<p dir="ltr">Healthcare-acquired infections (HAIs) cause a burden in acute care hospitals in the United States. HAIs are caused by <i>Staphylococcus aureus</i>, along with other pathogens found on high-touch and non-high-touch surfaces in hospital environments (e.g., bed rails, blood pressure cuffs, countertops, and floors). To minimize the growth and cross-contamination of pathogens, it is vital to use disinfectants for surface decontamination. In this work, the impact of different application methods and disinfectant active agents was evaluated for use on different healthcare-related surfaces. The first study examined the cross-contamination potential of an auto-scrubber when used to clean and disinfect a 2m² vinyl floor contaminated with <i>S. aureus</i>. Five EPA-registered disinfectants and a cleaner were used with three application methods. Hydrogen peroxide and quaternary ammonium compounds-based disinfectants significantly resulted in less cross-contamination compared to the cleaner. However, there were no significant differences among the application methods used. In the second study, manual floor cleaning and disinfecting on a two-square-meter vinyl floor with three different moping materials were evaluated to assess their ability to prevent cross-contamination. Evidence showed that there were significant differences among the products used, with Hydrogen peroxide and quaternary ammonium compound products being the most effective. The cleaner caused the most cross-contamination, while cotton mops resulted in significant cross-contamination among materials used. Study three investigated the differences among four application methods used with three different wiping cloths (Cotton, microfiber, and nonwoven) on a 2m² Formica board. A spray surface and wipe method was successful in decreasing <i>S. aureus</i> on the surface. A hydrogen peroxide-based product was most effective in reducing bacteria at contamination areas and minimizing cross-contamination. Microfiber cloth picked up significantly more bacteria at contaminated areas. Post disinfection, there was evidence of cross-contamination at sampling areas regardless of product type, wiping cloth, and application methods used, with the cotton cloth causing the most cross-contamination. Viable bacteria were found on the wiping cloths used and on worker's gloves. Together, this work shows that the use of disinfectants is important in hospital environments. The choice of product, wiping material, and application method are principal in the disinfection process as they influence disinfection failure or success.</p>

Yes / It is estimated that 5-10% of hospitalised patients in developed countries contract hospital acquired infections (HAI). Increasing levels of antimicrobial resistance manifested by many HAI-causing pathogens such as Acinetobacter spp in the intensive care unit (ICU) setting present a significant challenge to those managing these infections. Consequently, much attention has been focused on the prevention of HAIs. Particular emphasis has been placed on interventions intended to interrupt patient-to-patient transmission of pathogens, such as enhanced hand hygiene and identification of patients colonised with methicillin-resistant Staphylococcus aureus (MRSA) using rapid DNA-based screening techniques. However, comparatively little attention has been given to the hospital environment, including water supplies, as a source of nosocomial pathogens of importance for patients on the critical care unit. This article reviews the role of hospital water sources in the epidemiology of HAI and new technologies which can be employed in the prevention and control of such infections.

The aim of this thesis is summarising the issue of hospital related infections on intensive care units in district hospitals. This issue is greatly underestimated. The background section discusses the different types of healthcare acquired infection, where they are most commonly found and the most common types. They use statistical data to confirm these points. Within this section risk factors and preventive measures are also discussed. The researchers use a questionnaire to assess the intensive care units staff's knowledge of the procedures to prevent a healthcare acquired infection. The data is expressed using tables and graphs to aid clarity. The results of research reveal, that the staff all downgrade the prevalence and prevention of hospital acquired infections. Key words: Healthcare acquired infections / Nosocomial disease Prevention of hospital related diseases Hand hygiene Intensive care

O objetivo principal dessa tese foi avaliar se o tratamento com ceftriaxona e um macrolídeo leva a melhores desfechos quando comparada a monoterapia com ceftriaxona em pacientes hospitalizados com HIV/AIDS e pneumonia adquirida na comunidade (PAC). 227 adultos com HIV hospitalizados por uma suspeita de PAC foram randomizados numa proporção 1:1 para receber um dos dois regimes, ceftriaxona mais macrolídeo ou ceftriaxona mais placebo. Houve 2 exclusões após a randomização, um paciente retirou consentimento para uso de seus dados e outro paciente já havia sido incluído previamente no estudo, perfazendo um total de 225 pacientes analisados (112 receberam ceftriaxona mais placebo e 113 receberam ceftriaxona mais macrolídeo). Os pacientes tinham HIV há um longo tempo (período mediano de 10 anos) e a maioria não fazia uso regular de terapia antirretroviral. Somente 32/202 pacientes (16%) tinham carga viral menor que 50 cópias/mL e 146/202 (72%) tinham contagem de linfócitos T CD4+ menor que 200 células/mm³. A frequência do desfecho primário, letalidade durante a internação, não foi estatisticamente distinta entre os regimes estudados: 12/112 (11%) pacientes que receberam ceftriaxona mais placebo e 17/113 (15%) que receberam ceftriaxona mais macrolídeo foram a óbito durante a hospitalização (HR: 1.22, 95% CI: 0.57-2.59). Não foram encontradas diferenças entre os regimes para os desfechos secundários: letalidade em 14 dias (RR: 2.38, 95% CI: 0.87-6.53), uso de drogas vasoativas (OR: 1.18, 95% CI: 0.60-2.29) e ventilação mecânica (OR: 1.24, 95% CI: 0.64- 2.40). A etiologia das infecções pulmonares adquiridas na comunidade nesses pacientes com infecção pelo HIV também foi estudada e determinada prospectivamente. Essa investigação também buscou analisar a contribuição de diferentes métodos diagnósticos e o impacto de diferentes abordagens de investigação microbiológica. Além disso, os achados microbiológicos foram analisados levando em consideração a contagem de linfócitos T CD4+, gravidade da doença e a situação da vacina pneumocócica. 224 pacientes foram submetidos a investigação microbiológica estendida e 143 (64%) tiveram uma etiologia determinada. Por outro lado, a investigação microbiológica de rotina foi capaz de determinar o agente etiológico em 92 (41%) pacientes. Métodos baseados na reação em cadeia da polimerase foram essenciais para o diagnóstico de bactérias atípicas e vírus, além de melhorar a detecção de Pneumocystis jirovecii. Entre os 143 pacientes com uma etiologia determinada, Pneumocystis jirovecii foi o principal agente, detectado em 52 (36%) casos, seguido pelo Mycobacterium tuberculosis responsável por 28 (20%) casos. Streptococcus pneumoniae e Rhinovírus foram diagnosticados em 22 (15%) casos cada e Influenza em 15 (10%) casos. Entre as bactérias atípicas, Mycoplasma pneumoniae foi responsável por 12 (8%) e Chlamydophila pneumoniae por 7 (5%) casos. Infecções mistas ocorreram em 48 casos (34%). Streptococcus pneumoniae foi associado com maiores escores de gravidade, sem associação com o estado vacinal. A análise de agentes etiológicos baseada na contagem de linfócitos T CD4+ demonstrou que a etiologia da pneumonia nos pacientes que estavam gravemente imunossuprimidos (CD4+ < 200 células/mm³) foi similar aos que não estavam. Pneumocystis jirovecii foi o único agente mais frequente no primeiro grupo, um achado esperado levando em consideração os critérios diagnósticos empregados / The main purpose of this thesis was to evaluate if treatment with ceftriaxone and a macrolide improved patient outcome when compared with monotherapy with ceftriaxone in hospitalized patients with HIV/AIDS with community acquired pneumonia (CAP). 227 adult patients with HIV hospitalized due to suspected CAP were randomized to receive one of two regimens, ceftriaxone plus macrolide or ceftriaxone plus placebo, at a 1:1 proportion. We had 2 exclusions after randomization, one patient who withdrew consent for data inclusion and use and one that had previously been included, leaving a total of 225 patients to analyse (112 received ceftriaxone plus placebo and 113 received ceftriaxone plus macrolide). Patients had prolonged HIV infection, the median period was twelve years, and most of them did not make regular use of antiretroviral therapy. Only 32/202 patients (16%) had viral load below 50 copies/mL and 146/202 (72%) had a CD4+ T cell count below 200 cells/mm³. The frequency of the primary outcome, in-hospital mortality, was not statistically different between the studied regimens: 12/112 (11%) patients who received ceftriaxone plus placebo and 17/113 (15%) who received ceftriaxone plus macrolide died during hospitalization (HR: 1.22, 95% CI: 0.57-2.59). We did not find differences between the regimens for the secondary outcomes: mortality within 14 days (RR: 2.38, 95% CI: 0.87-6.53), need for vasoactive drug (OR: 1.18, 95% CI: 0.60-2.29) or mechanical ventilation (OR: 1.24, 95% CI: 0.64-2.40). The etiology of community-acquired pulmonary infections in these hospitalized patients with HIV was also studied and determined prospectively. This investigation also aimed to analyze the contribution of different diagnostic methods as well of the impact of different approaches to microbiological evaluation and to evaluate the microbiological findings in relation to the CD4+ T cell count, the severity of disease and pneumococcal vaccine status. 224 patients underwent the extended microbiological investigation of which 143 (64%) had an etiology determined. On the other hand, the microbiological routine investigation was able to determine the etiological agents in 92 (41%) patients. Polymerase chain reaction-based methods were essential for the diagnosis of atypical bacteria and viruses, besides contributing to ameliorate Pneumocystis jirovecii detection. Among the 143 patients with a determined etiology, Pneumocystis jirovecii was the main agent, detected in 52 (36%) cases and followed by Mycobacterium tuberculosis accounting for 28 (20%) cases. Streptococcus pneumoniae and Rhinovirus were diagnosed in 22 (15%) cases each and Influenza in 15 (10%) cases. Among atypical bacteria, Mycoplasma pneumoniae was responsible for 12 (8%) and Chlamydophila pneumoniae for 7 (5%) cases. Mixed infections occurred in 48 cases (34%). Streptococcus pneumoniae was associated with higher severity scores and not associated with vaccine status. Performing an analysis of causative agents based on CD4+ T cell count, we found that the etiology of pneumonia in those severely immunosuppressed (CD4+ < 200 cells/mm³) was similar to those who were not. Pneumocystis jirovecii is the only agent more frequent in the former group, an expected finding considering our diagnostic criteria

More than 13,000 deaths and $340 million in health care costs are the result of catheter-associated urinary tract infections (CAUTIs) annually in the United States. CAUTIs can also result in acute patient discomfort and potentially preventable exposure to antibiotics. The hospital for which this quality improvement project was developed was above the National Healthcare Safety Network CAUTI bench mark. Framed within the Iowa model of evidence-based practice, a multidisciplinary team of 8 hospital stakeholders guided the project (n=8). The purpose of the project was to develop an indwelling urinary catheter maintenance checklist using evidence-based practice guidelines related to preexisting inappropriate risk factors for catheterization and appropriate indications for catheterization, as well as evidence-based maintenance practices for care of the indwelling catheter. Each piece of evidence to be included in the checklist was evaluated by 4 content experts using a 10 item 5 point Likert scale ranging from 'strongly disagree' to 'strongly agree'. Descriptive analysis showed an average of 4.8/5 for all items with 'agree' being voiced in two of the items rather than 'strongly agree'. The checklist was completed and presented to hospital senior leadership who recommended that the checklist be incorporated into the hospital CAUTI prevention plan. All project team members (n=8) completed an 8 item 5 point Likert scale summative evaluation of the purpose, goal, objectives, and my leadership which averaged as 5 or 'strongly agree' supporting the development of the project. Implications for social change include improved patient outcomes, mindful stewardship of healthcare dollars, and increased patient and family satisfaction.

Gram-negative infection has been linked to hospital water although few studies have examined whether water systems are reservoirs of nosocomial pathogens. This study investigated longitudinal recovery of the opportunistic pathogens Pseudomonas aeruginosa, Stenotrophomonas maltophilia and Acinetobacter baumannii from water outlets of a haematology unit and evaluated Point-Of-Use Filtration (POU-F) as a control measure. In a two-year double cross-over trial, water samples and swabs were taken weekly from 39 showers/taps on the unit. Four study phases alternated between non-filtered (Phases 1 &amp; 3), and filtered outlets (Phases 2 &amp; 4) using Pall AquasafeTM 14-day filters. In Phases 1 &amp; 3; 99% of 1396 samples yielded bacterial growth, with colonies generally too numerous to count. Target species were isolated from 22% of water samples (P. aeruginosa 14%; S. maltophilia 10%) and 10% of swabs. P. aeruginosa was particularly associated with handwash stations and S. maltophilia with showers. A. baumannii was not isolated. With POU-F; 22% of 1242 samples yielded bacterial growth (mean CFU/100ml ,4.6). S. maltophilia was isolated only once from water but never from outlet swabs. PCR typing identified clusters of isolates colonizing different outlets over time but no clear association between water and patient isolates was identified. The incidence of Gram negative infections remained low throughout the study. Without POU-F, water from taps/showers represented a source of bacteria including the target species. POU-F substantially reduced the frequency and number of target species from every outlet, and merits further investigation as an intervention to protect immunocompromised patients from opportunistic pathogens.

Introduction - Health care acquired infections (HCAI) are a common complication that affects hospital treated patients. Basic hygiene practice is the most important to prevent HCAI. The occurrence of HCAI is a big problem in India, mostly because of a low compliance to hygiene practice. The nurse has an important role because of their ability to inform and motivate the staff to keep a good compliance to hygiene practice. Aim - To illuminate nurses’ experiences of impacting factors on hygiene practice and infection control in a rural hospital in India. Method - Data was gathered through nine qualitative interviews. Data Analysis – The interviews were tape recorded, transcribed and then analysed through content analysis. Results - Four main categories was identified as important for conducting a successful hygiene practice;Knowledge among health care staff, relatives and patients, Leadership, Resources and Routines. Conclusion – a variety of factors have an impact on hygiene practice and infection control. The nurses experienced that knowledge of infection transmission is vital, as well as a good leadership and implemented routines. It is important having enough staff, sufficient material and facilities in order to prevent the spread of HCAI.

Thematic Paper (M.C.T.M. (Tropical Pediatrics))--Mahidol University, 2005.

Thematic Paper (M.C.T.M. (Tropical Pediatrics))--Mahidol University, 2005.

O objetivo principal dessa tese foi avaliar se o tratamento com ceftriaxona e um macrolídeo leva a melhores desfechos quando comparada a monoterapia com ceftriaxona em pacientes hospitalizados com HIV/AIDS e pneumonia adquirida na comunidade (PAC). 227 adultos com HIV hospitalizados por uma suspeita de PAC foram randomizados numa proporção 1:1 para receber um dos dois regimes, ceftriaxona mais macrolídeo ou ceftriaxona mais placebo. Houve 2 exclusões após a randomização, um paciente retirou consentimento para uso de seus dados e outro paciente já havia sido incluído previamente no estudo, perfazendo um total de 225 pacientes analisados (112 receberam ceftriaxona mais placebo e 113 receberam ceftriaxona mais macrolídeo). Os pacientes tinham HIV há um longo tempo (período mediano de 10 anos) e a maioria não fazia uso regular de terapia antirretroviral. Somente 32/202 pacientes (16%) tinham carga viral menor que 50 cópias/mL e 146/202 (72%) tinham contagem de linfócitos T CD4+ menor que 200 células/mm³. A frequência do desfecho primário, letalidade durante a internação, não foi estatisticamente distinta entre os regimes estudados: 12/112 (11%) pacientes que receberam ceftriaxona mais placebo e 17/113 (15%) que receberam ceftriaxona mais macrolídeo foram a óbito durante a hospitalização (HR: 1.22, 95% CI: 0.57-2.59). Não foram encontradas diferenças entre os regimes para os desfechos secundários: letalidade em 14 dias (RR: 2.38, 95% CI: 0.87-6.53), uso de drogas vasoativas (OR: 1.18, 95% CI: 0.60-2.29) e ventilação mecânica (OR: 1.24, 95% CI: 0.64- 2.40). A etiologia das infecções pulmonares adquiridas na comunidade nesses pacientes com infecção pelo HIV também foi estudada e determinada prospectivamente. Essa investigação também buscou analisar a contribuição de diferentes métodos diagnósticos e o impacto de diferentes abordagens de investigação microbiológica. Além disso, os achados microbiológicos foram analisados levando em consideração a contagem de linfócitos T CD4+, gravidade da doença e a situação da vacina pneumocócica. 224 pacientes foram submetidos a investigação microbiológica estendida e 143 (64%) tiveram uma etiologia determinada. Por outro lado, a investigação microbiológica de rotina foi capaz de determinar o agente etiológico em 92 (41%) pacientes. Métodos baseados na reação em cadeia da polimerase foram essenciais para o diagnóstico de bactérias atípicas e vírus, além de melhorar a detecção de Pneumocystis jirovecii. Entre os 143 pacientes com uma etiologia determinada, Pneumocystis jirovecii foi o principal agente, detectado em 52 (36%) casos, seguido pelo Mycobacterium tuberculosis responsável por 28 (20%) casos. Streptococcus pneumoniae e Rhinovírus foram diagnosticados em 22 (15%) casos cada e Influenza em 15 (10%) casos. Entre as bactérias atípicas, Mycoplasma pneumoniae foi responsável por 12 (8%) e Chlamydophila pneumoniae por 7 (5%) casos. Infecções mistas ocorreram em 48 casos (34%). Streptococcus pneumoniae foi associado com maiores escores de gravidade, sem associação com o estado vacinal. A análise de agentes etiológicos baseada na contagem de linfócitos T CD4+ demonstrou que a etiologia da pneumonia nos pacientes que estavam gravemente imunossuprimidos (CD4+ < 200 células/mm³) foi similar aos que não estavam. Pneumocystis jirovecii foi o único agente mais frequente no primeiro grupo, um achado esperado levando em consideração os critérios diagnósticos empregados / The main purpose of this thesis was to evaluate if treatment with ceftriaxone and a macrolide improved patient outcome when compared with monotherapy with ceftriaxone in hospitalized patients with HIV/AIDS with community acquired pneumonia (CAP). 227 adult patients with HIV hospitalized due to suspected CAP were randomized to receive one of two regimens, ceftriaxone plus macrolide or ceftriaxone plus placebo, at a 1:1 proportion. We had 2 exclusions after randomization, one patient who withdrew consent for data inclusion and use and one that had previously been included, leaving a total of 225 patients to analyse (112 received ceftriaxone plus placebo and 113 received ceftriaxone plus macrolide). Patients had prolonged HIV infection, the median period was twelve years, and most of them did not make regular use of antiretroviral therapy. Only 32/202 patients (16%) had viral load below 50 copies/mL and 146/202 (72%) had a CD4+ T cell count below 200 cells/mm³. The frequency of the primary outcome, in-hospital mortality, was not statistically different between the studied regimens: 12/112 (11%) patients who received ceftriaxone plus placebo and 17/113 (15%) who received ceftriaxone plus macrolide died during hospitalization (HR: 1.22, 95% CI: 0.57-2.59). We did not find differences between the regimens for the secondary outcomes: mortality within 14 days (RR: 2.38, 95% CI: 0.87-6.53), need for vasoactive drug (OR: 1.18, 95% CI: 0.60-2.29) or mechanical ventilation (OR: 1.24, 95% CI: 0.64-2.40). The etiology of community-acquired pulmonary infections in these hospitalized patients with HIV was also studied and determined prospectively. This investigation also aimed to analyze the contribution of different diagnostic methods as well of the impact of different approaches to microbiological evaluation and to evaluate the microbiological findings in relation to the CD4+ T cell count, the severity of disease and pneumococcal vaccine status. 224 patients underwent the extended microbiological investigation of which 143 (64%) had an etiology determined. On the other hand, the microbiological routine investigation was able to determine the etiological agents in 92 (41%) patients. Polymerase chain reaction-based methods were essential for the diagnosis of atypical bacteria and viruses, besides contributing to ameliorate Pneumocystis jirovecii detection. Among the 143 patients with a determined etiology, Pneumocystis jirovecii was the main agent, detected in 52 (36%) cases and followed by Mycobacterium tuberculosis accounting for 28 (20%) cases. Streptococcus pneumoniae and Rhinovirus were diagnosed in 22 (15%) cases each and Influenza in 15 (10%) cases. Among atypical bacteria, Mycoplasma pneumoniae was responsible for 12 (8%) and Chlamydophila pneumoniae for 7 (5%) cases. Mixed infections occurred in 48 cases (34%). Streptococcus pneumoniae was associated with higher severity scores and not associated with vaccine status. Performing an analysis of causative agents based on CD4+ T cell count, we found that the etiology of pneumonia in those severely immunosuppressed (CD4+ < 200 cells/mm³) was similar to those who were not. Pneumocystis jirovecii is the only agent more frequent in the former group, an expected finding considering our diagnostic criteria