Análise da susceptibilidade e patogenicidade dos fômites de Sars-Cov-2 no Brasil: revisão da literatura / Analysis of the susceptibility and pathogenicity of the Sars-cov-2 fomites in Brazil: literature review

Objetivo ­ Verificar a suscetibilidade de criação de fômites de Sars-Cov-2 de acordo com temperatura, umidade e período de exposição. Métodos ­ Foi realizada uma revisão sistemática da literatura, entre março de 2021 e junho de 2022, utilizando-se a Biblioteca Virtual em Saúde (BVS), PubMed e Medline, através do cruzamento dos termos SARS-COV-2 AND desinfecção AND higienização AND fômites AND superfícies. Resultados ­ Dos 295 artigos encontrados, 24 foram selecionados e divididos em 3 categorias temáticas, "A influência das condições ambientais", "detecção por período de exposição" e "amostragens não experimental". Conclusões ­ Foi observado que existe a possibilidade da formação de fômites de Sars-Cov-2 e as condições ambientais influenciam diretamente, exigindo assim cuidado com superfícies possivelmente contaminadas. Descritores: Sars-Cov2; Desinfecção; Fômites; Superfícies

One-year monitoring SARS-CoV-2 RNA surface contamination in hospitals reveals no correlation with organic material and negative pressure as a limiting factor for contamination.

Understanding transmission routes of SARS-CoV-2 is crucial to establish effective interventions in healthcare institutions. Although the role of surface contamination in SARS-CoV-2 transmission has been controversial, fomites have been proposed as a contributing factor. Longitudinal studies about SARS-CoV-2 surface contamination in hospitals with different infrastructure (presence or absence of negative pressure systems) are needed to improve our understanding of their effectiveness on patient healthcare and to advance our knowledge about the viral spread. We performed a one-year longitudinal study to evaluate surface contamination with SARS-CoV-2 RNA in reference hospitals. These hospitals have to admit all COVID-19 patients from public health services that require hospitalization. Surfaces samples were molecular tested for SARS-CoV-2 RNA presence considering three factors: the dirtiness by measuring organic material, the circulation of a high transmissibility variant, and the presence or absence of negative pressure systems in hospitalized patients' rooms. Our results show that: (i) There is no correlation between the amount of organic material dirtiness and SARS-CoV-2 RNA detected on surfaces; (ii) SARS-CoV-2 high transmissible Gamma variant introduction significantly increased surface contamination; (iii) the hospital with negative pressure systems was associated with lower levels of SARS-CoV-2 surface contamination and, iv) most environmental samples recovered from contaminated surfaces were assigned as non-infectious. This study provides data gathered for one year about the surface contamination with SARS-CoV-2 RNA sampling hospital settings. Our results suggest that spatial dynamics of SARS-CoV-2 RNA contamination varies according with the type of SARS-CoV-2 genetic variant and the presence of negative pressure systems. In addition, we showed that there is no correlation between the amount of organic material dirtiness and the quantity of viral RNA detected in hospital settings. Our findings suggest that SARS CoV-2 RNA surface contamination monitoring might be useful for the understanding of SARS-CoV-2 dissemination with impact on hospital management and public health policies. This is of special relevance for the Latin-American region where ICU rooms with negative pressure are insufficient.

Estudio piloto de caracterización microbiológica de los billetes que circulan en la ciudad de Bucaramanga, Colombia / Pilot Study of Microbiological Characterization of Banknotes Circulating in the City of Bucaramanga, Colombia / Estudo piloto de caracterização microbiológica das notas em circulação na cidade de Bucaramanga, Colômbia

Introducción. Los billetes son un potencial medio de transmisión de microorganismos capaces de producir enfermedades. Es el caso del Staphylococcus aureus, una bacteria distribuida por toda América Latina, causante de infecciones y resistente a antibióticos de uso común. El objetivo del estudio es realizar una caracterización bacteriana y fúngica de billetes circulantes en la ciudad de Bucaramanga, y en especial identificar algunos que puedan relacionarse con problemas de salud pública. Metodología. Estudio observacional y cuantitativo, con una muestra de 50 billetes (5 diferentes denominaciones de 2 fechas de emisión). Se identificaron y cuantificaron los microorganismos mediante siembra en caldo peptona, posteriormente en agar Reasoner´s 2A (R2A), nutritivos y selectivos, además del uso de técnicas de índice analítico de perfil (API) y microscopia óptica. Se realizó un análisis estadístico de correlación de variables mediante el software Statistical Package for the Social Sciences (SPSS). Resultados. Se identificaron 21 géneros y 12 especies de bacterias, así como 3 géneros y 2 especies de hongos filamentosos, entre ellos algunos que pueden ocasionar infecciones como Klesiella, Enterobacter, Listeria, Staphylococcus, Cryptococcus y Aspergillus. Discusión. En relación con estudios internacionales, en este trabajo se identificaron menos tipologías de microorganismos, lo cual se explica en razón a las limitaciones propias de las técn icas utilizadas y del nivel de contaminación local. Conclusión. Se pudo establecer que el grado de contaminación microbiana no depende significativa o consistentemente de la fecha de emisión ni de la denominación; pero la identificación de patógenos sugiere plantear medidas para limitar su transmisión por esta vía.

Introduction. Banknotes are a potential means of transmission of microorganisms capable of producing diseases. This is the case of Staphylococcus aureus, a bacterium distributed throughout Latin America, which causes infections and is resistant to commonly used antibiotics. The objective of the study is to perform a bacterial and fungal characterization of banknotes circulating in the city of Bucaramanga, and especially to identify some that may be related to public health problems. Methodology. Observational and quantitative study, with a sample of 50 banknotes (5 different denominations of 2 issue dates). Microorganisms were identified and quantified by seeding in peptone broth, then on Reasoner's 2A agar (R2A), nutrient and selective, in addition to the use of analytical profile index (API) and light microscopy techniques. A statistical analysis of correlation of variables was performed using the Statistical Package for the Social Sciences (SPSS) software. Results. Twenty-one genera and 12 species of bacteria were identified, as well as 3 genera and 2 species of filamentous fungi, including some that can cause infections such as Klesiella, Enterobacter, Listeria, Staphylococcus, Cryptococcus, and Aspergillus. Discussion. In comparison with international studies, this study identified fewer types of microorganisms, which is explained by the limitations of the techniques used and the level of local contamination. Conclusion. It was possible to establish that the degree of microbial contamination does not depend significantly or consistently on the date of issue or the denomination; but the identification of pathogens suggests that measures should be taken to limit their transmission by this ro ute.

Introdução. As notas são um meio potencial de transmissão de microrganismos capazes de produzir doenças. É o caso do Staphylococcus aureus, bactéria distribuída por toda a América Latina, causadora de infecções e resistente aos antibióticos comumente utilizados. O objetivo do estudo é realizar uma caracterização bacteriana e fúngica das notas em circulação na cidade de Bucaramanga e, principalmente, identificar algumas que possam estar relacionadas a problemas de saúde pública. Metodologia. Estudo observacional e quantitativo, com uma amostra de 50 notas (5 denominações diferentes de 2 datas de emissão). Os microrganismos foram identificados e quantificados por meio de semeadura em caldo peptonado, depois em ágar Reasoner 2A (R2A), nutritivo e seletivo, além da utilização de índice de perfil analítico (API) e técnicas de microscopia óptica. Foi realizada uma análise estatística de correlação das variáveis por meio do software Statistical Package for the Social Sciences (SPSS). Resultados. Foram identificados 21 gêneros e 12 espécies de bactérias, além de 3 gêneros e 2 espécies de fungos filamentosos, incluido alguns que podem causar infecções como Klesiella, Enterobacter, Listeria, Staphylococcus, Cryptococcus e Aspergillus. Discussão. Em relação aos estudos internacionais, neste trabalho foram identificados menos tipos de microrganismos, o que se explica pelas limitações das técnicas utilizadas e pelo nível de contaminação local. Conclusão. Foi possível estabelecer que o grau de contaminação microbiana não depende de forma significativa ou consistente da data de emissão ou da denominação; mas a identificação de patógenos sugere considerar medidas para limitar sua transmissão por essa via.

Possible Occupational Infection of Healthcare Workers with Monkeypox Virus, Brazil.

We evaluated epidemiologic and molecular characteristics of monkeypox virus (MPXV) infections sampled from 2 healthcare nurses. Five days after collecting samples from an infected patient, the nurses showed typical MPXV manifestations; quantitative PCR and whole-genome sequencing confirmed MPXV infection, most likely transmitted through contact with fomites.

Contamination by antimicrobial-resistant enterobacteria isolated from cell phones and hands in a veterinary hospital.

Hospital infections are of great relevance in human and animal health, and fomites are important in the spread of pathogens in hospital units. The aim of this study was to investigate the frequency of enterobacteria in the operating room of a veterinary hospital, the potential cross-contamination of samples, and to characterise the susceptibility profile of the isolates to antimicrobials. Sixty-five samples were collected from five different surgical procedures. These samples came from the hands and cell phones of the surgical team and pet owners, operating tables, and patients. Species detection was performed through polymerase chain reaction, genetic diversity by pulsed-field gel electrophoresis (PFGE), and susceptibility to antimicrobials through an antibiogram. Escherichia coli and Proteus mirabilis isolates were obtained from eight samples, from the hands of the anaesthesiologist, the pet owner, and the surgeon; the surgeon's, the nurse's and the anaesthesiologist's cell phones, and two surgical tables. Furthermore, PFGE showed high genetic diversity among the isolates, which showed multidrug resistance. The identification of multidrug-resistant E. coli and P. mirabilis on cell phones of the surgical team is a major concern and, although no direct correlation was found, the isolation of these bacteria inside the clean area of the operating room shows the possibility of nosocomial transmission from cell phones to susceptible patients.

Perfil de resistencia genotípica y fenotípica presente en bacterias aisladas a partir de fómites en Armenia, Quindío-Colombia período junio-julio 2019 / Genotypic and phenotypic resistance profile present in bacteria isolated from fomites in Armenia, Quindío-Colombia period June-July 2019

Resumen Introducción: La antibiótico-resistencia es un fenómeno por el cual las bacterias logran sobrevivir al tratamiento con antimicrobianos; con incidencia en ambientes intra y extrahospitalarios como: fuentes hídricas, sector agrario/ganadero y fómites. Objetivo: Describir bacterias presentes en fómites de alta circulación en una región centro-occidental de Colombia junto a su perfil de sensibilidad fenotípica y presencia de genes para betalactamasas tipo TEM-full, OXA-3 y SHV-full. Metodología: Se aislaron cepas bacterianas de billetes, pasamanos de escaleras eléctricas y botones de cajeros automáticos; se evaluó su perfil de sensibilidad fenotípica por medio de concentración mínima inhibitoria-técnica automatizada/Vitek2® y genes para betalactamasas tipo TEM-full, OXA-3 y SHV-full mediante PCR convencional. Resultados: Se obtuvo 30 aislados; Acinetobacter baumannii complex, fue la más común; el fómite con mayor aislados y resistencia fueron los billetes; el 53% portó al menos uno de los genes estudiados. Se identificaron bacterias gramnegativas con resistencia frente a: Imipinem, Piperacilina/Tazobactam, Colistina, Ceftazidima, Tigeciclina y Ceftriaxona; bacterias grampositivas con resistencia frente a: Quinupristina/Dalfopristina, Minociclina, Tetraciclina, Teicoplanina, Nitrofuratoina, Oxacilina, Clindamicina, Trimetropina-sulfametoxazol, y Minociclina. Conclusión: Teniendo en cuenta la circulación de cepas con estas resistencias, es importante la educación en la comunidad para evitar la adquisición o propagación de infecciones por manipulación inadecuada de fómites.

Abstract Introduction: Antibiotic-resistance is a phenomenon by which bacteria manage to survive antimicrobial treatment; with incidence in intra and extra hospital environments such as: water sources, agricultural / livestock sector and fomites. Aim: To describe bacteria present in high circulation fomites in a central-western region of Colombia, with their phenotypic sensitivity profile and presence of genes beta-lactamases (TEM, OXA3 and SHV). Methodology: We isolate bacterial strains from banknotes, escalator handrails and ATM buttons. We evaluated its phenotypic sensitivity profile by minimal inhibitory concentration automated technique using Vitek 2® and presence of genes for beta-lactamases type TEM-full, OXA-3 and SHV-full by conventional PCR. Results: A total of 30 isolates were obtained; Acinetobacter baumannii complex, was the most common; banknotes were the form with the highest number of isolates and resistance. Of the total isolates, 53% carried at least one of the genes studied. Phenotypically, gram-negative bacteria were identified with resistance against: Imipinem, Piperacillin / Tazobactam, Colistin, Ceftazidime, Tigecycline and Ceftriaxone; Gram-positive bacteria with resistance to: Quinupristin / Dalfopristin, Minocycline, Tetracycline, Teicoplanin, Nitrofuratoin, Oxacillin, Clindamycin, Trimethropine-sulfamethoxazole, and Minocycline. Conclusion: Taking into account the circulation of strains with these resistances, it is important to educate the community to avoid the acquisition or spread of infections due to the inappropriate handling of this type of inanimate elements.

Contaminación microbiana en estetoscopios utilizados por proveedores de salud / Microbial contamination in stethoscopes used by health care providers

Introducción: El estetoscopio se ha descrito como un fómite capaz de transmitir patemas de tipo infeccioso a los trabajadores de la salud Objetivo: Caracterizar la presencia de contaminación microbiana en estetoscopios utilizados por proveedores de salud. Métodos: Estudio transversal en 50 muestras microbiológicas obtenidas de estetoscopios pertenecientes a proveedores de salud que laboran en el Hospital Pediátrico Cerro, de junio-octubre de 2019. Se aplicó una encuesta para evaluar variables demográficas y epidemiológicas de sus titulares relacionadas con la aplicación de medidas descontaminantes. Se examinaron los resultados mediante el análisis porcentual y prueba de Ji-cuadrada para buscar asociación significativa (p≤0,05) con los hábitos higiénicos. Resultados: El 100 por ciento de los estetoscopios están contaminados. Los aislamientos más frecuentes fueron: Staphylococcus alba 40,3 por ciento, Staphylococcus aureus 32,6 por ciento y Klebsiella pneumoniae 3,8 por ciento. Las áreas de mayor contagio fueron las de misceláneas (44,2 por ciento) y de respiratorio (36,5 por ciento). El personal con notable contaminación en sus equipos fueron los alumnos (81,4 por ciento) y los especialistas (14,8 por ciento). Las causas que determinaron no practicar la desinfección en los alumnos fue la falta de enseñanza (45,4 por ciento); en los especialistas, la carencia de hábitos (33,3 por ciento) y la falta de desinfectante (66,3 por ciento). Las bacterias gramnegativas fueron sensibles en su mayoría a los aminoglucósidos y Staphylococcus aureus a la clindamicina, vancomicina, ciprofloxacino y cloranfenicol. Conclusiones: Existe alta frecuencia de contaminación en los estetoscopios utilizados por los proveedores de salud motivado por la falta de hábito de desinfección en médicos y su desconocimiento en alumnos(AU)

Introduction: Stethoscopes has been described as a fomite which is able to transmit infectious agents to health care workers. Objective: To describe the presence of microbial contamination in stethoscopes used by health care providers. Methods: Cross-sectional study in 50 microbiological samples obtained from stethoscopes belonging to health care providers whom worked in Cerro Pediatric Hospital from June to October, 2019. It was applied a survey to evaluate demographic and epidemiologic variables of the owners related with the implementation of disinfection measures. The results were examined through percentage analysis and the Ji-square test to look for significative relation (p≤0,05) with hygene habits. Results: 100 percent of the stethoscopes were contamined. The most frequent isolated agents were: Staphylococcus alba 40.3 percent, Staphylococcus aureus 32.6 percent and Klebsiella pneumoniae 3.8 percent. The hospital areas with more contagion were: Miscellany (44.2 percent) and Respiratory (36.5 percent). The personnel with more contamination in their equipments were: students (81.4 percent) and specialists (14.8 percent). The cause of not doing the disinfection processes in the students was the lack of knowledge (45.4 percent); and in the specialists was the lack of hygene habits and the lack of disinfectant solutions (66.3 percent). Negative Gran bacteria were mostly sensitive to aminoglycosides and Staphylococcus aureus to clindamycin, vancomycin, ciprofloxacin and cloramphenicol. Conclusions: There is high frequency of contamination in the stethoscopes used by health care providers, mainly motived by the lack of disinfection habits in physicians and lack of knowledge on it in the students(AU)

Tiempo de vida del SARS-CoV-2 en el medio ambiente: potencial de transmisión por gotículas, aerosoles y fómites / Life time of SARS-CoV-2 in the environment: transmission potential by droplets, aerosols and fomites

La COVID-19 se ha extendido rápidamente en todos los países del mundo. Según los datos globales obtenidos hasta la fecha, el curso de la pandemia ha dejado un estimado de 44 871 314 casos y 1 178 751 de fallecidos a nivel mundial1. Muchos países han reportado una disminución de casos, lo que ha permitido una reapertura gradual de las actividades, estableciendo medidas de prevención para evitar la transmisión del virus entre la población. A pesar de esto, algunos países que experimentaron disminución de casos, ahora registran un segundo aumento. Este fenómeno ha formado parte de la discusión científica mundial, generando así la necesidad de estudiar con más detalle la forma de trasmisión del virus, describir su comportamiento en ambiente y determinar el tiempo en que permanece viable en superficies inertes. Se ha llegado al conceso que el virus SARS-CoV-2, que causa la COVID-19, se transmite a través de secreciones o gotículas respiratorias2. Se pude transmitir a través del contacto directo o indirecto entre las personas y por medio de superficies inertes contaminadas con el virus2. El potencial de transmisión por aerosol era poco conocido al inicio de la pandemia, sin embargo, la evidencia científica sobre la transmisión aérea del virus por aerosoles está aumentando y hay muchos estudios que sugieren, se considere como una importante vía de trasmisión. A continuación, se presenta una reseña científica sobre la transmisión del SARS-CoV-2 por medio del aire, superficies inertes y el agua, considerando algunos factores ambientales y la viabilidad que tiene en ciertas condiciones. Esta reseña científica no es una revisión sistemática, sin embargo, es un análisis rápido realizado a partir de publicaciones en revistas arbitradas y documentos de entidades de salud como la Organización Mundial de la Salud (OMS), entre otras.

COVID-19 has spread rapidly in all countries of the world. According to global data obtained to date, the course of the pandemic has left an estimated 44,871,314 cases and 1,178,751 deaths worldwide1. Many countries have reported a decrease in cases, which has allowed a gradual reopening of activities, establishing prevention measures to avoid the transmission of the virus among the population. Despite this, some countries that experienced declines in cases now register a second increase. This phenomenon has been part of the global scientific discussion, thus generating the need to study in more detail the way the virus is transmitted, describe its behavior in the environment and determine the time it remains viable on inert surfaces. It has been agreed that the SARS-CoV-2 virus, which causes COVID-19, is transmitted through respiratory secretions or droplets2. It can be transmitted through direct or indirect contact between people and through inert surfaces contaminated with the virus2. The potential for transmission by aerosol was little known at the beginning of the pandemic, however, scientific evidence on the airborne transmission of the virus by aerosols is increasing and there are many studies that suggest it is considered an important route of transmission. Next, a scientific review on the transmission of SARS-CoV-2 through the air, inert surfaces and water is presented, considering some environmental factors and its viability under certain conditions. This scientific review is not a systematic review, however, it is a quick analysis based on publications in peer-reviewed journals and documents from health entities such as the World Health Organization (WHO), among others.

Frecuencia de contaminación por enteroparásitos en pasamanos de autobuses de Barquisimeto, Venezuela / Enteric Parasite Contamination Frequency on Bus Handrails in Barquisimeto, Venezuela / Frequência da contaminação por enteroparasitos em corrimãos de ônibus em Barquisimeto, Venezuela

Introducción. La contaminación enteroparasitaria en autobuses por parte de usuarios infectados con malas conductas sanitarias potencia el riesgo de infección del resto de los pasajeros con el subsecuente peligro del desarrollo de patologías gastrointestinales. Por esto se evaluó la frecuencia de contaminación de autobuses con el fin de aportar datos que son desconocidos en Venezuela e inexistentes en Latinoamérica. Metodología. El trabajo fue descriptivo, transversal, con muestra no probabilística y accidental, donde la obtención de la muestra consistió en frotar el pasamanos de cada autobús (100 vehículos examinados) tres veces con un hisopo impregnado en solución salina isotónica 0.85%, resuspendiendolo en un tubo de ensayo con 10 ml de solución salina. La muestra se centrifugó a 3000 rpm por diez minutos para luego observar el sedimento al microscopio. Resultados. El 16% de las muestras presentaron contaminación, encontrándose solo dos especies de enteroparásitos, Blastocystis spp. (14% del total de muestras examinadas) y Endolimax nana (5%). Discusión. La abundancia del potencial patógeno Blastocystis sp., se relaciona con lo descrito en exámenes de heces de habitantes de Barquisimeto y del estado Lara, demostrando que los usuarios enfermos con malas conductas higiénicas convierten a los autobuses en un foco de infección que debe ser controlado. Conclusión. La falta de aseo constante en unidades de transporte público y la ausencia de conciencia sanitaria de algunos pasajeros infectados facilitan la transmisión de enteroparásitos endémicos potencialmente productores de enfermedades gastrointestinales. Cómo citar: Traviezo, L. Frecuencia de contaminación por enteroparásitos en pasamanos de autobuses de Barquisimeto, Venezuela. MedUNAB. 2020;23(3):434-440 doi: doi.org/10.29375/01237047.3913

Introduction. Enteroparasite contamination by infected users with poor sanitary habits in buses increases other passengers' risk of infection, with the subsequent danger of developing gastrointestinal pathologies. For this reason, bus contamination frequency was evaluated in order to provide data that is unknown in Venezuela and non-existent in Latin America. Methodology. The work was descriptive and cross-sectional, with non-probability and accidental sampling. The sample was obtained by rubbing each bus' handrail (100 examined vehicles) three times with a swab permeated with a 0.85% isotonic saline solution, resuspending it in a test tube with 10 ml of saline solution. The sample was centrifuged at 3,000 rpm for ten minutes to then observe the sediment under a microscope. Results. Sixteen percent of samples were contaminated, observing only two species of enteroparasites, Blastocystis sp. (14% of total examined samples) and Endolimax nana (5%). Discussion. The abundance of the potential pathogen, Blastocystis sp. is related to what has been described in feces exams on the inhabitants of Barquisimeto and the state of Lara, demonstrating that sick users with poor hygiene habits make buses a point of infection that must be controlled. Conclusion. The lack of constant cleaning in public transportation units and the absence of some infected passengers' sanitary awareness facilitates transmitting endemic enteroparasites that could potentially produce gastrointestinal diseases. Cómo citar: Traviezo, L. Frecuencia de contaminación por enteroparásitos en pasamanos de autobuses de Barquisimeto, Venezuela. MedUNAB. 2020;23(3):434-440 doi: doi.org/10.29375/01237047.3913

Introdução. A contaminação enteroparasitária em ônibus por usuários infectados com comportamentos sanitários inadequados aumenta o risco de infecção do resto dos passageiros com o consequente perigo de desenvolvimento de patologias gastrointestinais. Por isso, avaliou-se a frequência de contaminação de ônibus, a fim de fornecer dados até agora desconhecidos na Venezuela e inexistentes na América Latina. Metodologia. O trabalho foi descritivo, transversal, com amostra não-probabilística e acidental, em que a obtenção da amostra consistiu em esfregar o corrimão de cada ônibus (100 veículos examinados) três vezes com um cotonete impregnado em solução salina isotônica 0.85%, ressuspendendo-o em um tubo de ensaio com 10 ml de solução salina. A amostra foi centrifugada a 3,000 rpm por dez minutos para posteriormente observar o sedimento ao microscópio. Resultados. 16% das amostras apresentaram contaminação, sendo encontradas apenas duas espécies de enteroparasitas, Blastocystis sp. (14% do total das amostras examinadas) e Endolimax nana (5%). Discussão. A abundância do potencial patógeno Blastocystis sp., está relacionada ao que foi descrito em exames de fezes de moradores dos estados de Barquisimeto e Lara, mostrando que usuários doentes e com comportamentos sanitários inadequados fazem do ônibus um foco de infecção que deve ser controlado. Conclusão. A falta de limpeza constante nas unidades de transporte público e a falta de conscientização sobre a saúde de alguns passageiros infectados facilitam a transmissão de enteroparasitos endêmicos potencialmente produtoras de doenças gastrointestinais. Cómo citar: Traviezo, L. Frecuencia de contaminación por enteroparásitos en pasamanos de autobuses de Barquisimeto, Venezuela. MedUNAB. 2020;23(3):434-440 doi: doi.org/10.29375/01237047.3913

Contaminación enteroparasitaria de intercomunicadores en edificios de Barquisimeto y Cabudare, Venezuela / Enteroparites contamination of intercoms in buildings of Barquisimeto and Cabudare, Venezuela

Resumen Introducción. La falta de estudios en intercomunicadores como medios de propagación de enteroparásitos en Venezuela, motivó el presente estudio. Metodología. Se frotó el intercomunicador tres veces con un hisopo impregnado con solución salina 0,85% (SSI), resuspendiéndolo en un tubo con 10 ml de SSI, el cual se centrifugó a 3000 rpm por 10 minutos para luego observar el sedimente al microscopio. Resultados. El 65% de las muestras estuvieron contaminadas, encontrando 10 taxones de enteroparásitos, a saber: Blastocystis sp (49% del total de muestras examinadas), Endolimax nana (36%), lodamoeba butschlii (8%), Giardia lamblia (7%), Entamoeba coli (4%), Chilomastix mesnili (2%), Entamoeba hartmanni (2%), Trichuris trichiura (2%), Hymenolepis nana (2%) y Taenia sp (1%). Discusión. La diversidad de parásitos encontrados y su abundancia, se corresponden con lo reportado en poblaciones de la misma zona. Conclusión. La falta de higiene en la mayoría de los intercomunicadores facilitan el potencial de estos para transmitir los parásitos endémicos del estado Lara.

Abstract Introduction. The lack of studies in intercoms as means of propagation of enteroparasites in Venezuela, motivated the present study. Methodology. The intercom was rubbed three times with a swab impregnated with 0.85% saline solution (SSI), resuspending it in a tube with 10 ml of SSI, which was centrifuged at 3000 rpm for 10 minutes to then observe the pellet under a microscope. Results. 65% of the samples were contaminated, finding 10 taxa of enteroparasites, namely: Blastocystis sp (49% of the samples examined), Endolimax nana (36%), Iodamoeba butschlii (8%), Giardia lamblia (7%), Entamoeba coli (4%), Chilomastix mesnili (2%), Entamoeba hartmanni (2%), Trichuris trichiura (2%), Hymenolepis nana (2%) and Taenia sp (1%). Discussion. The diversity of parasites found and their abundance correspond to that reported in populations of the same area. Conclusion. The lack of hygiene of most of the intercoms facilitates the potential of these to transmit the endemic parasites of the Lara State.

Multidrug-resistant bacteria isolated from cell phones in five intensive care units: Exploratory dispersion analysis.

INTRODUCTION: Cell phones are susceptible to bacterial contamination. The aim of this study was to characterize the bacterial isolates and to explore their dispersion in five Intensive Care Units (ICUs) over the time. METHODS: We performed a secondary analysis of non-fermenting Gram-negative bacteria and Gram-positive cocci isolated from a 5-month observational cohort study developed among health care workers' cell phones in five ICUs. Cell phones were sampled using a swab every 15 days. Antimicrobial resistance was determined by the minimum inhibitory concentration method. We constructed resistance phenotypes to group the isolates according to species and antimicrobial resistance pattern to explore dispersion through time. RESULTS: A total of 35 P. aeruginosa, 16 Acinetobacter spp., 30 S. aureus and 26 Enterococcus spp. were isolated from 491 phone samples. Multidrug resistance was 2.9% for P. aeruginosa, 31.3% for Acinetobacter spp., 46.7% for S. aureus and 80.8% for Enterococcus spp. The resistance to methicillin in S. aureus and to vancomycin in Enterococcus spp. was 26.7% and 42.3%, respectively. We did not observe distribution patterns or clusters over the time for P. aeruginosa, Acinetobacter spp. and Enterococcus spp. isolates. All the S. aureus isolates grouped into eight phenotypes. Interestingly, we observed S. aureus isolates with the same phenotype in consecutive and separate sampling dates in the same cell phone. CONCLUSION: Cell phones are contaminated with highly harmful bacteria and potentially can maintain them for prolonged periods of time. These devices could be considered as a potential source of nosocomial infections in ICUs.

Surface Sampling Collection and Culture Methods for Escherichia coli in Household Environments with High Fecal Contamination.

Empiric quantification of environmental fecal contamination is an important step toward understanding the impact that water, sanitation, and hygiene interventions have on reducing enteric infections. There is a need to standardize the methods used for surface sampling in field studies that examine fecal contamination in low-income settings. The dry cloth method presented in this manuscript improves upon the more commonly used swabbing technique that has been shown in the literature to have a low sampling efficiency. The recovery efficiency of a dry electrostatic cloth sampling method was evaluated using Escherichia coli and then applied to household surfaces in Iquitos, Peru, where there is high fecal contamination and enteric infection. Side-by-side measurements were taken from various floor locations within a household at the same time over a three-month period to compare for consistency of quantification of E. coli bacteria. The dry cloth sampling method in the laboratory setting showed 105% (95% Confidence Interval: 98%, 113%) E. coli recovery efficiency off of the cloths. The field application demonstrated strong agreement of side-by-side results (Pearson correlation coefficient for dirt surfaces was 0.83 (p < 0.0001) and 0.91 (p < 0.0001) for cement surfaces) and moderate agreement for results between entrance and kitchen samples (Pearson (0.53, p < 0.0001) and weighted Kappa statistic (0.54, p < 0.0001)). Our findings suggest that this method can be utilized in households with high bacterial loads using either continuous (quantitative) or categorical (semi-quantitative) data. The standardization of this low-cost, dry electrostatic cloth sampling method can be used to measure differences between households in intervention and non-intervention arms of randomized trials.

Sphygmomanometers and thermometers as potential fomites of Staphylococcus haemolyticus: biofilm formation in the presence of antibiotics

BACKGROUND The association between Staphylococcus haemolyticus and severe nosocomial infections is increasing. However, the extent to which fomites contribute to the dissemination of this pathogen through patients and hospital wards remains unknown. OBJECTIVES In the present study, sphygmomanometers and thermometers were evaluated as potential fomites of oxacillin-resistant S. haemolyticus (ORSH). The influence of oxacillin and vancomycin on biofilm formation by ORSH strains isolated from fomites was also investigated. METHODS The presence of ORSH on swabs taken from fomite surfaces in a Brazilian hospital was assessed using standard microbiological procedures. Antibiotic susceptibility profiles were determined by the disk diffusion method, and clonal distribution was assessed in pulsed-field gel electrophoresis (PFGE) assays. Minimum inhibitory concentrations (MICs) of oxacillin and vancomycin were evaluated via the broth microdilution method. Polymerase chain reaction (PCR) assays were performed to detect the mecA and icaAD genes. ORSH strains grown in media containing 1/4 MIC of vancomycin or oxacillin were investigated for slime production and biofilm formation on glass, polystyrene and polyurethane catheter surfaces. FINDINGS ORSH strains comprising five distinct PFGE types were isolated from sphygmomanometers (n = 5) and a thermometer (n = 1) used in intensive care units and surgical wards. ORSH strains isolated from fomites showed susceptibility to only linezolid and vancomycin and were characterised as multi-drug resistant (MDR). Slime production, biofilm formation and the survival of sessile bacteria differed and were independent of the presence of the icaAD and mecA genes, PFGE type and subtype. Vancomycin and oxacillin did not inhibit biofilm formation by vancomycin-susceptible ORSH strains on abiotic surfaces, including on the catheter surface. Enhanced biofilm formation was observed in some situations. Moreover, a sub-lethal dose of vancomycin induced biofilm formation by an ORSH strain on polystyrene. MAIN CONCLUSIONS Sphygmomanometers and thermometers are fomites for the transmission of ORSH. A sub-lethal dose of vancomycin may favor biofilm formation by ORSH on fomites and catheter surfaces.

Analysis of the presence of organic matter (ATP) in mobile devices of healthcare workers in hospitals

We report the result of an awareness campaign about the importance of hand hygiene after using different devices used in assistance to patients, such as tablets, notebooks, mobile phones, identification cards, watches, cameras, showing the level of contamination found after detection of adenosine triphosphate (ATP) via bioluminescence, which enables a quantitative assessment ready and easy to implement. ATP molecules found in all living cells react with the enzyme complex to generate light and represent the presence of organic matter in such objects(AU)

Conductas de higiene en el uso de estetoscopios de estudiantes de un programa de medicina de la ciudad de Tunja, Colombia / Hygiene behaviors in the use of stethoscopes of students of a medicine program of the city of Tunja, Colombia

Introducción: múltiples investigaciones han demostrado que los estetoscopios se encuentran colonizados por bacterias causantes de infecciones humanas. A pesar de ello, no se han definido las causas por las que estos instrumentos se contaminan. Objetivo: determinar las conductas de higiene que tienen los estudiantes de un programa de medicina de la ciudad de Tunja, Colombia, en el uso de los estetoscopios. Materiales y métodos: se seleccionaron 50 estudiantes de medicina quienes diligenciaron un cuestionario con preguntas cerradas, construido con base en grupos focales que permitieron caracterizar las conductas de uso intra y extrahospitalarias del estetoscopio. Además, a cada estudiante participante se le solicitó su estetoscopio para tomar muestras de cuatro partes del mismo, que posteriormente fueron cultivadas en agar nutritivo y caracterizadas macroscópica y microscópicamente por medio de la coloración de Gram. Resultados: de los 50 estudiantes que diligenciaron el cuestionario se evidenció que el 48% nunca había limpiado el estetoscopio, el 24% lo limpiaba con alcohol antiséptico y el 2% realizaba limpieza antes de la valoración del paciente. En el 100% de los estetoscopios se aislaron colonias bacterianas, principalmente cocos Gram positivos, siendo el diafragma la parte más contaminada de este instrumento. Conclusiones: se determinaron conductas inadecuadas en el uso del estetoscopio a nivel intra y extrahospitalario, así como la falta de información para su adecuada desinfección. (AU)

Introduction: multiple investigations have shown that bacteria causing human infections colonize stethoscopes. However, the reasons why these instruments are contaminated have not been defined. Objective: To determine the hygiene behaviors that medicine students have in the use of stethoscopes. Materials and methods: 50 medicine students were selected to complete a questionnaire with closed questions, based on focus groups that allowed characterizing the intra and extrahospital behavior of the stethoscope use. In addition, each participant student was asked for his stethoscope in order to take samples of four parts of it, which were later culture on nutritive agar and characterized macroscopically and microscopically by Gram staining. Results: Of the 50 students, who completed the questionnaire, 48% have never cleaned the stethoscope, 24% cleaned it with antiseptic alcohol, and 2% cleaned before the patient's evaluation. In 100% of the stethoscopes bacterial colonies were isolated, mainly Gram-positive cocci, been diaphragm the most contaminated part of this instrument. Conclusions: inadequate behaviors were determined in the intra- and extra-hospital stethoscope use, as well as lack of information for it adequate disinfection. (AU)

Contaminación con bacterias patógenas de estetoscopios del personal médico en un hospital de nivel III en Lima, Perú / Contamination of medical stethoscopes with pathogenic bacteria in a level III hospital in Lima, Peru

Objetivos: Determinar el grado de contaminación bacteriana con bacterias patógenas de los estetoscopios del personal médico en un hospital general de Lima, Perú. Material y métodos: Estudio de tipo observacional,descriptivo y transversal, realizado en el Hospital Nacional Arzobispo Loayza, entre los meses de enero y juniodel 2013. Se estudiaron 124 muestras de estetoscopios del personal médico en las siguientes áreas: UCI 20; neonatología 13; quemados 3; medicina 52; emergencia 36. Se recolectaron las muestras con hisopos humedecidos,en condiciones estériles (En presencia de un mechero de vidrio para alcohol) y luego fueron introducidos en tuboscon preparado de caldo BHI (Infusión cerebro corazón) para ser incubados por 24 horas a 37°C; se cultivó en Agarsangre, Agar MacConkey, Agar manitol y Agar cetrimidepara su posterior determinación de bacterias patógenaspor procedimientos bioquímicos ,luego se identificó la susceptibilidad bacteriana con la técnica de Kirby- Bauer...

Objectives: To determine the degree of contamination with pathogenic bacteria by stethoscopes used for medical personnel in a general hospital in Lima, Peru. Methods: Cross sectional study carried-out at Hospital Nacional Arzobispo Loaya between January and June 2013. A total of 124 samples were evaluated from the following areas: 20 from the ICU, 13 from the neonatology service, 3 from the burn unit; 52 from medicine wards, and 36 from the emergency room. The samples were collected using a moist cotton swab in sterile conditions (using a alcohol bunser burner) and introduced in tubes containing brain-heart infusion to be incubated at 37C for 24 hours. The determination of pathogenic bacteria used MacConkey and manitol agar with specific biochemical methods. The Kirby-Bauer method was used to determine the antibiotic susceptibility pattern...

Influence of biological fluids in bacterial viability on different hospital surfaces and fomites.

BACKGROUND: The hospital environment is susceptible to bacterial contamination along with survival in fomites and surfaces, allowing dissemination of potential pathogenic strains. The present research aimed to evaluate the influence of biological fluids in bacterial viability on fomites and surfaces commonly present in nosocomial environment. METHODS: Four different fomites and surfaces (ceramic floor, cotton fabric fragments and synthetic fibers, and eggcrate foam mattress) were contaminated with potential pathogens (Staphylococcus aureus, Escherichia coli, Enterococcus faecalis, Pseudomonas aeruginosa, and Klebsiella pneumoniae), then submitted to influence of biological fluids (blood, urine, artificial saliva). The viability of strains was evaluated at 24 hours after contamination and then in intervals of 7 days, by the colony-forming unit count technique. RESULTS: S aureus presented viability (>70 days) in all conditions tested, E faecalis and K pneumoniae had decreased viability over time, and E coli did not exhibit a growth relationship with surfaces or fluids. Persistence and adaptability capacity of potential pathogens in fomites and surfaces exposed to the patient are important for guidance, planning, and outlining of protocols for microorganism dissemination control and prevention in the health care environment.

Viability of human adenovirus from hospital fomites.

The monitoring of environmental microbial contamination in healthcare facilities may be a valuable tool to determine pathogens transmission in those settings; however, such procedure is limited to bacterial indicators. Viruses are found commonly in those environments and are rarely used for these procedures. The aim of this study was to assess distribution and viability of a human DNA virus on fomites in an Adult Intensive Care Unit of a private hospital in Rio de Janeiro, Brazil. Human adenoviruses (HAdV) were investigated in 141 fomites by scraping the surface area and screening by quantitative PCR (qPCR) using TaqMan® System (Carlsbad, CA). Ten positive samples were selected for virus isolation in A549 and/or HEp2c cell lines. A total of 63 samples (44.7%) were positive and presented viral load ranging from 2.48 × 10(1) to 2.1 × 10(3) genomic copies per millilitre (gc/ml). The viability was demonstrated by integrated cell culture/nested-PCR in 5 out of 10 samples. Nucleotide sequencing confirmed all samples as HAdV and characterized one of them as specie B, serotype 3 (HAdV-3). The results indicate the risk of nosocomial transmission via contaminated fomites and point out the use of HAdV as biomarkers of environmental contamination.

Contaminación de billetes con enteroparásitos en Coro, estado Falcón, Venezuela / Contamination of banknotes with enteric parasites in Coro, Falcon state, Venezuela

El papel moneda es uno de los objetos que mayormente manipulan e intercambian los humanos, pudiendo representar un vehículo potencial en la transmisión de los parásitos intestinales. Entre mayo y julio de 2013, se evaluaron 185 muestras de billetes (Bs.F) de todas las denominaciones, los cuales se obtuvieron al azar en bancos y comercios de Coro, estado Falcón, Venezuela. Todas las muestras se lavaron con agua destilada estéril + Tween® 20 al 20%, y se sometieron a sedimentación espontánea por 2-3 horas, centrifugación y observación microscópica por métodos parasitológicos directo y tinción de Kinyoun. Se detectó que el 42,16% (78/185) de los billetes presentaron contaminación por uno o más taxones parasitarios/comensales, siendo los más frecuentemente observados: Blastocystis sp. (30,27%), Endolimax sp. (8,65%), Cyclospora sp. (8,11%) y Giardia sp. (7,57%). Los billetes sucios/mutilados (50,75%) presentaron porcentajes de contaminación parasitaria significativamente mayores que los nuevos (0%) y limpios (50%) (χ²= 26,11; P= 0,00001). No se encontró una relación estadísticamente significativa entre la denominación, la fecha de emisión de los billetes y los porcentajes de contaminación (P > 0,05). Se concluye que los billetes circulantes en la ciudad de Coro pueden potencialmente jugar un papel significativo en la diseminación de enfermedades parasitarias vía fómite. Por lo tanto, se recomienda programas de educación para la salud para el manejo y uso del papel moneda.

Banknotes are some of the objects most handled and exchanged by people, thus representing a potential vehicle for the transmission of intestinal parasites. Between May and July 2013, a total of 185 banknotes (Bs.F) from all denominations were randomly selected from trade centers and banks in Coro, Falcon state, Venezuela. The notes were washed with sterile distilled water + Tween® 20 (20 %) and then left at room temperature for 2-3 h for sedimentation to occur. Five mL of sediment were then centrifuged for 3-5min and the sediment was then examined with the aid of a light microscopy using direct parasitological methods and Kinyoun stained slides. A total of 42.16% (78/185) of the examined notes were contaminated by one or more parasitic/commensal taxa, with Blastocystis sp. (30.27%), Endolimax sp. (8.65%), Cyclospora sp. (8.11%) and Giardia sp. (7.57%) the most commonly isolated species. Dirty and damaged notes (50.75%) showed significantly higher percentages of contamination compared to mint (0%) and apparently clean (50%) ones (χ2= 26.11; P=0.0000). No statistically significant associations between the value of the notes, their date of emission and contamination frequencies were found (P > 0.05). We conclude that banknotes (Bs.F) circulating in Coro, Falcon state, Venezuela, could serve as a potential fomite for the spread of intestinal parasites. Sanitation awareness campaigns for the proper use and management of banknotes are therefore recommended.

Stethoscopes as potential intrahospital carriers of pathogenic microorganisms.

Stethoscopes can take part in the transmission of health care-associated infections. We cultured 112 stethoscopes by direct imprint on blood agar to estimate the prevalence of potentially pathogenic microorganisms. Forty-eight (47%) produced 50 potentially pathogenic microorganisms; from these, 43 (86%) were Staphylococcus aureus, of which 18 (42%) were methicillin-resistant S. aureus. We concluded that stethoscopes should be considered as potential fomites and must be disinfected routinely before and after each patient contact.