Notificação de infecções em unidade neonatal com critérios nacionais.

Backgound and Objectives: Healthcare Associated Infections in neonates represent a challenge and an active surveillance system is essential to develop preventive measures. This study aims to describe the main sites and data of Healthcare Associated Infections according to the criteria defi ned by National Agency for Sanitary Surveillance at a reference Neonatal Unit. Methods:This is a prospective observational study conducted from 2009 to 2010. We included all patients at risk and notifi cation of infections followed criteria defi ned by Agência Nacional de Vigilância Sanitária. For Statistical analysis, we calculated the incidence density of Healthcare Associated Infections, frequency and percentage of microorganisms, mortality, and incidence density of deviceassociated infections. Results: This study followed 609 newborns, with 13,215 patient-days. Incidence density of infection was 26.3 per 1000 patient-days, predominantly bloodstream infection (58.8%). microorganisms were isolated, in 116 (33.4%) cases, predominantly coagulase negative Staphylococcus. Conclusion: The main sites and data of IRAS were similar to other previous studies. The defi nition of parameters for national surveillance of Healthcare Associated Infections is critical for planning actions in order to prevent these diseases in susceptible populations as neonates.Justificativa e Objetivos: : O controle de infecções relacionadas à assistência a saúde em neonatos representa um desafio e um sistema de vigilância ativa é essencial definir medidas preventivas. Este estudo tem como objetivo descrever as principais topografias e indicadores de infecções relacionadas à assistência a saúde em Unidade Neonatal conforme os critérios de vigilância epidemiológica estabelecidos pela Agência Nacional de Vigilância Sanitária. Métodos: Trata-se estudo transversal, observacional, prospectivo, realizado de 2009 a 2010. Foram incluídos todos os pacientes sob risco e a notificação de infecções seguiu os critérios recomendados pela Agência Nacional de Vigilância Sanitária. Análise estatística, com cálculo da densidade de incidência de infecções, frequência e percentual de microrganismos, mortalidade, letalidade e densidade de incidência de infecções associadas a procedimentos invasivos. Resultados: Foram acompanhados 609 neonatos sob risco, totalizando 13.215 pacientes-dia no período. A densidade incidência de infecção foi de 26,3 por 1000 pacientes-dia, predominando infecção de corrente sanguínea (58,8%). Em 116 (33,4%) casos de infecções notificadas, houve isolamento de microrganismo, predominando Staphylococcus coagulase negativo. Conclusão: Os principais indicadores de infecções e topografias foram semelhantes a outros estudos conduzidos previamente. A definição de parâmetros de vigilância epidemiológica de infecções relacionadas à assistência a saúde em nível nacional é fundamental para o planejamento de ações com o objetivo de prevenir estes agravos em populações suscetíveis como neonatos. Descritores: Vigilância Epidemiológica, Infecção Hospitalar, Neonatologia

Notification of Infections in a Neonatal Unity Based on National Criteria

Backgound and Objectives: Healthcare Associated Infections in neonates represent a challenge and an active surveillance system is essential to develop preventive measures. This study aims to describe the main sites and data of Healthcare Associated Infections according to the criteria defi ned by National Agency for Sanitary Surveillance at a reference Neonatal Unit. Methods:This is a prospective observational study conducted from 2009 to 2010. We included all patients at risk and notifi cation of infections followed criteria defi ned by Agência Nacional de Vigilância Sanitária. For Statistical analysis, we calculated the incidence density of Healthcare Associated Infections, frequency and percentage of microorganisms, mortality, and incidence density of deviceassociated infections. Results: This study followed 609 newborns, with 13,215 patient-days. Incidence density of infection was 26.3 per 1000 patient-days, predominantly bloodstream infection (58.8%). microorganisms were isolated, in 116 (33.4%) cases, predominantly coagulase negative Staphylococcus. Conclusion: The main sites and data of IRAS were similar to other previous studies. The defi nition of parameters for national surveillance of Healthcare Associated Infections is critical for planning actions in order to prevent these diseases in susceptible populations as neonates

Association of respiratory symptoms and lung function with occupation in the multinational Burden of Obstructive Lung Disease (BOLD) study

Background Chronic obstructive pulmonary disease has been associated with exposures in the workplace. We aimed to assess the association of respiratory symptoms and lung function with occupation in the Burden of Obstructive Lung Disease study. Methods We analysed cross-sectional data from 28 823 adults (≥40 years) in 34 countries. We considered 11 occupations and grouped them by likelihood of exposure to organic dusts, inorganic dusts and fumes. The association of chronic cough, chronic phlegm, wheeze, dyspnoea, forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1)/FVC with occupation was assessed, per study site, using multivariable regression. These estimates were then meta-analysed. Sensitivity analyses explored differences between sexes and gross national income. Results Overall, working in settings with potentially high exposure to dusts or fumes was associated with respiratory symptoms but not lung function differences. The most common occupation was farming. Compared to people not working in any of the 11 considered occupations, those who were farmers for ≥20 years were more likely to have chronic cough (OR 1.52, 95% CI 1.19–1.94), wheeze (OR 1.37, 95% CI 1.16–1.63) and dyspnoea (OR 1.83, 95% CI 1.53–2.20), but not lower FVC (β=0.02 L, 95% CI −0.02–0.06 L) or lower FEV1/FVC (β=0.04%, 95% CI −0.49–0.58%). Some findings differed by sex and gross national income. Conclusion At a population level, the occupational exposures considered in this study do not appear to be major determinants of differences in lung function, although they are associated with more respiratory symptoms. Because not all work settings were included in this study, respiratory surveillance should still be encouraged among high-risk dusty and fume job workers, especially in low- and middle-income countries.publishedVersio

Cohort Profile: Burden of Obstructive Lung Disease (BOLD) study

The Burden of Obstructive Lung Disease (BOLD) study was established to assess the prevalence of chronic airflow obstruction, a key characteristic of chronic obstructive pulmonary disease, and its risk factors in adults (≥40 years) from general populations across the world. The baseline study was conducted between 2003 and 2016, in 41 sites across Africa, Asia, Europe, North America, the Caribbean and Oceania, and collected high-quality pre- and post-bronchodilator spirometry from 28 828 participants. The follow-up study was conducted between 2019 and 2021, in 18 sites across Africa, Asia, Europe and the Caribbean. At baseline, there were in these sites 12 502 participants with high-quality spirometry. A total of 6452 were followed up, with 5936 completing the study core questionnaire. Of these, 4044 also provided high-quality pre- and post-bronchodilator spirometry. On both occasions, the core questionnaire covered information on respiratory symptoms, doctor diagnoses, health care use, medication use and ealth status, as well as potential risk factors. Information on occupation, environmental exposures and diet was also collected

Importância da utilização da hemocultura de refluído e cultura da ponta de cateter para diagnóstico da sepse relacionada a cateter venoso central no período neonatal

Submitted by Janita Ferreira ([email protected]) on 2019-12-05T11:45:53Z No. of bitstreams: 1 TESE_JANITA_FERREIRA.pdf: 2093395 bytes, checksum: 90371a96e237dc8d82a40cb09ff34ef1 (MD5)Approved for entry into archive by Camila Silva ([email protected]) on 2019-12-23T17:33:53Z (GMT) No. of bitstreams: 1 TESE_JANITA_FERREIRA.pdf: 2093395 bytes, checksum: 90371a96e237dc8d82a40cb09ff34ef1 (MD5)Made available in DSpace on 2019-12-23T17:38:34Z (GMT). No. of bitstreams: 1 TESE_JANITA_FERREIRA.pdf: 2093395 bytes, checksum: 90371a96e237dc8d82a40cb09ff34ef1 (MD5) Previous issue date: 2019-08-12Objetivo- O estudo objetiva avaliar os critérios para diagnóstico da sepse relacionada a cateter (SRC) em neonatologia, com a comparação do uso da hemocultura de sangue refluído do cateter venoso central (CVC) e da cultura da ponta do CVC, bem como avaliar a associação entre a coleta do sangue refluído de cateter e a ocorrência de eventos adversos (EA). Método – Estudo de coorte prospectivo, realizado de 2012 a 2018, em Unidade Neonatal de referência. Foram incluídos todos os neonatos que utilizaram CVC e identificados todos os episódios de SRC. Foram avaliados a sensibilidade, a especificidade, o valor preditivo positivo (VPP), o valor preditivo negativo (VPN) e a acurácia da hemocultura de refluído e da cultura da ponta de CVC. Para avaliar associação entre a coleta de sangue refluído e a ocorrência de EA foi utilizado o teste X2. Resultados- Foram acompanhados 1.983 recém-nascidos, dos quais 1.495 (75,39%) fizeram uso de CVC e foram incluídos no estudo. Foram notificados 399 episódios de sepse, dos quais 105 episódios foram considerados SRC. Na comparação entre os critérios, o sangue refluído apresentou sensibilidade, especificidade, VPP, VPN e acurácia de 81,8%, 100,0%, 100%, 92,3% e 94,3, respectivamente. A ponta de CVC apresentou sensibilidade, especificidade, VPP, VPN e acurácia de 23,9%, 100%, 100%,74,2% e 76,1%, respectivamente. Foram notificados 209 EA com cateteres, sendo que não foi identificada associação entre a coleta de sangue refluído e a ocorrência de EA (teste X2; p=0,625). Conclusão- Observou-se maior identificação de casos de SRC e maior acurácia com o uso da hemocultura de sangue refluído de CVC, com maior sensibilidade em comparação com a cultura da ponta de cateter, sem evidências de associação com a ocorrência de eventos adversos

Avaliação dos critérios nacionais de infecção relacionada à assistência à saúde para vigilância epidemiológica em Neonatologia

Exportado OPUSMade available in DSpace on 2019-08-12T13:05:35Z (GMT). No. of bitstreams: 1 disserta__o_janita__2014.pdf: 1713304 bytes, checksum: 1f053b388fe15f1a01ed9fc8c297e04d (MD5) Previous issue date: 15Os estabelecimentos de saúde são sistemas complexos que tem incorporado tecnologias e técnicas elaboradas ao longo dos anos, com introdução de equipamentos para suporte avançado de vida, bem como antimicrobianos de espectro ampliado e agentes imunossupressores, prevalecendo o modelo clínico assistencial com características altamente invasivas e consequente risco de danos decorrentes da assistência ao paciente

Evaluation of national health-care related infection criteria for epidemiological surveillance in neonatology

OBJECTIVE: to assess the use of the Brazilian criteria for reporting of hospital-acquired infections (HAIs) in the neonatal unit and compare them with the criteria proposed by the National Healthcare Safety Network (NHSN). METHODS: this was a cross-sectional study conducted from 2009 to 2011. It included neonates with HAI reporting by at least one of the criteria. Statistical analysis included calculation of incidence density of HAIs, distribution by weight, and by reporting criterion. Analysis of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the national criteria was performed considering the NHSN as the gold standard, with agreement assessed by kappa. RESULTS: a total of 882 newborns were followed, and 330 had at least one infection notified by at least one of the criteria. A total of 522 HAIs were reported, regardless of the criteria. An incidence density of 27.28 infections per 1,000 patient-days was observed, and the main topographies were sepsis (58.3%), candidiasis (15.1%), and conjunctivitis (6.5%). A total of 489 (93.7%) were notified by both criteria, eight infections were notified only by the national criteria (six cases of necrotizing enterocolitis and two cases of conjunctivitis), and 25 cases of clinical sepsis were reported by NHSN criteria only. The sensitivity, specificity, PPV, and NPV were 95.1%, 98.6%, 98.4%, and 95.7%, respectively, for all topographies, and were 91.8%, 100%, 100%, and 96.3% for the analysis of sepsis. Kappa analysis showed an agreement of 96.9%. CONCLUSION: there was a high rate of agreement between the criteria. The use of the national criteria facilitates the reporting of sepsis in newborns, and can help to improve the specificity and PPV

Impact of the COVID-19 pandemic on patients with paediatric cancer in low-income, middle-income and high-income countries: a multicentre, international, observational cohort study

OBJECTIVES: Paediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerbated the disparity in paediatric cancer outcomes between LMICs and HICs. DESIGN: A multicentre, international, collaborative cohort study. SETTING: 91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020. PARTICIPANTS: Patients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, Wilms' tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas or neuroblastomas, in keeping with the WHO Global Initiative for Childhood Cancer. MAIN OUTCOME MEASURE: All-cause mortality at 30 days and 90 days. RESULTS: 1660 patients were recruited. 219 children had changes to their treatment due to the pandemic. Patients in LMICs were primarily affected (n=182/219, 83.1%). Relative to patients with paediatric cancer in HICs, patients with paediatric cancer in LMICs had 12.1 (95% CI 2.93 to 50.3) and 7.9 (95% CI 3.2 to 19.7) times the odds of death at 30 days and 90 days, respectively, after presentation during the COVID-19 pandemic (p<0.001). After adjusting for confounders, patients with paediatric cancer in LMICs had 15.6 (95% CI 3.7 to 65.8) times the odds of death at 30 days (p<0.001). CONCLUSIONS: The COVID-19 pandemic has affected paediatric oncology service provision. It has disproportionately affected patients in LMICs, highlighting and compounding existing disparities in healthcare systems globally that need addressing urgently. However, many patients with paediatric cancer continued to receive their normal standard of care. This speaks to the adaptability and resilience of healthcare systems and healthcare workers globally