ABSTRACT
BACKGROUND: Nursing home residences suffered a lockdown from the beginning of the COVID-19 pandemic. The present study prospectively evaluates the frailty, functional, and nutritional statuses of nursing home residents. METHODS: Three hundred and one residents from three nursing homes took part in the study. Frailty status was measured using the FRAIL scale. Functional status was evaluated using the Barthel Index. Additionally, Short Physical Performance Batter (SPPB), SARC-F, hand-grip strength, and gait speed were also evaluated. Nutritional status was determined using the mini nutritional assessment test (MNA) and several anthropometrical and biochemical markers. RESULTS: Mini Nutritional Assessment test scores decreased in 20% throughout the confinement (p < .001). Barthel index, SPPB and SARC-F scores also decreased, although to a lesser extent, reflecting a decrease in functional capacity. However, both anthropometric parameters, hand grip strength and gait speed, remained stable throughout confinement (p > .050 in all cases). Morning cortisol secretion significantly decreased by 40% from baseline to post-confinement. A significant reduction in daily cortisol variability was observed, which may suggest increased distress. Fifty-six residents died during the period of confinement (81.4% survival rate). Sex, FRAIL and Barthel Index scores were significant predictors of resident survival. CONCLUSION: After the first COVID-19 blockade, several alterations in residents' frailty markers were observed, which were small and potentially reversible. However, many of the residents were pre-frail after the lockdown. This fact highlights the need for preventive strategies to reduce the impact of future social and physical stressors on these vulnerable individuals.
Subject(s)
COVID-19 , Frailty , Humans , Aged , Prospective Studies , Hand Strength , Hydrocortisone , Pandemics , Geriatric Assessment , COVID-19/epidemiology , Communicable Disease Control , Nutritional Status , Nursing Homes , Frail ElderlyABSTRACT
Objetivo: avaliar a incidência da pneumonia associada à ventilação mecânica em unidade de terapia intensiva (UTI). Método: trata-se de um estudo de coorte retrospectivo desenvolvido em um hospital universitário. Análises univariadas foram realizadas por meio do teste Qui-quadrado ou teste exato de Fisher para variáveis categóricas e teste não paramétrico de Mann-Whitney para variáveis numéricas. Resultados: Durante 24 meses foram admitidos 190 pacientes na UTI, desses, 90,5% utilizaram Ventilação Mecânica (VM). A incidência de pneumonia associada à VM foi de 23,2%, sendo notificada em 100% dos pacientes que utilizaram VM; a densidade de incidência foi de 32,4/1000 ventiladores/dia e a taxa de mortalidade global dos pacientes com pneumonia foi de 72,7%. Houve associação positiva entre a ocorrência de pneumonia e o tempo de internação >15 dias (RR: 7,29), o tempo de VM >10 dias (RR: 11,33) e reintubação (RR: 6,31). Conclusão: a pneumonia foi considerada como uma doença de alta morbidade na Unidade de Terapia Intensiva. Torna-se necessário a implantação de medidas efetivas para qualidade e segurança no cuidado de pacientes críticos. (AU)
Objective: To evaluate the incidence of ventilator-associated pneumonia in intensive care unit (ICU). Method: A retrospective cohort study, was carried in a university hospital. Univariate analyzes were performed using the chi-square test or Fisher's exact test for categorical variables, and nonparametric Mann-Whitney test for numerical variables. Results: In a period of 24 months, 190 patients were admitted in the ICU, and 90.5% of them used mechanical ventilation. The incidence of ventilatorassociated pneumonia (VAP) was 23.2%, being notified in 100% of the patients who used the mechanical ventilation; the incidence density of VAP was 32.4/1000 ventilator days and the overall mortality associated with VAP was 72.7%. There was a positive association between the occurrence of pneumonia and the period of hospitalization in the intensive care unit > 15 days (RR: 7.29), time of mechanical ventilation > 10 days (RR: 11.33), and reintubation (RR: 6.31). Conclusion: pneumonia is considered a high morbidity condition in the intensive care unit. Thus, it is necessary to implement effective measures for quality and safety on the care of critically ill patients (AU)
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Cross Infection , Pneumonia, Bacterial , Pneumonia, Ventilator-Associated , Patient Safety , Incidence , Intensive Care UnitsABSTRACT
BACKGROUND: Microorganisms may contaminate hospital mattresses even after terminal cleaning. We investigated the recovery of resistant bacteria from the mattresses of patients under contact precautions at a university hospital. METHODS: We conducted a cross-sectional study. Samples were obtained from the surface of mattresses, spread on replicate organism detection and counting plates, and cultivated at 37°C for 48 hours. After collecting samples, we identified microorganisms and tested for antimicrobial susceptibility using the Vitek 2 (bioMérieux SA, Marcy-l'Etoile, France) automation system. RESULTS: We evaluated 51 mattresses. A total of 26 had resistant bacteria on the surface; the predominant species were Acinetobacter baumannii (69.2%), Klebsiella pneumoniae (11.5%), and Pseudomonas aeruginosa (11.5%). The median length of hospital stay was 41 days; the bed occupancy for patients under contact precautions and the time at which the patient was diagnosed as a carrier of resistant bacteria was 18 days. CONCLUSIONS: The phenotypic similarity of A baumannii in inpatient units (mattresses) suggests circulation of the same strain. These results highlight the importance of controlling the potential spread of microorganisms through hospital mattresses.
Subject(s)
Bacteria/isolation & purification , Beds/microbiology , Bacteria/classification , Bacteriological Techniques , Cross Infection/transmission , Cross-Sectional Studies , Drug Resistance, Bacterial , France , Hospitals, University , Humans , Patient Isolation , PhenotypeABSTRACT
Objetivou-se determinar as características epidemiológicas de microrganismos presentes nos jalecos de trabalhadores de saúde em um hospital de grande porte. Tratou-se de um estudo transversal conduzido no período de janeiro a agosto de 2011. Realizou-se a rolagem de swabs no bolso e região do abdômendo jaleco. Foi realizada estatística descritiva e teste qui-quadrado de Pearson. Participaram do estudo100 profissionais. Foram obtidas 200 amostras dos jalecos. Dessas 47% foram positivas com crescimento microbiano, 73,6% apresentaram resistência a um ou mais antimicrobiano sendo 55,7% nos bolsos e 44,3% na região abdominal. A recuperação do Staphylococcus ssp nas duas áreas analisadas com resistência a vários antimicrobianos, dentre eles a oxacilina mereceu destaque. A maior contaminação foi verificada entre jalecos dos profissionais de enfermagem (p< 0,05). Os jalecos de trabalhadores de saúde podem tornar-se contaminados por microrganismos de relevância epidemiológica, contribuindo, para a possível disseminação de patógenos entre diferentes pacientes e ambientes...
The objective was to determine the epidemiological characteristics of microorganisms present in the healthcare workers coats in a large hospital. It was a cross-sectional study carried out from January to August 2011. The samples were obtained by swabs from the pocket and abdominal region of professionalscoats. Data were analyzed by descriptive statistics and chi-square test. The study included 100 professionals.We obtained 200 samples of coats. Of these 47% were positive with microbial growth, 73.6%showed resistance to one or more antimicrobials being 55.7% in the pockets and 44.3% in the abdominal region. The most important was the recovery of Staphylococcus spp in the two analyzed areas with resistance to various antibiotics, including oxacillin. The highest contamination was observed between nursing professionals coats (p <0.05). The coat of health care workers can become contaminated by microorganismsof epidemiological relevance, contributing to the potential spread of pathogens between patients and different environments...
Subject(s)
Humans , Male , Female , Cross Infection , Health Personnel , ClothingABSTRACT
BACKGROUND AND OBJECTIVES: A safety culture is essential to minimize errors and adverse events. Its measurement is needed to design activities in order to improve it. This paper describes the methods and main results of a study on safety climate in a nation-wide representative sample of public hospitals of the Spanish NHS. MATERIAL AND METHOD: The Hospital Survey on Patient Safety Culture questionnaire was distributed to a random sample of health professionals in a representative sample of 24 hospitals, proportionally stratified by hospital size. Results are analyzed to provide a description of safety climate, its strengths and weaknesses. Differences by hospital size, type of health professional and service are analyzed using ANOVA. RESULTS: A total of 2503 responses are analyzed (response rate: 40%, (93% from professionals with direct patient contact). A total of 50% gave patient safety a score from 6 to 8 (on a 10-point scale); 95% reported < 2 events last year. Dimensions "Teamwork within hospital units" (71.8 [1.8]) and "Supervisor/Manager expectations and actions promoting safety" (61.8 [1.7]) have the highest percentage of positive answers. "Staffing", "Teamwork across hospital units", "Overall perceptions of safety" and "Hospital management support for patient safety" could be identified as weaknesses. Significant differences by hospital size, type of professional and service suggest a generally more positive attitude in small hospitals and Pharmacy services, and a more negative one in physicians. CONCLUSIONS: Strengths and weaknesses of the safety climate in the hospitals of the Spanish NHS have been identified and they are used to design appropriate strategies for improvement.
Subject(s)
Delivery of Health Care/standards , Hospitals, Public/standards , Organizational Culture , Patients , Safety Management , Humans , SpainABSTRACT
The current study suggests the need for routine post-discharge surveillance to improve reliability on surgical site infection incidence rates. Surveillance only during hospitalization may not provide precise data on the incidence of surgical site infection, underestimating a true postoperative infection rate.
Subject(s)
Digestive System Surgical Procedures/adverse effects , Stomach/surgery , Surgical Wound Infection/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Brazil , Female , Hospitals, University/statistics & numerical data , Humans , Male , Middle Aged , Patient Discharge , Population Surveillance , Prospective Studies , Surgical Wound Infection/etiologyABSTRACT
In the last decades it has been observed an increase in frequency on nosocomial infections by resistant microorganisms, especially in Intensive Care Units (ICU). This study aimed to determine main sites of nosocomial infections and prevalence of multidrug resistant microorganisms. An epidemiological and descriptive study was developed in an adult ICU of a University Hospital of Belo Horizonte, Minas Gerais, from January to December, 2004. Among the most prevalent nosocomial infections were pneumonia, urinary tract infections, and bloodstream infections. Among the resistant microorganisms prevailed Pseudomonas aeruginosa, Acinetobacter baumanii, MRSA, Klebsiella, Enterobacteriaceas and Serratia. As this study is still going on, we expect to determine temporal trends for resistant microorganisms related to nosocomial infections main sites.
Nas últimas décadas tem-se observado o aumento da freqüência das infecções hospitalares (IH) por microrganismos resistentes. Essa realidade é ainda mais evidente em Unidades de Tratamento Intensivo (UTI). Objetivou-se nesse estudo determinar os principais sítios de ocorrência das IH e a prevalência dos microrganismos multirresistentes, nesta unidade. Tratou-se de um estudo epidemiológico, descritivo, desenvolvido na UTI adulto de um Hospital Universitário de Belo Horizonte, Minas Gerais no período de janeiro a dezembro de 2004. Dentre as infecções hospitalares mais prevalentes apresentadas verificou-se que a pneumonia, infecção do trato urinário e da corrente sangüínea foram respectivamente as mais importantes. Na prevalência do microrganismo resistente destacaram a Pseudomonas aeruginosa, Acinetobacter baumanii, MRSA, Klebsiella, Enterobacteriáceas e Serratia. Sendo este um projeto em continuidade espera-se determinar em um período maior a tendência temporal dos microrganismos resistentes correlacionados aos principais sítios de IH.
Subject(s)
Humans , Male , Female , Critical Care , Nursing , Epidemiologic Studies , Cross InfectionABSTRACT
Introduction:The actions of the Infection Hospital Control Comitte (HICC) according to federal regulations 2616/98, are based essentially on the surveillance epidemiologic that makes possible the definition of guidelines?s prevention and control infection. However a high unrest for the health care workers refer the fact that during the health care they haven't understood that the infection control is an ineherent aspect in their practice because of the risk in manipulation of organic matter, secretions and excretions, in addition to contact with microorganisms disseminated by differents route of transmission.Objective: to identify the perception of the healthcare workers team about the performance of Infection Hospital Control Committee (HICC). Methods: This is a descriptive study, completed in a hospital university of Belo Horizonte. A questionnaire was applied to 86 professionals (nurses, physicians and physiotherapists). Results: It was found that 88% of the professionals had knowledge of the meaning of the acronym HICC, 64% of them could identify a case of hospital infection, however just 48,8% had knowledge about the identification criterion of the resistant microorganisms. The lack of knowledge and commitment were the main cause for the low or not adhesion of control measures for hospital infection. In relation to the professional's perception of the HICC, the majority considers it actively participative. Conclusion: this study has important contributions for the reflections of the practices of the healthcare workers team, as well as, for the HICCs think about yours strategic of the training and involvement with the hospital community.
Introdução: As ações das Comissões de Controle de Infecção Hospitalar, de acordo com a portaria 2.616/98, fundamentam-se essencialmente na vigilância epidemiológica que possibilita a definição de diretrizes de prevenção e controle de infecções. Apesar disso,uma grande inquietação para os profissionais, refere-se ao fato de que estes, durante a realização da assistência em saúde não têm entendido que o controle de infecções é um aspecto inerente à sua prática,devido aos riscos na manipulação de matéria orgânica,secreções e excreções,além do contato com microrganismos disseminados por diferentes vias de transmissão. Objetivo: conhecer a percepção da equipe multiprofissional a respeito da atuação da Comissão de Controle de Infecção Hospitalar (CCIH). Método: Realizou-se um estudo descritivo, em um hospital universitário de Belo Horizonte. Utilizou-se um questionário aplicado a 86 profissionais (enfermagem, médicos e fisioterapeutas). Resultados: Verificou-se que 88% dos profissionais conheciam o significado da sigla CCIH, 64% souberam identificar um caso de Infecção hospitalar porém, apenas 48,8% tinham conhecimento sobre os critérios de identificação de microrganismos resistentes. Para a baixa ou não-adesão às medidas de controle das infecções hospitalares, a falta de conhecimento e de compromisso foram os principais motivos citados. Em relação à percepção dos profissionais sobre a CCIH, a maioria a considerou atuante. Conclusão: Acredita-se que este estudo apresenta importantes contribuições para a reflexão, tanto das práticas da equipe multiprofissional como também para as CCIHs de repensarem suas estratégias de treinamento e envolvimento junto à comunidade hospitalar.
