required mechanical ventilation and 10% died, which emphasizes the importance of considering these pathogens in nosocomial infections, since their identification can influence the decrease in hospital costs and be taken into account in infection control policies.

Seroprevalencia de Bordetella pertussis en el personal de enfermería y médicos residentes del Hospital Infantil de México Federico Gómez / Seroprevalence of Bordetella pertussis in pediatric healthcare workers at the Hospital Infantil de México Federico Gómez

Resumen Introducción Bordetella pertussis es el agente causal de la tosferina, una enfermedad de alta letalidad, especialmente en menores de 6 meses, pero prevenible mediante la vacunación. Los reportes en hospitales de brotes de tosferina muestran que el caso índice suelen ser personas adultas. En adultos, la enfermedad se manifiesta principalmente con tos persistente. El propósito de este estudio fue conocer la seroprevalencia de B. pertussis en el personal de salud de un hospital pediátrico en un país donde aún no se considera la vacunación obligatoria para los empleados. Métodos Participaron personal de enfermería y médicos residentes en trato directo con pacientes hospitalizados. A cada participante se le realizó detección de anticuerpos inmunoglobulina G, antitoxina de pertussis (anti-TP) y se le aplicó un cuestionario para datos clínicos y demográficos. Resultados Se incluyeron 93 individuos, el 85% de personal de enfermería con mediana de edad de 35 años (rango intercuartil: 29-42.5). El 21.5% de los participantes laboraban en el Servicio de Urgencias, el 8.6%, en la Unidad de Terapia Intensiva Pediátrica, el 6.5%, en la Unidad de Cuidados Intensivos Neonatales. Se encontraron títulos detectables de anticuerpos anti-TP en el 18.3%, de los cuales, el 53% presentaron títulos de infección reciente y solamente el 23.5%, historia de tos de más de dos semanas de evolución. Conclusiones El personal de salud está en riesgo de sufrir la enfermedad y de transmitirla a los lactantes, quienes pueden fallecer por esta causa. Este estudio sugiere que las políticas actuales de vacunación en personal de salud se deben de modificar para determinar obligatoriedad de la vacuna, especialmente en quienes atienden a la población pediátrica.

Abstract Background Bordetella pertussis is the causative agent of pertussis, a disease that is preventable by vaccination but has a high mortality, particularly in children < 6 months. Reports of pertussis outbreaks in hospitals show that the index case is usually an adult. In adults, the disease manifests mainly with persistent cough. The purpose of this study was to determine the seroprevalence of B. pertussis in the health personnel of a pediatric hospital in a country where vaccination of this staff is not considered mandatory. Methods Nursing staff and resident doctors who were involved in direct treatment with hospitalized patients participated in the study. Each participant was screened for immunoglobulin G anti-pertussis toxin antibodies (anti-PT), and a questionnaire was applied for clinical and demographic data. Results Ninety-three individuals were included, of which 85% were nurses, median age 35 years (interquartile range: 29-42.5). The participants worked in the emergency department (21.5%), in the Pediatric Intensive Care Unit (8.6%), and in the Neonatal Intensive Care Unit (6.5%). Detectable titers of anti-TP antibodies were found in 18.3%, of which 53% presented titles suggestive of recent infection and only 23.5% cough > 2 weeks of duration. Conclusions Health personnel are at risk of suffering from the disease and be potential transmitters to infants, who may die from this cause. This study suggests that the current vaccination policies in health personnel should be modified to determine the compulsory nature of the vaccination, especially in those individuals in charge of the care of the pediatric population.

Seroprevalence of Bordetella pertussis in pediatric healthcare workers at the Hospital Infantil de México Federico Gómez.

Background: Bordetella pertussis is the causative agent of pertussis, a disease that is preventable by vaccination but has a high mortality, particularly in children < 6 months. Reports of pertussis outbreaks in hospitals show that the index case is usually an adult. In adults, the disease manifests mainly with persistent cough. The purpose of this study was to determine the seroprevalence of B. pertussis in the health personnel of a pediatric hospital in a country where vaccination of this staff is not considered mandatory. Methods: Nursing staff and resident doctors who were involved in direct treatment with hospitalized patients participated in the study. Each participant was screened for immunoglobulin G anti-pertussis toxin antibodies (anti-PT), and a questionnaire was applied for clinical and demographic data. Results: Ninety-three individuals were included, of which 85% were nurses, median age 35 years (interquartile range: 29-42.5). The participants worked in the emergency department (21.5%), in the Pediatric Intensive Care Unit (8.6%), and in the Neonatal Intensive Care Unit (6.5%). Detectable titers of anti-TP antibodies were found in 18.3%, of which 53% presented titles suggestive of recent infection and only 23.5% cough > 2 weeks of duration. Conclusions: Health personnel are at risk of suffering from the disease and be potential transmitters to infants, who may die from this cause. This study suggests that the current vaccination policies in health personnel should be modified to determine the compulsory nature of the vaccination, especially in those individuals in charge of the care of the pediatric population.

Introducción: Bordetella pertussis es el agente causal de la tosferina, una enfermedad de alta letalidad, especialmente en menores de 6 meses, pero prevenible mediante la vacunación. Los reportes en hospitales de brotes de tosferina muestran que el caso índice suelen ser personas adultas. En adultos, la enfermedad se manifiesta principalmente con tos persistente. El propósito de este estudio fue conocer la seroprevalencia de B. pertussis en el personal de salud de un hospital pediátrico en un país donde aún no se considera la vacunación obligatoria para los empleados. Métodos: Participaron personal de enfermería y médicos residentes en trato directo con pacientes hospitalizados. A cada participante se le realizó detección de anticuerpos inmunoglobulina G, antitoxina de pertussis (anti-TP) y se le aplicó un cuestionario para datos clínicos y demográficos. Resultados: Se incluyeron 93 individuos, el 85% de personal de enfermería con mediana de edad de 35 años (rango intercuartil: 29-42.5). El 21.5% de los participantes laboraban en el Servicio de Urgencias, el 8.6%, en la Unidad de Terapia Intensiva Pediátrica, el 6.5%, en la Unidad de Cuidados Intensivos Neonatales. Se encontraron títulos detectables de anticuerpos anti-TP en el 18.3%, de los cuales, el 53% presentaron títulos de infección reciente y solamente el 23.5%, historia de tos de más de dos semanas de evolución. Conclusiones: El personal de salud está en riesgo de sufrir la enfermedad y de transmitirla a los lactantes, quienes pueden fallecer por esta causa. Este estudio sugiere que las políticas actuales de vacunación en personal de salud se deben de modificar para determinar obligatoriedad de la vacuna, especialmente en quienes atienden a la población pediátrica.