Surtos bacterianos em uma Unidade de Terapia Intensiva Neonatal: histórico de cinco anos

Introdução: A internação em Unidade de Terapia Intensiva Neonatal (UTIN) costuma ser prolongada e os neonatos são submetidos a vários fatores de risco, possibilitando a ocorrência de surtos de tempos em tempos apesar das precauções. Objetivo: investigar a ocorrência de surtos bacterianos em uma UTIN de um hospital universitário do interior de Minas Gerais no período de janeiro de 2013 a dezembro de 2017. Métodos: os dados foram coletados a partir dos registros de surtos ocorridos em UTIN disponibilizados nos documentos do Serviço de Controle de Infecção Hospitalar do hospital, incluindo as fichas de vigilância epidemiológica “National Healthcare Safety Network” - NHSN, memorandos, resultados de exames e registros eletrônicos das descrições dos surtos. Resultados: foram encontrados quatro surtos em um período de cinco anos de estudo. O primeiro surto identificado ocorreu no ano de 2013, por infecção de corrente sanguínea pela bactéria Pantoea agglomerans e envolveu seis neonatos. O segundo ocorreu entre novembro de 2014 e março 2015 onde seis neonatos foram envolvidos e não houve um sítio predominante, sendo o Acinetobacter baumannii o micro-organismo isolado, da mesma forma que o terceiro surto, ocorrido em 2015 por esse mesmo agente, englobando 10 neonatos. O último surto aconteceu no ano de 2016 por Pseudomonas aeruginosa, sendo um surto predominantemente de colonização, onde 13 neonatos foram atingidos. Não houveram surtos no ano de 2017. Conclusão: Após levantamento epidemiológico foram identificados quatro surtos, todos por bactérias Gram-negativas. Os neonatos mais acometidos foram os prematuros e de baixo peso ao nascer. Foram identificados micro-organismos resistentes aos carbapenêmicos que, apesar de poucos, se revelaram como um problema presente no local do estudo

The cost impact, infrastructure for hand hygiene and magnitude of healthcare-associated infections in a Referral Hospital in Minas Gerais

Background: The principal focus of all efforts to control and prevent healthcare-associated infections (HAIs) is the inherent necessity to measure the burden of these infections as well as the risks and costs associated. Objectives: This study aimed to map the prevalence of HAIs caused by epidemiologically important pathogens in the hospital environment, as well as to evaluate the direct costs and reimbursement by the Brazilian government associated with critical patients, in a Tertiary Referral Hospital in Brazil. Additionally, the Hospital's infrastructure diagnosis for HAI control was performed, mainly related to hand hygiene. Methods: In 2017, a point prevalence survey was carried out in all clinics at the hospital, through systematic screening of patients' medical records and visits to clinics. A case study (patient with HAI present at the time of the prevalence survey) versus control (patients who had not yet acquired HAI on the "corresponding day") was paired to assess risk factors, total mortality and hospitalization costs. Cases and controls were matched for hospitalization clinic, age, sex and time of risk. For the calculation of reimbursement, the total amount charged for each hospitalization to the Unified Health System (SUS) was obtained through the Hospital Billing Sector and for the calculation of direct costs, those related only to the adult ICU care were included, through an annual survey (2018). A Monte Carlo simulation was carried out, with 50,000 simulations, of the direct annual cost of patients with HAI admitted to the adult ICUs in 50 federal university hospitals in Brazil, covering three prevalence scenarios. The diagnosis of the hospital's infrastructure was focused on 4 essential areas: hospital infection control service, sterilization service, microbiology laboratory and, mainly, on resources for hand hygiene. Results: 423 patients were included, in which the total prevalence of patients with HAI was 19.6%, being especially high in the adult ICU (50.0%). The prevalences of bloodstream infections (BSI), pneumonia (PNM) and urinary tract infection (UTI) were 32.6%, 22.4% and 21.4%, respectively, mainly caused by Enterobacteriaceae, Gram-negative bacilli (BGN) non-fermenters and E. coli in those with microbiological evidence (60.2%), respectively. The use of invasive devices was an independent risk factor for HAI. It was observed that the presence of central venous catheter, mechanical ventilation and urinary catheter increases the risk for BSI, PNM and UTI by 9.5; 16.0 and 9.5 times, respectively. In addition, the patient's presence in the adult ICU was strongly related to the development of pneumonia (OR: 4.2408). In total, 45.6% of the patients received at least one antimicrobial. Of all antimicrobials used to treat infection, only 48.6% of patients were based on microbiological results. This study demonstrated an average proportion of the number of patients per sink of 3.42 ± 2.33, with a compliance rate (CI) of 91% and the number of patients per alcoholic dispenser of 1.61 ± 1.12 patient / dispenser (CI = 86%). However, evaluating the performance of hand hygiene by indirect methodology, the rate of adherence to the practice of hand hygiene was 10% and 15% in the ICUs and other clinics, respectively. This study revealed that the cost of reimbursement for hospitalization of patients with HAIs was 75% higher than patients without HAIs, even higher among patients with infection by resistant phenotypes. 41% of the total reimbursement amount for hospitalization of all patients included in the study was allocated to patients with HAI, however the number of patients with HAI corresponded to 19.6% of the total. When the direct cost was assessed, extremely high values were observed when the same comparison was made, with the direct cost being 111.5% higher than the reimbursement value (US $11776 x US$ 5569, respectively) for the patient with HAI. From the Monte Carlo simulation, an additional direct cost of US $2,824,817 was observed for each 1$ 11776 x US$5569, respectivamente) para o paciente com IRAS. A partir da simulação de Monte Carlo, observou-se custo direto adicional de US$2.824.817 a cada 1% de aumento na prevalência de IRAS. Conclusão: Este estudo fornece dados alarmantes de IRAS bem como de custos, com altas taxas de infecções que apresentam pior prognóstico (sepse e pneumonia), causadas principalmente por BGN multirresistentes, significativamente associado à presença do paciente na UTI, bem como uso de ventilação mecânica e cateteres venosos centrais. Apesar do hospital avaliado possuir infraestrutura e recursos adequados para a higienização das mãos, o desempenho à prática da HM foi extremamente baixo

Prevalência de sintomas de ansiedade e depressão em pacientes com diabetes tipo 2 com e sem dependência nicotínica e em tabagistas não diabéticos

Introduction: Diabetic individuals who are smokers have higher risks of cardiovascular disease, premature death, and microvascular complications. The present study aims to evaluate the degree of nicotine dependence and the prevalence of symptoms of anxiety and depression in smokers with type 2 diabetes mellitus (T2D). Methods: Each of the T2D smoking patients treated at the Endocrinology Clinic of the Hospital de Clinicas, Federal University of Uberlândia, was matched with two controls. Thus, three study groups were formed: 46 T2D smokers (DS), 46 T2D non-smokers (D), and 46 smokers without diabetes (S), totaling 138 participants. The presence of symptoms of anxiety and depression was determined based on the Hospital Anxiety and Depression (HAD) scale, and the Fagerström Test for Nicotine Dependence was used to evaluate the degree of nicotine dependence. Results: The prevalence of high nicotine dependence among smokers with and without T2D was 39.1% and 37.1%, respectively (p = 0.999). There was no significant difference in the proportion of individuals with symptoms of anxiety in the DS group (50%) compared to group D (39.1%) or S (63%) (p = 0.072). The same was observed for symptoms of depression in groups DS, D, and S (30.4%, 39.1%, and 32.6%, respectively, p = 0.657). The consumption of anxiolytics in the DS group (19.6%) was higher than in group D (2.2%) (p = 0.028). Among male patients, the diabetic smokers had a higher prevalence of anxiety symptoms (19.6%) than non-smokers (2.9%) (p = 0.003). The prevalence of symptoms of anxiety and depression among nicotine addicts (54.6% and 37.1%, respectively) and non-addicts (57.7% and 28.1%, respectively) was similar. Conclusions: The prevalence of depression and anxiety among diabetic and non-diabetic smokers and diabetic non-smokers is similar, although the consumption of anxiolytics among diabetic smokers is significantly higher than diabetic nonsmokers. Diabetic male smokers have more symptoms of anxiety than non-smokers with diabetes. There is no difference in the prevalence of nicotine dependence among diabetics and non-diabetics. The presence of anxiety or depression symptoms is similar between individuals who are dependent and not dependent on nicotine.Mestre em Ciências da SaúdeIntrodução: Vários estudos têm demonstrado que indivíduos diabéticos fumantes apresentam um risco mais elevado de doença cardiovascular, morte prematura e complicações microvasculares. O presente estudo tem como objetivo conhecer o grau de dependência nicotínica e a prevalência de sintomas de ansiedade e depressão em pacientes tabagistas com diagnóstico de diabetes mellitus tipo 2 (DM2). Métodos: Cada um dos pacientes tabagistas com DM2, atendidos no Ambulatório de Endocrinologia do Hospital de Clínicas da Universidade Federal de Uberlândia, foi pareado com outros dois controles, compondo, assim, três grupos: 46 com DM2 e tabagistas (DT); 46 com DM2 e não tabagistas (D); 46 tabagistas não diabéticos (T); totalizando 138 participantes. A presença de sintomas de ansiedade e depressão foi averiguada com base na escala Hospital Anxiety and Depression (HAD) e utilizou-se do Fagerström Test for Nicotine Dependence para avaliar o grau de dependência à nicotina. Resultados: A prevalência de dependência nicotínica elevada entre os tabagistas com e sem DM2 foi de 39,1% e 37,1%, respectivamente (p=0,999). Não houve diferença estatisticamente significativa na proporção de indivíduos com sintomas de ansiedade no grupo DT (50%) em relação aos grupos D (39,1%) e T (63%) (p=0,072) e o mesmo ocorreu em relação aos sintomas de depressão nos grupos DT, D e T (30,4%, 39,1% e 32,6%, respectivamente, p=0,657). O consumo de ansiolíticos no grupo DT (19,6%) foi maior que no grupo D (2,2%) (p=0,028). Entre os pacientes do sexo masculino, os diabéticos fumantes apresentaram maior prevalência de sintomas de ansiedade (19,6%) do que os não fumantes (2,9%) (p=0,003). A prevalência de sintomas de ansiedade e depressão entre os dependentes (54,6% e 37,1%) e não dependentes nicotínicos (57,7% e 28,1%) foi semelhante. Conclusões: A prevalência de depressão e ansiedade entre os indivíduos fumantes diabéticos e não diabéticos e diabéticos não fumantes é semelhante, embora o consumo de ansiolíticos pelos diabéticos fumantes seja significativamente maior do que pelos diabéticos não fumantes. Os homens diabéticos tabagistas apresentam mais sintomas de ansiedade do que os diabéticos não tabagistas. Não há diferença na prevalência de dependência nicotínica entre os indivíduos diabéticos e não diabéticos. A presença de sintomas de ansiedade ou depressão é semelhante entre dependentes e não dependentes nicotínicos

Prescribing errors in a Brazilian neonatal intensive care unit

Abstract Pediatric patients, especially those admitted to the neonatal intensive care unit (ICU), are highly vulnerable to medication errors. This study aimed to measure the prescription error rate in a university hospital neonatal ICU and to identify susceptible patients, types of errors, and the medicines involved. The variables related to medicines prescribed were compared to the Neofax prescription protocol. The study enrolled 150 newborns and analyzed 489 prescription order forms, with 1,491 medication items, corresponding to 46 drugs. Prescription error rate was 43.5%. Errors were found in dosage, intervals, diluents, and infusion time, distributed across 7 therapeutic classes. Errors were more frequent in preterm newborns. Diluent and dosing were the most frequent sources of errors. The therapeutic classes most involved in errors were antimicrobial agents and drugs that act on the nervous and cardiovascular systems