5 results
A surveillance program for long-term central venous access–associated infections in outpatient chemotherapy services
- Maristela P. Freire, Denise Brandão Assis, Fabianne Carlesse, Juliana De Cassia Belizario, Priscila Costa Pimentel Germano, Juliana Monteiro Virolli, Anna Claudia Turdo, Beatriz Quental Rodrigues, Amanda Luiz Pires Maciel, Priscila Goncalves, Icaro Boszczowski, Edson Abdala, Anna S. Levin
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 44 / Issue 10 / October 2023
- Published online by Cambridge University Press:
- 11 April 2023, pp. 1555-1561
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- October 2023
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Objective:
In this study, we described the first results of a surveillance system for infections associated with long-term central venous catheters (LT-CVC) in patients under outpatient chemotherapy.
Design:This was a multicentric, prospective study.
Setting:Outpatient chemotherapy services.
Participants:The study included 8 referral cancer centers in the State of São Paulo.
Intervention:These services were invited to participate in a newly created surveillance program for patients under chemotherapy. Several meetings were convened to share previous experiences on LT-CVC infection surveillance and to define the surveillance method. Once the program was implemented, all bloodstream infection (LT-CVC BSIs), tunnel infection, and exit-site infections associated with LT-CVC were reported. Data from January to May 2021 were analyzed. The median monthly number of chemotherapy sessions per clinic was 925 (IQR, 270–5,855). We used Poisson regression to analyze the association of rates with the characteristics of the services.
Results:In total, 107 LT-CVC infections were reported, of which 95% were BSIs, mostly associated with totally implantable devices (76%). Infections occurred a median of 4 days after the last catheter manipulation and 116 after the LT-CVC insertion. Also, 102 microorganisms were isolated from LT-CVC BSIs; the most common pathogen was Staphylococcus epidermidis, at 22%. Moreover, 44 infections (44%) fulfilled the criteria for CVC-related LT-CVC BSI and 27 infections (27%) met the criteria for mucosal barrier injury. The 1-year cumulative LT-CVC BSI rate was 1.94 per 1,000 CVC days of use. The rates were higher in public hospitals (IRR, 6.00; P < .001) and in hospitals that already had in place surveillance for LT-CVC infections (IRR, 2.01; P < .01).
Conclusion:Our study describes an applicable surveillance method for infections in cancer outpatients using LT-CVC.
Healthcare Professionals Perception of Mobile Phone Usage and Hand Hygiene Adhesion in Intensive Care Units
- Evelyn Sanchez, Lauro Perdigão-Neto, Sânia Alves dos Santos, Camila Rizek, Maria Renata Gomez, Roberta Martins, Gaspar de Oliveira, Thais Guimaraes, Icaro Boszczowski, Flavia Rossi, Maristela Freire, Anna Levin, Silvia Figueiredo Costa, Marina Farrel
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, p. s346
- Print publication:
- October 2020
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Background: The introduction of new technologies into the medical field has the duality of improvement and concerns about correct usage and cleaning. Mobile phones are used by healthcare professionals (HCPs) in the work place, and there is not an official policy about their use in health environment. Methods: We asked 60 intensive care unit (ICU) HCPs from 2 units (the burn unit and the internal medicine unit) to participate in an electronic survey about mobile phone usage and hand hygiene compliance; we also cultured the hands and mobile phones of the participants. Unfortunately, 13 HCPs did not participate. Susceptibility testing of the strains was conducted, as well as molecular testing. Results: Overall, 47 HCPs responded to the inquiry: 19% were nurses (9 of 47), 19% were resident physicians (9 of 47), 17% were nursery technicians (8 of 47), 17% were physiotherapists (8 of 47), 13% were cleaning staff (6 of 47), 11% were consultants (5 of 47), and 4% were technicians (2 of 47). Moreover, 26 of 47 participants (55%) were woman and 21 (45%) were men. From all HCP categories, 39 of 47 respondents (83%) reported that they had optimal hand hygiene compliance. However, 92% of respondents had a colonized hand and 90% had a colonized mobile phone. Also, 44 of 47 HCPs (94%) reported that the took their personal mobile phone into the workplace; 40 (85%) reported that they used it during the work day and 35 (74%) reported that they cleaned it. However, 8 HCPs (26%) reported that they had never cleaned the device. All of the HCPs understood that mobile phones can harbor bacteria, and 27 of 47 HCPs (57.45%) indicated that they use 70% alcohol to clean their mobile phones. In contrast, the first choice for hand hygiene was water and soap in 51% of HCPs (24 of 47). Also, 3 HCPs did not have any colonization in the hand culture but had healthcare-associated infection (HAI) pathogens in the mobile phone culture. Conclusions: A policy regarding mobile phone usage in the healthcare setting should be in place, and cleaning of electronic devices in hospitals should be standardized.
Funding: None
Disclosures: None
Funding: None
Disclosures: None
Barriers and Facilitators to Improving Hospital Cleanliness in a Brazilian Hospital
- Amanda Luiz Pires Maciel, Marcia Maria Baraldi, Icaro Boszczowski, Janaina Alves Bezerra, Filipe Piastrelli, Eduardo Fernandes Camacho, Cristiane Schmitt
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s138-s139
- Print publication:
- October 2020
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Background: Antimicrobial resistance is a global public health threat. Integrated actions are necessary to reduce multidrug-resistant organisms (MDROs) in healthcare settings, including antimicrobial stewardship, infection prevention measures, and optimal environmental hygiene. We developed a project to improve hospital hygiene that involves 3 phases: (1) diagnostic, compounded by assessment of cleanliness and identification of barriers and facilitators for environment cleanliness improvement; (2) intervention, based on review of structure and processes followed by a training program focused on major weaknesses identified; and (3) evaluation, impact of the intervention assessment. Objectives: We performed group interviews to identify barriers and facilitators for improving environment cleanliness. Methods: The project was performed by the infection control team and the housekeeping manager in a 350-bed, private hospital located in the city of São Paulo (Brazil). Two group interviews were conducted, one involving supervisors and the other involving housekeeping cleaners. All professionals were invited to participate. A semistructured questionnaire was used to guide the discussion, which was compounded by the following topics: working process, availability of human and material resources, training on institutional norms and routines, perception regarding work conditions, and quality of cleanliness. Results: In total, 33 professionals attended the interviews: 12 were supervisors and 21 were housekeeping cleaners. The main facilitator identified was a good perception by the housekeeping team regarding the project. We identified several sets of barriers: (1) human resources, such as supervisor executing the cleaning, inadequate sizing of human resources in shifts, reduced scale on Sunday and holiday shifts, and lack of professional replacement for sick leave and vacation; (2) supplies and equipment, such as torn bed linen, insufficient mops, centralized and inadequate dilution of sanitizers causing delays and impacting quality of hygiene; (3) education, such as lack of training program perceived by supervisors (management) and housekeeping cleaners (basic procedures for cleaning) and knowledge regarding who cleans what; (4) motivation and relationships, such as supervisor perceptions that housekeeping cleaners are unmotivated, and this causes absenteeism. The team feels that they are disregarded by doctors, and they have relationship problems with nursing and hospital engineering staff. Also, they are afraid of being physically assaulted by coworkers. Finally, professionals reported the perception that the hospital is not clean enough and that this is related to the short time goals imposed on the staff. Conclusions: The main barriers identified were related to education strategies and management of human and material resources. The results will support the intervention phase.
Funding: None
Disclosures: None
Staphylococcus spp Resistance to Chlorhexidine: Is There Any Impact Related to the Routine Use for Hand Hygiene?
- Icaro Boszczowski, William Kazumassa Minami, Marcia Baraldi, Ana Paula Marchi, nia Alves dos Santos, o Paulo cristiane schmitt, Amanda Luiz Pires Maciel, Maria Eduarda Rufino Zani, cia Muniz Souza, Nicole Soares de Souza, Silvia Figueiredo Costa
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s390-s391
- Print publication:
- October 2020
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Background: Although guidelines recommend the use of chlorhexidine gluconate (CHG) for hand hygiene (HH), the impact of its routine use on antimicrobial resistance is not clear. Objective: To analyze the impact on the CHG susceptibility among isolates obtained from hands of HCW during its routine use for HH. Methods: We conducted a crossover study at 4 medical-surgical wards of a tertiary-care hospital in São Paulo, Brazil. In 2 units (intervention group), we established routine use of CHG for HH. For the other 2 units (control group), regular soap was provided. The availability of alcohol formulation for HH was not changed during the study. Every 4 months we swapped the units, ie, those using CHG changed for regular soap and vice versa. At baseline, we cultured the hands of HCWs. Only nursing staff hands were investigated. For hand culturing, HCWs placed their hands inside a sterile bag containing a solution of phosphate-buffered saline, Tween 80, and sodium thiosulfate. After the solution incubated overnight, it was inoculated onto brain-heart infusion. Next, it was plated on McConkey and Mannitol agar. MALDI-TOF was used for identification. Agar dilution was performed for Staphylococcus spp. We selected all Staphylococcus spp with MIC ≥ 8 and performed inhibition of efflux pump test. For isolates that showed a decrease of 2 dilutions, we searched the gene qacA/B by polymerase chain reaction. Results: We obtained 262 samples from HCW hands yielding 428 isolates. The most frequent genera were Staphylococcus spp (58%), Acinetobacter spp (8%), Enterobacter spp (8%), Stenotrophomonas spp (5%), Klebsiella spp (4%), Pseudomonas spp (3%), and others (14%). Staphylococcus spp were less frequent in the intervention compared to control group (43% vs 61%; OR, 0.48; 95% CI, 0.29–0.69; P = .005). Among all Staphylococcus spp, the proportion of chlorhexidine resistance (RCHG; MIC ≥ 8) was 12%. All resistant isolates recovered susceptibility after inoculation with pump-efflux inhibitor. For pump-inhibited isolates, 53% had the gene qacA/B amplified by PCR. We did not investigate RCHG among gram-negative isolates. There was a nonsignificant increase in Staphylococcus spp RCHG in the intervention group (4% to 6%; P = .90). Healthcare-acquired infection rates did not change significantly during the intervention. The consumption of CHG increased from 7.3 to 13.9 mL per patient day. Conclusions: We did not detect a significant difference in RCHG during the routine use of CHG for HH, although we observed increasing resistance. Further investigation is needed to clarify other reasons for increasing MIC to CHG.
Funding: None
Disclosures: None
Point Prevalence Surveys and Customized Interventions Are Good Strategies to Improve Antimicrobial Use: The Brazilian Experience
- Ana Paula Matos Porto, Icaro Boszczowski, Ann Versporten, Ines Pauwels, Thais THAIS, Evelyne Girão, Patricia Esteves, Claudia Carrilho, Tiago Luiz Ferraz, Camila Donini, Herman Goossens, Silvia Figueiredo
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, p. s523
- Print publication:
- October 2020
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Background: Although antimicrobial stewardship is recommended by Brazilian government, data regarding prescription practices in the country are scarce. Objective: To describe the impact of 2 point-prevalence surveys and customized interventions on antimicrobial consumption among 8 hospitals in 3 regions of Brazil. Method: In 2017 and 2018, 8 tertiary-care Brazilian hospitals conducted the Global Point Prevalence Survey of Antimicrobial Consumption and Resistance (Global-PPS). All enrolled hospitals were provided the 2017 results. The group discussed intervention strategies by WhatsApp and e-mail. Hospitals customized interventions, including feedback to prescribers, discussion with pharmacists, and antimicrobial use data in accreditation process. A web-based program was used for data entry, validation, and reporting of details on AMC prescriptions. The Global-PPS was developed by the University of Antwerp and was funded by bioMérieux. The 1-day prevalences in 2017 and 2018 are presented as risk ratios. The main outcomes are whole antimicrobial use in hospitals and intensive care units (ICUs). Prevalence of infections caused by multidrug-resistant organisms (MDROs) were reported. Results: Overall, 1,716 patients were evaluated, of whom 420 (52.5%) and 429 (46.8%) were using antimicrobials in 2017 and 2018, respectively (P = .02). In 33 ICUs, 170 patients (61.4%) and 204 patients (56.8%) were on antimicrobials, in 2017 and 2018, respectively (P = .20). Significant decreases of overall use were observed for vancomycin (from 11% to 7%; P =.01), meropenem (from 12% to 9%; P = .04), and linezolid (from 1.5% to 0.33%; P =.01). There was no significant increase in any singular drug or class of drugs. Within ICUs, vancomycin use decreased significantly (from 19% to 11%; P = .005), linezolid use decreased significantly (from 2.9% to 0.3%; P = .01), colistin use decreased significantly (from 4.3% to 1.7%; P = .05), and metronidazole use decreased significantly (from 6.5% to 2.8%; P = .03). We observed a nonsignificant decrease of infections caused by MDROs across the whole hospital (from 8.7% to 6.6%; P = .10) and in the ICUs (from 15.2% to 12.3%; P = .30). The most frequent infectious diagnoses were pneumonia (27%), intra-abdominal sepsis (14%), skin and soft-tissue infection (SSTI) (9.4%), urinary tract infection (9.1%), and sepsis and septic shock with no identified focus (SSNIF) (7.4%). There was a significant increase in SST (from 7.6% to 11.4%; P = .03) and a decrease in SSNIF (from 10.7% to 4.1%; P = .00002). In 2018, there were significantly fewer antimicrobial prescriptions for healthcare-acquired infections (from 52.6% to 43.6%; P = .0007) and more antimicrobial prescriptions for community-acquired infections (from 27.4% to 34.6%; P = .003). We detected no difference for medical or surgical prophylaxis. Conclusions: Feedback of prescription practices might have had an impact on local policies of antimicrobial use, as demonstrated by an overall decrease is antimicrobial use and a decrease in the ICU.
Funding: This study was supported by Biomérieux.
Disclosures: None