Orientador: Carlos Magno Castelo Branco Fortaleza / Resumo: Seasonality of healthcare-associated infections (HCAIs) has been recently reported, especially involving Gram-negative bacilli (GNB). Factors underlying this phenomenon were not elucidated. It is theoretically conceivable it reflects seasonal variations in traditional risk factors for those infections. With this in mind, we conducted a study to analyze the interplay of season, weather and usual predictors of healthcare-associated bloodstream infections caused by Gram-negative bacilli (GNB-BSI). The study had a retrospective, case-only desing. It was conducted in the teaching hospital from Botucatu School of Medicine (450 beds). The study enrolled 446 patients with GNB-BSI caused by Escherichia coli, Enterobacter spp., Klebsiella spp., Pseudomonas aeruginosa or Acinetobacter baumannii, diagnosed from July 2012 through June 2016. Demographic data, comorbidities, invasive procedures and use of antimicrobials were reviewed in medical charts. The season in which GNB-BSI occurred, as well as weather parameters of the day of diagnosis, were recorded. We analyzed factors associated with occurrence of GNB-BSI in different seasons (with winter as reference category) and caused by different GNB (reference category, E. coli). Univariate and multivariable models of polytomous (multinomial) logistic regressions were used for analysis. In multivariable analysis, GNB-BSI diagnosed in summer were more likely to be caused by Klebsiella spp. (OR, 5.33; 95%CI, 2.04-13.96) or A. baumannii (OR, 2.... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Seasonality of healthcare-associated infections (HCAIs) has been recently reported, especially involving Gram-negative bacilli (GNB). Factors underlying this phenomenon were not elucidated. It is theoretically conceivable it reflects seasonal variations in traditional risk factors for those infections. With this in mind, we conducted a study to analyze the interplay of season, weather and usual predictors of healthcare-associated bloodstream infections caused by Gram-negative bacilli (GNB-BSI). The study had a retrospective, case-only desing. It was conducted in the teaching hospital from Botucatu School of Medicine (450 beds). The study enrolled 446 patients with GNB-BSI caused by Escherichia coli, Enterobacter spp., Klebsiella spp., Pseudomonas aeruginosa or Acinetobacter baumannii, diagnosed from July 2012 through June 2016. Demographic data, comorbidities, invasive procedures and use of antimicrobials were reviewed in medical charts. The season in which GNB-BSI occurred, as well as weather parameters of the day of diagnosis, were recorded. We analyzed factors associated with occurrence of GNB-BSI in different seasons (with winter as reference category) and caused by different GNB (reference category, E. coli). Univariate and multivariable models of polytomous (multinomial) logistic regressions were used for analysis. In multivariable analysis, GNB-BSI diagnosed in summer were more likely to be caused by Klebsiella spp. (OR, 5.33; 95%CI, 2.04-13.96) or A. baumannii (OR, 2.... (Complete abstract click electronic access below) / Mestre

This diploma thesis is focused on the prevention and monitoring of healthcare-associated infections at the Hospital Prachatice, a.s. The main objective was to describe current situation in the field of prevention of nosocomial infections in this hospital. I focused on verification of medical personnel knowledge of nosocomial infections, the work of cleaners and the quality of hand hygiene of medical personnel. Diploma thesis is focused on the 4 selected departments of the hospital department of internal medicine, gynecology-obstetric department, surgical department and ARO and ICU. Thesis is divided into theoretical and practical part. The present knowledge about the healthcare-associated infections are processed in the theoretical part. To obtain all needed information was used domestic and foreign professional literature. The practical part was about the observation and the short research in the Hospital Prachatice, a.s. The research part was combined. The qualitative method including short interviews with the cleaners was combined with a quantitative method. Within this quantitative method have been used short questionnaires, which were intended for nurses. With these questionnaires I tried to find out their basic knowledge about nosocomial diseases and how they prevent them. The microbiological department of the Hospital Prachatice, a.s. was helpful in monitoring the quality of hand hygiene through method of microbiological fingerprinting. The questionnaires were handed out to nurses which worked on shift in that time on four mentioned departments of hospital. I return total 32 questionnaires back. Questionnaire had 11 questions and my plan was find out the basic knowledge of nurses about the issue. Interviews were conducted with cleaners working on focused departments where the research took place. The microbial fingerprints of hands were collected from medical staff on current work shift including doctors and cleaners. The fingerprints were made on blood agar where after 24-hours of incubation the colonies of bacteria were evaluated. None of the fingerprints was completely negative. I determined totaly 4 research questions: 1. Are all workers of selected hospital departments well informed about nosocomial diseases? 2. What is the hygiene quality of hands among medical staff? 3. On what hygienic level is job of cleaners how often they are cleaning, which way and how often they are changing the working equipment and are the all hygiene criterions followed? 4. How is manipulated with laundry? The results of the questionnaires was surprised for me because most of the medical personnel correctly answered all the asked questions. It was found a total 16 kinds of gram+ and gram microorganisms during a hand hygiene by microbial fingerprints. Most occurred findings was Staphylococcus epidermidis and Microccocus species. In two cases occurred a epidemiologically significant Staphylococcus aureus, which in both cases was found among cleaners. From my observation, investigation and interviews with cleaners I can infer that the work they are doing, they do really conscientiously and normally the health regulations are not violated. Further was found that the manipulation with laundry in Hospital Prachatice, a.s. is in accordance with the hygiene requirements for medical devices. What is important is the effective education of personnel in the prevention of infections and supervision of compliance of mandated procedures.

The present thesis focuses on nosocomial infections and their causes. The theoretical part summarizes information on especially the sources of these infections, the way of their transfer and the most frequent infection agents. Clostridium difficile is studied in more detail. The illness caused by this pathogen leads to the complications especially with in-patients with a previous antibiotic therapy and immuno-compromised individuals. And this is the problem the present thesis is also concerned with. The thesis also divides nosocomial infections by their clinical manifestations and contains basic anti-epidemic measures and surveillance methods. Its empirical part focuses on the description of an occurrence of select nosocomial infections in Strakonice Hospital, a.s., especially an occurrence of the Clostridium difficile pathogen and methicillin-resistant Staphylococcus aureus (MRSA).

Pseudomonas aeruginosa est un pathogène d’origine environnementale capable de croître et de persister dans les systèmes de distribution d’eau et la plomberie. A l’hôpital, la fréquence des infections et épidémies associées aux soins dues à P. aeruginosa soulève de nombreuses questions quant à son cycle de transmission à l’homme dans l’environnement hospitalier. La situation épidémiologique du Centre Hospitalier Régional Universitaire de Montpellier a permis d’établir une collection de 730 souches de P. aeruginosa isolées durant une période de 9 ans. Cette collection est représentative des différentes niches environnementales et de deux périodes épidémiologiques marquées. Les souches cliniques impliquées dans des phénomènes épidémiques et des infections graves ont aussi été collectées. L’analyse génétique et phénétique de cette collection a pour objectif de mieux comprendre la structure, la dynamique et la persistance des populations de P. aeruginosa dans divers réservoirs environnementaux hospitaliers ainsi que les relations entre les réservoirs environnementaux et le succès épidémiologique des populations de P. aeruginosa.L’analyse intégrée des données obtenues dans les trois parties de cette étude convergent vers les résultats principaux suivants. Les réservoirs environnementaux médico-technologiques présentent une forte dynamique avec des phénomènes d’émergence clonale en relation avec les traitements réalisés sur les réseaux. A l’échelle d’un hôpital, le réservoir environnemental est directement impliqué dans les phénomènes épidémiques. La rupture du cycle homme/environnement par des barrières physiques conduit à un changement de situation épidémiologique avec une limitation de l’importance et de la fréquence des épidémies clonales. De plus, les souches les plus ubiquitaires et les plus persistantes dans l’environnement correspondent aux génotypes à fort risque épidémique local et mondial ou clones EHR (Epidemic High Risk). La structure de population de P. aeruginosa au sein de l’hôpital est similaire à celle de la population mondiale ou à celle décrite dans d’autres études : une structure épidémique avec la recombinaison qui a un effet prépondérant sur l’émergence des lignées. Le clone EHR majoritaire ST308 est plus résistant aux antibiotiques que les clones prévalants dans l’hôpital mais non impliqués dans des épidémies. Toutefois, la caractérisation de 46 souches du clone EHR majoritaire, ST308, montre une extrême variabilité au sein du génotype avec, en particulier, des comportements divers en termes de résistance aux antibiotiques. La forte capacité de formation de biofilm et la faible motilité décrites dans la littérature comme caractéristique des clones EHR ne sont pas observées dans cette étude. Notre principale hypothèse est que le succès épidémique du clone EHR ST308 dans l’hôpital est lié à sa diversité intraclonale plutôt qu’à un caractère particulier partagé par toutes les souches EHR.Ce travail apporte des arguments forts en faveur de l’implication des réservoirs environnementaux hospitaliers dans les épidémies d’infections associées aux soins dues à P. aeruginosa. Dans le but de mieux contrôler ces épidémies, les résultats de cette étude incitent à la surveillance des clones EHR de P. aeruginosa quel que soit leur profil de résistance aux antibiotiques et à mettre en place des mesures barrières entre l’environnement hydrique et le patient dès qu’un réservoir environnemental d’EHR se constitue.Mots clés : Pseudomonas aeruginosa, infections associées aux soins, épidémie, environnement, réseau d’eau, structure de population, clone à haut risque épidémique, résistance aux antibiotiques, biofilm, motilité, variabilité intraclonale, adaptation / Pseudomonas aeruginosa is an environmental pathogen that growths in water and plumbing systems. In hospital, the rate of healthcare associated infections (HAIs) and outbreaks caused by P. aeruginosa raised questions about the cycle of its transmission to human beings in the hospital environment. P. aeruginosa epidemiology at the Montpellier Academic Hospital allowed to collect 730 strains isolated over a 9-years period. This collection is representative of various environmental niches and two marked epidemiological periods. Clinical strains involved in outbreak events and serious infections were also included in the study. Genetic and phenetic analysis were performed with the aim to understand structure, dynamics and persistence of P. aeruginosa populations in various hospital reservoirs as well as the relationships between environmental reservoirs and epidemic success of P. aeruginosa.The experimental study, organized in 3 parts, produced the following major results. Medical and technological reservoirs of P. aeruginosa are highly dynamic and clonal emergence occurs in these systems, particularly in relation with networks decontamination by biocides. At the hospital scale, environmental reservoirs are directly involved in outbreak events. Physical barriers between water and patients cut the cycle of transmission from environment to human and markedly changed the epidemiology with a decrease of outbreaks in frequency and incidence. Moreover, the most ubiquitary strains that also persists in environment correspond to Epidemic High Risk (EHR) clones that succeed locally and globally. Population structure of P. aeruginosa within the hospital is similar to the worldwide population or to more local populations previously described: an epidemic structure with a background of recombinations involved in lineages emergence. The major EHR clone ST308 is more resistant to antibiotics than other prevalent clones not involved in outbreaks. However, the study of 46 strains in ST308 showed extreme within genotype variability, particularly various behaviours against antimicrobial agents. Increased ability to form biofilm and decreased motility have been described in literature as specific traits of EHR clones but it is not observed in this study. Our main hypothesis is that epidemic success of EHR clone ST308 in the hospital was linked to its diversity and versatility rather than to specific characters shared by all EHR strains.This study provides strong arguments in favour of the involvement of P. aeruginosa environmental reservoirs in HAI outbreaks. For a better control of these outbreaks, a surveillance of EHR clones of P. aeruginosa should be implemented independently to their antibiotic resistance. Moreover, barriers between environment and patient should be established as soon as an environmental reservoir of EHR clone is detected.Key words : Pseudomonas aeruginosa, Healthcare Associated Infections, outbreak, environment, water network, population structure, epidemic high risk clone, resistance to antibiotics, biofilm, motility, intraclonal variation, adaptation

No description available.

<p><strong>ABSTRACT</strong><strong></strong></p> <p><strong>Background</strong>: Healthcare-associated infections (HAIs) and HAI disease outbreaks present challenges for healthcare facilities. In 2008, a <em>Clostridium difficile</em> outbreak in Ontario resulted in the deaths of 91 patients and raised awareness of HAIs. Over the last 5 years, the outbreak rate has risen dramatically. Traditionally, HAI research has focused on epidemiology, healthcare systems, and the economic burden. Little is known about the impact HAI disease outbreaks have on the work of healthcare professionals.</p> <p><strong>Purpose</strong>: The purpose of this study was to examine the effects of HAI outbreaks on healthcare professionals in a large acute care hospital in Ontario.</p> <p><strong>Methods</strong>:<strong> </strong>A retrospective exploratory case study approach was used, including individual interviews, document analysis, and incidence analysis of HAIs hospital data. The sample was frontline nurses, clinical managers, infection control professionals, and environmental service staff. Document analysis included hospital policies and protocols related to infectious diseases and HAI disease outbreaks.</p> <p><strong>Findings</strong>: The incidence rates of Methicillin-resistant s<em>taphylococcus aureus</em>, <em>Clostridium difficile</em>, and Vancomycin-resistant<em> </em>enterococci<em> </em>have decreased but remained above the provincial benchmarks. The daily work of healthcare professionals was impacted by HAI outbreaks. Nurses experienced workload challenges, time pressures, and increased documentation. Infection control professionals' responsibilities have expanded. The environmental services staffs' cleaning processes have become more intensive. In response, several unique innovations were developed by hospital staff.</p> <p><strong>Conclusion</strong>: The daily work of healthcare professionals at the study site has been affected by HAI outbreaks. Implications for future research include the need to review healthcare professionals’ workloads and evaluate contributing factors to HAI outbreaks.</p> / Master of Science in Nursing (MSN)

Ventilator-associated pneumonia (VAP) is the most common healthcare-associated infection in the intensive care unit, resulting in a high burden of illness, mortality and increased cost. The literature around the cost-effectiveness of probiotics in prevention of health-care associated infections has not been previously well-described, and a definitive health economic evaluation alongside a well-designed randomized control trial assessing probiotic prophylaxis has not been previously performed. This thesis consists of 3 separate manuscripts (with 2 published in peer-reviewed journals and 1 pending). The theme of this thesis was to: (1) describe the literature about the cost-effectiveness of probiotics in hospitalized patients in preventing healthcare-associated infections; (2) design a protocol for an economic evaluation alongside a randomized control trial (RCT) examining probiotic prophylaxis of VAP; and then (3) perform and analyze the health economic evaluation presented in the protocol. The first component of this thesis is a systematic review of probiotic prophylaxis of healthcare-associated infections in hospitalized patients. We performed an extensive search including multiple databases which found 7 studies. Probiotics demonstrated favourable cost-effectiveness in 6 of 7 (86%) economic evaluations, with 3 studies being manufacturer-supported, all suggesting cost-effectiveness. Certainty of cost-effectiveness evidence was very low due to risk of bias, imprecision and inconsistency using the GRADE approach. Hence further RCTs with economic evaluations were stated as a solution. The second component of this thesis is a study protocol for an economic evaluation alongside the Probiotics to Prevent Severe Pneumonia and Endotracheal Colonization Trial (PROSPECT), which assessed the efficacy of probiotic prophylaxis in the prevention of healthcare-associated infections (specifically VAP). The third component of this thesis is the cost-effectiveness analysis performed utilizing the individual patient data from PROSPECT to produce the economic evaluation (E-PROSPECT). As of the date of thesis submission, PROSPECT is still pending publication, and hence E-PROSPECT is also pending analysis and publication. However, I have prepared a draft manuscript (along with figures and tables) that will be produced at the conclusion of E-PROSPECT for thesis committee review. / Thesis / Master of Health Sciences (MSc) / Ventilator-associated pneumonia (VAP) is the most common healthcare-associated infection in the intensive care unit, resulting in a high burden of illness, mortality and increased cost. The literature around the cost-effectiveness of probiotics in prevention of health-care associated infections has not been previously well-described, and a definitive health economic evaluation alongside a well-designed randomized control trial assessing probiotic prophylaxis has not been previously performed. This thesis consists of 3 separate manuscripts (with 2 published in peer-reviewed journals and 1 pending). The theme of this thesis was to: (1) describe the literature about the cost-effectiveness of probiotics in hospitalized patients in preventing healthcare-associated infections; (2) design a protocol for an economic evaluation alongside a randomized control trial (RCT) examining probiotic prophylaxis of VAP; and then (3) perform and analyze the health economic evaluation presented in the protocol. The first component of this thesis is a systematic review of probiotic prophylaxis of healthcare-associated infections in hospitalized patients. We performed an extensive search including multiple databases which found 7 studies. Probiotics demonstrated favourable cost-effectiveness in 6 of 7 (86%) economic evaluations, with 3 studies being manufacturer-supported, all suggesting cost-effectiveness. Certainty of cost-effectiveness evidence was very low due to risk of bias, imprecision and inconsistency using the GRADE approach. Hence further RCTs with economic evaluations were stated as a solution. The second component of this thesis is a study protocol for an economic evaluation alongside the Probiotics to Prevent Severe Pneumonia and Endotracheal Colonization Trial (PROSPECT), which assessed the efficacy of probiotic prophylaxis in the prevention of healthcare-associated infections (specifically VAP). The third component of this thesis is the cost-effectiveness analysis performed utilizing the individual patient data from PROSPECT to produce the economic evaluation (E-PROSPECT). As of the date of thesis submission, PROSPECT is still pending publication, and hence E-PROSPECT is also pending analysis and publication. However, I have prepared a draft manuscript (along with figures and tables) that will be produced at the conclusion of E-PROSPECT for thesis committee review.

As infecções relacionadas à assistência à saúde (IRAS) são um grave problema de saúde pública cujo prognóstico tem sido desfavorecido pela emergência e endemicidade de bactérias multirresistentes (MRs). Neste cenário, seguindo uma tendência mundial, no Brasil, infecções por cepas de Acinetobacter baumannii MRs produtoras de carbapenemases do tipo OXA são atualmente consideradas uma emergência clínica e epidemiológica. Na falta de alternativas terapêuticas efetivas para infecções relacionadas, este trabalho objetivou avaliar efeitos sinérgicos (utilizando checkerboard e time-kill) decorrentes da combinação de 10 antimicrobianos de diferentes classes, contra 8 cepas MRs de A. baumannii, clonalmente não relacionadas, produtoras de carbapenemases do tipo OXA-23, OXA-72, OXA-58 e OXA-143, representativas de diferentes centros hospitalares do Brasil. Como resultado, a combinação amicacina/tigeciclina apresentou atividade sinérgica (S= &#931;CIF &#8804; 0,5) e parcialmente sinérgica (PS= &#931CIF ;0,5-0,75) contra 4 (50%) cepas produtoras de OXA-143 ou OXA-72, e 2 cepas (25%) produtoras de OXA-23, respectivamente. Por outro lado, a combinação polimixina B/imipenem apresentou atividade S e PS contra 3 (37,5%) isolados OXA-143, OXA-23 ou OXA-72 positivos, e 1 (12,5%) isolado produtor de OXA-58, respectivamente. Já, a combinação amicacina/ampicilina-sulbactam foi S contra 2 (25%) A. baumannii OXA-143 ou OXA-23 positivos, sendo PS contra dois (25%) A. baumannii OXA-58 ou OXA-143/23 positivos. De interesse, foi o efeito S da combinação polimixina B/vancomicina, contra 2 cepas (25%) produtoras de OXA-72 ou OXA-23. Por outro lado, a combinação ampicilina-sulbactam/rifampicina apresentou atividade PS contra 6 (75%) cepas produtoras das variantes OXA-23, OXA-143, OXA-72 ou OXA-58. Da mesma forma, rifampicina combinada com polimixina B foi sinérgica para uma cepa OXA-23 (12,5%) e PS para 5/8 (62,5%) cepas produtoras de OXA-72, OXA-58, OXA-23/-OXA143 ou OXA-143. O efeito sinérgico da combinação polimixina B/imipenem foi confirmado, in vivo, no modelo murino de infecção, tanto por avaliação histopatológica como por redução das UFC/g pulmão ou baço (p &#8804; 0,05). Finalmente, foi avaliada a atividade, in vitro, do lípide catiônico brometo de dioctadecildimetilamônio (DDA), individualmente e em combinação com tigeciclina. DDA possui efeito bactericida, e potencializou sinergicamente a tigeciclina contra 2 (25%) cepas OXA-143 ou OXA-23 positivas. A atividade do DDA, assim como a atividade da sua combinação com tigeciclina foram efetivas já na segunda hora de interação, como avaliado pelas curvas de morte. Em resumo, o efeito sinérgico decorrente do uso combinado de amicacina, tigeciclina, polimixina B, imipenem, rifampicina ou ampicilina/sulbactam, pode constituir uma alternativa terapêutica para o tratamento de infecções produzidas por cepas de A. baumannii MRs produtoras de oxacilinases, sendo que nanofragmentos catiônicos de bicamada do lipídeo sintético de DDA tem potencial para consolidar um produto de aplicação clínica. / Healthcare-associated infections (HAIs) are a serious public health issue, which have been related with an unfavorable prognosis due to the emergence and endemicity of multidrug-resistant (MDR) bacteria. In this scenario, following a worldwide trend, in Brazil, infections produced by MDR OXA-type carbapenemase-producing Acinetobacter baumannii are currently considered a clinical and epidemiological urgency. In the absence of effective therapeutic alternatives for related infections, this study aimed to evaluate synergistic effects (by using time-kill and checkerboard assays) achieved by the combination of 10 different classes of antimicrobial against 8 strains of MDR, clonally unrelated, A. baumannii strains producing OXA-23, OXA-72, OXA-58 and OXA-143 carbapenemases, being representatives of different medical centers in Brazil. As a result, the combination of amikacin / tigecycline showed synergistic (S = &#931;FIC &#8804; 0.5) and partially synergistic (PS = 0.5 to 0.75 &#931;FIC) activity against 4 (50%) OXA-72 or OXA-143 producing A. baumannii strains, and two strains (25%) producing OXA-23, respectively. Moreover, the combination of polymyxin B / imipenem showed S and PS activity against 3 (37.5%) OXA-143, OXA-23 and OXA-72 positive isolates, and 1 (12.5%) OXA-58 producer, respectively. On the other hand, the combination amikacin / ampicillin-sulbactam was S against 2 (25%) OXA-143 and OXA-23 positive strains, being PS against two (25%) OXA-58- and OXA-143/23-producing A. baumannii. Of interest was the synergistic effect achieved by polymyxin B plus vancomycin against two strains (25%) producing OXA-72 and OXA-23, respectively. Furthermore, the ampicilina-sulbactam / rifampicin combination displayed a PS activity against six (75%) strains producing OXA-23, OXA-143, OXA-72 or OXA-58-type enzymes. Likewise, rifampicin combined with polymyxin B was S against 1 (25%) OXA-23-positive A. baumannii being PS to 5/8 (62.5%) strains producing OXA-72, OXA-58, OXA-23/-OXA143 or OXA-143. The synergistic effect of the combination polymyxin B / imipenem was confirmed, in vivo, in the murine model of infection, by using both histopathological studies and bacterial clearance from the lungs and spleen (CFU/g, p&#8804; 0.05). Finally, we evaluated the in vitro activity of the cationic lipid dioctadecyldimethylammonium bromide (DDA), alone and in combination with tigecycline. DDA display a bactericidal effect, enhancing synergistically the activity of tigecycline against 2 (25%) OXA-143 and OXA-23 positive strains, respectively. DDA activity alone and in combination with tigecycline was effective on the second hour of interaction, as evaluated by time-kill assays. In summary, the synergistic effect resulting from the combined use of amikacin, tigecycline, polymyxin B, imipenem, rifampicin or ampicillin / sulbactam, could be an alternative therapy for the treatment of infections caused by MDR A. baumannii strains producing oxacilinases. On the other hand, cationic bilayer nanofragments of DDA has potential for consolidating a product for medical application.

Introduktion: Ett av röntgensjuksköterskans ansvarsområden är att förebygga spridning av vårdrelaterade infektioner, och inom interventionell radiologi innebär detta att arbeta med aseptisk teknik. Munskydd har varit standard inom kirurgi i ett århundrade men inom interventionell radiologi saknas nationella riktlinjer för dess användande, trots att den sterila tekniken i övrigt är densamma. Syfte: Syftet med denna litteraturöversikt var att klargöra huruvida kirurgiska munskydd kan förebygga infektion hos patienten vid interventionell radiologi. Metod: Studien genomfördes som en allmän litteraturöversikt enligt Friberg (2017) för att sammanställa kunskapsläget inom området. Tolv kvantitativa artiklar hittades genom systematisk litteratursökning i PubMed. Artiklarna kvalitetsgranskades, analyserades och resultatet presenterades i två huvudkategorier. Resultat: Munskydd har ingen påvisad effekt att förebygga postoperativa sårinfektioner vid kirurgi eller coronarangiografi men förhindrar till viss del spridning av bakterier. Slutsats: Forskningen på munskydd är begränsad vilket gör det svårt att dra några slutsatser. Fler studier som fokuserar på munskydds effektivitet inom interventionell radiologi behövs. Författarna anser att munskydd inom interventionell radiologi inte bör vara obligatoriskt utan upp till varje avdelning att från fall till fall bestämma huruvida det ska användas eller inte. / Introduction: One of the radiographer's responsibilities is to prevent the spread of healthcare-associated infections. In interventional radiology, this means working with aseptic technique. Surgical face mask protection has been the standard of surgery for a century, but in interventional radiology there are no national guidelines for its use, even though the sterile technique is the same. Aim: The aim of this study was to clarify whether surgical face masks prevent infection in patient in interventional radiology. Methodology: A literature review (Friberg, 2017) has been done to identify the current knowledge in the field. The study includes twelve quantitative articles collected through a systematic literature search in PubMed. After quality review the articles were analyzed and presented into two main categories. Result: Concerning postoperative wound infections, there is no strong evidence to prove that using surgical face masks prevents infections during surgery or coronary angiography. However, using such mask prevents the spread of bacteria to some extent. Conclusion: Research on oral protection is limited, making it difficult to draw any conclusions. A set of new tests are needed to identify the effect of using mask in today’s interventional radiology. Based on the results of the studies, it can be concluded that: generally, mouth protection within interventional radiology should not be mandatory. However, each radiology department need to consider the operating condition and status of the patient and decide if the personal should follow mouth protection process.

Healthcare-associated infections (HAIs) represent a great risk factor to patient well-being, which in turn brings a significant economic factor onto health services worldwide. Hand hygiene (HH) is considered a high impact measure with the least expense incurred when it comes to controlling infections related to health care, as it avoids the cross transmission of microorganisms. This study aimed to evaluate the effectiveness of the multimodal strategy to improve the HH from the World Health Organization (WHO) in a Brazilian University hospital. This is an ecological study, prospective, pre and post-intervention type, conducted between December 2012 and October 2013. Data were collected by direct observation and employment self-administered instrument to health professionals from seven inpatient units: Adult Intensive Care Unit (AICU), Pediatric Intensive Care Unit (PICU), Kidney Transplant Sector (SECTRAN), Internal Medicine (IM), Clinical Surgery 1 (SC1), Clinical Surgery 2 (SC2), Burn Unit (BU). HAI rates were evaluated, joining the HM and the knowledge and perception of health professionals in relation to IRAS and HM. There were 2.297 hand hygiene opportunities observed. The adherence rate was of 54.86% during the pre-intervention period and 51.02% for post-intervention (p>0.05). The authors did not find any direct relationship between the rates of adherence of hand hygiene with infections related to health care. One of the failures detected in the implementation design, was the fact that feedback of infection rates related to health care did not include that of health care professionals. It is concluded that the implementation of the multimodal strategy to improve the HM the WHO is not necessarily effective. / As infecções relacionadas à assistência à saúde (IRAS) representam um grande risco para a segurança do paciente e causam um impacto econômico significativo sobre os sistemas de saúde no mundo todo. A higienização das mãos (HM) é considerada a medida de maior impacto e menos dispendiosa para prevenir e controlar as IRAS, uma vez que evita a transmissão cruzada de microrganismos. Este estudo objetivou avaliar a efetividade da estratégia multimodal de HM da Organização Mundial de Saúde (OMS) em um hospital universitário brasileiro. Trata-se de um estudo ecológico, prospectivo, do tipo pré e pós-intervenção, realizado entre dezembro de 2012 e outubro de 2013. Os dados foram coletados por observação direta e emprego de instrumento autoaplicável aos profissionais de saúde de sete unidades de internação: Unidade de Terapia Intensiva para Adultos (UTIA), Unidade de Terapia Intensiva Pediátrica (UTIP), Setor de Transplante Renal (SETRAN), Clínica Médica (CM), Clínica Cirúrgica 1 (CC1), Clínica Cirúrgica 2 (CC2), Unidade de Queimados (UQ). Foram avaliadas as taxas de IRAS, a adesão à HM e o conhecimento e percepção dos profissionais de saúde em relação às IRAS e HM. Foram observadas 2.297 oportunidades para HM. A adesão foi de 54,86% no período pré-intervenção e de 51,02% após a intervenção (p>0,05). Não encontramos relação direta das taxas de adesão à HM com as IRAS. Uma das falhas detectáveis na forma de implantação foi a não utilização do feedback das taxas de IRAS e do teste de conhecimento para os profissionais de saúde. Conclui-se que a implantação da estratégia multimodal de melhoria da HM da Organização Mundial de Saúde não é necessariamente efetiva. / Mestre em Ciências da Saúde