La surveillance des infections acquises en réanimation (IAR) représente un outil majeur dans la stratégie de lutte contre les infections nosocomiales. Nous avons enrichi la base de données de surveillance REA-RAISIN avec des données médico-administratives du PMSI afin de disposer d’informations sur l’hospitalisation complète et d’analyser des facteurs de risques supplémentaires. L’étude descriptive détaillée des 11 années de notre cohorte a permis de montrer des variations temporelles et les groupes les plus à risque. L’estimation de l’impact de ces IAR sur la mortalité et la durée de séjour nécessite des techniques statistiques multiples afin de prendre en compte les biais dont la durée d’apparition de l’IAR et le risque compétitif. Cet impact dépend du type d’IAR. La mortalité est très impactée par les bactériémies, peu par les pneumopathies et pas par les infections urinaires. L’augmentation de la durée de séjour est la plus importante pour les pneumopathies, suivie des infections urinaires et est modérée pour les bactériémies. L’étude du portage de S. aureus méticillino-résistant est parue insuffisante pour détecter des épidémies. / Monitoring the infection acquired in intensive care units (ICU-AI) is a strategic tool for the control of hospital-associated infections. We enhanced the national surveillance database REA-RAISIN with the local diagnosis-related group database. This allows us to have data on the whole hospitalization and assess additional risk factors. The assessment of the impact of these ICU-AI on mortality and length of stay needs appropriate and multiple statistical analysis to take in account various potential bias, including time-dependent bias and competitive risk. This impact is a function of the kind of IAR. Mortality is most affected by bacteremia, more lightly by pneumonia and stay equivalent for patients with or without urinary tract infections. On the other hand, excess of length of stay was the most important for patients with pneumonia and urinary tract infections but moderate for those with bacteremia.Finally, studying the carriage of methicillin-resistant S. aureus appeared insufficient to detect outbreaks and does not measure the risk associated with SASM carriage.

Skin related injuries are some of the most dangerous forms of wounds. In addition to treating the wound itself, health care providers must be cautious of microbial infections. In this study, we evaluate a novel all-natural antimicrobial gel compound (AMG) designed to kill planktonic bacteria, penetrate bacterial biofilms, and accelerate wound healing. In -vitro experiments demonstrate that AMG is effective in inhibiting planktonic growth and biofilm development of eight common pathogens. LIVE/DEAD staining and confocal microscopy reveal that planktonic growth and three-dimensional structure of biofilms were significantly reduced. Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) was used to investigate a small panel of genes (PrsA, Sprx) and showed potential targets for future study. A physiologically relevant wound model was created for treating S. aureus infections by using AMG alone or in combination with a common topical antibiotic, Mupirocin. AMG is a safe and effective treatment option for skin related infection.

En dépit de nombreux essais thérapeutiques, les syndromes septiques sont la première cause de mortalité en service de soins intensifs. La population septique étant très hétérogène, une meilleure caractérisation des patients serait essentielle afin de mieux individualiser et cibler les thérapeutiques potentiellement bénéfiques. Une approche multiparamétrique de l’utilisation des biomarqueurs est une alternative qui viserait à appréhender la situation de manière plus globale. Notre travail s’inscrit dans ce contexte au travers de l’étude plus spécifique de la défaillance des systèmes cardio-vasculaire et immunitaire. Au-delà de la confirmation de l’intérêt des biomarqueurs présentement étudiés (prohormones cardio-vasculaires et PD-1) dans la prédiction de la mortalité et du risque d’infections nosocomiales, nos résultats apportent des éléments nouveaux. Nous avons montré que (1) la sur-expression des molécules PD-1 est associée à l’énergie leucocytaire, (2) un même biomarqueur peut apporter une information différente au cours du temps, (3) l’information apportée par l’analyse simultanée de deux biomarqueurs est supérieure à celle de la somme de leurs valeurs individuelles, et (4) l’expression dynamique d’un biomarqueur est meilleure que son expression à un temps donné. Au total, notre travail illustre l’intérêt potentiel d’un panel de biomarqueurs pour mieux appréhender la complexité des états septiques et leur rapide évolution. Il reste néanmoins à développer des outils biostatistiques capables de donner au clinicien une vision globale en temps réel des processus en cours. Cela constituera une étape clé pour mieux stratifier et cibler les prochains essais cliniques dans le domaine. / Septic syndromes remain the leading cause of death in the intensive care units despite numerous clinical trials. Septic patients constitute a very heterogeneous population. Therefore improved characterisation of patients in order to better target and personalize potential new therapeutics is highly desirable. A multiparametric biomarker-based approach could be an attractive alternative to obtain a global view of the pathophysiologic situation. In this context, we worked specifically on cardio-vascular and immune dysfunctions. We first confirmed the predictive value of biomarkers for mortality or nosocomial infections, and showed new elements. We observed that (1) PD-1 overexpression is associated with leukocyte anergy, (2) one biomarker could give different information over time, (3) information provided by the association of two biomarkers is more interesting than the addition of their individual values, and (4) dynamic expression of one biomarker is more informative than its expression at a given time point. Finally, our results illustrate the potential interest of biomarker panels to improve our understanding of the septic syndrome complexity and to reflect their rapid evolution. Consequently, next step will depend on our capacity to develop biostatistic tools that enable clinicians to get, in real time, a global view of the process over time. This key step is likely necessary to decrease the heterogeneity of septic patient population in order to better stratify and target next clinical trials in the field.

Os materiais de uso único (MUU) são utilizados há décadas na assistência à saúde. Inicialmente produzidos com a finalidade de prontamente disponibilizar os materiais para uso na assistência a saúde e ao mesmo tempo diminuir a sobrecarga com o trabalho inerente ao reprocessamento dos materiais. Com o passar do tempo, principalmente por questões financeiras, estes passaram a ser reutilizados. A partir de então diversos questionamentos têm sido suscitados a respeito do risco de transmissão de infecção pelo reuso destes artigos em decorrência da dificuldade para de limpeza, desinfecção e esterilização seguras destes. Os materiais utilizados para as cirurgias vídeo-laparoscópicas encontram-se entre os MUU de preço considerável e complexidade importante em relação às dificuldades para limpeza, devido à sua conformação com espaços internos inacessíveis e impossibilidade de desmonte. Isto posto, as pinças grasper, dissector, tesoura, agulha de Veress, sistema de sonda de eletrocirurgia (ou aspirador e irrigador) e sua respectiva haste, instrumentais básicos nos procedimentos de vídeo-cirurgia-laparoscópica, foram o objeto desta investigação com o propósito de avaliar a eficácia da esterilidade destes acessórios de uso único após contaminação artificial desafio e comparar os resultados dos testes de esterilidade dos MUU com os dos materiais equivalentes reprocessáveis – denominados neste estudo como grupo controle. Tratou-se de uma pesquisa experimental, laboratorial e comparativa. O inóculo utilizado para a contaminação artificial dos instrumentais de uso único constituiu-se de suspensão de esporos bacterianos do Bacillus atrophaeus var. niger e de sangue de carneiro desfibrinado esterilizado. Para o grupo controle o microrganismo eleito foi o Geobacillus stearothermophilus acrescido também de sangue de carneiro desfibrinado. Antes de proceder aos experimentos validou-se a metodologia analítica em duas fases: fase 1 - realizada a contagem de U.F.C. em três unidades de cada um dos materiais dos grupos experimental e controle após a contaminação artificial antecedendo a limpeza; fase 2 - realizada a contagem de U.F.C. em três unidades de cada um dos materiais dos grupos experimental e controle após a contaminação artificial e procedimento de limpeza. Desta forma, assegurada a recuperação dos contaminantes em todas as amostras da primeira fase e a diminuição do bioburden inicial após a limpeza dos instrumentais na 2ª fase, deu-se prosseguimento aos experimentos. Os materiais laparoscópicos foram intencionalmente contaminados com o inóculo desafio e submetidos após ao protocolo teste para validação que consistiu da seguinte seqüência: limpeza automatizada em lavadora ultra-sônica com retrofluxo com auxílio do detergente enzimático, limpeza manual complementar com serpilhos e irrigação dos lumens dos instrumentais com água sob pressão. Por fim, foi realizado o enxágüe com água destilada esterilizada, secagem com ar comprimido medicinal, acondicionamento em embalagem de papel grau cirúrgico e filme e submetidos a esterilização em Óxido de Etileno 12/88 (materiais de uso único) e em autoclave (materiais de aço inoxidável). Os materiais esterilizados foram inoculados diretamente nos meios de cultura de caseína soja e incubados por 20 dias quando foi feita a leitura final dos resultados das culturas. Os resultados encontrados foram 100% negativos para a recuperação dos microrganismos contaminantes nos 2 grupos - experimental e controle. Estes achados permitiram concluir que o reprocessamento dos materiais de uso único foi validado em relação à esterilidade permitindo chegar a um protocolo de reprocessamento / Single use devices (SUD) have been used in healthcare for decades. They were initially produced for making them readily available for use in healthcare and at the same time lower the inherent workload for device reprocessing. After time, mainly for financial reasons, they became reused. Since then, several questioning has been raised regarding to the risk of infection transmission by reusing these devices due to their difficulty of safe cleaning, disinfection and sterilization. Devices used for videosurgeries are among the SUD of considerable price and important complexity due to cleaning difficulties, because of their adjustments in inaccessible inner spaces and impossibility of taking them out into pieces. Thus, grasper calipers, dissecting forceps, scissors, Veress insuflation needle, electrosurgery probe system (or suction and irrigation tubes) and its respective dissector cannula, basic devices in videosurgery laparoscopic procedures were all the subject of investigation aimed to evaluate the effectiveness of sterility of these single use products after challenged artificial contamination and comparing the results of sterility tests of SUD to their equivalent reprocessed devices – named in this study as control group. It’s a comparative, laboratory experimental research. The inoculum used for artificial contamination of single use devices was the suspension of Bacillus atrophaeus var. niger bacteria spores and sterilized defibrinated sheep blood. For the control group, the elected strain was Geobacillus stearothermophilus adding also the defibrinated sheep blood. Before carrying out the experiments, the analytical methodology was validated in two phases: phase 1 – counting the colony formation units in three units of each one of the devices from the experimental and control groups after the artificial contamination and cleaning procedures. This way, assured the contaminant recovery in all samples of the 1st phase and the reduction of initial bioburden after device cleaning in the 2nd phase, it was carried on the experiments. The laparoscopic devices were intentionally contaminated with challenged inoculum and submitted after the trial test to validation that was consisted of the following sequence: cleaning in automated narrow-lumen cleaner with enzymatic detergent, complementary manual cleaning with brush and lumen washing of devices with water under pressure. At last, it was made rinsing with sterile distillated water, drying with medical compressed air, packing in surgical paper and film wrapping and submitted to sterilization in ethylene oxide 12/88 (single use devices) and in autoclave (stainless steel devices). The sterilized devices were contaminated directly in the casein soy media and incubated for 20 days when it was made the final reading of media results. The outcomes found were 100% negative for recovering of contamination strains in the 2 groups – the experimental and the control. These findings permitted us to conclude that single use device reprocessing was validated regarding to sterility allowing us to get a reprocessing guideline

La résistance bactérienne aux antibiotiques dans les établissements de santé complique la prise en charge thérapeutique et entraîne une surmortalité des patients infectés. L'objectif de ce travail était d'évaluer différentes approches ayant pour finalité la prévention et la maîtrise des infections nosocomiales. Ce travail s'articule autour de trois questions : (i) Existe-t-il une stratégie de promotion d'un juste usage des antibiotiques à privilégier ? (ii) Comment évaluer la performance en matière d'hygiène des mains ? (iii) Quelles mesures pouvons-nous proposer pour limiter la diffusion de P. aeruginosa ?Nous avons d'abord montré que la diffusion de recommandations sous la forme de guides régionaux ou de messages de pharmacovigilance était suivie d'une modification des prescriptions antibiotiques conformes aux recommandations.Ensuite, nous avons évalué le niveau de performance des établissements de santé en matière d'hygiène des mains en étudiant plus particulièrement l'indicateur de consommation de solution hydro-alcoolique (ICSHA). Nous avons ainsi pu montrer que le nombre minimal d'opportunité d'hygiène des mains servant à son calcul, était sous-estime. Dans une autre étude, nous avons été confrontés aux limites liées à sa construction, ces dernières étant en partie responsable de l'absence de relation observée entre cet indicateur et la prévalence des infections associées aux dispositifs invasifs.Enfin, nous avons montré que la charge en soins et la contamination des réseaux d'eau propre des établissements de santé étaient des facteurs de risque contextuels d'acquisition du bacille pyocyanique. Un autre travail a mis en évidence que les réseaux d'eau usée étaient impliqués dans la diffusion extra-hospitalière de souches résistantes. Une étude est actuellement en cours pour évaluer l'intérêt d'une approche globale associant dépistage et précautions complémentaires chez les patients porteurs de P. aeruginosa.En conclusion, si ce travail confirme l'efficacité de certaines actions de prévention tout en mettant en avant les limites d'autres approches, il ne permet pas de privilégier une stratégie particulière. Il apparaît ainsi nécessaire de mettre en place des stratégies globales et transversales allant au-delà des seuls établissements de santé / Bacterial resistance to antibiotics in health care facilities complicates the therapeutic burden and increased mortality of infected patients. The objective of this work was to evaluate different approaches which aim was to prevent and control hospital-acquired infections. This work focuses on three issues: (i) Is there a strategy already in place to promote the appropriate use of antibiotics? (ii) How can we evaluate performance in terms of hand hygiene? (iii) What measures can we implement to limit the spread of P. aeruginosa?We first showed that the distributions of regional guidelines or drug monitoring alerts were followed by a change in the uptake of antibiotic prescriptions in line with such recommandations.Then we evaluated the performance of health care facilities for hand hygiene, focusing especially on the index of consumption of alcohol-base hand-rub solution. We showed that the number of alcohol-based hand-rub is far higher than that defined by the French Ministry of Health. In another study, we were faced with limitations in its construction, the latter being partly responsible for the lack of a relationship between this indicator and the prevalence of invasive devices associated with infections.Finally, we have shown that the burden of care and the contamination of clean water networks of health facilities were contextual risk factors for acquisition of Pseudomonas aeruginosa. Another study showed that wastewater networks were involved in extra-hospital spread of resistant strains. A study is currently underway to assess the value of a global approach combining screening and additional precautions in patients with P. aeruginosa.In conclusion, this study confirms the effectiveness of some preventive measures while underlining the limitations of other approaches. However it does not promote a particular strategy. Because in terms of BMR, it is necessary to define global and cross-sectorial strategies which go beyond the health care facilities

Os materiais de uso único (MUU) são utilizados há décadas na assistência à saúde. Inicialmente produzidos com a finalidade de prontamente disponibilizar os materiais para uso na assistência a saúde e ao mesmo tempo diminuir a sobrecarga com o trabalho inerente ao reprocessamento dos materiais. Com o passar do tempo, principalmente por questões financeiras, estes passaram a ser reutilizados. A partir de então diversos questionamentos têm sido suscitados a respeito do risco de transmissão de infecção pelo reuso destes artigos em decorrência da dificuldade para de limpeza, desinfecção e esterilização seguras destes. Os materiais utilizados para as cirurgias vídeo-laparoscópicas encontram-se entre os MUU de preço considerável e complexidade importante em relação às dificuldades para limpeza, devido à sua conformação com espaços internos inacessíveis e impossibilidade de desmonte. Isto posto, as pinças grasper, dissector, tesoura, agulha de Veress, sistema de sonda de eletrocirurgia (ou aspirador e irrigador) e sua respectiva haste, instrumentais básicos nos procedimentos de vídeo-cirurgia-laparoscópica, foram o objeto desta investigação com o propósito de avaliar a eficácia da esterilidade destes acessórios de uso único após contaminação artificial desafio e comparar os resultados dos testes de esterilidade dos MUU com os dos materiais equivalentes reprocessáveis – denominados neste estudo como grupo controle. Tratou-se de uma pesquisa experimental, laboratorial e comparativa. O inóculo utilizado para a contaminação artificial dos instrumentais de uso único constituiu-se de suspensão de esporos bacterianos do Bacillus atrophaeus var. niger e de sangue de carneiro desfibrinado esterilizado. Para o grupo controle o microrganismo eleito foi o Geobacillus stearothermophilus acrescido também de sangue de carneiro desfibrinado. Antes de proceder aos experimentos validou-se a metodologia analítica em duas fases: fase 1 - realizada a contagem de U.F.C. em três unidades de cada um dos materiais dos grupos experimental e controle após a contaminação artificial antecedendo a limpeza; fase 2 - realizada a contagem de U.F.C. em três unidades de cada um dos materiais dos grupos experimental e controle após a contaminação artificial e procedimento de limpeza. Desta forma, assegurada a recuperação dos contaminantes em todas as amostras da primeira fase e a diminuição do bioburden inicial após a limpeza dos instrumentais na 2ª fase, deu-se prosseguimento aos experimentos. Os materiais laparoscópicos foram intencionalmente contaminados com o inóculo desafio e submetidos após ao protocolo teste para validação que consistiu da seguinte seqüência: limpeza automatizada em lavadora ultra-sônica com retrofluxo com auxílio do detergente enzimático, limpeza manual complementar com serpilhos e irrigação dos lumens dos instrumentais com água sob pressão. Por fim, foi realizado o enxágüe com água destilada esterilizada, secagem com ar comprimido medicinal, acondicionamento em embalagem de papel grau cirúrgico e filme e submetidos a esterilização em Óxido de Etileno 12/88 (materiais de uso único) e em autoclave (materiais de aço inoxidável). Os materiais esterilizados foram inoculados diretamente nos meios de cultura de caseína soja e incubados por 20 dias quando foi feita a leitura final dos resultados das culturas. Os resultados encontrados foram 100% negativos para a recuperação dos microrganismos contaminantes nos 2 grupos - experimental e controle. Estes achados permitiram concluir que o reprocessamento dos materiais de uso único foi validado em relação à esterilidade permitindo chegar a um protocolo de reprocessamento / Single use devices (SUD) have been used in healthcare for decades. They were initially produced for making them readily available for use in healthcare and at the same time lower the inherent workload for device reprocessing. After time, mainly for financial reasons, they became reused. Since then, several questioning has been raised regarding to the risk of infection transmission by reusing these devices due to their difficulty of safe cleaning, disinfection and sterilization. Devices used for videosurgeries are among the SUD of considerable price and important complexity due to cleaning difficulties, because of their adjustments in inaccessible inner spaces and impossibility of taking them out into pieces. Thus, grasper calipers, dissecting forceps, scissors, Veress insuflation needle, electrosurgery probe system (or suction and irrigation tubes) and its respective dissector cannula, basic devices in videosurgery laparoscopic procedures were all the subject of investigation aimed to evaluate the effectiveness of sterility of these single use products after challenged artificial contamination and comparing the results of sterility tests of SUD to their equivalent reprocessed devices – named in this study as control group. It’s a comparative, laboratory experimental research. The inoculum used for artificial contamination of single use devices was the suspension of Bacillus atrophaeus var. niger bacteria spores and sterilized defibrinated sheep blood. For the control group, the elected strain was Geobacillus stearothermophilus adding also the defibrinated sheep blood. Before carrying out the experiments, the analytical methodology was validated in two phases: phase 1 – counting the colony formation units in three units of each one of the devices from the experimental and control groups after the artificial contamination and cleaning procedures. This way, assured the contaminant recovery in all samples of the 1st phase and the reduction of initial bioburden after device cleaning in the 2nd phase, it was carried on the experiments. The laparoscopic devices were intentionally contaminated with challenged inoculum and submitted after the trial test to validation that was consisted of the following sequence: cleaning in automated narrow-lumen cleaner with enzymatic detergent, complementary manual cleaning with brush and lumen washing of devices with water under pressure. At last, it was made rinsing with sterile distillated water, drying with medical compressed air, packing in surgical paper and film wrapping and submitted to sterilization in ethylene oxide 12/88 (single use devices) and in autoclave (stainless steel devices). The sterilized devices were contaminated directly in the casein soy media and incubated for 20 days when it was made the final reading of media results. The outcomes found were 100% negative for recovering of contamination strains in the 2 groups – the experimental and the control. These findings permitted us to conclude that single use device reprocessing was validated regarding to sterility allowing us to get a reprocessing guideline

CoordenaÃÃo de AperfeiÃoamento de NÃvel Superior / A sepse neonatal à atualmente a infecÃÃo mais freqÃente e importante causa de Ãbito de RN internados nas UTIN de paÃses desenvolvidos. Para conhecer a dimensÃo desse problema em um Hospital UniversitÃrio de atendimento terciÃrio localizado no Nordeste do Brasil, foi realizado um estudo de coorte retrospectivo de todos as crianÃas que nasceram e foram admitidas na UTIN no perÃodo de outubro de 1997 a abril de 1998. Uma coorte de 422 pares de recÃm-nascidos e suas respectivas mÃes foi formada; os RN foram seguidos do nascimento à alta ou Ãbito na UTIN ou atà a idade de 28 dias enquanto internados na UTIN. Ao todo, cerca de 34 variÃveis maternas, do neonato e procedimentos hospitalares foram pesquisadas em cada membro da coorte. Os testes estatÃsticos utilizados foram: Teste do Qui-quadrado e o Teste exato de FISCHER, cÃlculo do risco relativo com os respectivos intervalos de confianÃa. Em seguida procedeu-se a anÃlise multivariada com transformaÃÃo para logÃstica dos fatores mais significativos (p<0,05). Ao final, cinco fatores foram selecionados como preditores independentes da sepse neonatal: cateterizaÃÃo venosa central (OR=8,7, IC95%=2,3 a 32,6), faixa ponderal 1000 a 1499g (OR=4,8, IC95%=2,3 a 9,9), transfusÃo de hemoderivados (OR=3,6, IC95%=1,8 a 7,4), gravidez Ãnica (OR=2,3, IC95%=1,0 a 5,4) e faixa ponderal 1500 a 2499g (OR=2,3, IC95%=1,3 a 4,0). A incidÃncia de sepse na coorte foi de 40,4 para cada 100 RN admitidos (167/413). As bactÃrias mais prevalentes dos casos confirmados foram os bacilos gram-negativos; 67% dos episÃdios surgiram nos seis primeiros dias de vida. A internaÃÃo dos RN com sepse foi 4,3 vezes superior a internaÃÃo dos RN nÃo acometidos. A mortalidade global na UTIN foi de 25,59 para cada 100 RN admitidos, enquanto a letalidade pelo desfecho foi de 41,31%, com risco relativo de morte por sepse de 2,8. Este estudo poderà ser Ãtil para futuras estratÃgias com vistas a diminuir a morbimortalidade por sepse neonatal. / OBJECTIVE: Neonatal sepsis is currently the most frequent infection and an important cause of death among the newborns admitted at NICU. In order to evaluate the extension of this problem in a tertiary care University Hospital of Northeastern Brazil, a retrospective cohort survey was carried out on all inborn and admitted infants at the Assis Chateaubriand NICU from October 1997 to April 1998. METHOD: the survey design was a retrospective cohort carried out on all inborn infants admitted at the Neonatal Intensive Care Unit during seven consecutive months; 422 newborns were enrolled in the study and each one was followed up from birth to discharge from NCIU or death at the NICU. To compare the levels of the risk factors, two groups were formed: one by the all subjects who developed the outcome and another by all those who did not to. Each member of the cohort was investigated for 34 potential predictors variables concerning mothers factors, neonates factors and hospital procedures. In case of presence of sepsis, the variables were measured just up to the outcome. Standard National Nosocomial Infection Surveillance (NNIS-CDC) definitions of sepsis were used. Chi Square and Fischerâs exact tests were applied for comparison of frequencies; relative risk (RR) with their respective confidence interval of 95% (CI95%) was calculated. Subsequently, a multivariate analysis was done using logistic regression of most significant factors (OR). The level of statistical significance considered was p=0,05. RESULTS: The cohort sepsis incidence was 40,4 for each hundred of newborn admitted at NICU. The bacterias more prevalent of the confirmed cases were the gram-negative bacilli. Most sepsis episodes appeared in the first six days of life (67%). The time of NICU hospitalization of the sick newborn was 4,3 times longer compared to that non-sick newborn. Five factors were selected as independent predictors for neonatal sepsis: central venous catheter (OR=8,7, CI95%=2,31 to 32,69, p=0,001), birth weight of 1000-1499g (OR=4,8, CI95%=2,39 to 9,97, p=0,000), blood transfusions (OR=3,6, CI95%=1,81 to 7,45, p=0,003), singular gestation (OR=2,3, CI95%=1,04 to 5,44, p=0,04) and birth weight of 1500<2500g (OR=2,3, CI95%=1,34 to 4,04, p=0,002). Global mortality reached 25,59% of the cohort. Mortality associated to sepsis was 41,31% with Relative Risk for death = 2,8. CONCLUSION: neonatal sepsis incidence and mortality rates found are higher than in developed countries rates. Birth weight under 2500g, singular gestation, central venous catheter and blood transfusions proved be independent predictors related to neonatal sepsis. This study may contribute for the future strategies for reduction of neonatal sepsis rates and its sequels in our hospital.

Made available in DSpace on 2014-07-29T15:04:40Z (GMT). No. of bitstreams: 1 Dulcelene Melo.pdf: 680160 bytes, checksum: 55d8a4c2a66fae3c908abe807d75735e (MD5) Previous issue date: 2005-03-31 / This was a qualitative study done in a big-sized general public hospital in the city of Goiânia Goiás The aims was to analyze nurses´ adherence to standard precautions according to Rosenstock´s health belief model (HBM) (1974) Data were collected using a semi-structured interview guide based on principles of Critical Incidence Technique (CIT) The instrument was validated by judges and was then pre-tested The ethical-legal research principles were observed Among 90 nurses selected to participate in the study 82 agreed to take part in this study Inclusion criteria were nurses who were either in direct contact with patients or in supervisory positions in the hospital cleaning, laundry or sterilization services Data were analyzed in accordance with CIT The analysis categories were constructed using the dimensions of the HBM A total of 139 critical incidents were identified of which 66 were considered positive and 73 negative HBM dimensions were identified within 131 situations: 74 (56,5%) related to perceived susceptibility; 17 (13,0%) to perceived benefits and 40 (30,5%) to perceived barriers The majority of the reported critical incidents related to situations of occupational exposure to biological materials Among the Standard Precautions (SP) use of protective barriers was most frequently utilized Denial of susceptibility was indicated by the lack of use of protective barriers improper management of sharp objects and non-adherence to SP related to patients with multi-resistant pathogens Moderate perceived susceptibility was associated with partial adherence to SP in cases of patients requiring more complex levels of care; in situations following occupational exposure; and when patients needs took priority over personal protection High perceived susceptibility was observed in situations of caring for patients suspected or diagnosed with infections due to pathogens of epidemiological importance and those related to nurses responsibility Perceived seriousness was evident in behaviors and consequences related to critical incidences after occupational exposure in moments when nurses expressed feelings experienced psychosomatic symptoms and were diagnosed with an infection. Perceived benefits emerged above all from positive critical incidente with focus on protective barriers understood as protection strategies which lead to safety while procedures are executed Perceived barriers were: lack of personnel preparation lack of material resources insufficient personnel improper physical structure patient emergencies psychosocial factors lack of personnel policies for cases of exposure to biological material These barriers contribute to lower adherence of SP but they could be addressed by the Health Care Facilities since nurses have demonstrated adequate perception of susceptibility and benefits HBM dimensions were associated with nurses adherence to SP suggesting that plans should be developed to improve the nurses actions and decision-making in day-to-day nursing cars prioritizing the safety of those individuals involved in this process / Estudo qualitativo desenvolvido em um hospital público geral de grande porte de Goiânia-Go Teve como objetivo analisar a adesão dos enfermeiros às precauções padrão (PP) à luz do modelo de crenças em saúde (MCS) de Rosenstock (1974) Os dados foram coletados por meio de entrevista com roteiro semi-estruturado e conforme preconizado pela técnica de incidentes críticos (TIC) O instrumento foi validado por juizes seguido do pré-teste Foram observados os aspectos ético-legais da pesquisa Fizeram parte do estudo 82 enfermeiros dos 90 eleitos que estavam em atividade assistencial direta ao paciente ou atuavam nos setores: de higienização hospitalar reprocessamento de roupas e materiais odonto-médico-hospitalares Procedemos a análise de conteúdo dos dados conforme a TIC As dimensões do MCS foram utilizadas como categorias prévias de análise Obtivemos 139 incidentes críticos sendo que 66 foram positivos e 73 negativos de acordo com a polaridade referida Destes 131 situações remetiam às dimensões do modelo de crenças em saúde: 74 (56,5%) eram relacionadas à suscetibilidade percebida; 17 (13,0%) aos benefícios percebidos e 40 (30,5%) às barreiras percebidas Os incidentes críticos relatados predominantemente relacionavam-se às situações de exposição ocupacional a material biológico O uso de barreiras protetoras foi a PP que obteve maior freqüência de indicação A negação da suscetibilidade foi observada pelo não uso das barreiras protetoras no manuseio inadequado de perfurocortante e não adesão às PP relacionadas ao paciente portador de patógeno multi-resistente A moderada suscetibilidade percebida associou-se à adesão parcial às PP no atendimento a pacientes com maior complexidade nos cuidados assistenciais Estes comportamentos adotados sinalizam limitada percepção da necessidade de intervenção nos cuidados pós-exposição ocupacional priorizando o atendimento às necessidades dos pacientes A alta suscetibilidade percebida foi observada nas situações de atendimento ao paciente sob suspeita ou com diagnóstico de infecção por patógenos de importância epidemiológica e àquelas relacionadas à responsabilidade do enfermeiro nesta particularidade da assistência A severidade percebida foi evidenciada somente nos comportamentos e conseqüências dos incidentes críticos relatados nos momentos de pós-exposição ocupacional expressa em sentimentos alterações psicossomáticas e experiência de infecção Os benefícios percebidos emergiram sobretudo dos incidentes críticos positivos com enfoque no uso das barreiras protetoras que foram compreendidas como estratégia de proteção ratificando a segurança na execução dos procedimentos As barreiras percebidas foram: falta de preparo do profissional falta de material de consumo e permanente número insuficiente de profissionais estrutura física inadequada atendimento a pacientes em situações de urgência/emergência fatores psicossociais e falta de fluxo para o atendimento ao profissional em situação de pós-exposição a material biológico; que poderiam ser minimizadas com a organização do Serviço de Assistência à Saúde pois se constituíram em impedimentos para a adesão às precauções padrão embora os enfermeiros apresentassem adequada percepção da suscetibilidade e benefícios Verificamos que as dimensões do modelo de crenças em saúde elucidaram a adesão dos enfermeiros às PP sugerindo que empreendimentos devam ser feitos para melhor instrumentalizá-los para a tomada e modalidade de ação no cotidiano da assistência que priorize a segurança dos sujeitos envolvidos nesse processo

Made available in DSpace on 2014-07-29T15:30:34Z (GMT). No. of bitstreams: 1 Dissertacao Diana Christina P S Goncalves.pdf: 438422 bytes, checksum: 43edf5906fb5547aa85bb981cb94aaf2 (MD5) Previous issue date: 2009-02-18 / P. aeruginosa is frequently isolated in hospitals and the clinical importance has been increased due to gravity of infections. The metallo-beta-lactamase (MBL) production is an emergent mechanism of resistance in P. aeruginosa. The study aimed to determine the antimicrobial susceptibility profile of P. aeruginosa isolated of patients admitted in a hospital in Goiânia, to verify the MBL production by diffusion test and detect MBL genes by PCR technique. A total of 75 samples were evaluated, isolated of various clinical samples, in the period of January/2005 to January/2007. The biochemical identification was performed by automation technique system (API 20E ®) and antimicrobial susceptibility profile by Kirby- Bauer method. The 75 P. aeruginosa presented multi-drug resistance and, the resistance profile was: 90.7% to ceftazidime: 30.7% to aztreonam, 97.3% to ciprofloxacin; 48.0% of resistance to piperacilin/tazobactam, 88.0% to cefepime; amicacin, gentamicin and tobramicina whit resistance profile of 78.7%, 84.0% and 77.4%, respectively. The MBL production by difusion disc method was 46.7% (35/75). The gene blaSPM-1 was detected in 39 (52.0%) and gene blaIMP-1 in three (4.0%) isolates. The high frequency of P. aeruginosa resistant and MBL production alert to necessity of control the dissemination of bacteria multi-drug resistant in hospital, as well as the adoption of preventive actions and explanation of the health workers about rational use of antibiotics. / P. aeruginosa é frequentemente isolada em ambientes hospitalares e sua importância clínica têm aumentado devido à gravidade das infecções. A produção de metalo-beta-lactamase (MBL) é um mecanismo de resistência emergente entre P. aeruginosa. O estudo teve como objetivo determinar o perfil de suscetibilidade antimicrobiana de P. aeruginosa isoladas de pacientes internados em um hospital de Goiânia, realizar a triagem fenotípica para verificar a produção de MBL e detectar genes que codificam MBL pela técnica de PCR. Foram avaliadas 75 amostras, isoladas de diversos sítios, no período de janeiro de 2005 a janeiro de 2007. A identificação bioquímica foi realizada pelo sistema API 20E e o antibiograma pelo método de Kirby-Bauer. Todos os 75 isolados de P. aeruginosa apresentaram multirresistência, 82,7% foram resistentes ao imipenem; ceftazidima 90,7%; aztreonam 30,7%; ciprofloxacina 97,3%; 48,0% de resistência a piperacilina/tazobactam, 88,0% ao cefepime; amicacina, gentamicina e tobramicina, com resistência de 78,7%, 84,0% e 77,4%, respectivamente. A produção de MBL pelo método de disco aproximação foi detectada em 46,7% (35/75). O gene blaSPM-1 foi detectado em 39 (52,0%) e o blaIMP-1 em três (4,0%) amostras através da técnica de PCR. A frequência elevada de P. aeruginosa multirresistentes e produtoras de MBL alerta para necessidade de controle da disseminação de resistência no ambiente hospitalar, bem como a adoção de medidas preventivas e esclarecimento das equipes de saúde sobre uso racional dos antimicrobianos.

Introdução - A crescente resistência antimicrobiana em bactérias responsáveis por infecções hospitalares é um grande desafio à Saúde Pública. as B-lactamases de espectro estendido (ESBL), que hidrolisam a maioria dos compostos B-lactâmicos, são reconhecidas mundialmente como um grande problema para pacientes hospitalizados, devido à localização de seus genes em elementos transferíveis, facilitando sua disseminação. Objetivo - Caracterizar geneticamente cepas de Enterobactérias produtoras de ESBL isoladas de pacientes de um hospital público da cidade de São Paulo. Material e métodos - Todas as cepas de enterobactérias produtoras de ESBL isoladas em um ano foram submetidas a análises moleculares pela PCR, com iniciadores específicos para oito genes bla, e as cepas de Klebsiella pneumoniae ESBL positivas (ESBL-Kp) identificadas nesse período foram comparadas pela técnica de PFGE.Resultados - Os genes, bla(tem), bla(shv), bla(ctx-m), bla(per-2) bla(veb) and bla(ges) foram identificados em 9 espécies: Klebsiella pneumoniae (71,5 por cento), Escherichia coli (13,5 por cento), Morganella morganii (6 por cento), Proteus mirabilis (3 por cento), Klebsiella oxytoca (1,5 por cento), Providencia rettgeri (1,5 por cento), Providencia stuartii (1,5 por cento), Enterobacter aerogenes (0,75 por cento). Os genes bla(per-1) e bla(oxa) não foram detectados. O PFGE revelou 8 perfis moleculares principais em 68,4 por cento das ESBL-Kp, e 31,6 por cento das cepas não estavam relacionadas. Conclusões - Os resultados de PCR revelaram uma grande variedade de grupos de ESBL, e aparentemente este é o primeiro relato de grupos GES e VEB em enterobactérias no Brasil. / Introduction - The increasing antimicrobial resistance in pathogenic bacteria causing nosocomial infections is a major public health challenge. The extended-spectrum &#946;-lactamases (ESBL), which hydrolyze most of &#946;-lactams, are recognized worldwide as a great problem to hospitalized patients, due to the transferable location of their genes, which facilitates their spreading. Objective - Genetically characterize ESBL-producing Enterobacteriaceae strains isolated from patients of a Public Hospital in the city of São Paulo. Material and Methods - All Enterobacteriaceae ESBL-producing strains isolated in an 1-year period were submitted to molecular analysis by PCR with specific primers for eight bla genes, and all ESBL Klebsiella pneumoniae (ESBL-Kp) identified in this period were compared by the PFGE technique. Results - Genes blaTEM, blaSHV, blaCTX-M, blaPER-2, blaVEB and blaGES were identified in 9 species: Klebsiella pneumoniae (71,5%), Escherichia coli (13,5%), Morganella morganii (6%), Proteus mirabilis (3%), Klebsiella oxytoca (1,5%), Providencia rettgeri (1,5%), Providencia stuartii (1,5%), Enterobacter aerogenes (0,75%) and Enterobacter cloacae (0,75%). Genes blaPER-1 and blaOXA were not detected in any strain. PFGE revealed 8 distinct main molecular patterns in 68,4% of ESBL-Kp, and 31,6% of the strains were totally unrelated. Conclusions - PCR results showed a great variety of ESBL groups in the institution, and apparently this is the first report of GES- and VEB-ESBL groups in enterobacteria in Brazil. The results suggest the spread of resistance genes in different strains of ESBL-Kp in some hospital wards, and also that some strongly related clones of these bacteria colonized patients from a neonatal ward in a 3-month period.