Outbreak of KPC-producing Klebsiella pneumoniae at a Portuguese university hospital: Epidemiological characterization and containment measures.

Background: KPC-producing K pneumoniae (KPC-Kp) is a public health problem with important clinical and epidemiological implications. We describe an outbreak of KPC-Kp at vascular surgery and neurosurgery wards in a central hospital in Porto, Portugal. Methods: A case of KPC-Kp was considered to be a patient positive for KPC-Kp with strong epidemiological plausibility of having acquired this microorganism in the affected wards and/or with genetic relationship ≥92% between KPC-Kp isolates. Active surveillance cultures (ASCs) and real-time polymerase chain reaction were used for the detection of carbapenemase genes through rectal swab in a selected population. Molecular analysis was performed using pulsed-field gel electrophoresis at the National Reference Laboratory. Patient risk factors were collected from the electronic medical record system. Information regarding outbreak containment strategy was collected from the Infection Control Unit records. Results: Of the 16 cases, 11 (69%) were identified through active screening, representing 1.4% of the total 766 ASCs collected. The most frequent risk factors identified were previous admission (63%), antibiotic exposure in the past 6 months (50%), and immunodepression (44%). The length of stay until KPC-Kp detection was high (0-121 days, mean 35.6), as was the total length of stay (5-173 days, mean 56.6). Three patients (19%) were infected by KPC-Kp, 2 of whom died. One previously colonized patient died later because of KPC-Kp infection. Conclusions: Multifactorial strategy based on contact precautions (with patient and healthcare professional cohorts) and ASC, as well as Antibiotic Stewardship Program reinforcement, allowed to contain this KPC-Kp outbreak.

Medical masks' and respirators' pattern of use, adverse effects and errors among Portuguese health care professionals during the COVID-19 pandemic: A cross-sectional study.

BACKGROUND: During COVID-19 pandemic, a shortage of surgical masks (Mask) and respirators (Resp) was experienced worldwide. We aimed to assess its pattern of use, adverse effects and user errors by Portuguese health care professionals (HCP). METHODS: A cross-sectional study was conducted through snowball convenience sample, collected by email/ social media to health care organizations. Participants answered an online anonymous survey in March 2021. RESULTS: Mean age of 3052 respondents was 42.1 years old, 83.6% were female and 77.8% provided direct health care to COVID-19 patients. Mean time of use per shift was 6-8 hours in 40.8% of the participants. 28.0% reported never changing it during their shift. Resp use (vs Mask) was more associated with discomfort (58.2% vs 26.8%), affecting task performance (41.5 vs 18.9%) and communication (55.0 vs 40.9%), dyspnea (36.0 vs 14.4%), skin rash (37.5 vs 19.4%) and headache (37.5 vs 19.4%). Frequent user errors included touching the front while in use (70.1% Mask vs 66.3% Resp) and omitting hand hygiene before (61.8% Mask vs 55.0% Resp) or after use (61.3% Mask vs 57.0% Resp). Average number of errors was higher for Mask (4.3), than for Resp (3.2) (all: P < .001). CONCLUSIONS: Most HCP admitted an extended use of Mask/ Resp. Resp were more prone to adverse effects and Mask more prone to errors. Strategies to reinforce good practices should be considered.

Native Knee Septic Arthritis Due to Cutibacterium acnes: A Case Report.

Commensal skin anaerobes have been described as causative agents of prosthetic joint infections. Infection of native joints by these agents are, however, less common. We present the case of a 34-year-old male with recurrent joint effusion following closed trauma to the knee, four years ago, refractory to corticosteroid injections and several arthrocenteses. A synovial biopsy revealed Cutibacterium acnes infection leading to antibiotic therapy with clindamycin, and the patient was referred to orthopaedic and submitted to arthroscopic lavage. Atypical cartilage lesions, resembling the "growth of bacterial colonies", were found in the tibial plateaus with repeated isolation of C. acnes. Inpatient treatment with penicillin and vancomycin was conducted, followed by an oral course of amoxicillin, with no further registered recurrences. In this case, the authors describe a rare cause of native knee septic arthritis while highlighting the importance of repeated microbiology studies and adequate collection technique and sample handling, in order to better ascertain whether the isolated agent represents a contaminated sample or a true infection.

A Thorn in a Haystack: A Rare Case of Septic Arthritis.

Pantoea agglomerans is a facultative anaerobe and environmental bacterium that could be a cause of opportunistic human infections, especially in wound infection with plant material. Arthritis or synovitis secondary to penetrating plant thorn injuries is not frequently reported. We present the case of a 35-year-old otherwise healthy male with a bramble thorn penetrating injury of the left knee. P. agglomerans was isolated from the synovial fluid. The patient was treated with amoxicillin/clavulanate according to sensitivity testing. This case highlights the importance of precise and thorough medical history, especially for less common presentations, as well as source control.

Risk Perception of COVID-19 Among the Portuguese Healthcare Professionals and General Population.

Risk perception assessment of COVID-19 among Portuguese Healthcare Professionals (HCP) and General Population (GPop) was evaluated in a snowball 3 403 individual's sample. 54.9% of HCP believed there is a high probability of becoming infected, in contrast with 24.0% of GPop (p <0.001) and, in more than 1/4, that this could happen to their family. Regarding prophylactic isolation, more than 70% agreed with its effectiveness. A large proportion perceived that health services are poorly prepared (50.1% GPop versus 63.5% HCP, p<0.001). Regarding Health Authorities' communication, about 60% were "moderately" satisfied. 46.7% GPop and 52.8% HCP had the opinion the pandemic could be controlled in three to six months (p=0.01).

[Respiratory and Facial Protection: Current Perspectives in the Context of the COVID-19 Pandemic]. / Proteção Facial e Respiratória: Perspetivas Atuais no Contexto da Pandemia por COVID-19.

The new SARS-CoV-2 pandemic is an example of an international public health emergency, which is associated with considerable social and economic challenges. At the healthcare level there is the risk that nosocomial outbreaks can be local amplifiers. Adequate infection control practices are of critical importance, which include proper use of personal protective equipment. This equipment must be appropriate to the pathogen transmission route that, in the case of SARS-CoV-2, occurs through droplet and contact routes. The infected individual, when talking, coughing or sneezing, spreads droplets containing the virus, directly contaminating other individuals within one to two meters of distance, as well as the surrounding environment. Airborne transmission may occur when aerosol-generating procedures are performed. Concerning respiratory protection, there is currently weak evidence that the use of respirators provides better protection than surgical masks for SARS-CoV-2 or other viruses (with the exception of aerosol-generating procedures, in which case the use of a respirator is recommended). Eye protection should be guaranteed whenever there is a risk of splashes, droplets or aerosols. The use of different, or higher than necessary, level of personal protective equipment, for the transmission route of the agent, is a form of misuse and can affect its supply for situations when it is clearly indicated. The adequate provision of protective equipment, as well as training of healthcare professionals in its correct use, is highly recommended to ensure safety of care.

A nova pandemia por SARS-CoV-2 é um exemplo de uma emergência de saúde pública de âmbito internacional, associada a consideráveis desafios sociais e económicos. A nível das unidades de saúde há o risco que surtos nosocomiais sejam amplificadores locais. Perante tal, práticas de controlo de infeção são de importância crítica no funcionamento destes serviços, de que faz parte a utilização adequada de equipamento de proteção individual. Este deve ser adequado à via de transmissão do agente que, no caso do SARS-CoV-2, é através de gotícula e contacto. O indivíduo infetado, ao falar, tossir ou espirrar, dissemina gotículas que contêm o vírus, contaminando diretamente outros indivíduos, que estão num raio de um a dois metros, assim como o ambiente. A transmissão por via aérea também poderá ocorrer, no caso de procedimentos geradores de aerossóis. A nível da proteção respiratória existe, atualmente, fraca evidência que a utilização de respiradores permita maior proteção que máscara cirúrgica para o SARS-CoV-2 ou outros vírus(com exceção dos procedimentos geradores de aerossóis, em que a utilização de um respirador é recomendada). A proteção ocular deverá ser garantida sempre que houver risco de salpicos, gotículas ou aerossóis. A utilização incorreta de equipamento de proteção individual, para a via de transmissão do agente ou superior ao necessário, é uma forma de uso indevido e pode afetar o seu suprimento para as situações em que é realmente indicado. A disponibilização deste equipamento de proteção, e formação dos profissionais de saúde na sua correta utilização, é fortemente recomendado para garantir a prestação de cuidados seguros.

Knowledge, source of information, and perception of Portuguese medical students and junior doctors of infection control precautions.

Medical education should include infection control precautions (ICPs). Portuguese medical students showed reasonable knowledge in ICPs; however, contact isolation and glove and mask use should be reinforced. Only 25% referred to the curriculum as the most important information source. There was a positive association between academic year (P = .032), previous training in ICPs (P = .016), and knowledge. Main strategies proposed to acquire competences in ICPs were bedside teaching (26.9%) and curriculum and bedside teaching (20.2%).

[Strategy to control methicillin-resistant Staphylococcus aureus: the 5 year experience of a hospital]. / Estratégia para controlar o Staphylococcus aureus resistente à meticilina: a experiência de cinco anos de um hospital.

INTRODUCTION: Methicillin-resistant Staphylococcus aureus remains one of the principal resistant pathogens causing serious healthcareassociated infections. The objective of this study was to control and monitor methicillin-resistant Staphylococcus aureus cases using multimodal strategy in a Portuguese hospital. MATERIAL AND METHODS: Multistep procedure involving isolation measures and active surveillance cultures in a selected population (patients from other hospitals and nursing homes; history of hospitalization/ methicillin-resistant Staphylococcus aureus; intensive and intermediate care patients and, in other inpatient services, direct contacts of newly detected methicillin-resistant Staphylococcus aureus patients and, since 2012, patients doing hemodialysis). Other parallel activities: (a) review of isolation and standard precautions policy, (b) reinforcement of alcohol-based handrubs at point of patient care, (c) information sessions to health professionals, (d) targeted information flyer for health professionals, (e) information leaflet for patients/ visitors; (f) procedure monitoring by audit (g) patient decolonization in intensive and intermediate care units, with follow-up screenings. RESULTS: Between 2007 and 2012, methicillin-resistant Staphylococcus aureus surveillance detected a decrease in proportion from 66% to 57% and, in density of incidence, from 1.80 to 0.68 cases per thousand days of hospitalization (p < 0.001; RR 0.38; CI95%: 0.29-0.49). DISCUSSION/CONCLUSION: According to published European data, using blood and cerebrospinal fluid isolates only, Portugal was the country with the highest level of methicillin-resistant Staphylococcus aureus in 2011. Using this inclusion criteria, our hospital reveled a proportion of methicillin-resistant Staphylococcus aureus below its national level (34% versus 55%) in 2011. Fighting methicillinresistant Staphylococcus aureus using a multimodal strategy is being effective in a high endemic level hospital, but perseverance is needed through continuous surveillance of cases, feed-back to professionals and procedure audits.

Introdução: O Staphylococcus aureus resistente à meticilina é um dos microrganismos multirresistentes mais frequentemente implicados em infeções associadas a cuidados de saúde. Definiu-se como objetivo implementar uma estratégia multimodal para controlar este microrganismo num hospital.Material e Métodos: Procedimento baseado em rastreio ativo e medidas de isolamento numa população selecionada (doentes provenientes de outras instituições de saúde e lares ou com historial de internamento/ staphylococcus aureus resistente à meticilina; doentes dos cuidados intensivos e intermédios e, nos restantes serviços, rastreio aos contactos diretos se detetado um novo caso de staphylococcus aureus resistente à meticilina e, desde 2012, hemodialisados). Outras ações paralelas: (1) revisão das normas Precauções Básicas e Isolamento; (2) reforço dos pontos de desinfeção alcoólica das mãos; (3) sessões de esclarecimento aos profissionais de saúde; (4) folha 'Alerta de staphylococcus aureus resistente à meticilina' no processo dos doentes; (5) panfleto de informação aos doentes/ visitas; (6) monitorização do procedimento através de auditoria e (7) descolonização de doentes nos cuidados intensivos e intermédios, com rastreios de follow-up.Resultados: Entre 2007 e 2012 registou-se um decréscimo da proporção de staphylococcus aureus resistente à meticilina de 66% para 57% e da densidade de incidência de 1,80 para 0,68 casos por mil dias de internamento (p < 0,001; RR 0,38; IC95%: 0,29-0,49).Discussão/Conclusão: De acordo com dados europeus publicados, referentes a isolados no sangue e líquor, Portugal foi o país com maior proporção de staphylococcus aureus resistente à meticilina em 2011. Utilizando este critério de inclusão, o nosso hospital revelou uma proporção de staphylococcus aureus resistente à meticilina inferior à média nacional (34% versus 55%). A estratégia multimodal demonstrou ser eficaz na diminuição dos casos de staphylococcus aureus resistente à meticilina. Salvaguarda-se a necessidade de realizar vigilância epidemiológica deste agente, bem como monitorização da aplicação do procedimento, com feedback aos profissionais de saúde.