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      Overview of the actions to combat bacterial resistance in large hospitals* Translated title: Panorama das ações de combate à resistência bacteriana em hospitais de grande porte Translated title: Panorama de acciones para combatir la resistencia bacteriana en hospitales de gran porte

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          Abstract

          Objective:

          to analyze, in the clinical practice of large hospitals, how the adoption of measures to prevent and control the spread of bacterial resistance has occurred, and to propose a score for the institutions’ adherence.

          Method:

          a cross-sectional study carried out in 30 large hospitals of Minas Gerais, from February 2018 to April 2019, after approval by the Ethics and Research Committee. Interviews were conducted with hospital managers, with Hospital Infection Control Services coordinators, and with the care coordinators of the Inpatient Units and Intensive Care Center. In addition, observations were made of the adoption of preventive measures by the multidisciplinary team in the care units.

          Results:

          in the 30 participating hospitals, 93.3% (N=28) had protocols for prophylactic antibiotics, and 86.7% (N=26) performed their audit, 86.7% (N=26) for therapeutic antibiotics and 83.3% (N=25) their audit; 93.3% (N=56) used gloves and cloaks for patients in contact precautions, and 78.3% (N=47) of the professionals were unaware of or answered incompletely on the five moments for hand hygiene. In the score to identify the adoption of measures to control bacterial resistance, 83.3% (N=25) of the hospitals were classified as partially compliant, 13.3% (N=04) as deficient, and 3.4% (N=01) as non-adoption.

          Conclusion:

          it was found that the recommended measures to contain bacterial resistance are not consolidated in the clinical practice of the hospitals.

          Translated abstract

          Objetivo:

          analisar, na prática clínica dos hospitais de grande porte como tem ocorrido a adoção das medidas de prevenção e controle da disseminação da resistência bacteriana e propor um escore de adesão das instituições.

          Método:

          estudo transversal realizado em 30 hospitais de grande porte de Minas Gerais, no período de fevereiro de 2018 a abril de 2019, após aprovação pelo Comitê de Ética e Pesquisa. Realizaram-se entrevistas com os gestores dos hospitais, com os coordenadores dos Serviços de Controle de Infecção Hospitalar e com os coordenadores assistenciais das Unidades de Internação e Centro de Terapia Intensiva. Além disso, conduziram-se observações da adoção das medidas de prevenção pela equipe multiprofissional nas unidades assistenciais.

          Resultados:

          nos 30 hospitais participantes, 93,3% (N=28) apresentaram protocolos para antibióticos profiláticos, e 86,7% (N=26) realizavam sua auditoria, 86,7% (N=26) para antibióticos terapêuticos e 83,3% (N=25) sua auditoria; 93,3% (N=56) utilizavam luvas e capotes para pacientes em precaução de contato, e 78,3% (N=47) dos profissionais desconheciam ou responderam de forma incompleta sobre os cinco momentos para higienização das mãos. No escore para identificar a adoção das medidas de controle da resistência bacteriana, 83,3% (N=25) dos hospitais foram classificados como com adesão parcial, 13,3% (N=04) com adesão deficiente e 3,4% (N=01) como não adoção.

          Conclusão:

          constatou-se que as medidas recomendadas para contenção da resistência bacteriana não estão consolidadas na prática clínica dos hospitais.

          Translated abstract

          Objetivo:

          analizar, en la práctica clínica de los hospitales de gran porte, cómo se ha producido la adopción de medidas preventivas y de control de la propagación de resistencias bacterianas y proponer un puntaje de adhesión de las instituciones.

          Método:

          estudio transversal realizado en 30 hospitales de gran porte de Minas Gerais, de febrero de 2018 a abril de 2019, previa aprobación del Comité de Ética e Investigación. Se realizaron entrevistas con los administradores de los hospitales, con los coordinadores de los Servicios de Control de Infección Hospitalaria y con los coordinadores de atención de las Unidades de Internación y del Centro de Cuidados Intensivos. Además, se hicieron observaciones sobre la adopción de medidas preventivas por parte del equipo multidisciplinario en las unidades de atención.

          Resultados:

          en los 30 hospitales participantes, el 93,3% (N=28) presentaban protocolos de antibióticos profilácticos, y el 86,7% (N=26) realizaron su auditoría, el 86,7% (N=26) de antibióticos terapéuticos y el 83,3% (N=25) realizaron su auditoría; El 93,3% (N=56) utilizó guantes y batas para los pacientes en precaución de contacto, y el 78,3% (N=47) de los profesionales desconocía o respondía de forma incompleta sobre los cinco momentos de higiene de manos. En el puntaje para identificar la adopción de medidas para el control de la resistencia bacteriana, el 83,3% (N=25) de los hospitales se clasificaron como con adhesión parcial, el 13,3% (N=04) con adhesión deficiente y el 3,4% (N=01) como sin adopción.

          Conclusión:

          se descubrió que las medidas recomendadas para contener la resistencia bacteriana no están consolidadas en la práctica clínica de los hospitales.

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          Most cited references74

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          Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis

          Summary Background Infections due to antibiotic-resistant bacteria are threatening modern health care. However, estimating their incidence, complications, and attributable mortality is challenging. We aimed to estimate the burden of infections caused by antibiotic-resistant bacteria of public health concern in countries of the EU and European Economic Area (EEA) in 2015, measured in number of cases, attributable deaths, and disability-adjusted life-years (DALYs). Methods We estimated the incidence of infections with 16 antibiotic resistance–bacterium combinations from European Antimicrobial Resistance Surveillance Network (EARS-Net) 2015 data that was country-corrected for population coverage. We multiplied the number of bloodstream infections (BSIs) by a conversion factor derived from the European Centre for Disease Prevention and Control point prevalence survey of health-care-associated infections in European acute care hospitals in 2011–12 to estimate the number of non-BSIs. We developed disease outcome models for five types of infection on the basis of systematic reviews of the literature. Findings From EARS-Net data collected between Jan 1, 2015, and Dec 31, 2015, we estimated 671 689 (95% uncertainty interval [UI] 583 148–763 966) infections with antibiotic-resistant bacteria, of which 63·5% (426 277 of 671 689) were associated with health care. These infections accounted for an estimated 33 110 (28 480–38 430) attributable deaths and 874 541 (768 837–989 068) DALYs. The burden for the EU and EEA was highest in infants (aged <1 year) and people aged 65 years or older, had increased since 2007, and was highest in Italy and Greece. Interpretation Our results present the health burden of five types of infection with antibiotic-resistant bacteria expressed, for the first time, in DALYs. The estimated burden of infections with antibiotic-resistant bacteria in the EU and EEA is substantial compared with that of other infectious diseases, and has increased since 2007. Our burden estimates provide useful information for public health decision-makers prioritising interventions for infectious diseases. Funding European Centre for Disease Prevention and Control.
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            Effect of antibiotic stewardship on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infection: a systematic review and meta-analysis

            The Lancet Infectious Diseases, 17(9), 990-1001
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              Healthcare workers and health care-associated infections: knowledge, attitudes, and behavior in emergency departments in Italy

              Background This survey assessed knowledge, attitudes, and compliance regarding standard precautions about health care-associated infections (HAIs) and the associated determinants among healthcare workers (HCWs) in emergency departments in Italy. Methods An anonymous questionnaire, self-administered by all HCWs in eight randomly selected non-academic acute general public hospitals, comprised questions on demographic and occupational characteristics; knowledge about the risks of acquiring and/or transmitting HAIs from/to a patient and standard precautions; attitudes toward guidelines and risk perceived of acquiring a HAI; practice of standard precautions; and sources of information. Results HCWs who know the risk of acquiring Hepatitis C (HCV) and Human Immunodeficiency Virus (HIV) from a patient were in practice from less years, worked fewer hours per week, knew that a HCW can transmit HCV and HIV to a patient, knew that HCV and HIV infections can be serious, and have received information from educational courses and scientific journals. Those who know that gloves, mask, protective eyewear, and hands hygiene after removing gloves are control measures were nurses, provided care to fewer patients, knew that HCWs' hands are vehicle for transmission of nosocomial pathogens, did not know that a HCW can transmit HCV and HIV to a patient, and have received information from educational courses and scientific journals. Being a nurse, knowing that HCWs' hands are vehicle for transmission of nosocomial pathogens, obtaining information from educational courses and scientific journals, and needing information were associated with a higher perceived risk of acquiring a HAI. HCWs who often or always used gloves and performed hands hygiene measures after removing gloves were nurses, provided care to fewer patients, and knew that hands hygiene after removing gloves was a control measure. Conclusions HCWs have high knowledge, positive attitudes, but low compliance concerning standard precautions. Nurses had higher knowledge, perceived risk, and appropriate HAIs' control measures than physicians and HCWs answered correctly and used appropriately control measures if have received information from educational courses and scientific journals.
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                Author and article information

                Journal
                Rev Lat Am Enfermagem
                Rev Lat Am Enfermagem
                rlae
                Revista Latino-Americana de Enfermagem
                Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo
                0104-1169
                1518-8345
                12 April 2021
                2021
                : 29
                : e3407
                Affiliations
                [1 ]Universidade Federal de Minas Gerais, Escola de Enfermagem, Belo Horizonte, MG, Brazil.
                [2 ]Hospital Socor, Belo Horizonte, Minas Gerais, Brazil.
                Author notes
                Corresponding author: Mariana Sanches de Mello. E-mail: msdm_2013@ 123456hotmail.com

                Associate Editor: Maria Lúcia Zanetti

                Authors’ Contribution:

                Study concept and design: Mariana Sanches de Mello, Adriana Cristina Oliveira. Obtaining data: Mariana Sanches de Mello, Adriana Cristina Oliveira. Data analysis and interpretation: Mariana Sanches de Mello. Statistical analysis: Mariana Sanches de Mello. Obtaining financing: Adriana Cristina Oliveira. Drafting the manuscript: Mariana Sanches de Mello. Critical review of the manuscript as to its relevant intellectual content: Mariana Sanches de Mello, Adriana Cristina Oliveira.

                All authors approved the final version of the text.

                Conflict of interest: the authors have declared that there is no conflict of interest.

                Author information
                http://orcid.org/0000-0003-0668-6499
                http://orcid.org/0000-0002-4821-6068
                Article
                00309
                10.1590/1518-8345.3952.3407
                8040782
                33852679
                f4ae672f-758c-4274-b056-b636fb6381f6
                Copyright © 2020 Revista Latino-Americana de Enfermagem

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 14 November 2019
                : 01 August 2020
                Categories
                Original Article

                cross infection,drug resistance, bacterial,patient safety,epidemiological monitoring,hospitals,health personnel,infecção hospitalar,resistência bacteriana a antibióticos,segurança do paciente,vigilância epidemiológica,hospitais,pessoal de saúde,infección hospitalaria,farmacorresistencia bacteriana,seguridad del paciente,monitoreo epidemiológico,hospitales,personal de salud

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