scholarly journals Hospital Preparedness for a Community Measles Outbreak in Ribeirao Preto, Brazil

2020 ◽  
Vol 41 (S1) ◽  
pp. s253-s253
Author(s):  
Silvia Fonseca ◽  
Ivana Lucca ◽  
Franceliana Sgobi ◽  
Andre Fioravante ◽  
Alexandre Celia ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Maculopapular Rash ◽  
Sao Paulo ◽  
Suspected Case ◽  
Care Hospital ◽  
São Paulo ◽  
Measles Outbreak ◽  
Hospital Infection Control ◽  
Hospital Preparedness ◽  
Measles Vaccination

Background: Measles was considered eradicated in Brazil in 2016, but the virus reemerged in the country in 2018, causing large outbreaks. Ribeirao Preto has been measles free since 1997, but the outbreak in Sao Paulo City, 180 miles away in June 2019, alerted us to the possibility of measles patients coming to our emergency room (ER). The preparedness challenge was considerable: most healthcare workers (HCWs) had never seen a measles case before, and confirmatory measles laboratory tests were not readily available to us. Objective: To describe the hospital preparedness for the coming community measles outbreak. Methods: Hospital So Francisco is a 170-bed, general, tertiary-care hospital with 10,000 ER visits monthly. Measles preparedness consisted of measles training classes for HCWs, and flow charts with pictures and measles information in every ER office, also sent to HCW cell phones. We also designated areas for suspected measles patients for prompt medical evaluation; and we implemented mass measles vaccination for all hospital HCWs regardless of vaccination status, excluding pregnant or immunosuppressed HCWs. We considered a measles suspected case any person with fever, 1 of 3 symptoms (cough, coryza or conjunctivitis), and a generalized maculopapular rash with head-to-toe distribution. All contacts for suspected cases were recommended to obtain a measles vaccination. Detection of viral RNA in a biological sample and or a positive IgM result in serum was used to confirm a clinically suspected case. The study period spanned July 2019 to September 2019. Results: Measles training occurred for 3 weeks in July–August and reached 200 HCWs. The measles vaccination was offered July 23 to August 15; 1,362 HCWs were already vaccinated (93% of target population). In total, 35 clinical suspected measles cases were seen in the ER, and 3 of these were HCWs who had received the measles vaccine in their incubation period. Also, 3 patients were admitted to the hospital and 1 to the intensive care unit; there were no deaths. Overall, 8 patients had laboratory-confirmed measles, and 1,343 community contacts of these patients were vaccinated. We did not detect measles transmission to inpatients or to other HCWs after mass vaccination began. In the same period, Sao Paulo state had >7,000 laboratory-confirmed measles cases and 12 deaths. Conclusions: Community measles outbreaks are a challenge for the hospital infection control team, and they can potentially disrupt the daily activities in the hospital. We were able to adequately prepare for the largest state outbreak in 20 years without secondary cases or deaths.Funding: NoneDisclosures: None

scholarly journals The Worth of Surveillance for Vancomycin-Resistant Enterococci in the Hematology-Oncology Unit

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 6009-6009
Author(s):  
Marcelo Bellesso ◽  
Edson Abdala ◽  
Juliana Pereira ◽  
Rodrigo Santucci ◽  
Karim Yaqub Ibrahim ◽  
...  
Keyword(s):  
Neutrophil Count ◽  
The United States ◽  
Sao Paulo ◽  
Care Hospital ◽  
São Paulo ◽  
Microbiological Methods ◽  
Hospital Infection Control ◽  
Vancomycin Resistant ◽  
Oncology Unit

Abstract Background: Vancomycin-resistant enterococcus (VRE) has become a nosocomial pathogen of increasing importance. First identified in Europe in 1988, it has since been identified in multiple sites in the United States and Canada, as well as in Latin America. A 20-fold increase in the percentage of enterococci associated with nosocomial infections that were resistant to vancomycin, from 0.4% in 1989 to 7.9% in 1993, has been reported by the Centers for Disease Control and Prevention. VRE outbreak has been identified on February 2012 in hematology-oncology unit. It has since implemented some outbreak measures in order to control this outbreak, and as part of the control program during this outbreak of VRE infection in oncology-hematology unit of our tertiary care hospital, swab anal cultures have been performed weekly for inpatients as well as at the moment of their hospitalization. Objectives: To assess the incidence of colonization and infection by VRE of admitted patients in oncology-hematology unit and to evaluate the role of neutropenia and central line as well as their impact on blood stream infection (BSI) by VRE in previous colonized patients. Methods: All patients admitted to hematology-oncology unit in Instituto do Câncer do Estado de São Paulo São Paulo (ICESP) were undertaken to surveillance for VRE by Hospital Infection Control Committee from March 1, 2012 to May 31, 2014. It is important to highlight that ICESP has not promoted bone marrow transplantation. Neutropenia was defined as a neutrophil count ≤0.5 x 109/L. Feces (in patients with neutropenia) or rectal swab for those with a neutrophil count >0.5 x 109/L were collected for research VRE on admission and weekly for those that persist with negative results. Enterococci were isolated by standard microbiological methods. It was considered patients with colonized VRE when a bacterium is present, without any signs or symptoms of infection. BSI by VRE was defined in patients with positive blood culture for VRE. Results: A total of 1,666 patients had been screening for VRE colonization. One hundred sixty-one cases of VRE colonization were detected among them. The rate of VRE colonization during hospitalization was 9.7%. The incidence rate of VRE colonization was 9.4 cases per 1,000 inpatient-days. Twenty (12.4%) out of 161 VRE colonized patients developed BSI by VRE. The incidence of BSI by VRE was 1.2 cases per 1,000 inpatient-days. Eleven (55%) patients with BSI by VRE presented Acute Leukemia. A hundred percent of patients with BSI by VRE presented neutropenia and 14 (70%) out of 20 had central venous catheter inserted as well. Conclusions: We conclude that it is important to perform surveillance for VRE due to our incidence of patients colonized by VRE such as BSI by VRE. We believe these data may justify surveillance attendance and contact precautions. It was observed the importance of neutropenia to BSI by VRE in patients previously colonized. Thus, this fact could suggest that others studies are necessary in order to evaluate the role of antibiotic as linezolid for febrile neutropenia treatment in patients colonized by VRE. Disclosures No relevant conflicts of interest to declare.

scholarly journals Gestão da Enfermagem em Hospital Geral Público Acreditado no Enfrentamento da Pandemia por COVID-19

2020 ◽  
Vol 11 (1.ESP) ◽  
Author(s):  
Paula Maria Corrêa de Gouveia Araujo ◽  
Elena Bohomol ◽  
Tereza Aparecida Benjamim Teixeira
Keyword(s):  
General Hospital ◽  
State Government ◽  
Tertiary Care ◽  
Sao Paulo ◽  
Direct Care ◽  
Care Hospital ◽  
São Paulo ◽  
Nursing Management ◽  
Hospital Unit ◽  
Hospital General

Objetivo: Relatar a experiência vivenciada pela gestão de enfermagem de um hospital geral público acreditado e apresentar as principais mudanças na estrutura institucional para o enfrentamento da pandemia. Método: Relato de experiência em uma Organização Social de Saúde de parceria com governo estadual. Trata-se de um hospital geral de nível terciário com 247 leitos. Resultados: As principais mudanças estruturais e de processos de trabalho ocorridas durante o período de 13 de março a 23 de abril de 2020 foram: Implantação de um Comitê de Crise; programação de treinamentos institucionais; medidas administrativas voltadas ao cancelamento de cirurgias eletivas; disponibilização de equipamentos de proteção individual; mudanças no fluxo de entrada do paciente com suspeita de COVID-19; mudanças nas características das unidades; incremento no número de leitos; contratação de pessoal; e apoio para equipe. Conclusão: Destaca-se a importância da equipe de enfermagem e seu preparo para gerenciar novos espaços, alocar recursos e treinar a equipe no atendimento direto ao paciente.Descritores: pandemia; COVID-19; enfermagem; infecções por coronavírus. NURSING MANAGEMENT IN AN ACCREDITED PUBLIC GENERAL HOSPITAL IN THE RESPONSE TO THE COVID-19 PANDEMICObjective: Reporting the experiences of the nursing management team of an accredited Brazilian public general hospital and the main institutional changes made to face the COVID-19 pandemic. Method: An experience report about a Social Healthcare Organization that has a partnership with the São Paulo state government. This is a 247-bed tertiary care hospital. Results: During the period between March 13 and April 23 2020, the main changes made to the institution and its work practices were: Implementing a Crisis Committee; scheduling institutional trainings; managerial measures concerning the cancellation of elective surgeries; providing personal protective equipment; changes in the admission of patients with suspected COVID-19; changes in the characteristics of the hospital unit; an increase in the number of beds; hiring new personnel; and supporting the current staff. Conclusion: This highlights the importance of the nursing team and how prepared it is to manage new rooms, allocate resources, and get the staff ready for the direct care of patients.Descriptors: pandemic, COVID-19; nursing; coronavirus infections. GESTIÓN DE ENFERMERÍA EN UN HOSPITAL GENERAL PÚBLICO ACREDITADO EN EL ENFRENTAMIENTO DE LA PANDEMIA DE COVID-19Resumen Objetivo: Reportar la experiencia de la gestión de enfermería de un hospital general público acreditado brasileño y presentar los principales cambios en la estructura institucional para enfrentar la pandemia de COVID-19. Metodo: Registro de experiencia en una Organización Social de Salud en colaboración con el gobierno del Estado de São Paulo. Se trata de un hospital general de nivel tercer nivel con 247 camas. Resultados: Los principales cambios estructurales y en los procesos de trabajo ocurridos en el periodo entre el 13 de marzo y el 23 de abril fueron: La implantación de un Comité de Crisis; programación de prácticas institucionales; medidas administrativas dirigidas a la cancelación de cirugías electivas;  disponibilidad de  equipos de protección individual;  cambios en el flujo de ingreso de pacientes con sospecha de COVID-19; cambios en las características de la unidad hospitalaria; incremento en el número de camas; contratación de personal; y apoyo al equipo. Conclusión: Se destaca la importancia del equipo de enfermería y su preparación para gestionar nuevos espacios, alocar recursos e instruir el equipo para la atención directa al paciente.Descriptores: pandemia; COVID-19; enfermaría; infecciones por coronavirus.

scholarly journals Genetic relatedness among clinical strains of Stenotrophomonas maltophilia in tertiary care hospital settings in São Paulo State, Brazil

2007 ◽  
Vol 38 (2) ◽  
pp. 278-284 ◽  
Author(s):  
Margarete Teresa Gottardo Almeida ◽  
Fernando Gôngora Rubio ◽  
Doroti Oliveira Garcia ◽  
Érika Cristina Pavarino-Bertelli ◽  
Andrea Regina Baptista Rossit ◽  
...  
Keyword(s):  
Stenotrophomonas Maltophilia ◽  
Genetic Relatedness ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Sao Paulo ◽  
Care Hospital ◽  
São Paulo ◽  
Clinical Strains ◽  
Paulo State ◽  
São Paulo State

scholarly journals Assessing screening practices among health care workers at a tertiary-care hospital in Sao Paulo, Brazil

Clinics ◽  
2010 ◽  
Vol 65 (2) ◽  
pp. 151-155 ◽  
Author(s):  
Ana Claudia Gonçalves-Silva ◽  
Cristiane Murta-Nascimento ◽  
José Eluf-Neto
Keyword(s):  
Health Care ◽  
Health Care Workers ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Sao Paulo ◽  
Care Hospital ◽  
São Paulo ◽  
Screening Practices ◽  
Care Workers

scholarly journals HIV-infected youths transitioning from pediatric to adult outpatient care in a teaching tertiary care hospital in São Paulo city, Brazil

2019 ◽  
Vol 23 (5) ◽  
pp. 291-297
Author(s):  
Angela Carvalho Freitas ◽  
Vivian Iida Avelino-Silva ◽  
Eliana Battaggia Gutierrez ◽  
Heloisa Helena de Souza Marques ◽  
Giuliana Stravinskas Durigon ◽  
...  
Keyword(s):  
Outpatient Care ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Sao Paulo ◽  
Care Hospital ◽  
São Paulo ◽  
Adult Outpatient

scholarly journals Device associated and surgical site infections, quality indicators in a tertiary care hospital: A 5 year study

2021 ◽  
Vol 9 (3) ◽  
pp. 132-146
Author(s):  
Bilolikar AK ◽  
Banerjee J ◽  
Thomas KM
Keyword(s):  
Quality Indicators ◽  
Tertiary Care ◽  
Surgical Site Infections ◽  
Central Line ◽  
Bench Mark ◽  
Care Hospital ◽  
Statistical Tool ◽  
Hospital Infection Control ◽  
Control And Prevention ◽  
Healthcare Associated

Purpose: In the present study, an attempt is made to understand the pattern of HAIs (Healthcare Associated Infections) [device associated infections such as Catheter Associated Urinary Tract Infection (CAUTI), Ventilator Associated Event (VAE), Central Line-Associated Bloodstream Infection (CLABSI) & Surgical Site Infection (SSI) by analyzing statistical tool of quality indicators] and to establish a bench mark for HAIs in a single hospital for a period of 5 years. Methods: The Microbiologist & ICN’s conduct rounds in ICU’s & wards and collect data for active surveillance. The details of culture positive samples are collected by Microbiologist from the laboratory for passive surveillance. The surveillance forms (active & passive) capture details of individual patients. The data collection forms are prepared and updated as per Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN) guidelines. The data is analyzed and presented in the meeting of Hospital Infection Control Committee meeting & discussed with clinicians. Results: The cumulative (5 years) CAUTI rate is 0.45, VAE is 2.42, CLABSI is 1.35 & SSI is 0.21. HAI rates were highest for VAE (2.42/1000 ventilator days), the next was CLABSI (1.35/1000 central line days), followed by CAUTI (0.45/1000 urinary catheter days). SSI rate was 0.21/ 100 surgeries. Conclusions: Before the study was started, the benchmark were 2 for CAUTI, 5.5 for VAE, 3 for CLABSI and 2 for SSI. We could able to reduce the baseline benchmark and established our new benchmark as 1 for CAUTI, 3 for VAE, 2 for CLABSI and 1 for SSI that can be used in developing HAI prevention policies by the institution.

scholarly journals Paradigm Shift in Antimicrobial Resistance Pattern of Bacterial Isolates during the COVID-19 Pandemic

Antibiotics ◽  
2021 ◽  
Vol 10 (8) ◽  
pp. 954
Author(s):  
Vikas Saini ◽  
Charu Jain ◽  
Narendra Pal Singh ◽  
Ahmad Alsulimani ◽  
Chhavi Gupta ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Antimicrobial Resistance ◽  
Tertiary Care ◽  
Public Health Problem ◽  
Resistance Pattern ◽  
Coagulase Negative Staphylococcus ◽  
Care Hospital ◽  
Bacterial Isolates ◽  
Hospital Infection Control ◽  
And Staphylococcus Aureus

Antimicrobial resistance (AMR) is an emerging public health problem in modern times and the current COVID-19 pandemic has further exaggerated this problem. Due to bacterial co-infection in COVID-19 cases, an irrational consumption of antibiotics has occurred during the pandemic. This study aimed to observe the COVID-19 patients hospitalized from 1 March 2019 to 31 December 2020 and to evaluate the AMR pattern of bacterial agents isolated. This was a single-center study comprising 494 bacterial isolates (blood and urine) that were obtained from patients with SARS-CoV-2 admitted to the ICU and investigated in the Department of Microbiology of a tertiary care hospital in Delhi, India. Out of the total bacterial isolates, 55.46% were gram negative and 44.53% were gram positive pathogens. Of the blood samples processed, the most common isolates were CoNS (Coagulase Negative Staphylococcus) and Staphylococcus aureus. Amongst the urinary isolates, most common pathogens were Escherichia coli and Staphylococcus aureus. A total of 60% MRSA was observed in urine and blood isolates. Up to 40% increase in AMR was observed amongst these isolates obtained during COVID-19 period compared to pre-COVID-19 times. The overuse of antibiotics gave abundant opportunity for the bacterial pathogens to gradually develop mechanisms and to acquire resistance. Since the dynamics of SARS-COV-2 are unpredictable, a compromise on hospital antibiotic policy may ultimately escalate the burden of drug resistant pathogens in hospitals. A shortage of trained staff during COVID-19 pandemic renders it impossible to maintain these records in places where the entire hospital staff is struggling to save lives. This study highlights the extensive rise in the use of antibiotics for respiratory illness due to COVID-19 compared to antibiotic use prior to COVID-19 in ICUs. The regular prescription audit followed by a constant surveillance of hospital infection control practices by the dedicated teams and training of clinicians can improve the quality of medications in the long run and help to fight the menace of AMR.

scholarly journals Phenotypic and Genotypic Detection of Methicillin Resistant Staphylococcus aureus in Health Care Workers and Its Containment in a Tertiary Care Hospital, in South India

2021 ◽  
Author(s):  
Shamim Rahman ◽  
Ragini Ananth Kashid
Keyword(s):  
Staphylococcus Aureus ◽  
Tertiary Care ◽  
Meca Gene ◽  
Control Measures ◽  
Care Hospital ◽  
Beta Lactam ◽  
Accurate Identification ◽  
Mortality And Morbidity ◽  
Sensitivity Pattern ◽  
Hospital Infection Control

MRSA causes nosocomial and community based infections. It is associated with significant mortality and morbidity. Resistance in MRSA is encoded by mecA gene. Anterior nares are the ecological niche of Staphylococcus aureus. HCWs who are colonized with MRSA, act as agents of cross contamination of hospital and community acquired MRSA. Treating MRSA infections is a therapeutic challenge as it is resistant to beta lactam group of drugs. Therefore, there is a need for rapid and accurate detection of MRSA carriage in HCWs and to understand its antibiotic susceptibility pattern.The objective of the present study is to estimate the occurrence of MRSA in HCWs, using phenotypic and genotypic methods. A prospective study for six months was conducted after obtaining Institutional Ethical Committee clearance. Anterior nasal swabs of those HCWs who gave informed consent were taken processed for culture and sensitivity as per standard protocol. To detect MIC for oxacillin, E-strip method was used. mecA gene detection was done by PCR. A total of 300 HCWs were sampled.14.66% (44/300) of the isolates were identified as Staphylococcus aureus, of which 10 isolates were detected as MRSA. The overall isolation rate of MRSA is 3.33 %(10/300). MRSA carriage was high amongst nurses (5/59, 8.47%), followed by doctors (4/105, 3.80%).Antibiotic sensitivity pattern showed that highest resistance was to penicillin (75%) followed by amoxiclav (70.45 %).9 MRSA isolates were detected as mecA gene positive by PCR. MRSA carriers were decontaminated successfully with 2% mupirocin ointment and 2% chlorhexidine shampoo. This study reiterates the need for rapid and accurate identification of HCWs who have nasal colonization with MRSA, for reinforcing hospital infection control measures and decontamination protocol. This will help prevent the spread of MRSA in our community.

scholarly journals Overview of exanthems: a case series in a tertiary care hospital

2020 ◽  
Vol 6 (4) ◽  
pp. 484
Author(s):  
Ramesh A. ◽  
Thamizhinian K.
Keyword(s):  
Medical Records ◽  
Analytical Study ◽  
Viral Infections ◽  
Tertiary Care ◽  
Case Series ◽  
Maculopapular Rash ◽  
Care Physician ◽  
Care Hospital ◽  
Medical College ◽  
Madras Medical College

<p class="abstract"><strong>Background:</strong> Generalized rashes are the most common conditions seen by primary care physician and the most common reason for new patient visit to dermatologists. There is often difficulty in diagnosing a generalized rash because many conditions produce similar rashes and a single condition can result in rashes with varied appearance. Accurate diagnosis is important because treatment varies depending on the cause. Hence, we decided to undertake a steady on the various presentations of exanthems in Madras medical college Chennai. To find out the incidence of exanthems in the OPD of Department of Dermatology, Venerology and Leprosy (DVL) in Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai to help in early diagnosis and treatment of the diseases.  </p><p class="abstract"><strong>Methods:</strong> The study included all the newly diagnosed cases attending to the OPD of DVL, Madras Medical College, Chennai for a period of three months. Diagnosis was done based on clinical grounds and lab investigations were done whenever required.<strong></strong></p><p class="abstract"><strong>Results:</strong> An analytical study of the medical records of patients attending the OPD of DVL, Madras Medical College, Chennai shows that maculopapular rash is the most common presentation of exanthems followed by papules, vesiculobullous, pustular, nodules, verrucous lesions.</p><p class="abstract"><strong>Conclusions:</strong> The present study includes exanthems as a whole on contrary to many such studies performed in other parts of India which included rashes caused by viral infections and drugs. Our study included generalized skin eruptions due to infections, drugs, specific dermatoses, allergy.   </p>

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