Preventive strategies in paediatric cardiovascular surgery: impact on surgical site infections and beyond.

BACKGROUND: Surgical management of congenital heart disease (CHD) has increased worldwide, but healthcare-associated infections (HAIs) can threaten these efforts. AIM: To analyse the incidence of HAI, the impact of preventive interventions, and microbiological profiles in a paediatric cardiovascular surgery programme. METHODS: Cohort study including children aged <12 years with CHD who underwent cardiovascular surgery between 2010 and 2021 in Medellín, Colombia (a middle-income setting). Data were collected from medical and laboratory records and infection control programme databases. Impact of various preventive interventions was assessed using a Poisson model. P < 0.05 was considered statistically significant. FINDINGS: A total of 2512 surgeries were analysed. Incidence of surgical site infection (SSI) was 5.9%, followed by central line-associated bloodstream infection (CLABSI; 4.7%), catheter-associated urinary tract infection (CAUTI; 2.2%), and ventilator-associated pneumonia (VAP; 1.4%). Most of the strategies focused on preventing SSI, resulting in a reduction from 9.5% in 2010 to 3.0% in 2021 (P = 0.030). Antibiotic prophylaxis based on patient weight and continuous infusion had an impact on reducing SSI (RR: 0.56; 95% CI: 0.32-0.99). Vacuum-assisted closure (VAC) in clean wounds reduced 100% of infections. No significant risk reduction was observed for other HAI with the implemented interventions. CONCLUSION: Preventive strategies effectively reduced SSI but no other infections, emphasizing the need for targeted approaches to address a broader spectrum of HAI successfully.

Preparing schools for future pandemics: Insights on water, sanitation and hygiene solutions from the Brazilian school reopening policies.

Post-COVID-19, schools urgently need to enhance infection control and prevention (IPC) measures, including water, sanitation, and hygiene (WASH), to prepare for future outbreaks and pandemics. Particularly in Brazil, that is of particular concern, as students are still recovering from the 20th longest school closure in the world. Hence, the current study had two goals: (i) to describe WASH solutions outlined in policies released at the federal, state, and capital city levels in Brazil during the COVID-19 pandemic for the safe reopening of schools and (ii) to discuss their potential to enhance school's capacity to remain operational during a new pandemic or outbreak. With a qualitative exploratory approach, we performed content analysis to discuss the direction (what, where, how and for whom?) of 66 public policies by integrating four frameworks. Solutions were discussed in the light of the principles of human rights and the human rights to water and sanitation, international guidelines for WASH and IPC in schools and the Sphere minimum standards for humanitarian aid. One hundred and fifty-nine solutions, spanning five thematic areas and five population groups, including software and hardware interventions, were compiled for potential use in Brazil and beyond. While suggested solutions have the potential to provide a cleaner and safer learning environment, it is essential to exercise caution when implementing these measures and adapt them to the specific circumstances of each school.

Does high school health education class satisfaction influence student perceptions of public health and pandemic response?

BACKGROUND: The COVID-19 pandemic significantly affected high school students. Little is known about the mediators of student perceptions of infection prevention and public health entities. We piloted a survey to evaluate the relationship between student perceptions of COVID-19 topics and satisfaction with their most recent health class. METHODS: Students from one private high school in southeast Michigan completed a survey in early 2022. The primary outcomes were 4 domains: vaccination knowledge, intervention effectiveness, intervention impact, and willingness to readopt an intervention. We assessed the associations between health class satisfaction and these outcomes using multiple linear regression. RESULTS: One-hundred ninety students reported their health class satisfaction and were eligible for analysis. Students reported high confidence in vaccines (93%) but limited knowledge of COVID-19 vaccination (45%). Students perceived COVID-19 interventions as highly effective (range, 72% [hand hygiene]-93% [vaccination]) and reported a willingness to readopt them (range, 73% [stay-at-home orders]-96% [vaccination]). Health class satisfaction (54%) was positively associated with composite scores on vaccination knowledge and intervention effectiveness. DISCUSSION: Assessing students' intrapandemic perspectives on infection prevention illuminated areas of strength (ie, intervention confidence) and areas for improvement (ie, intervention knowledge and institutional confidence). CONCLUSIONS: Students reported favorable perceptions regarding common infection prevention interventions. Future work should investigate the role of educational satisfaction in mediating confidence in public health interventions and institutions.

Addressing an increase in surgical site infections during the COVID-19 pandemic-Identifying opportunities during a chaotic time.

BACKGROUND: Health care systems saw increases in device-associated infections and decreases in surgical site infections (SSI) during the COVID-19 pandemic. However, following an increase in SSIs, an acute care hospital assessed the risk and preventative factors of SSIs among patients. METHODS: A retrospective cohort study on surgeries performed between January 2020 and September 2021 analyzed associations of SSI with risk and preventive factors utilizing χ2, t-tests, and odds ratios. A secondary analysis was utilized to determine the association of case urgency and prevention practice performance. RESULTS: There was a significant difference in the administration of correct perioperative antibiotic selection between SSI (78.1%) and non-SSI (86.2%) along with 2.9 greater odds of developing an SSI with incorrect perioperative antibiotics. Patients who had urgent cases were significantly less likely than elective to receive preoperative chlorhexidine gluconate wipes (81.6%, 61.5%, respectively), correct antibiotic selection and timing (93.2%, 70.8%, respectively) and chlorhexidine and alcohol skin preparation (81.6%, 67.5%, respectively). DISCUSSION: Disruption of perioperative workflow during the COVID-19 pandemic likely resulted in an increase in SSI. Numerous opportunities were identified for focused prevention efforts. CONCLUSIONS: The next steps include implementing strategies to improve SSI prevention and establish a culture that can withstand workflow disruptions to maintain a safe environment during significant changes.

Mobile phones of anesthesiologists as reservoirs of nosocomial bacteria in a quaternary teaching hospital: an observational study

Abstract Background: Mobile phones in hospital settings have been identified as an important source of cross-contamination because of the low frequency with which mobile phones are cleaned by health workers and cyclical contamination of the hands and face. The aim of this study was to investigate whether the mobile phones of the anesthesia team at a teaching hospital are potential reservoirs of nosocomial bacteria. In addition, differences in device sanitization and hand hygiene habits between attending and resident anesthesiologists were correlated with mobile phone colonization. Methods: A prevalence study was conducted over a 6-month period from 2017 to 2018 that involved the collection of samples from the mobile phones of the anesthesiology team and culturing for surveillance. A questionnaire was administered to assess the mobile phone sanitization and hand washing routines of the anesthesia team in specific situations. Results: Bacterial contamination was detected for 86 of the 128 mobile phones examined (67.2%). A greater presence of Micrococcus spp. on devices was correlated with a higher frequency of mobile phone use (p = 0.003) and a lower frequency of sanitization (p = 0.003). The presence of bacteria was increased on the mobile phones of professionals who did not perform handwashing after tracheal intubation (p = 0.003). Conclusion: Hand hygiene and device sanitization habits were more important than the use behavior, as a higher presence of bacteria correlated with poorer hygiene habits. Furthermore, handwashing is the best approach to prevent serious colonization of mobile devices and the possible transmission of pathogens to patients under the care of anesthesiologists.

Mobile phones of anesthesiologists as reservoirs of nosocomial bacteria in a quaternary teaching hospital: an observational study.

BACKGROUND: Mobile phones in hospital settings have been identified as an important source of cross-contamination because of the low frequency with which mobile phones are cleaned by health workers and cyclical contamination of the hands and face. The aim of this study was to investigate whether the mobile phones of the anesthesia team at a teaching hospital are potential reservoirs of nosocomial bacteria. In addition, differences in device sanitization and hand hygiene habits between attending and resident anesthesiologists were correlated with mobile phone colonization. METHODS: A prevalence study was conducted over a 6-month period from 2017 to 2018 that involved the collection of samples from the mobile phones of the anesthesiology team and culturing for surveillance. A questionnaire was administered to assess the mobile phone sanitization and hand washing routines of the anesthesia team in specific situations. RESULTS: Bacterial contamination was detected for 86 of the 128 mobile phones examined (67.2%). A greater presence of Micrococcus spp. on devices was correlated with a higher frequency of mobile phone use (p=0.003) and a lower frequency of sanitization (p=0.003). The presence of bacteria was increased on the mobile phones of professionals who did not perform handwashing after tracheal intubation (p=0.003). CONCLUSION: Hand hygiene and device sanitization habits were more important than the use behavior, as a higher presence of bacteria correlated with poorer hygiene habits. Furthermore, handwashing is the best approach to prevent serious colonization of mobile devices and the possible transmission of pathogens to patients under the care of anesthesiologists.

Conocimientos, actitudes y prácticas sobre prevención y control de infecciones (PCI) en alumnos de Estomatología de la UAM-Xochimilco / Knowledge, attitudes and practices on infection prevention and control in Stomatology students UAM-Xochimilco

Introducción: la prevención y control de infecciones (PCI) pretenden prevenir, detener y propagar enfermedades infecciosas en pacientes y trabajadores de la salud. Este enfoque debe comenzar con la formación y capacitación del profesional de la salud, inmunizaciones recomendadas y ejecución de medidas universales de protección. Objetivos: evaluar conocimientos, actitudes y prácticas en la prevención y control de infec- ciones de los estudiantes y pasantes de servicio social de la licenciatura en Estomatología de la UAM-X. Material y métodos: se realizó un estudio descriptivo, transversal y observacional mediante una encuesta anónima como instrumento para recolección de datos a una muestra de 108 alumnos y pasantes. Resultados: se encontró que al contestar el interrogatorio sobre «prevención y control de infecciones¼, 59.3% tuvo un nivel de conocimientos aceptable y 40.7% tuvo un nivel muy bueno. De los encuestados, 87% desinfecta y cambia las barreras de protección entre cada paciente, 9.3% al comenzar y finalizar el día; el restante 3.7%, cuando está visiblemente sucio o cuando hay derrame de sustancias de líquidos corporales. Conclusión: los encuestados tienen adecuados conocimientos y prácticas, lo que infiere que tienen el sustento teórico y habilidades para enfrentarse a la etapa postpandemia para la atención de pacientes (AU)

ntroduction: infection prevention and control (IPC) efforts to prevent, stopping and spreading infectious diseases in patients and healthcare workers. This approach should begin with education and training of the health professional, recommended immunizations and implementation of universal protective measures. Objectives: to evaluate knowledge, attitudes and practices in infection prevention and control stomatology career's students and social service interns UAM-X. Material and methods: a descriptive, cross-sectional and observational study was carried out using an anonymous survey as an instrument for data collection from a sample of 108 students and interns. Results: it was found that when answering the questionnaire on «infection prevention and control¼, 59.3% had an acceptable level of knowledge and 40.7% had a very good level. 87% of the respondents disinfect and change the protective barriers between each patient, 9.3% at the beginning and end of the day; the remaining 3.7% when visibly dirty or when there is spillage of body fluids. Conclusion: respondents have adequate knowledge and practices, inferring that they have the theoretical support and skills to face the post-pandemic stage of patient care (AU)

Conocimiento y percepción sobre bioseguridad en estudiantes de medicina / Knowledge and perception about biosafety in medical students

Los estudiantes de medicina pueden estar expuestos a infecciones graves relacionadas con la atención de la salud si no siguen las medidas de prevención y control. Hay información limitada sobre el conocimiento y la percepción de los estudiantes de medicina con respecto a la bioseguridad y los enfoques educativos utilizados para enseñarles estas prácticas. El objetivo fue evaluar el conocimiento y la percepción de los estudiantes de medicina hacia las prácticas básicas de bioseguridad. Una encuesta descriptiva y transversal basada en entrevistas incluyó a 120 estudiantes de medicina de la Universidad Regional Autónoma de los Andes, Ecuador. Los estudiantes completaron un cuestionario sobre el conocimiento y la percepción con respecto a las prácticas de bioseguridad. El conocimiento de los estudiantes se evaluó por sus respuestas correctas a las preguntas del instrumento. El 57,5% de los estudiantes cumplen con las medidas de bioseguridad. La mayoría de los estudiantes perciben alto de riesgo de exposición a través de diferentes rutas con distintos patógenos, el argumento mayormente reportado fue el que puede ocurrir un accidente. Se observó que 81(67,5%) de los estudiantes mostraron tener conocimiento adecuado sobre bioseguridad, mientras que 39 demostraron lo contrario. El conocimiento sobre la bioseguridad fue bueno aunque se necesita más énfasis para mejorar su conocimiento en secciones como la técnica de colocación de guantes, momento de colocarse el gorro y qué es una sustancia antiséptica. Los cursos de Prevención y Control de Infecciones se pueden impartir a partir de su primer año de educación universitaria(AU)

Medical students can be exposed to serious health care-associated infections, if they are not following prevention and control measures. There is limited information on medical students' knowledge and perception of biosafety and the educational approaches used to teach these practices. The objective was to evaluate the knowledge and perception of medical students towards basic biosafety practices. A descriptive and cross-sectional, interview-based survey included 120 medical students from the Autonomous Regional University of the Andes, Ecuador. The students completed a questionnaire on knowledge and perception regarding biosafety practices. The knowledge of the students was evaluated by their correct answers to the questions of the instrument. 57.5% of students comply with biosafety measures. Most of the students perceive a high risk of exposure through different routes with different pathogens, the most reported argument was that an accident can occur. It was observed that 81 (67.5%) of the students showed adequate knowledge about biosafety, while 39 showed the opposite. Biosafety knowledge was good although more emphasis is needed to improve their knowledge in sections such as gloving technique, time to put on the cap and what is an antiseptic substance. Infection Prevention and Control courses can be taught beginning in your first year of college education(AU)

Measles Experience, Practice, and Knowledge by Pediatricians in the Context of Resurgent US Outbreaks.

OBJECTIVE: To assess measles experience, practice, and knowledge by pediatricians in the context of resurgent US outbreaks in 2018-2019. STUDY DESIGN: A nationally representative network of pediatricians were surveyed by email and mail from January to April 2020. RESULTS: The response rate was 67% (297 of 444). In the 3 years preceding the survey, 52% of the respondents reported awareness of measles cases in/near their community. Most thought that media reports about recent measles outbreaks had decreased delay/refusal of measles, mumps, and rubella (MMR) vaccine (6% "greatly decreased"; 66% "moderately decreased"). More than 60% of the pediatricians responded correctly for 6 of 9 true/false measles knowledge items. Less than 50% responded correctly for 3 true/false items, including statements about pretravel MMR recommendations for a preschooler and measles isolation precautions. The most common resources that the pediatricians would "sometimes" or "often/always" consult for measles information were those from the American Academy of Pediatrics (72%), a state or local public health department (70%), and the Centers for Disease Control and Prevention (63%). More than 90% of the pediatricians reported correct clinical practice for MMR vaccination of a 9-month-old before international travel. More than one-third of the respondents did not have a plan for measles exposures in their clinic. Pediatricians aware of measles cases in/near their community in the previous 3 years and those working in a hospital/clinic or Health Maintenance Organization setting were more likely to have a plan for measles exposures. CONCLUSIONS: During this time of heightened risk for measles outbreaks, there are opportunities to strengthen the knowledge and implementation of measles pretravel vaccination and infection prevention and control recommendations among pediatricians.

Comparing surgeons' skin tolerance and acceptability to alcohol-based surgical hand preparation vs traditional surgical scrub: A matched quasi-experimental study.

BACKGROUND: We aimed to compare the tolerance and acceptability of alcohol-based surgical hand preparation versus handscrubbing with antimicrobial soap and water by surgeons. METHODS: Matched quasi-experimental trial in an academic quaternary care hospital in Ribeirão Preto, Brazil, from April 1 to October, 31, 2017. Participants were cardiac and orthopedics surgeons from the study facility. In the first study phase, they performed handscrubbing with either 2% chlorhexidine (CHG) or 10% iodopovidone (PVP-I) and, in the second phase, they performed handrubbing with alcohol-based handrub (ABHR). Surgeons' skin tolerance and acceptability were evaluated using WHO-validated tools. Data were analyzed using the MacNemar's test within STATA. RESULTS: A total of 33 surgeons participated to the "per protocol" population; the majority were male (94%); mean age of 35 years (SD, 8.5). On product tolerance, there was a minimal variation in redness, scaliness, fissures, and visual evaluation of the skin when handrubbing with ABHR was compared to handscrubbing with either PVP-I or CHX. Regarding acceptability, participants rated better handrubbing with ABHR than handscrubbing with PVP-I when assessing product smell (66.6% vs 0%, p=0.002), color (73.3% vs 0%, p=0.001), product texture (60% vs 0%, p=0.004), skin dryness (60% vs 0%, p=0.004), ease of application (66.6% vs 0%, p=0.002) and overall satisfaction (66.6% vs 6.7% p=0.011). Participants rated similarly handrubbing with ABHR and handscrubbing with CHX, except for product texture, where handrubbing rated better (71,4% vs. 0%, p=0.002). Handrubbing with ABHR was preferred by 73.3%. CONCLUSION: Although handrubbing and handscrubbing were equally well tolerated by surgeons, alcohol-based surgical hand preparation fell into the personal preference for most of them. TRIAL REGISTRATION: Brazilian Clinical Trials Registry (ReBEC), RBR-8ym9yj.

Performance of a multidisciplinary team and the impact of bundles for reducing health care associated infections in adult intensive care unit: 22 years of experience.

A retrospective cohort study was conducted to evaluate the bundle of techniques developed by the multidisciplinary team to minimize infections in an adult intensive care unit over a 22-year span. Two periods were analyzed: 1996-2006 and 2007-2017. Bloodstream infections, urinary tract infections, and ventilator-associated pneumonia declined 58.6%, 56.7%, and 82.6%, respectively (P < .05) from 2007 to 2017 compared with these same infections during 1996-2006.

Impact of covid-19 on people living with HIV-1: care and prevention indicators at a local and nationwide level, Santo André, Brazil

ABSTRACT The world has been dealing with Aids for forty years, covid-19 accentuated societal inequalities and promoted a rupture in care and prevention, including for people living with HIV. We compiled official HIV indicators, analyzed the impact of covid-19 in Brazil, at São Paulo State (SP), and compared it to the municipality of Santo André (in the state of São Paulo), which adopted linkage/retention strategies to mitigate the impact of covid-19. From 2019 to 2020, suppression/adhesion rates remained stable. The number of new treatments decreased both in Brazil (-19.75%) and São Paulo (-16.44%), but not in Santo André, where 80% of new patients started treatment within 30 days from their first TCD4 test (70% in São Paulo and 64% in Brazil). However, PrEP dispensing increased during this period. The distribution of 2,820 HIV self-tests in Santo André lead to only one documented new HIV diagnosis linked to care. Synergistic strategies to swiftly diagnose and connect new cases, ensuring retention as well as rescuing missing patients deserve priority in the fight against HIV, especially in times of covid-19.

A Competency-based Approach to Promoting Effective Hand Hygiene in Longterm Care Facilities / Un enfoque basado en la competencia para promover la higiene de las manos eficaz en los centros de atención a largo plazo / Uma abordagem baseada na competência para promover a higiene das mãos ecaz em centros de atenção em longo prazo

Introduction: Long-term care facilities comprise a large proportion of healthcare service users due to the increasing ageing population. Healthcare-associated infections constitute a major burden in long-term care facilities and are associated with significant infectious disease outbreaks and mortality. The non-adherence to effective hand hygiene practice due to missed opportunities for staff to explore its role in infection prevention and control within these settings has been emphasised by the Covid-19 pandemic.Methods: This article is designed to assist the continuing professional development needs of nursing and associate professionals in long-term care facilities. It explores the factors contributing to the poor attitude of staff members towards non-compliance with infection prevention and control measures in long-term care facilities.Results: Recommendations for improving infection prevention and control measures were further made based on the Infection Prevention Society competency framework which serves as a tool for individuals to improve their performance continually and become efficient practitioners.Conclusion: After reading this article, healthcare practitioners should be able to (i) identify various means of promoting adequate hand hygiene in long-term care facilities; (ii) understand that every activity taken to prevent the spread of healthcare-associated infections begins and ends with effective hand hygiene; (iii) recognise steps to prevent cross-infection through improved compliance with the five moments of hand hygiene in long-term care facilities; (iv) develop a satisfactory attitude towards hand hygiene compliance in the workplace, and (v) appraise own competence, and promote staff compliance through feedback.

Introducción: Los centros de cuidados de larga duración representan una gran proporción de usuarios de servicios sanitarios debido al creciente envejecimiento de la población. Las infecciones asociadas a la asistencia sanitaria constituyen una carga importante en los centros de asistencia de larga duración y están asociadas a importantes brotes de enfermedades infecciosas y a la mortalidad. La falta de adherencia a la práctica efectiva de la higiene de manos debido a la pérdida de oportunidades para que el personal explore su papel en la prevención y el control de las infecciones dentro de estos entornos ha sido enfatizada por la pandemia de COVID-19. Métodos: Este artículo está diseñado para ayudar a las necesidades de desarrollo profesional continuo de los profesionales de enfermería y asociados en los centros de cuidados de larga duración. Explora los factores que contribuyen a la mala actitud de los miembros del personal hacia el incumplimiento de las medidas de prevención y control de infecciones en los centros de cuidados de larga duración. Resultados: Se formularon además recomendaciones para mejorar las medidas de prevención y control de las infecciones basadas en el marco de competencias de la Sociedad de Prevención de Infecciones, que sirve de herramienta para que los individuos mejoren continuamente su rendimiento y se conviertan en profesionales eficientes. Conclusión: Después de leer este artículo, los profesionales sanitarios deberían ser capaces de (i) identificar diversos medios para promover una adecuada higiene de las manos en los centros de cuidados de larga duración; (ii) comprender que toda actividad realizada para prevenir la propagación de las infecciones asociadas a la asistencia sanitaria comienza y termina con una higiene de las manos eficaz; (iii) reconocer los pasos para prevenir la infección cruzada mediante un mejor cumplimiento de los cinco momentos de la higiene de las manos en los centros de cuidados de larga duración; (iv) desarrollar una actitud satisfactoria hacia el cumplimiento de la higiene de las manos en el lugar de trabajo, y (v) evaluar la propia competencia, y promover el cumplimiento del personal mediante la retroalimentación.

Introdução: Os centros de cuidados de longa duração representam uma grande proporção de usuários de serviços sanitários devido ao crescente envelhecimento da população. As infeções associadas à assistência sanitária constituem um fardo significativo em centros de assistência de longa duração e estão associadas a importantes surtos de doenças infeciosas e à mortalidade. A falta de adesão à prática efetiva da higiene de mãos devido à perda de oportunidades para o pessoal explorar o seu papel na prevenção e controle das infeções dentro desses ambientes já foi enfatizada pela pandemia de COVID-19. Métodos: Este artigo foi desenhado para ajudar às necessidades de desenvolvimento profissional continuo dos profissionais de enfermagem e associados nos centros de cuidados de longa permanencia. Explora os fatores que contribuem para as más atitudes dos funcionários para o não cumprimento das medidas de prevenção e controle de infeções nos centros de cuidados de longa duração. Resultados: Foram formuladas também recomendações para melhorar as medidas de prevenção e controle das infeções baseadas no quadro de competências da Sociedade de Prevenção de Infeções, que serve de ferramenta para que os indivíduos melhorem continuamente seu desempenho e se tornem profissionais eficientes. Conclusão: Após a leitura deste artigo, os profissionais sanitários devem ser capazes de (i) identificar diversos meios para promover uma adequada higiene das mãos nos centros de cuidados de longa duração; (ii) entender que toda atividade realizada para prevenir a propagação das infeções associadas à assistência sanitária começa e termina com uma higiene eficaz das mãos; (iii) reconhecer os passos para prevenir a infeção cruzada por meio de uma melhor adesão aos cinco momentos da higiene das mãos em centros de cuidados de longa duração; (iv) desenvolver uma atitude satisfatória em relação à adesão da higiene das mãos no local de trabalho, e (v) avaliar a própria competência, e promover a adesão da equipe mediante a retroalimentação.

Systematic review: SARS-COV-2 contagion prevention measures in vision health professionals.

The disease, which originated from the SARS-CoV-2 virus, is primarily transmitted by direct contact with infected individuals. Visual healthcare professionals perform clinical practices that pose a significant risk of infection due to their proximity with patients during the examination. This systematic review aims to identify preventive measures that will aid in reducing the risk of infection during standard appointments between patients and visual health professionals. A systematic review was done for articles published in indexed journals from December 2019 to December 2020. The search for these articles was done in 3 electronic databases. As part of the search criteria, articles were selected if they had the keywords (SARS-CoV-2), (COVID-19), and coronavirus combined with ophthalmology, optometry, eye care, and the eye. Once duplicated and unrelated items were eliminated, 36 articles of interest were selected. Seven sections were described in detail: telephone screening, (COVID-19) triage, decreasing transmission within shared spaces, hand washing, use of personal protective equipment Personal Protective Equipment (PPE), cleaning of diagnostic instruments, and use of telemedicine. This paper helps healthcare professionals to better understand the context of the "new normal" clinical practice. Visual health professionals and their patients must adhere to norms and use the indicated PPE during the consultation to safeguard each other.

Hospital-Acquired SARS-CoV-2 infection among patients admitted to a university hospital.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a public health emergency, as it is a highly contagious disease, health services had to adapt to the high demand for hospitalizations in order to contain hospital outbreaks. We aimed to identify the impact of nosocomial transmission of severe acute respiratory coronavirus virus 2 among inpatients at a university hospital in São Paulo, Brazil. Among 455 inpatients diagnosed with coronavirus disease 2019 in March-May, 2020, nosocomial infection was implicated in 42 (9.2%), of whom 23 (54.7%) died. becoming routine, especially when community transmission occur with high levels of incidence. It was possible to observe with this study that the nosocomial transmission by SARS-CoV-2 was present even with these measures instituted, and some of the damages caused by these infections are intangible.

Dissemination interventions to improve healthcare workers' adherence with infection prevention and control guidelines: a systematic review and meta-analysis.

BACKGROUND: The COVID-19 pandemic has challenged health systems worldwide since 2020. At the frontline of the pandemic, healthcare workers are at high risk of exposure. Compliance with infection prevention and control (IPC) should be encouraged at the frontline. This systematic review aimed to assess the effects of dissemination interventions to improve healthcare workers' adherence with IPC guidelines for respiratory infectious diseases in the workplace. METHODS: We searched CENTRAL, MEDLINE, Embase, and the Cochrane COVID-19 Study Register. We included randomized controlled trials (RCTs) and cluster RCTs that assessed the effect of any dissemination strategy in any healthcare settings. Certainty of evidence was assessed using the GRADE approach. We synthesized data using random-effects model meta-analysis in Stata 14.2. RESULTS: We identified 14 RCTs conducted from 2004 to 2020 with over 65,370 healthcare workers. Adherence to IPC guidelines was assessed by influenza vaccination uptake, hand hygiene compliance, and knowledge on IPC. The most assessed intervention was educational material in combined strategies (plus educational meetings, local opinion leaders, audit and feedback, reminders, tailored interventions, monitoring the performance of the delivery of health care, educational games, and/or patient-mediated interventions). Combined dissemination strategies compared to usual routine improve vaccination uptake (risk ratio [RR] 1.59, 95% confidence interval [CI] 1.54 to 1.81, moderate-certainty evidence), and may improve hand hygiene compliance (RR 1.70; 95% CI 1.03 to 2.83, moderate-certainty). When compared to single strategies, combined dissemination strategies probably had no effect on vaccination uptake (RR 1.01, 95% CI 0.95 to 1.07, low-certainty), and hand hygiene compliance (RR 1.16, 95% CI 0.99 to 1.36, low-certainty). Knowledge of healthcare workers on IPC improved when combined dissemination strategies were compared with usual activities, and the effect was uncertain in comparison to single strategy (very low-certainty evidence). CONCLUSIONS: Combined dissemination strategies increased workers' vaccination uptake, hand hygiene compliance, and knowledge on IPC in comparison to usual activities. The effect was negligible when compared to single dissemination strategies. The adoption of dissemination strategies in a planned and targeted way for healthcare workers may increase adherence to IPC guidelines and thus prevent dissemination of infectious disease in the workplace. TRIAL REGISTRATION: Protocol available at http://osf.io/aqxnp .

COVID-19: A Cross-Sectional Study of Healthcare Students' Perceptions of Life during the Pandemic in the United States and Brazil.

Societal influences, such as beliefs and behaviors, and their increasing complexity add to the challenges of interactivity promoted by globalization. This study was developed during a virtual global educational exchange experience and designed for research and educational purposes to assess personal social and cultural risk factors for students' COVID-19 personal prevention behavior and perceptions about life during the pandemic, and to inform future educational efforts in intercultural learning for healthcare students. We designed and implemented a cross-sectional anonymous online survey intended to assess social and cultural risk factors for COVID-19 personal prevention behavior and students' perceptions about life during the pandemic in public health and healthcare students in two public universities (United States n = 53; Brazil n = 55). Statistically significant differences existed between the United States and Brazil students in degree type, employment, risk behavior, personal prevention procedures, sanitization perceptions, and views of governmental policies. Cultural and social differences, risk messaging, and lifestyle factors may contribute to disparities in perceptions and behaviors of students around the novel infectious disease, with implications for future global infectious disease control.

Impact of In-Hospital infection with SARS-CoV-2 among Inpatients at a university hospital.

OBJECTIVE: The objective of this study was to evaluate the incidence of nosocomial infection and the impact of cross-transmission of SARS-CoV-2 among inpatients at a tertiary care teaching hospital. METHODS: This was a retrospective cohort study involving inpatients admitted to a tertiary university hospital in the city of São Paulo, Brazil, between March 2020 and February 2021. Cases were identified on the basis of a positive reverse-transcription polymerase chain reaction result for SARS-CoV-2 and the review of electronic medical records. Nosocomial transmission was defined by applying the criteria established by the Brazilian National Health Regulatory Agency. RESULTS: We identified 2146 cases of SARS-CoV-2 infection, 185 (8.6%) of which were considered cases of nosocomial transmission. The mean age was 58.3 years. The incidence density was 1.78 cases per 1,000 patient-days on the general wards, being highest on the cardiac surgery ward, and only 0.16 per 1,000 patient-days on the COVID-19 wards. Of the 185 patients evaluated, 115 (62.2%) were men, 150 (81.1%) cases had at least one comorbidity, and 104 (56.2%) evolved to death. CONCLUSIONS: Despite the preventive measures taken, nosocomial transmission of SARS-CoV-2 occurred throughout our hospital. Such measures should be intensified when the incidence of community transmission peaks.

A Retrospective Cohort Study of Risk Factors for Surgical Site Infection Following Lung Transplant.

BACKGROUND: Surgical site infections (SSIs) are among the leading health care-associated infections as well as a major problem in the postoperative period of lung transplant recipients. Little is known about the risk factors in this specific population. The objective of this study was to identify the incidence, risk factors, and outcomes of SSI following lung transplant. METHODS: Digital medical records of adult recipients subjected to lung transplant from July 2011 and June 2016 in a large Brazilian referral teaching public center were analyzed in this retrospective cohort follow-up. RESULTS: Among the 121 recipients analyzed, 19 (15.7%) had SSI; of these, 11 (57.8%) had superficial incisional infections, 1 (5.2%) had a deep incisional infection, and 7 (36.8%) had organ/space infection. Recipient-related risk factors for SSI were high body mass index (P = .041), prolonged surgery time (P = .043), and prolonged duration of chest drain placement (P = .009). At the multiple logistic regression was found that each hour elapsed in the surgical time increased the odds of SSI by around 2 times (odds ratio 2.34; 95% CI, 1.46-4.53; P = .002). Donor-related risk factors included smoking status (P = .05) and positive bronchoalveolar lavage (P < .001). Having an SSI was associated with an increased length of stay in intensive care units (P = .003), reoperation (P = .014), and a higher 1-year mortality rate (P = .02). CONCLUSIONS: The identified incidence rate was higher to that observed in the previous studies. The risk factors duration of chest tube placement and donor smoking status are different from those reported in the scientific literature.