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Objective The objective of this study was to evaluate the incidence of nosocomial infection and the impact of cross-transmission of SARS-CoV-2 among inpatients at a tertiary care teaching hospital. Methods This was a retrospective cohort study involving inpatients admitted to a tertiary university hospital in the city of Sao Paulo, Brazil, between March 2020 and February 2021. Cases were identified on the basis of a positive reverse-transcription polymerase chain reaction result for SARS-CoV-2 and the review of electronic medical records. Nosocomial transmission was defined by applying the criteria established by the Brazilian National Health Regulatory Agency. Results We identified 2146 cases of SARS-CoV-2 infection, 185 (8.6%) of which were considered cases of nosocomial transmission. The mean age was 58.3 years. The incidence density was 1.78 cases per 1,000 patient-days on the general wards, being highest on the cardiac surgery ward, and only 0.16 per 1,000 patient-days on the COVID-19 wards. Of the 185 patients evaluated, 115 (62.2%) were men, 150 (81.1%) cases had at least one comorbidity, and 104 (56.2%) evolved to death. Conclusions Despite the preventive measures taken, nosocomial transmission of SARS-CoV-2 occurred throughout our hospital. Such measures should be intensified when the incidence of community transmission peaks.

Background:Data on short-term peripheral intravenous catheter–related bloodstream infections per 1,000 peripheral venous catheter days (PIVCR BSIs per 1,000 PVC days) rates from Latin America are not available, so they have not been thoroughly studied.Methods:International Nosocomial Infection Control Consortium (INICC) members conducted a prospective, surveillance study on PIVCR BSIs from January 2010 to March 2018 in 100 intensive care units (ICUs) among 41 hospitals, in 26 cities of 9 countries in Latin America (Argentina, Brazil, Colombia, Costa Rica, Dominican-Republic, Ecuador, Mexico, Panama, and Venezuela). The Centers for Disease Control and Prevention (CDC) National Health Safety Network (NHSN) definitions were applied, and INICC methodology and INICC Surveillance Online System software were used.Results:In total, 10,120 ICU patients were followed for 40,078 bed days and 38,262 PVC days. In addition, 79 PIVCR BSIs were identified, with a rate of 2.06 per 1,000 PVC days (95% confidence interval [CI], 1.635–2.257). The average length of stay (ALOS) of patients without a PIVCR BSI was 3.95 days, and the ALOS was 5.29 days for patients with a PIVCR BSI. The crude extra ALOS was 1.34 days (RR, 1.33; 95% CI, 1.0975–1.6351; P = .040).The mortality rate in patients without PIVCR BSI was 3.67%, and this rate was 6.33% in patients with a PIVCR BSI. The crude extra mortality was 1.70 times higher. The microorganism profile showed 48.5% gram-positive bacteria (coagulase-negative Staphylococci 25.7%) and 48.5% gram-negative bacteria: Acinetobacter spp, Escherichia coli, and Klebsiella spp (8.5% each one), Pseudomonas aeruginosa (5.7%), and Candida spp (2.8%). The resistances of Pseudomonas aeruginosa were 0% to amikacin and 50% to meropenem. The resistance of Acinetobacter baumanii to amikacin was 0%, and the resistance of coagulase-negative Staphylococcus to oxacillin was 75%.Conclusions:Our PIVCR BSI rates were higher than rates from more economically developed countries and were similar to those of countries with limited resources.

Environmental cleaning and disinfection are fundamental health care-associated infection prevention measures. This study aimed to evaluate the disinfection compliance of high-touch surfaces in a COVID-19-only intensive care unit, using a fluorescent marker. It was divided into 3 phases, baseline assessment, educational feedback, and post feedback. Disinfection compliance improved significantly from the first to the third phase, 14.3% to 51.4% (P.001), respectively.

Objectives: to verify the relationship of cardiovascular diseases with acute kidney injury and assess the prognosis of patients in renal replacement therapy. Methods: a cohort study, carried out in a public hospital specialized in cardiology. Treatment, comorbidities, duration of treatment, laboratory tests, discharge and deaths were analyzed. Results: of the 101 patients, 75 (74.3%) received non-dialysis treatment. The most frequent cardiological diagnoses were hypertension, cardiomyopathies and coronary syndrome. Hospitalization in patients undergoing dialysis was 18 days, hemoglobin

RESUMO Objetivos: verificar a relação de patologias cardíacas com injuria renal aguda e avaliar o prognóstico do paciente em terapia de substituição renal. Métodos: estudo de coorte, realizado em hospital público especializado em cardiologia. O tratamento, comorbidades, tempo de tratamento, exames laboratoriais, alta e óbitos foram analisados. Resultados: dos 101 pacientes, 75 (74,3%) receberam tratamento não dialítico. Os diagnósticos cardiológicos mais frequentes foram hipertensão arterial, miocardiopatias e síndrome coronariana. A internação nos pacientes dialíticos foi de 18 dias, a hemoglobina

Objectives: to assess the prevalence of colonization and infection by multidrug-resistant bacteria in patients undergoing kidney transplantation and identify the rate of infection, morbidity and mortality and associated risk factors. Methods: a prospective cohort of 200 randomly included kidney transplant recipients. Epidemiological surveillance of the studied microorganisms was carried out in the first 24 hours and 7 days after transplantation. Results: ninety (45%) patients were considered colonized. Female sex, hypertension and diabetes (p

Objetivo: investigar o consumo de álcool entre universitários de enfermagem e avaliar intervenção breve para abusadores de álcool. Método: estudo longitudinal, experimental. Dados coletados por questionário autoaplicável e três instrumentos. Análise estatística descritiva e utilização de testes específicos. Resultados: participaram 36 universitários e as drogas mais utilizadas foram: álcool (vodka, cerveja), tabaco e maconha. Idade do primeiro uso de álcool: 15 anos; repercussões após uso: quedas, cefaleia, vômitos e amnésia; e os motivos para consumo: social, sensação e prazer. Intervenção breve diminuiu significativamente o consumo de risco entre os abusadores. Entre os bebedores de baixo risco, metade referiu estar preparada para diminuir o consumo. Conclusão: intervenção breve diminui significativamente o padrão de consumo de álcool, promovendo a saúde.

Introdução: As infecções da corrente sanguínea (ICS) estão entre as infecções mais graves adquiridas por pacientes hospitalizados que necessitam de tratamentos intensivos (UTIs). Atualmente, estamos vivendo uma pandemia de COVID-19 e o Hospital São Paulo - Unifesp é um importante centro de tratamento para estes pacientes. Objetivos: Analisar o impacto das ICS em pacientes internados em UTIs de um hospital universitário; identificar quais são os padrões de prescrição médica empírica de antibióticos em ICS e quais são os fatores para letalidade nos pacientes observados; avaliar o impacto das ICS primárias em pacientes com diagnóstico de COVID-19. Casuística e métodos: Estudo tipo coorte, com o período de 01/2020 a 12/2020. Local: UTIs do Hospital Universitário HSP-Unifesp (120 leitos). Os dados foram coletados por vigilância prospectiva de pacientes com ICS pelo prontuário eletrônico com o apoio da Comissão de Controle de Infecção Hospitalar do HSP-Unifesp. O acompanhamento dos casos foi realizado até 30 dias após o resultado positivo no exame de hemocultura para definição dos desfechos. O estudo foi aprovado pelo Comitê de Ética em Pesquisa - Plataforma Brasil sob o número CAAE: 12251219.2.0000.5505. Resultados: Foram 112 casos de ICS em 105 pacientes. Destes, 46 pacientes eram COVID-19 positivos e 59 não tinham infecção por COVID-19 (56,2%). Pacientes COVID-19 positivos apresentaram densidade de incidência de ICS de 9,82 casos ICS/1000 pacientes UTI-dia; e não COVID-19 de 4,97 casos ICS/1000 pacientes UTI-dia; p < 0,001, OR = 1,98 (1,36-2,88)). Ambos os grupos apresentaram alta mortalidade (71,74% COIVD-19 e de 60,01% sem COVID; p = 0,251). O estudo dos pacientes com ICS, em relação com seus desfechos, independente do COVID-19, mostrou que maiores índices no score APACHE II, aplicado nas primeiras 48 horas da admissão, tiveram menor sobrevida (média 17,74 pontos no grupo com óbito e 11,47 pontos no grupo com alta; p < 0,001, OR = 0,84 (0,78-0,91)). A vigência de um tratamento empírico correto à ICS apresentou maior sobrevida (33,33% no grupo alta e 10,14% com óbito; p = 0,003; OR = 4,42 (1,55-12,58)). Conclusão: O estudo mostrou elevada mortalidade geral associada às ICS. Índices mais elevados no score APACHE II estavam relacionados à maior mortalidade. A vigência de uma terapia empírica adequada esteve relacionada à maior sobrevida. Observamos que a infecção pelo SARS-CoV-2 é uma variável de maior risco de ICS com elevada morbimortalidade.

Background: Kidney transplant recipients are a group of patients at risk for healthcare-related infections. The results of this study make an important clinical contribution and contribute to findings options to decrease the infection-related morbidity and mortality that affects this patient population. Objectives: We evaluated the prevalence of colonization by multidrug-resistant bacteria, Klebsiella pneumoniae carbapenemase (KPC)–producing bacteria, vancomycin-resistant enterococci (VRE), and methicillin-resistant Staphylococcus aureus (MRSA) in renal transplant patients; we identified the infection rate, morbidity, and mortality in this population. Methods: Prospective cohort study was conducted at the Kidney and Hypertension Hospital from 2012 to 2015. This project was approved by the Unifesp Research Ethics Committee (no. 1630/11) and an informed consent form was obtained from patients included in the study. Study protocol: Data collection was performed in 2 phases: within the first 24 hours after transplantation and 7 days after transplantation. For all included patients, the following data were collected: identification data, clinical data, and laboratory tests of the first day in the study. All included patients (colonized or not) were followed prospectively for 6 months or until treatment change or death. Results: The study included 200 renal transplant patients in accordance with the inclusion and exclusion criteria. We observed that 76 (38%) patients included in our sample were colonized; 8% S. aureus, 11% Enterococcus, and 19% K. pneumoniae. We verified the presence of concomitant colonization of 1 or more of these pathogens. The most prevalent concomitance identified in our population was E. coli and K. pneumoniae. We identified the presence of diabetes and diabetes associated with hypertension as risk factor for colonization. Thus, patients with more systemic complications may be at risk for colonization by multidrug-resistant bacteria. Another risk factor for colonization was antibiotic use in the 6 months prior to transplantation. Transplant-related outcomes were length of stay after transplantation, delayed graft function (ie, dialysis after the transplantation) and postoperative care in an intensive care unit. At the 6-month follow-up, we identified urinary infection and surgical site infection as risk factors. One death occurred due to stroke in the group of colonized patients, unrelated to infectious causes. Conclusions: These results show fundamental aspects for health professionals for bacterial characterization, transmission, and resistance mechanisms and, mainly, tools for prevention and control of multidrug-resistant bacteria from patients colonized under conservative treatment before the complexity of high-risk procedures begins, such as dialysis and transplantation to reduce morbidity and mortality.Funding: FAPESP São Paulo Research Support FoundationDisclosures: None

Objective: to analyze clinical, serological, biochemical and hematological aspects in patients infected with the hepatitis B (HBV) and Delta (HDV) viruses. Method: cross-sectional, descriptive and retrospective study, performed with patients chronically infected with HBV and superinfected with HDV. Results: among the 112 patients selected, 74% were monoinfected with HBV (Group HBV) and 26% were superinfected with HDV (Group HBV+HDV). There was no difference in gender distribution. The average age was 36 years with standard deviation of ±12 years. The symptoms and signs presented a higher proportion in Group HBV+HDV (p=0.001). In both groups, most patients had non-reactive AgHBe. The records of biochemical and hematologic changes showed highest proportion in Group VHB+VHD Group (p

A infecção por Streptococcus do grupo B (GBS) é considerada importante problema de saúde pública. Está associada à sepse neonatal, meningite, pneumonia, óbito neonatal, aborto séptico, coriomnionite, endometrite e outras infecções perinatais. O objetivo deste estudo foi determinar a melhor estratégia de rastreamento de GBS em gestantes. Como método usou-se a revisão sistemática com metanálise. A pesquisa foi realizada no Departamento de Enfermagem/Universidade Federal de São Paulo (UNIFESP)/Centro Cochrane do Brasil. Para a busca usaram-se as fontes Embase, LILACS, MEDLINE, lista de referências bibliográficas, comunicação pessoal e Cochrane Library. Usaram-se, como critério de seleção, os estudos que analisaram algum tipo de rastreamento para GBS em gestantes. Independente do comparador, os resultados apontam que todas as análises foram favoráveis ao programa de screening universal para a redução da incidência de sepse neonatal. Pode-se concluir que evidências obtidas no estudo são sugestivas de que a estratégia de screening universal para as gestantes, associada ao uso de antibiótico profilático, é segura e efetiva. Infection with Group B Streptococcus (GBS) is considered an important public health problem. It is associated with: Neonatal sepsis, meningitis, pneumonia, neonatal death, septic abortion, chorioamnionitis, endometritis and other perinatal infections. The aim of this study was to determine the best screening strategy for GBS in pregnant women. For this a systematic review and meta-analysis were carried out in the Nursing Department of the Federal University of São Paulo, Cochrane Center, Brazil. Sources used were, EMBASE, LILACS, Medline, list of references, personal communication and the Cochrane library. The criterion for the selection of the studies was; studies which analyze some type of screening for GBS in pregnant women. Independent of the comparator, all analyses were in favor of a universal screening program for reducing the incidence of neonatal sepsis. The evidence obtained in this study suggests that the strategy of universal screening of pregnant women associated with the use of prophylactic antibiotics is safe and effective. La infección por Streptococcus del grupo B (GBS) es considerada un importante problema de salud pública. Los estreptococos están asociados a: sepsis neonatal, meningitis, neumonía, muerte neonatal, aborto séptico, corioamnionitis, endometritis y otras infecciones perinatales. El objetico del estudio fue determinar la mejor estrategia de rastreo de GBS en gestantes. Se trata de una revisión Sistemática con Metanálisis. Fue realizada en el Departamento de Enfermería de la Universidad Federal de São Paulo, Centro Cochrane de Brasil. Se utilizaron las siguientes fuentes: EMBASE, LILACS, Medline, lista de referencias bibliográficas, comunicación personal y Cochrane Library. Como criterio para la selección de los estudios, se escogieron los que analizaron algún tipo de rastreo para GBS en gestantes. Independientemente del comparador, todos los análisis fueron favorables al programa de screening universal para la reducción de la incidencia de sepsis neonatal. Las evidencias obtenidas en el estudio sugieren que la estrategia de screening universal para las gestantes asociado al uso de antibióticos profilácticos es segura y efectiva. Universidade Federal de São Paulo (UNIFESP) Departamento de Enfermagem UNIFESP, Depto. de Enfermagem SciELO

The objective of this study was to investigate the occurrence of vancomycin-resistant Enterococcus (VRE) cross-transmission between two patient groups (long-term dialysis and kidney transplant patients). Molecular typing, by automated ribotyping with the RiboPrinter Microbial Characterization System (Qualicon, USA), was used to analyze VRE isolates from 31 fecal samples of 320 dialysis patients and 38 fecal samples of 280 kidney transplant patients. Clonal spread of E. faecalis and E. casseliflavus was observed intragroup, but not between the two groups of patients. In turn, transmission of E. gallinarum and E. faecium between the groups was suggested by the finding of vancomycin-resistant isolates belonging to the same ribogroup in both dialysis and transplant patients. The fact that these patients were colonized by VRE from the same ribogroup in the same health care facility provides evidence for cross-transmission and supports the adoption of stringent infection control measures to prevent dissemination of these bacteria.

OBJETIVOS: Avaliar a efetividade de dois tipos de curativos utilizados em cateter venoso central (CVC) em pacientes submetidos à hemodiálise; identificar a taxa de infecção no local de saída e de bacteremia comparando o curativo com gaze e micropore em relação ao filme transparente. MÉTODOS: Foi realizado um ensaio clínico randomizado controlado abrangendo 66 pacientes, sendo 33 nos grupos 1 e 2, respectivamente. No Grupo 1 o curativo utilizado foi gaze e micropore e no Grupo 2 filme transparente. Foram coletados os dados sócio demográficos, clínicos e os relacionados às infecções. Os 66 pacientes permaneceram no estudo até a indicação de retirada do cateter que ocorreu nos episódios de infecção quando foram realizadas culturas de óstio e da ponta do CVC e hemocultura quando indicado. RESULTADOS: Não houve diferença estatística significante quanto ao tipo de curativo e as variáveis estudadas. Os CVC posicionados a 90º em relação a pele apresentaram maior taxa de infecção por S. aureus. CONCLUSÃO: O uso do filme transparente não proporcionou redução de infecção, porém a análise qualitativa deste tipo de curativo teve melhor aceitação pelos pacientes e profissionais da Unidade de Diálise de um Hospital Universitário. OBJECTIVES: To evaluate the efficacy of two types of dressings used on central venous catheter (CVC) in patients undergoing hemodialysis and to determine the rate of local and systemic bacterial infection when using gauze and micropore dressings or transparent film dressings. METHODS: This study was a controlled randomized clinical trial with 66 subjects who were equally assigned to two groups (33 subjects per group). Group 1 used gauze and micropore dressings and group 2 used transparent film dressings. Measures consisted of a socio demographic questionnaire, clinical data, and catheter tip and blood culture tests. Subjects remained in the study until removal of the catheter. RESULTS: There were no statistically significant differences regarding the types of dressings. Positioning of CVCs at 90 degrees in relation to the skin had higher rate of infections by S. Aureus. CONCLUSION: Although the use of transparent film dressings did not reduce infection, qualitative data analysis suggested that this type of dressing was preferred by the patients and by the health care providers from a university hospital. OBJETIVOS: Evaluar la efectividad de dos tipos de curativos utilizados en cateter venoso central (CVC) en pacientes submetidos al hemodiálisis; identificar el índice de infección en el local de salida y de bacteremia comparando el curativo con gaza y micropore el con al filme transparente. MÉTODOS: Fue realizado un ensayo clínico randomizado controlado. En el Grupo 1 el curativo utilizado fue gaza y micropore y en el Grupo 2 filme transparente. Fueron colectados los datos sócio demográficos, clínicos y los relacionados a las infecciones. Los 66 pacientes permanecieron en el estudio hasta la indicación de retirada del cateter que ocurrió en los episodios de infección cuando fueron realizadas culturas de óstio y de la extremidad del CVC y hemocultura cuando indicado. RESULTADOS: Fueron incluídos 33 pacientes en cada grupo. No hubo diferencia estadística significante cuanto al tipo de curativo y las variables estudiadas. Los CVC posicionados a 90º en relación a la piel presentaron mayor índice de infección por S. aureus. CONCLUSIÓN: El uso del filme transparente no proporcionó reducción de infección, sin embargo el análisis cualitativo de este tipo de curativo tuvo mejor aceptación por los pacientes y profesionales.

Background Infection is the leading cause of morbidity and the second leading cause of mortality in patients on renal replacement therapy. The rates of bloodstream infection in hemodialysis patients vary according to the type of venous access used. Gram-positive bacteria are most frequently isolated in blood cultures of hemodialysis patients. This study evaluated risk factors for the development of bloodstream infections in patients undergoing hemodialysis. Methods Risk factors associated with bloodstream infections in patients on hemodialysis were investigated using a case–control study conducted between January 2010 and June 2013. Chronic renal disease patients on hemodialysis who presented with positive blood cultures during the study were considered as cases. Controls were hemodialysis patients from the same institution who did not present with positive blood cultures during the study period. Data were collected from medical records. Logistic regression was used for statistical analysis. Results There were 162 patients included in the study (81 cases and 81 controls). Gram-positive bacteria were isolated with the highest frequency (72%). In initial logistic regression analysis, variables were hypertension, peritoneal dialysis with previous treatment, type and time of current venous access, type of previous venous access, previous use of antimicrobials, and previous hospitalization related to bloodstream infections. Multiple regression analysis showed that the patients who had a central venous catheter had an 11.2-fold (CI 95%: 5.17–24.29) increased chance of developing bloodstream infections compared with patients who had an arteriovenous fistula for vascular access. Previous hospitalization increased the chance of developing bloodstream infections 6.6-fold (CI 95%: 1.9–23.09). Conclusions Infection prevention measures for bloodstream infections related to central venous catheter use should be intensified, as well as judicious use of this route for vascular access for hemodialysis. Reducing exposure to the hospital environment through admission could contribute to a reduction in bloodstream infections in this population.

OBJECTIVE To verify if the type of donor is a risk factor for infection in kidney transplant recipients. METHODS Systematic Review of Literature with Meta-analysis with searches conducted in the databases MEDLINE, LILACS, Embase, Cochrane, Web of Science, SciELO and CINAHL. RESULTS We selected 198 studies and included four observational studies describing infections among patients distinguishing the type of donor. Through meta-analysis, it was shown that in patients undergoing deceased donor transplant, the outcome infection was 2.65 higher, than those who received an organ from a living donor. CONCLUSION The study showed that deceased kidney donor recipients are at an increased risk for developing infections and so the need for establishing and enforcing protocols from proper management of ischemic time to the prevention and control of infection in this population emerges.

OBJECTIVES: to assess renal function in elderly patients undergoing contrast-enhanced computed tomography and identify the preventive measures of acute kidney injury in the period before and after the examination.METHOD: longitudinal cohort study conducted at the Federal University of São Paulo Hospital, from March 2011 to March 2013. All hospitalized elderly, of both sexes, aged 60 years and above, who performed the examination, were included (n=93). We collected sociodemographic data, data related to the examination and to the care provided, and creatinine values prior and post exam.RESULTS: an alteration in renal function was observed in 51 patients (54%) with a statistically significant increase of creatinine values (p