Compliance with handwashing at two intensive care units in São Paulo

Handwashing compliance was compared at two medical- surgical intensive care units (ICUs) of a teaching and a non-teaching hospital. The mean compliance was 22.2% and 42.6%, respectively. Respiratory therapists at the non-teaching hospital had the best handwashing compliance (52.6%). Nursing assistants at the teaching hospital had the worst compliance (11.5%). Nursing assistant was the only health-care worker category with a significant difference between the two ICUs (odds ratio = 6.0; 95% confidence interval = 3.83-9.43; p< 0.001).Federal University of São Paulo Division of Infectious Diseases Healthcare Epidemiology CommitteeFederal University of São Paulo Diadema State Hospital Infection Control CommitteeUNIFESP, Division of Infectious Diseases Healthcare Epidemiology CommitteeUNIFESP, Diadema State Hospital Infection Control CommitteeSciEL

Correlation between Rates of Carbapenem Consumption and the Prevalence of Carbapenem-Resistant Pseudomonas aeruginosa in a Tertiary Care Hospital in Brazil: A 4-Year Study

Universidade Federal de São Paulo, Div Infect Dis, Hosp Epidemiol Comm, São Paulo, BrazilUniversidade Federal de São Paulo, Div Infect Dis, Hosp Epidemiol Comm, São Paulo, BrazilWeb of Scienc

Risk factors for surgical site infection in kidney transplant recipients

We analyzed the epidemiologic characteristics and risk factors for surgical site infection (SSI) in kidney transplant recipients. From among 1,939 kidney transplant recipients, 120 with corresponding control subjects were evaluated in this study (1: 1 ratio). Reoperation, chronic glomerulonephritis, acute graft rejection, delayed graft function, diabetes, and high body mass index were identified in the analysis as risk factors for SSI.Hosp Rim & Hipertensao, Dept Internal Med, Div Infect Dis, São Paulo, BrazilHosp Rim & Hipertensao, Div Nephrol, São Paulo, BrazilUniversidade Federal de São Paulo, Div Stat, Dept Prevent Med, São Paulo, BrazilUniversidade Federal de São Paulo, Div Stat, Dept Prevent Med, São Paulo, BrazilWeb of Scienc

Implementation of an antibiotic prophylaxis protocol in an intensive care unit

Background: When properly employed, the prophylactic use of antimicrobials is associated with a reduction in surgical site infections (SSIs). We found that the appropriate use of antimicrobial prophylaxis was only 50.5% (53/105) among patients undergoing surgery in the adult intensive care unit of our hospital. in 2001, a protocol was designed to improve compliance with recommended practice.Methods: We used a prospective interventional study and a case control study carried out between 2001 and 2007, including follow-up and daily intervention to improve compliance with antimicrobial prophylaxis guidelines and to monitor antimicrobial consumption and SSI rates. Cases of noncompliance to the prophylaxis protocol (group I) were matched to controls (group II) with appropriate prophylaxis and compared with regards to type of surgery, operative duration, intraoperative antimicrobial use, type of antimicrobial used, length of hospital stay, severity of illness, comorbidities, invasive devices, possible adverse reactions, and death.Results: Compliance with antimicrobial prophylaxis metrics reached 85%; however, we were unable to detect a change in SSI rate or consumption and cost of antimicrobials. Inappropriate use was not associated with higher likelihood of death. There were no other significant differences between the 2 groups.Conclusion: Our intervention increased compliance with appropriate antimicrobial surgical prophylaxis with no negative impact on patient safety. Copyright (C) 2012 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.Hosp Israelita Albert Einstein, Intens Care Unit, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Infect Dis, São Paulo, BrazilIIEP, Dept Stat, São Paulo, BrazilHosp Israelita Albert Einstein, Div Med Practice, São Paulo, BrazilVirginia Commonwealth Univ, Sch Med, Dept Internal Med, Richmond, VA USAUniversidade Federal de São Paulo, Dept Infect Dis, São Paulo, BrazilWeb of Scienc

Imipenem-resistant Pseudomonas aeruginosa infection at a medical-surgical intensive care unit: Risk factors and mortality

Objectives: the aim of this study was to evaluate the risk factors and attributable mortality associated with imipenem-resistant Pseudomonas aeruginosa (IRPA) infections in a medical-surgical intensive care unit (ICU).Methods: A retrospective case-control study was carried out at a 16-bed medical-surgical ICU in a 780-bed, university-affiliated hospital. All patients admitted from January 1, 2003, to December 31, 2004, who had nosocomial infection caused by IRPA, were included in the study.Results: Imipenem-resistant P. aeruginosa was recovered from 63 patients during the study period. One hundred eighty-two controls were matched with cases by period of admission, age, and time at risk. Urinary tract (34.9%) and respiratory tract (22.2%) were the main sources of IRPA isolation. in multivariate analysis, a previous stay in the ICU (odds ratio, 3.54; 95% confidence interval [CI], 1.29-9.73; P = .03) was the only independent risk factor for IRPA infection. the in-hospital mortality rate among case patients was 49% (31 of 63) compared with 33% (61 of 182) for control patients (odds ratio, 1.92; 95% CI, 1.07-3.44; P = .02). Thus, we had an attributable mortality of 16% (95% CI, 9.74%-22.3%; P = .03).Conclusions: Our study suggests that IRPA infections are strongly related to previous ICU stay, and that IRPA infections significantly increase mortality in those critical patients. (C) 2009 Elsevier Inc. All rights reserved.Universidade Federal de São Paulo, Hosp Epidemiol Comm, Div Infect Dis, BR-04037004 São Paulo, BrazilUniversidade Federal de São Paulo, Hosp Epidemiol Comm, Div Infect Dis, BR-04037004 São Paulo, BrazilWeb of Scienc