6 research outputs found
Uso de diagramas de controle na vigilùncia epidemiológica das infecçÔes hospitalares
OBJECTIVE: To monitor occurrence trends and identify clusters of nosocomial infection (NI) using statistical process control (SPC) charts. METHODS: Between January 1998 and December 2000 nosocomial infection occurrence was evaluated in a cohort of 460 patients admitted to the Pediatric Intensive Care Unit of a university hospital, according to the concepts and criteria proposed by the National Nosocomial Infection Surveillance System of the Centers for Disease Control, in the United States. Graphs were plotted using Poisson statistical distribution, including four horizontal lines: center line (CL), upper warning limit (UWL) and upper control limit (UCL). The CL was the arithmetic mean NI rate calculated for the studied period; UWL and UCL were drawn at 2 and 3 standard deviations above average NI rates, respectively. Clusters were identified when NI rates remained above UCL. RESULTS: Mean NI incidence was 20 per 1,000 patient days. One urinary tract infection cluster was identified in July 2000, with an infection rate of 63 per 1,000 patient days, exceeding UCL and characterizing a period of epidemic. CONCLUSIONS: The use of SPC charts for controlling endemic levels of NI, through both global and site-specific evaluation, allowed for the identification of uncommon variations in NI rates, such as outbreaks and epidemics, and for their distinction from the natural variations observed in NI occurrence rates, without the need for calculations and hypothesis testing.OBJETIVO: Monitorizar a tendĂȘncia de ocorrĂȘncia e identificar surtos de infecçÔes hospitalares utilizando diagramas de controles. MĂTODOS: No perĂodo de janeiro de 1998 a dezembro de 2000, a ocorrĂȘncia de infecçÔes hospitalares foi avaliada em uma coorte de 460 pacientes, internados em uma Unidade de Terapia Intensiva PediĂĄtrica de um hospital universitĂĄrio, segundo os conceitos e critĂ©rios da metodologia do sistema "National Nosocomial Infection Surveillance", do "Centers for Disease Control" (EUA). Os grĂĄficos foram construĂdos de acordo com a distribuição probabilĂstica de Poisson. Quatro linhas horizontais foram plotadas. A linha central foi representada pela incidĂȘncia mĂ©dia das infecçÔes hospitalares no perĂodo estudado e as linhas de alerta superior e de controle superior foram calculadas a partir de dois e trĂȘs desvios-padrĂŁo acima da incidĂȘncia mĂ©dia das infecçÔes hospitalares, respectivamente. Os surtos de infecção hospitalar foram identificados quando sua incidĂȘncia mensal permaneceu acima da linha do limite de controle superior. RESULTADOS: A incidĂȘncia mĂ©dia de infecçÔes hospitalares por mil pacientes dia foi de 20. Um surto de infecção do trato urinĂĄrio foi identificado em julho de 2000, cuja taxa de infecção foi de 63 por mil pacientes dia, ultrapassando a linha de controle superior, configurando um perĂodo epidĂȘmico. CONCLUSĂES: A utilização dos diagramas de controle do nĂvel endĂȘmico, tanto por avaliação global e sĂtio especĂfica, possibilitou identificar e distinguir das variaçÔes naturais nas taxas de ocorrĂȘncia de infecçÔes hospitalares aquelas de causas incomuns, como os surtos ou epidemias, dispensando o uso de cĂĄlculos e testes de hipĂłteses
Vacinação contra o sarampo: influĂȘncia da idade em sua eficĂĄcia
The authors compare the serologic efficacy and the clinical protection afforded by three different measles vaccination schemes in adequately nourished children in SĂŁo Paulo city, Brazil. Two hundred forty two children were divided into three groups. Group A, comprising 117 children who had received the vaccine before 12 months of age and a second dose at 12 months of age or more. Group B, comprising 46 children who had received only one dose, before 12 months of age. Group C, comprising 79 children who had received only one dose, at 12 months of age or more. The geometric mean titer of antibodies in Group A was 790.1; in Group B, 251.1; and in Group C, 550.3. There was no statistically significant difference between Groups A and C. The exposure to the measles virus was probably similar in all groups, and the children in Groups A and C had similar chances of acquiring the disease after vaccination whereas in Group B the chances were higher when compared to the other two groups. The results obtained in this study favor the use, in developing countries, of a vaccination program against measles that includes an early first dose at eight months of age and revaccination after 12 months of age.Os autores comparam a eficĂĄcia sorolĂłgica e a proteção clinica obtidas com trĂȘs esquemas diferentes de vacinação contra o sarampo, em crianças eutrĂłficas, na cidade de SĂŁo Paulo, Brasil. Duzentas e quarenta e duas crianças foram divididas em trĂȘs grupos. Grupo A, compreendendo 117 crianças primovacinadas antes dos 12 meses de idade e revacinadas com 12 ou mais meses de idade. Grupo B, compreendendo 46 crianças vacinadas com dose Ășnica, antes dos 12 meses de idade. Grupo C, compreendendo 79 crianças vacinadas com dose Ășnica, aos 12 ou mais meses de idade. A mĂ©dia geomĂ©trica do tĂtulo de anticorpos no grupo A foi 790,1; no grupo B, 251,1; e no grupo C, 550,3. NĂŁo houve diferença estatisticamente significante entre os grupos A e C. A exposição ao vĂrus do sarampo foi provavelmente semelhante em todos os grupos. As crianças dos grupos A e C apresentaram risco de adoecimento semelhante apĂłs vacinação, enquanto que tal risco foi maior no grupo B quando comparado aos outros dois grupos. Os resultados obtidos neste estudo falam a favor do uso, em paĂses em desenvolvimento, de um programa de vacinação contra o sarampo que inclua uma primeira dose Ă os oito meses de idade e revacinação apĂłs os 12 meses de idade
Uso de diagramas de controle na vigilùncia epidemiológica das infecçÔes hospitalares
Impact of an intervention in the use of sequential antibiotic therapy in a Brazilian university hospital
INTRODUCTION: Sequential antibiotic therapy (SAT) is safe and economical. However, the unnecessary use of intravenous (IV) administration usually occurs. The objective of this work was to get to know the effectiveness of an intervention to implement the SAT in a teaching hospital in Brazil. METHODS: This was a prospective and interventional study, historically controlled, and was conducted in the Hospital de ClĂnicas, Universidade Federal de UberlĂąndia, State of Minas Gerais, Brazil, a high complexity teaching hospital having 503 beds. In each of the periods, from 04/04/05 to 07/20/05 (pre-intervention) and from 09/24/07 to 12/20/07 (intervention), 117 patients were evaluated. After the pre-intervention period, guidelines were developed which were implemented during the intervention period along with educational measures and a reminder system added to the patients' prescription. RESULTS: In the pre-intervention and intervention periods, the IV antibiotics were used as treatment for a average time of 14.8 and 11.8 days, respectively. Ceftriaxone was the antibiotic most prescribed in both periods (23.4% and 21.6% respectively). Starting from the first prescription of antibiotics, the average length of hospitalization time was 21.8 and 17.5 days, respectively. The SAT occurred only in 4 and 5 courses of treatment, respectively, and 12.8% and 18.8% of the patients died in the respective periods. CONCLUSIONS: Under the presented conditions, the evaluated intervention strategy is ineffective in promoting the exchange of the antibiotic administration from IV to oral treatment (SAT)