Submitted by LUCIA HELENA DE ALMEIDA TESTA null (luciatesta2011@gmail.com) on 2016-03-07T22:13:50Z No. of bitstreams: 1 Infecção viral respiratória comunitária e hospitalar em pacientes submetidos a transplante de células tronco hematopoiéticas.pdf: 1140941 bytes, checksum: 93b0313920244f35bff64660455608c7 (MD5) / Approved for entry into archive by Ana Paula Grisoto (grisotoana@reitoria.unesp.br) on 2016-03-09T14:00:14Z (GMT) No. of bitstreams: 1 testa_lha_me_bot.pdf: 1140941 bytes, checksum: 93b0313920244f35bff64660455608c7 (MD5) / Made available in DSpace on 2016-03-09T14:00:14Z (GMT). No. of bitstreams: 1 testa_lha_me_bot.pdf: 1140941 bytes, checksum: 93b0313920244f35bff64660455608c7 (MD5) Previous issue date: 2016-02-03 / As infecções por vírus respiratórios (VR) são causas importantes de mortalidade em pacientes submetidos a Transplante de Células-Tronco Hematopoiéticas (TCTH) especialmente no período anterior à pega do enxerto. Estas infecções também podem ser adquiridas dentro dos hospitais, possivelmente transmitida por contato com profissionais de saúde ou cuidadores infectados, ou com objetos ou superfícies contaminadas. Portanto, é importante caracterizar o tipo de transmissão para que medidas rigorosas de controle possam ser implantadas. Objetivos: Analisar os casos de infecção por vírus respiratórios (VR) nos pacientes submetidos a TCTH entre agosto de 2010 a dezembro de 2013 e caracterizar os tipos de transmissão durante esse período. Método: O presente estudo foi realizado no Hospital Amaral Carvalho de Jahu nas unidades de internação e ambulatório de TCTH e na unidade de hematologia, incluindo pacientes com diagnóstico comprovado de VR por imunofluorescência ou PCR multiplex em amostras de lavado nasal. A transmissão foi definida como hospitalar na ausência de sintomas respiratórios à admissão e diagnóstico de VR comprovado laboratorialmente após cinco dias da internação ou até cinco dias após a alta hospitalar. Resultados: Durante este período 187 pacientes tiveram 214 episódios de infecção por VR. Cento e oitenta e três (85,5%) foram considerados infecção comunitária e 31 (14,5%) episódios foram considerados infecção hospitalar, sendo que 17 (7,9 %) episódios ocorreram na unidade de TCTH e 21 (9,8 %) episódios na unidade de hematologia (p=NS). A permanência hospitalar por mais de 23 dias se associou a transmissão hospitalar (p=<0,001) e o ano de 2013 mostrou uma queda significante desse tipo de transmissão (p=0,04). O VSR foi o VR com maior frequência de progressão para pneumonia. Conclusão: Concluímos que a higienização das mãos, coleta de lavado nasal (LN) antes das internações para o transplante de células tronco hematopoiéticas (TCTH), isolamento de contato para os pacientes com vírus respiratório positivo, busca ativa de sintomas e a educação continuada para os pacientes, familiares e profissionais da saúde devem ser contínua para o controle das infecções por VR nas unidades de TCTH. A maioria dessas medidas são de baixo custo e altamente efetivas. Cuidadores, contactuantes domiciliares e profissionais de saúde devem aderir às medidas de controle para garantir a segurança dos pacientes. / Introduction: Community-acquired respiratory viruses (RV) are the most frequent etiologic agents causing acute respiratory infections (ARI) in humans. These agents have a wide antigenic range, universal distribution, affect people in all age groups, and may cause various clinical syndromes involving both the upper and lower respiratory tract. These respiratory infections are major causes of mortality in patients undergoing hematopoietic stem cell transplantation (HSCT), especially in the period prior to engraftment. These infections may also be acquired in hospitals, possibly transmitted by contact with infected health professionals or patient caregivers, or with contaminated objects or surfaces. Since 2008, a continued education program was started at the HSCT Program of Amaral Carvalho Foundation aiming to improve the control of RV transmission. Patients, caregivers, donors, family members and employees are invited to participate in the activities. Objectives: To review the cases of RV infections in patients undergoing HSCT from August 2010 to December 2013, characterize the type of transmission, if community- or hospital-acquired during this period, and determine the morbidity and mortality of RV infections. Methods: The study was conducted at the HSCT Service of Amaral Carvalho Hospital, analyzing the charts of HSCT recipients with RV infection diagnosed by immunofluorescent assay or multiplex PCR. Medical data and images from patients admitted to the HSCT and hematology wards, as well as from patients assisted at the outpatient clinic were retrospectively reviewed. Hospital transmission was defined when the interval between hospital admission and the first symptoms was more than five days, or when the interval between patient discharge and the first symptoms was up to five days. Results: During this period, 187 patients had 214 episodes of VRI. Thirty-one episodes (14.5%) were considered hospital-acquired. Rates of hospital transmission were similar between HSCT unit (7,9%) and the hematology ward (9,8%). Hospital stay for more than 23 days was associated with hospital transmission (p=0.001) and a significant decrease in this type of transmission was observed in 2013 (p=0.04). VSR was the RV with the highest frequency of progression to pneumonia (42%). Conclusion: We conclude that hand hygiene, nasal lavage collection (LN) before hospitalizations for hematopoietic stem cell transplantation (HSCT), contact isolation for patients with positive respiratory virus, active pursuit of symptoms and continuing education for patients, family and healthcare professionals should be continuous for the control of infections in HSCT VR units. Most of these policies have low cost and are highly effective. Caregivers, household contacts and health professionals must comply with the control policies to ensure the safety of patients.

Orientador: Clarisse Martins Machado / Resumo: As infecções por vírus respiratórios (VR) são causas importantes de mortalidade em pacientes submetidos a Transplante de Células-Tronco Hematopoiéticas (TCTH) especialmente no período anterior à pega do enxerto. Estas infecções também podem ser adquiridas dentro dos hospitais, possivelmente transmitida por contato com profissionais de saúde ou cuidadores infectados, ou com objetos ou superfícies contaminadas. Portanto, é importante caracterizar o tipo de transmissão para que medidas rigorosas de controle possam ser implantadas. Objetivos: Analisar os casos de infecção por vírus respiratórios (VR) nos pacientes submetidos a TCTH entre agosto de 2010 a dezembro de 2013 e caracterizar os tipos de transmissão durante esse período. Método: O presente estudo foi realizado no Hospital Amaral Carvalho de Jahu nas unidades de internação e ambulatório de TCTH e na unidade de hematologia, incluindo pacientes com diagnóstico comprovado de VR por imunofluorescência ou PCR multiplex em amostras de lavado nasal. A transmissão foi definida como hospitalar na ausência de sintomas respiratórios à admissão e diagnóstico de VR comprovado laboratorialmente após cinco dias da internação ou até cinco dias após a alta hospitalar. Resultados: Durante este período 187 pacientes tiveram 214 episódios de infecção por VR. Cento e oitenta e três (85,5%) foram considerados infecção comunitária e 31 (14,5%) episódios foram considerados infecção hospitalar, sendo que 17 (7,9 %) episódios oc... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Community-acquired respiratory viruses (RV) are the most frequent etiologic agents causing acute respiratory infections (ARI) in humans. These agents have a wide antigenic range, universal distribution, affect people in all age groups, and may cause various clinical syndromes involving both the upper and lower respiratory tract. These respiratory infections are major causes of mortality in patients undergoing hematopoietic stem cell transplantation (HSCT), especially in the period prior to engraftment. These infections may also be acquired in hospitals, possibly transmitted by contact with infected health professionals or patient caregivers, or with contaminated objects or surfaces. Since 2008, a continued education program was started at the HSCT Program of Amaral Carvalho Foundation aiming to improve the control of RV transmission. Patients, caregivers, donors, family members and employees are invited to participate in the activities. Objectives: To review the cases of RV infections in patients undergoing HSCT from August 2010 to December 2013, characterize the type of transmission, if community- or hospital-acquired during this period, and determine the morbidity and mortality of RV infections. Methods: The study was conducted at the HSCT Service of Amaral Carvalho Hospital, analyzing the charts of HSCT recipients with RV infection diagnosed by immunofluorescent assay or multiplex PCR. Medical data and images from patients admitted to the HSC... (Complete abstract click electronic access below) / Mestre

Emerging multidrug-resistant tuberculosis (MDR/XDR-TB) has become a major public health problem, placing millions at risk. Further, nosocomial transmission of MDR/XDR-TB places both patients and healthcare workers at an even higher risk. Effective tuberculosis (TB) infection prevention and control (IPC) policies in high-risk settings must use evidence-based science and should be customized to the setting. However, the growing incidence of MDR/XDR-TB in some global settings raises questions about whether adequate healthcare-related TB IPC policies are in place and whether they are implemented effectively. The purpose of this systematic literature review was to catalogue healthcare-related TB IPC policy research conducted in high-prevalence settings and draw a picture of existing evidence-based TB IPC policies and their implementation, with a focus on preventing and controlling nosocomial transmission of MDR/XDR-TB. Two databases (PubMed and Embase) were searched from 1990 – 2013 and outputs were categorized by region/country, income, MDR/XDR-TB incidence, level of IC intervention, and time period. None of the 20 captured research studies were conducted in TB high-prevalence, low-income settings. Most (12/20) were implemented within the Pan American Health Organization region, followed by the African (4/20) and European (4, 20%) regions. Most studies reviewed (70%) were undertaken because of an outbreak and most (70%) were published between 1990 – 2000. This systematic literature review showed a gap in research on TB IPC policies addressing nosocomial transmission of MDR/XDR-TB in high-prevalence, low-income settings. TB IPC policy development and implementation should be routinely undertaken as a part of effective and efficient public health practice. Development of TB IPC global best practices should be guaranteed and a concerted effort to promote, distribute, train, and implement these TB IPC best practices in low-resource countries would help mitigate the growing incidence of MDR/XDR-TB worldwide.