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      Infecciones relacionadas con la asistencia a la salud en unidades de terapia intensiva neonatal: una revisión integradora Translated title: Health-care-associated Infections in neonatal intensive care units: an Integrative review Translated title: Infecções relacionadas à assistência em saúde em unidades de terapia intensiva neonatal: uma revisão integrativa

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          Abstract

          Resumen Revisión integradora, con el objetivo de analizar las evidencias científicas sobre las infecciones asociadas a la atención en salud (IAAS) en Unidades de Cuidados Intensivos Neonatales (UCIN). Los datos fueron obtenidos a partir de bases de datos electrónica MEDLINE y LILACS, desde 2000 hasta 2015. Se analizaron 36 publicaciones sobre IAAS, con exclusión de las infecciones virales. Los principales microorganismos que causan infecciones hospitalarias son: Staphylococcus (30%), Candida (23,3%), Klebsiella pneumoniae y Pseudomonas aeruginosa (13,3%), Acinetobacter y Serratia marcescens (6,7%), Enterobacter y Enterococcus (3,3%). Entre las causas de septicemia incluyen: Staphylococcus (50%), Candida (30%) y Acinetobacter baumannii (20%). Las IAAS principales en la UCIN se producen por transmisión cruzada de microorganismos de la mano de profesionales de la salud, de las superficies ambientales, equipos y elementos no críticos contaminados. Para la prevención y control de infecciones hospitalarias en la UCIN es necesario formación de los profesionales para adecuada higiene de manos y la limpieza y desinfección de superficies ambientales, equipos y artículos no críticos.

          Translated abstract

          Abstract This integrative review aimed to evaluate the scientific evidence on the healthcare-associated Infections (HAIs) in Neonatal Intensive Care Units (NICU). Data were collected from electronic databases MEDLINE and LILACS, from 2000 to 2015. We analyzed 36 publications on HAIs, excluding viral infections. Results: The main micro-organisms that cause HAIs are: Staphylococcus (30%), Candida (23.3%), Klebsiella pneumoniae and Pseudomonas aeruginosa (13.3%), Acinetobacter and Serratia marcescens (6.7%), Enterobacter and Enterococcus (3.3%). Among the causes of septicemia include: Staphylococcus (50%), Candida (30%) and Acinetobacter baumannii (20%). The main HAIs in NICU occur by cross-transmission of micro-organisms through contaminated the hands of health professionals and environmental surfaces, equipment and noncritical items. For the prevention and control of HAIs in the NICU is needed for adequate training of professional about hand hygiene and cleaning and disinfection of environmental surfaces, equipment and noncritical items.

          Translated abstract

          Resumo Trata-se de revisão integrativa, com objetivo de analisar as evidências científicas sobre as infecções relacionadas à assistência em saúde (IRAS) em Unidades de Terapia Intensiva Neonatal (UTIN). Os dados foram coletados nas bases eletrônicas LILACS e MEDLINE, no período de 2000 a 2015. Foram analisadas 36 publicações sobre IRAS, excluídas as infecções virais. Os principais micro-organismos causadores de IRAS são: Staphylococcus (30%), Candida (23,3%), Klebsiella pneumoniae e Pseudomonas aeruginosa (13,3%), Acinetobacter e Serratia marcescens (6,7%), Enterobacter e Enterococcus (3,3%). Dentre os causadores de septicemia destacam-se: Staphylococcus (50%), Candida (30%) e Acinetobacter baumannii (20%). As principais IRAS em UTIN ocorreram pela transmissão cruzada de micro-organismos por meio das mãos dos profissionais de saúde, superfícies ambientais, equipamentos e artigos não críticos contaminados. Para prevenção e controle das IRAS em UTIN é necessário capacitação dos profissionais para adequada higiene de mãos e limpeza e desinfecção de superfícies ambientais, equipamentos e artigos não críticos.

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          Most cited references37

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          Genotypic and phenotypic analysis of Enterobacter sakazakii strains from an outbreak resulting in fatalities in a neonatal intensive care unit in France.

          In 1994, an outbreak of Enterobacter sakazakii infections occurred in a neonatal intensive care unit in France from 5 May to 11 July. During the outbreak, 13 neonates were infected with E. sakazakii, resulting in 3 deaths. In addition, four symptomless neonates were colonized by E. sakazakii. The strains were subjected to 16S rRNA gene sequence analysis, genotyped using pulsed-field gel electrophoresis, and phenotyped for a range of enzyme activities. E. sakazakii was isolated from various anatomical sites, reconstituted formula, and an unopened can of powdered infant formula. A fourth neonate died from septic shock, attributed to E. sakazakii infection, during this period. However, 16S rRNA gene sequence analysis revealed that the organism was Enterobacter cloacae. There were three pulsotypes of E. sakazakii associated with infected neonates, and three neonates were infected by more than one genotype. One genotype matched isolates from unused prepared formula and unfinished formula. However, no pulsotypes matched the E. sakazakii strain recovered from an unopened can of powdered infant formula. One pulsotype was associated with the three fatal cases, and two of these isolates had extended-spectrum beta-lactamase activity. It is possible that E. sakazakii strains differ in their pathogenicities, as shown by the range of symptoms associated with each pulsotype.
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            Horizontal transmission of Candida parapsilosis candidemia in a neonatal intensive care unit.

            This report describes the nosocomial acquisition of Candida parapsilosis candidemia by one of the six premature newborns housed in the same room of a neonatal intensive care unit at the Ospedale Santa Chiara, Pisa, Italy. The infant had progeria, a disorder characterized by retarded physical development and progressive senile degeneration. The infant, who was not found to harbor C. parapsilosis at the time of his admission to the intensive care unit, had exhibited symptomatic conjunctivitis before the onset of a severe bloodstream infection. In order to evaluate the source of infection and the route of transmission, two independent molecular typing methods were used to determine the genetic relatedness among the isolates recovered from the newborn, the inanimate hospital environment, hospital personnel, topically and intravenously administered medicaments, and indwelling catheters. Among the isolates collected, only those recovered from the hands of two nurses attending the newborns and from both the conjunctiva and the blood of the infected infant were genetically indistinguishable. Since C. parapsilosis was never recovered from indwelling catheters or from any of the drugs administered to the newborn, we concluded that (i) horizontal transmission of C. parapsilosis occurred through direct interaction between nurses and the newborn and (ii) the conjunctiva was the site through which C. parapsilosis entered the bloodstream. This finding highlights the possibility that a previous C. parapsilosis colonization and/or infection of other body sites may be a predisposing condition for subsequent C. parapsilosis hematogenous dissemination in severely ill newborns.
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              Healthcare-associated infections among neonates in Brazil.

              To describe the epidemiology of healthcare-associated infections (HAIs) among neonates. Prospective surveillance of HAIs was conducted during 2 years. Infections beginning within 48 hours of birth were defined as HAIs of maternal origin. Death occurring during an active episode of HAI was considered related to HAI. Seven neonatal units located in three Brazilian cities. All admitted neonates were included and observed until discharge. Twenty-two percent of 4,878 neonates had at least one HAI. The overall incidence density was 24.9 per 1,000 patient-days, and 28.1% of all HAIs were maternally acquired. HAI rates ranged from 12.3% in the group with a birth weight (BW) of more than 2,500 g to 51.9% in the group with a BW of 1,000 g or less. The main HAIs were bloodstream infection (BSI) and pneumonia. Coagulase-negative staphylococci, Enterobacter species, Staphylococcus aureus, and Klebsiella pneumoniae were the main pathogens. Forty percent of all deaths were related to HAI. Central venous catheter (CVC)-associated BSIs per 1,000 CVC-days ranged from 17.3 (BW, 1,501 to 2,500 g; device utilization [DU], 0.11) to 34.9 (BW, < or = 1,000 g; DU, 34.92). Ventilator-associated pneumonia per 1,000 ventilator-days ranged from 7.0 (BW, < or = 1,000 g; DU, 0.34) to 9.2 (BW, 1,001 to 1,500 g; DU, 0.14). The high proportion of HAIs of maternal origin highlights perinatal care issues in Brazil and the need to improve the diagnosis of neonatal HAIs. The very low BW group and device-associated infections should be priorities for prevention strategies in this population.
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                Author and article information

                Journal
                eg
                Enfermería Global
                Enferm. glob.
                Universidad de Murcia (Murcia, Murcia, Spain )
                1695-6141
                2017
                : 16
                : 45
                : 508-536
                Affiliations
                [1] Goiás orgnameUniversidade Federal de Goiás orgdiv1Facultad de Enfermería Brazil angelicaopaula@ 123456gmail.com
                [3] Goiás orgnameUniversidade Federal de Goiás orgdiv1Facultad de Enfermería Brazil
                [2] Goiânia Goiás orgnameUniversidade Federal de Goiás orgdiv1Facultad de Enfermería Brazil
                Article
                S1695-61412017000100508 S1695-6141(17)01604500508
                10.6018/eglobal.16.1.238041
                ce0e0a8f-c8db-4962-a26b-7043230bc26f

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 International License.

                History
                : 29 November 2015
                : 28 September 2015
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 37, Pages: 29
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                SciELO Spain

                Categories
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                Infecção Hospitalar,Intensive Care units,Unidades de Cuidado Intensivo Neonatal,Recém-Nascido,Recién Nacido,Unidades de Terapia Intensiva Neonatal,Newborn,Infección Hospitalaria,Cross Infection,Neonatal

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