Subject(s)
Candidemia/epidemiology , Catheter-Related Infections/epidemiology , Catheter-Related Infections/microbiology , Gram-Negative Bacterial Infections/epidemiology , Gram-Positive Bacterial Infections/epidemiology , Infection Control/methods , Bacteremia/epidemiology , Bacteremia/microbiology , Candidemia/microbiology , Catheter-Related Infections/prevention & control , Cross Infection/epidemiology , Cross Infection/microbiology , Cross Infection/prevention & control , Gram-Negative Bacterial Infections/microbiology , Gram-Positive Bacterial Infections/microbiology , Humans , Incidence , Patient Care Bundles , Retrospective StudiesABSTRACT
OBJECTIVE: To investigate an apparent outbreak involving simultaneous isolation of Pseudomonas aeruginosa and Serratia marcescens from bronchoalveolar lavage (BAL) samples. DESIGN: Retrospective and prospective cohort studies using chart review, environmental sampling, and ribotyping of all available isolates. Cleaning and disinfection procedures for the bronchoscopes were also evaluated. SETTING: A 380-bed private hospital in São Paulo, Brazil PATIENTS: Forty-one patients who underwent bronchoscopic procedures between December 1994 and October 1996 and from whom P. aeruginosa and S. marcescens were concomitantly isolated. Bronchoscopes and related items were microbiologically assessed. RESULTS: P. aeruginosa and S. marcescens were simultaneously isolated from BAL samples 12.6% of the time (41 of 324) during the epidemic period versus 1.8% of the time (1 of 54) in the pre-epidemic period (P = .035). Ribotyping revealed two strains of P. aeruginosa and one of S. marcescens that were isolated from BAL samples of patients with no signs of respiratory tract infection, suggesting a pseudo-outbreak. Evaluation of bronchoscope disinfection revealed that inappropriate methods were being used. Implementation of simple control measures resulted in a significant decrease in simultaneous isolation of these species. CONCLUSION: Prevention of pseudo-outbreaks requires meticulous use of preventive measures for infection-prone medical procedures.
Subject(s)
Bronchoscopes/microbiology , Bronchoscopy/adverse effects , Cross Infection/epidemiology , Cross Infection/etiology , Disease Outbreaks , Equipment Contamination , Pseudomonas Infections/transmission , Pseudomonas aeruginosa/isolation & purification , Serratia Infections/transmission , Serratia marcescens/isolation & purification , Brazil/epidemiology , Bronchoalveolar Lavage , Cohort Studies , Disinfection/methods , Equipment Reuse , Hospitals, Private , Humans , Prospective Studies , Pseudomonas aeruginosa/pathogenicity , Retrospective Studies , Ribotyping , Serratia marcescens/pathogenicityABSTRACT
O sitema de vigilância nutricional de adultos (idade * 20 anos), realizado no Centro de Saúde Escola Germano Sinval Faria (CSEGSF), registra diariamente dados de massa corporal (Kg), estatura (m) e morbidades, além de dados sócio-econômicos de sua clientela, que sao moradores de sete favelas da regiao de Manguinhos, RJ. Esse sistema tem como objetivo o controle permanente, a nível individual e epidemiológico, da situaçao nutricional desta populaçao. O presente trabalho apresenta dados relativos à demanda espontânea de 1352 indivíduos (1.111 mulheres e 241 homens) maiores de 20 anos de idade atendidos entre agosto e dezembro de 1989. O estado nutricional (EN) foi determinado a partir do índice de massa corporal (IMC=kg.(m quadrado)elevado a -1): baixo peso (BP; IMC maior que 20), normal (20 *IMC maior que 25), sobrepeso (SP; 25 *IMC maior que 30) e obeso (IMC *30). A frequência (%) do EN para mulheres e homens, respectivamente, foi BP = 9,5 e 17,5; normal = 37,2 e 46,9; SP = 31,3 e 29,0; obesidade = 22,0 e 6,6. Estes dados demonstram que, nesta populaçao ambulatorial de baixa renda, pelos menos 50% das mulheres apresentam SP. Os autores especulam que esta alta frequencia de SP pode estar relacionada com fatores alimentares, qualitativos e quantitativos, além da influência do número de gravidez, e mais remotamente, a possibilidade de haver adaptaçao à baixa ingestao energética na infância. Com relaçao ao serviço, houve uma proposta de utilizaçao de um nomograma para o cálculo do IMC pelos profissionais do PAISA (Programa de Atençao Integral à Saúde do Adulto), o que facilitará a implantaçao da vigilância nutricional no serviço
