Overview of Healthcare-Related Infections in Intensive Care Units of a public hospital
DOI:
https://doi.org/10.26694/repis.v10i1.5404Keywords:
Cross Infection, Patient Safety, Infection Control, Intensive Care UnitsAbstract
Introduction: Healthcare-Associated Infections are illnesses acquired after the patient's admission to the hospital unit and which manifest themselves during hospitalization or after discharge. Aim: To analyze the panorama of health-related infections in patients admitted to intensive care units. Outlining: Cross-sectional, retrospective study, collected from the Hospital Infection Control Commission database in a public hospital from July to December 2022. Crude and adjusted odds ratios were calculated using logistic regressions. The study followed the ethical and legal precepts of resolution 466/2012. Results: There was a predominance of males and those aged over 60 years. The main clinical problems were co infection with COVID-19 and co-infection with HIV. Regarding previous conditions, Systemic Arterial Hypertension stood out. When analyzing the etiological agents, the presence of Klebsiella pneumoniae showed a marginally significant association with an increase in the chances of death. Implications: The use of invasive devices, prolonged hospital stay and other factors such as age, associated comorbidities, were predictors of mortality among patients, as well as risk factors for the development of Klebsiella Pneumoniae Carbapenemase infection.
References
Brasil. Ministério da Saúde. Portaria Nº 2.616, de 12 de maio de 1998. Expede na forma de anexos diretrizes e normas para a prevenção e controle das infecções hospitalares. Diário Oficial da União, 1998. Brasília: Ministério da Saúde, 1998. [cited 2023 May 24]. Available from: https://bvsms.saude.gov.br/bvs/saudelegis/gm/1998/prt2616_12_05_1998.html
Agência Nacional de Vigilância Sanitária. Resolução RDC n. 36, de 25 de julho de 2013. Institui ações para a segurança do paciente em serviços de saúde e dá outras providências. Diário Oficial da União, Brasília: ANVISA; 2013. [cited 2023 May 24]. Available from: https://bvsms.saude.gov.br/bvs/saudelegis/anvisa/2013/rdc0036_25_07_2013.html
Agência Nacional de Vigilância Sanitária. Programa Nacional de Prevenção e Controle de Infecções Relacionadas À Assistência À Saúde (Pnpciras) 2021 a 2025. Brasília: Anvisa, 2021. [cited 2023 May 24]. Available from: https://www.gov.br/anvisa/pt-br/centraisdeconteudo/publicacoes/servicosdesaude/publicacoes/pnpciras_2021_2025.pdf
Sousa MAS, Nascimento GCBI, Oliveira LB, Oliveira ADS. Infecções hospitalares relacionadas a procedimentos invasivos em unidades de terapia intensiva: revisão integrativa. Rev Pre Infec e Saúde [Internet]. 2017 May [cited 2023 May 29];3(3):49-58. Available from: https://doi.org/10.26694/repis.v3i3.4251
World Health Organization. Health care without avoidable infections: The critical role of infection prevention and control. Genebra: WHO, 2026. [cited 2023 May 24]. Available from: https://iris.who.int/bitstream/handle/10665/246235/WHO-HIS-SDS-2016.10-eng.pdf;jsessionid=2F75F591050EA75366DDC584286313D5?sequence=1
Zingg W, Holmes A, Dettenkofer M, Goetting T, Secci F, Clack L, Schreiber PW. Hospital organisation, management, and structure for prevention of health-care-associated infection: a systematic review and expert consensus. Lancet Infect Dis [Internet]. 2015 Feb [cited 2023 May 29];15(2):212-224. Available from: https://doi.org/10.1016/S1473-3099(14)70854-0
Souza ES, Belei RA, Carrilho CMDM, Matsuo T, Yamada-ogatta SF, Andrade G. Mortality and risks related to healthcare-associated infection. Texto contexto – enferm [Internet]. 2015 Dec [cited 2023 May 29];24(1):220-8. Available from: http://dx.doi.org/10.1590/0104-07072015002940013
Giroti ALB, Ferreira AM, Rigotti MA, Sousa AFL, Frota OP, Andrade D. Programas de Control de Infección Hospitalaria: evaluación de indicadores de estructura y processo. Rev. esc. enferm. USP [Internet]. 2018 Set [cited 2023 May 29];52(1):1-12. Available from: https://doi.org/10.1590/S1980-220X2017039903364
Cassini A, Högberg LD, Plachouras D, Quattrocchi A, Hoxha A, Simonsen GS, et al. 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. Lancet Infect Dis [Internet]. 2019 Jul [cited 2023 May 29];19(1);56-66. Available from: https://doi.org/10.1016/S1473-3099(18)30605-4
Leoncio JM, Almeida VF, Ferrari RAP, Capobiango JD, Kerbauy G, Tacla MTGM. Impact of healthcare-associated infections on the hospitalization costs of children. Rev Esc Enferm USP [Internet]. 2019 Jul [cited 2023 May 29];53(1):1-12. Available from: http://dx.doi.org/10.1590/S1980-220X2018016303486
Weber DJ, Rutala WA, Miller MB, Huslage K, Sickbert-Bennett E. Role of hospital surfaces in the transmission of emerging health care–associated pathogens: norovirus, Clostridium difficile, and Acinetobacter species. Am J Infect Control. [Internet]. 2010 Jul [cited 2023 May 29];47(5):60-67. Available from: http://dx.doi.org/10.1016/j.ajic.2010.04.196
Serafim CTR, Dell’Acqua MCQ, Novelli e Castro MC, Spiri WC, Nunes HRC. Severity and workload related to adverse events in the ICU. Rev Bras Enferm [Internet]. 2017 Oct [cited 2023 May 29];70(5):942-8. Available from: http://dx.doi.org/10.1590/0034-7167-2016-0427
Stone PW, Herzig CTA, Pogorzelska-Maziarz M, Carter E, Bjarnadottir R, Semeraro, P, et al. Understanding infection prevention and control in nursing homes: a qualitative study. Geriatric Nursing [Internet]. 2018 Dec [cited 2023 May 29];39(6):661-667. Available from: http://dx.doi.org/10.1016/j.gerinurse.2015.02.023
Macedo CC, Carneiro M, Krummenauer EC, Menezes RM. Assessment of Adherence to Clinical Protocols and Interface with Antimicrobial Stewardship Program. Rev Prev Infec Saúde [Internet]. 2023 Jan [cited 2023 May 29];8(1):1-13. Available from: https://doi.org/10.26694/repis.v8i1.2565
Oliveira AC, Garcia PC, Nogueira LS. Nursing workload and occurrence of adverse events in intensive care: a systematic review. Rev Esc Enferm USP [Internet]. 2016 Jan [cited 2023 May 29];50(4):1-10. Available from: http://dx.doi.org/10.1590/S0080-623420160000500020
Agência Nacional de Vigilância Sanitária. Orientações para vigilância das Infecções Relacionadas à assistência à Saúde (IRAS) e resistência microbiana (RM) em serviços de saúde. Nota técnica GVIMS/GGTES/DIRE3/ANVISA nº 01/2024. Brasília: Anvisa. [cited 2023 May 29]. Available from: https://www.gov.br/anvisa/pt-br/centraisdeconteudo/publicacoes/servicosdesaude/notas-tecnicas/notas-tecnicas-vigentes/nota-tecnica-no-01-2024-vigilancia-das-iras
Sinésio MCT, Magro MCS, Carneiro TA, Silva KGN. Risk factors for healthcare-associated infections in intensive care units. Cogitare enferm [Internet]. 2018 Jan [cited 2023 May 29];23(2):1-12. Available from: http://dx.doi.org/10.5380/ce.v23i2.53826
Rodrigues TS, Santos AMR, Lima PC, Moura MEB, Goiano PDOL, Fontinele DRS. Resistência Bacteriana á Antibióticos na Unidade de Terapia Intensiva: Revisão Integrativa. Rev Pre Infec e Saúde [Internet]. 2018 Nov [cited 2023 May 29];4(1):1-12. Available from: https://doi.org/10.26694/repis.v4i0.7350
Araujo PL, Mendonça AEO, Medeiros RA, Neto VLS, Nobre TTX, Costa IKF. Prevalência de infecção relacionada à assistência à saúde em pacientes internados em unidade de terapia intensiva. Rev eletr de enfermería [Internet]. 2018 Jan [cited 2023 May 29];52(1):1-12. Available from: http://dx.doi.org/10.6018/eglobal.17.4.289311
Oliveira AC, Paula AO, Iquiapaza RA, Lacerda ACS. Healthcare associated infections and severity of illness index of patients in Intensive Care Units. Rev Gaúcha Enferm [Internet]. 2012 Nov [cited 2023 May 29];33(3):89-96. Available from: https://doi.org/10.1590/S1983-14472012000300012
Lima MFP, BorgeS MA, Parente RS, Victória Júnior RC, Oliveira ME. Staphylococcus aureus e as infecções hospitalares – revisão de literatura. UNINGÁ Rev [Internet]. 2015 Ago [cited 2023 May 29];21(1):1-10. Available from: https://revista.uninga.br/uningareviews/article/view/1616
Fowler RA, Filate W, Hartleib M, Frost DW, Lazongas C, Hladunewich M. Sex and critical illness. Curr Opin Crit Care [Internet]. 2009 [cited 2023 May 29];15(5):442-9. Available from: https://doi.org/10.1097/MCC.0b013e3283307a12
Carneiro TC. Fatores associados à infecção e mortalidade por enterobactérias produtoras de klebsiella pneumoniae carbapenemase em uma unidade de terapia intensiva em Teresina, Piauí. Dissertação (Mestrado em Medicina Tropica) Instituto Oswaldo Cruz, Pós- graduação em Medicina Tropical, 2018. [cited 2023 May 29]; Disponível em: https://www.arca.fiocruz.br/handle/icict/37714
Courtenay WH. Constructions of masculinity and their influence on men's well-being: a theory of gender and health. Soc Sci Med [Internet]. 2000 May [cited 2023 May 29];50(10): 1385-1401. Available from: https://doi.org/10.1016/s0277-9536(99)00390-1
Chomistek AK, Manson JE, Stefanick ML, Lu B, Sands-Lincoln M, Going SB, et al. Relationship of sedentary behavior and physical activity to incident cardiovascular disease: results from the Women's Health Initiative. J Am Coll Cardiol [Internet]. 2013 Jun [cited 2023 May 29];61(23):2346-54. Available from: https://doi.org/10.1016/j.jacc.2013.03.031
National Center for Health Statistics. Health, United States, 2020–2021: Annual Perspective. Hyattsville, MD. 2023. [cited 2023 May 29]. Available from: https://dx.doi.org/10.15620/cdc:122044
Castro RR, Barbosa NB, Alves T, Najberg E. Perfil das internações em unidades de terapia intensiva adulto na cidade de Anápolis - Goiás - 2012. Rev Gest Sist Saúde [Internet]. 2016 Dec [cited 2023 May 29];5(2):115-24. Available from: https://doi.org/10.5585/rgss.v5i2.243
El-Fakhouri S, Carrasco HV, Araújo GC, Frini IC. Epidemiological profile of ICU patients at Faculdade de Medicina de Marília. Rev Assoc Med Bras [Internet]. 2016 [cited 2023 May 29];62(3):248-54. Available from: https://doi.org/10.1590/1806-9282.62.03.248
Conselho Federal de Medicina (CFM). Medicina Intensiva no Brasil (2018). Menos de 10% dos municípios brasileiros possuem leito de UTI [atualizado12/09/2018]. Brasília (DF); CFM; 2018. [cited 2023 May 29]. Available from: https://portal.cfm.org.br/noticias/menos-de-10-dosmunicipios-brasileiros-possuem-leito-de-uti/
Seibert G, Hôrner R, Meneghetti BH, Righi RA, Forno NLF, Salla A. Infecções hospitalares por enterobactérias produtoras de Klebsiella pneumoniae carbapenemase em um hospital escola. Einstein [Internet]. 2014 Out [cited 2023 May 29];12(3):282-6. Available from: https://doi.org/10.1590/S1679-45082014AO313
Sousa ÁFL, Queiroz AAFLN, Oliveira LB, Moura LKB, Andrade D, Watanabe E, Moura MEB. Deaths among the elderly with ICU infections. Rev. Bras. Enferm [Internet]. 2017 Dec [cited 2023 May 29];70(4):733-739. Available from: https://doi.org/10.1590/0034-7167-2016-0611
Bagshaw SM, Webb SA, Delaney A, George C, Pilcher D, Hart GK, Bellomo R. Very old patients admitted to intensive care in Australia and New Zealand: a multi-centre cohort analysis. Crit Care [Internet]. 2009 [cited 2023 May 29];13(2):45-75. Available from: https://doi.org/10.1186/cc7768
Guidet B, Leblanc G, Simon T, Woimant M, Quenot JP, Ganansia O, et al. Effect of Systematic Intensive Care Unit Triage on Long-term Mortality Among Critically Ill Elderly Patients in France: A Randomized Clinical Trial. JAMA [Internet]. 2017 Oct [cited 2023 May 29];318(15):1450-1459. Available from: https://doi.org/10.1001/jama.2017.13889
Boumendil A, Angus DC, Guitonneau AL, Menn AM, Ginsburg C, Takun K, et al. Variability of intensive care admission decisions for the very elderly. PLoS One [Internet]. 2012 Ago [cited 2023 May 29];7(4):e34387. Available from: https://doi.org/10.1371/journal.pone.0034387
Stokes EK, Zambrano LD, Anderson KN, Marder EP, Raz KM, El Burai Felix S, Tie Y, Fullerton KE. Coronavirus Disease 2019 Case Surveillance - United States, January 22-May 30, 2020. MMWR Morb Mortal Wkly Rep. [Internet]. 2020 Ago [cited 2023 May 29];69(24):759-765. Available from: https://doi.org/10.15585/mmwr.mm6924e2
Li J, Huang DQ, Zou B, Yang H, Hui WZ, Rui F, et al. Epidemiology of COVID-19: A systematic review and meta-analysis of clinical characteristics, risk factors, and outcomes. J Med Virol [Internet]. 2021 Ago [cited 2023 May 29];93(3):1449-1458. Available from: https://doi.org/10.1002/jmv.26424
Langford BJ, So M, Raybardhan S, Leung V, Westwood D, MacFadden DR, et al. Bacterial co-infection and secondary infection in patients with COVID-19: a living rapid review and meta-analysis. Clin Microbiol Infect [Internet]. 2020 Ago [cited 2023 May 29];26(1);1622-9. Available from: https://doi.org/10.1016/j.cmi.2020.07.016
Sathyakamala R, Peace AR, Shanmugam P. A Comparative Study on Bacterial Co-Infections and Prevalence of Multidrug Resistant Organisms among Patients in COVID and Non-COVID Intensive Care Units. J Prev Med Hyg [Internet]. 2022 Ago [cited 2023 May 29];63(1):19-26. Available from: https://doi.org/10.15167/2421-4248/jpmh2022.63.1.2175
World Health Organization. Global status report on noncommunicable diseases 2010. Geneva: World Health Organization; 2018. [cited 2023 May 29]; Available from: https://www.who.int/docs/default-source/ncds/9789241514620-eng.pdf?sfvrsn=48f7a45c_2
Feliciano SCC, Villela PB, Oliveira GMM. Association between Mortality from Chronic Noncommunicable Diseases and Human Development Index in Brazil between 1980 and 2019. Arq Bras Cardiol [Internet]. 2023 Set [cited 2023 May 29];120(4):1=10. Available from: https://doi.org/10.36660/abc.20211009
Cardoso LSM, Teixeira RA, Ribeiro ALP. Premature mortality due to non-communicable diseases in Brazilian municipalities estimated for the three-year periods of 2010 to 2012 and 2015 to 2017. Braz J Epidemiol [Internet]. 2021 Ago [cited 2023 May 29];24(Suppl 1):1-12. Available from: https://doi.org/10.1590/1980-549720210005
Needham DM, Davidson J, Cohen H, Hopkins RO, Weinert C, Wunsch H, et al. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders' conference. Crit Care Med [Internet]. 2012 Feb [cited 2023 May 29];40(2):502-9. Available from: https://doi.org/10.1097/CCM.0b013e318232da75
Pandharipande PP, Girard TD, Jackson JC, Morandi A, Thompson JL, Pun BT, et al. Long-term cognitive impairment after critical illness. N Engl J Med [Internet]. 2013 Oct [cited 2023 May 29];369(14):1306-16. Available from: https://doi.org/10.1056/NEJMoa1301372
Halpern NA, Pastores SM. Critical care medicine in the United States 2000-2005: an analysis of bed numbers, occupancy rates, payer mix, and costs. Crit Care Med [Internet]. 2010 Jan [cited 2023 May 29];38(1):65-71. Available from: https://doi.org/10.1097/CCM.0b013e3181b090d0
Herridge MS, Tansey CM, Matté A, Tomlinson G, Diaz-Granados N, Cooper A, et al. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med [Internet]. 2011 Apr [cited 2023 May 29];364(14):1293-304. Available from: https://doi.org/10.1056/NEJMoa1011802
Tuon FF, Rocha JL, Toledo P, Arend LN, Dias CH, Leite TM, et al. Risk factors for KPC-producing Klebsiella pneumoniae bacteremia. Braz J Infect Dis [Internet]. 2012 Sep-Oct [cited 2023 May 29];16(5):416-9. Available from: https://doi.org/10.1016/j.bjid.2012.08.006
Miranda IF, Santos ML, Oliveira WCS, Oliveira MC. Klebsiella pneumoniae produtora de carbapenemase do tipo kpc: disseminação mundial e situação atual no Brasil. Braz J Surg Clin Res [Internet] 2019 Oct [cited 2023 May 29];25(2):113-119. . Available from: https://www.mastereditora.com.br/periodico/20190103_214103.pdf
Cuervo SI, Sánchez R, Gómez-Rincón JC, Almenares C, Osorio JP, Vargas MJ. Comportamiento de casos de Klebsiella pneumoniae productora de carbapenemasas en pacientes con cáncer de un hospital de tercer nivel de Bogotá, D.C. Biomédica [Internet]. 2014 [cited 2023 May 29]; 34(Suppl1):170-180. Available from: http://dx.doi.org/10.7705/biomedica.v34i0.1680
Córdova E, Lespada MI, Gómez N, Pasterán F, Oviedo V, Rodríguez-Ismael C. Descripción clínica y epidemiológica de un brote nosocomial por Klebsiella pneumoniae productora de KPC en Buenos Aires. Argentina. Enferm Infecc Microbiol Clin [Internet]. 2012 [cited 2023 May 29]; 30(7):376-9. Available from: http://dx.doi.org/10.1016/j.eimc.2011.12.003
Nordmann P, Cuzon G, Naas T. The real threat of Klebsiella pneumoniae carbapenemase-producing bacteria. Lancet Infect Dis [Internet]. 2009 Dec [cited 2023 May 29]; 9(4):228-236. Available from: http://dx.doi.org/10.1016/S1473-3099(09)70054-4
Engelman B. Assistência a saúde em adultos hospitalizados: uma revisão integrativa. Trabalho de Conclusão de Curso. Universidade Federal do Rio Grande do Sul – 2016. [cited 2023 May 29]; Available from: https://lume.ufrgs.br/bitstream/handle/10183/184413/001000511.pdf;sequence=1
