Ants in a hospital environment and their potential as mechanical bacterial vectors

Introduction We studied the richness and abundance of ant species, their bacteria and the bacteria isolated from patient clinical samples. Methods Ants were collected with baited traps at 64 sites in a public hospital in São Luis, State of Maranhão, Brazil. Results In total, 1,659 ants from 14 species were captured. The most frequent species were Crematogaster victima, Solenopsis saevissima, Tapinoma melanocephalum, Camponotus vittatus and Paratrechina fulva. Forty-one species of bacteria were isolated from the ants and 18 from patients. Conclusions Ants are potential vehicles for pathogenic and opportunistic bacteria, and they can represent a risk factor in nosocomial infections.

Occurrence of tooth injuries in patients treated in hospital environment in the region of Aracatuba, Brazil during a 6-year period

Dental trauma has been considered as a public health problem that affects mainly children and youngsters and due to its impact on the patient's quality of life. This study presents the results of a 6-year survey of the occurrence and characteristics of dental trauma in patients admitted to the Service of Surgery and Oral and Maxillofacial Traumatology of the School of Dentistry of Aracatuba (UNESP, Brazil) after emergency care in hospital facilities in the region of Aracatuba, SP, Brazil. For such purpose, the clinical files of patients treated at the Service between 1999 and 2005 were reviewed. Information regarding gender, age, number of traumatized teeth, etiology and diagnosis of the trauma was collected from the files of patients with tooth injuries and recorded in case report forms specifically designed for this purpose. The results showed that from a total of 4112 patients admitted to the Service within the surveyed period, 266 (6.5%) had tooth injuries (172 males - 64.7%; 94 females - 35.3%). The total number of traumatized teeth was 496. Most patients belonged to the 16-20 year-old age group (20.3%) and the most frequent causes of tooth injuries were bicycle accidents (28.6%), motorcycle accidents (19.2%) and falls (18.8%). Injuries to the periodontal tissues were the most frequent type of tooth injuries (408 teeth; 82.26%), occurring in 118 primary and 290 permanent teeth. Among the injuries to the periodontal tissues, avulsion was the most common (32.86%) (29.41% for primary and 34.0% for permanent teeth), followed by extrusive luxation (19.15%) (25.21% for primary and 17.24% for permanent teeth). In conclusion, in the surveyed population, cases of tooth injuries were more frequent in males aged 16-20 years old due to cyclist accidents with predominance of injuries to the periodontal tissues, in particular, avulsions.

Integrated pest management programme in hospital environment

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Perception of a hectic hospital environment at admission relates to acute stress disorder symptoms in myocardial infarction patients.

OBJECTIVE Hospital crowding is a public health problem that may impact on the quality of medical treatment and increase the risk of developing traumatic stress, e.g., after myocardial infarction (MI). This study examines whether subjective appraisal of crowding at hospital admission due to MI is associated with acute stress disorder (ASD) symptoms. METHOD We investigated 102 consecutive patients with acute MI within 48h after having reached stable circulatory conditions. The appraisal of crowding was measured by the retrospective assessment of the perception of a hectic hospital environment at admission. Furthermore, patients completed the Acute Stress Disorder Scale to rate the psychological stress reaction. RESULTS The perception of a hectic hospital environment was associated with the development of ASD symptoms (r=0.254, P=.013) independently of demographic, peritraumatic and medical factors. Post hoc analysis revealed associations with dissociative (r=0.211, P=.041), reexperiencing (r=0.184, P=.074) and arousal (r=0.179, P=.083) symptoms. CONCLUSION The findings suggest that, besides objective circumstances, the way hospital admission due to MI is perceived by the patient may influence the development of MI-triggered ASD symptoms. The psychological and physiological long-term outcomes of the perception of a hectic hospital environment and the role of preventive interventions need further examination.

Mathematical modelling of patient risks in a hospital environment, using multiple regression analysis

The aim of this research work was primarily to examine the relevance of patient parameters, ward structures, procedures and practices, in respect of the potential hazards of wound cross-infection and nasal colonisation with multiple resistant strains of Staphylococcus aureus, which it is thought might provide a useful indication of a patient's general susceptibility to wound infection. Information from a large cross-sectional survey involving 12,000 patients from some 41 hospitals and 375 wards was collected over a five-year period from 1967-72, and its validity checked before any subsequent analysis was carried out. Many environmental factors and procedures which had previously been thought (but never conclusively proved) to have an influence on wound infection or nasal colonisation rates, were assessed, and subsequently dismissed as not being significant, provided that the standard of the current range of practices and procedures is maintained and not allowed to deteriorate. Retrospective analysis revealed that the probability of wound infection was influenced by the patient's age, duration of pre-operative hospitalisation, sex, type of wound, presence and type of drain, number of patients in ward, and other special risk factors, whilst nasal colonisation was found to be influenced by the patient's age, total duration of hospitalisation, sex, antibiotics, proportion of occupied beds in the ward, average distance between bed centres and special risk factors. A multi-variate regression analysis technique was used to develop statistical models, consisting of variable patient and environmental factors which were found to have a significant influence on the risks pertaining to wound infection and nasal colonisation. A relationship between wound infection and nasal colonisation was then established and this led to the development of a more advanced model for predicting wound infections, taking advantage of the additional knowledge of the patient's state of nasal colonisation prior to operation.

Role of copper in reducing hospital environment contamination

The environment may act as a reservoir for pathogens that cause healthcare-associated infections (HCAIs). Approaches to reducing environmental microbial contamination in addition to cleaning are thus worthy of consideration. Copper is well recognised as having antimicrobial activity but this property has not been applied to the clinical setting. We explored its use in a novel cross-over study on an acute medical ward. A toilet seat, set of tap handles and a ward entrance door push plate each containing copper were sampled for the presence of micro-organisms and compared to equivalent standard, non-copper-containing items on the same ward. Items were sampled once weekly for 10 weeks at 07:00 and 17:00. After five weeks, the copper-containing and non-copper-containing items were interchanged. The total aerobic microbial counts per cm2 including the presence of ‘indicator micro-organisms’ were determined. Median numbers of microorganisms harboured by the copper-containing items were between 90% and 100% lower than their control equivalents at both 07:00 and 17:00. This reached statistical significance for each item with one exception. Based on the median total aerobic cfu counts from the study period, five out of ten control sample points and zero out of ten copper points failed proposed benchmark values of a total aerobic count of <5 cfu/cm2. All indicator micro-organisms were only isolated from control items with the exception of one item during one week. The use of copper-containing materials for surfaces in the hospital environment may therefore be a valuable adjunct for the prevention of HCAIs and requires further evaluation.

Cultura da (in) segurança nos contextos de trabalho em enfermagem: o caso do Hospital do Espírito Santo de Évora - E.P.E.

Mestrado em Intervenção Sócio-Organizacional na Saúde - Área de especialização: Políticas de Administração e Gestão de Serviços de Saúde

No grupo de teatro terapêutico: hospital Júlio de Matos

Este trabalho escrito visa relatar a experiência vivenciada com o Grupo de Teatro Terapêutico do Júlio de Matos do Centro Hospitalar Psiquiátrico de Lisboa na preparação de um espectáculo de teatro pelo grupo. Nele vêm-se descritas as actividades referentes ao levantamento do trabalho teatral com um grupo de pessoas com diagnóstico psiquiátrico e ligadas a uma instituição hospitalar, e são referenciadas as práticas e teorias terapêuticas que são associadas à dinamização do grupo. Terminando com a reflexão sobre a componente terapêutica indissociável à natureza do processo artístico.

O Papel do Ar e Água Ambientais como Veículos de Transmissão de Infeções Fúngicas no Hospital Agostinho Neto, Cidade da Praia, Cabo Verde

Os fungos são um grupo de microrganismos diversificado com uma grande ubiquidade na natureza, podendo ser encontrados no solo, no ar e na água. Alguns destes microrganismos são considerados como verdadeiros agentes patogénicos para humanos e, embora na grande maioria sejam inofensivos para indivíduos saudáveis, tornam-se patogénicos para indivíduos com fragilidade imunológica. A infeção por estes agentes em ambiente hospitalar tem sido relatada neste últimos anos como a principal causa de morte nos pacientes internados com debilidade imunológica. Neste estudo foi feita a monitorização da presença de fungos no ambiente de algumas unidades mais críticas do Hospital Agostinho Neto na cidade da Praia em Cabo Verde durante o mês de Janeiro de 2012, nomeadamente no Bloco Operatório do hospital, no serviço de internamento Cirúrgico e Queimadura, no serviço de internamento de Neonatologia, no serviço de internamento de Infeciologia, no serviço de Oncologia e no serviço de Hemodiálise. No total foram recolhidas 34 amostras de diferentes locais, detectadas 393ufc/m3 no ar, 685ufc/m3 na água e 2696ufc/m2 nas superfícies e isolados 104 fungos morfologicamente diferentes, sendo sido obtidos 29 a partir do ar, 21 de amostras da água e 54 de superfícies. A análise micológica destas amostras revelou uma forte presença dos géneros como Penicillium sp., Cladosporium sp. e Aspergillus sp. em todas as colheitas. Sabendo que a contaminação do ambiente hospitalar por estes agentes pode ser um fator de risco para infeção nosocomial em pacientes com sistema imunitário muito debilitado, sugerimos no final do trabalho algumas linhas orientadoras para minimizar os fatores de risco e propor trabalhos futuros para correlacionar esses fatores com casos de ocorrência de infeções fúngicas no Hospital Agostinho Neto na cidade da Praia, Cabo Verde.

Assistance au suicide en hôpital de soins aigus: sommes-nous prêts [Physician-assisted suicide in university hospital: are we ready?]

Assisting people to commit suicide has generated a passionate public debate. In exceptional situations, access to this support can be granted to the demanders in a hospital environment. So did the CHUV and the academic hospitals of Geneva draw up a procedure permitting, in principle, the access to an assistance to commit suicide. Two recent clinical situations experienced in the CHUV's Service of internal medicine have created a lot of discussions, doubts and revealed, sometimes, divergent positions. By the light of this clinical cases, we wished to share the perspective of the internist in charge of the ethician, of the chaplain, of the medical director, of the psychiatrist and of the palliative care responsible. Theses complex situations illustrate the deep ambivalence felt by the clinicians confronted to situations which require a multidisciplinary approach.

The Stealthy Superbug: the Role of Asymptomatic Enteric Carriage in Maintaining a Long-Term Hospital Outbreak of ST228 Methicillin-Resistant Staphylococcus aureus.

UNLABELLED: Whole-genome sequencing (WGS) of 228 isolates was used to elucidate the origin and dynamics of a long-term outbreak of methicillin-resistant Staphylococcus aureus (MRSA) sequence type 228 (ST228) SCCmec I that involved 1,600 patients in a tertiary care hospital between 2008 and 2012. Combining of the sequence data with detailed metadata on patient admission and movement confirmed that the outbreak was due to the transmission of a single clonal variant of ST228, rather than repeated introductions of this clone into the hospital. We note that this clone is significantly more frequently recovered from groin and rectal swabs than other clones (P < 0.0001) and is also significantly more transmissible between roommates (P < 0.01). Unrecognized MRSA carriers, together with movements of patients within the hospital, also seem to have played a major role. These atypical colonization and transmission dynamics can help explain how the outbreak was maintained over the long term. This "stealthy" asymptomatic colonization of the gut, combined with heightened transmissibility (potentially reflecting a role for environmental reservoirs), means the dynamics of this outbreak share some properties with enteric pathogens such as vancomycin-resistant enterococci or Clostridium difficile. IMPORTANCE: Using whole-genome sequencing, we showed that a large and prolonged outbreak of methicillin-resistant Staphylococcus aureus was due to the clonal spread of a specific strain with genetic elements adapted to the hospital environment. Unrecognized MRSA carriers, the movement of patients within the hospital, and the low detection with clinical specimens were also factors that played a role in this occurrence. The atypical colonization of the gut means the dynamics of this outbreak may share some properties with enteric pathogens.

A substantive theory of the realization of stroke patients’ dignity in hospital care

Dignity is seen important in health care context but considered as a controversial and complex concept. In health care context, it is described as being influenced by for example autonomy, respect, communication, privacy and hospital environment. Patient dignity is related to satisfaction with care, reduced stress, better confidence in health services, enhanced patient outcomes and shorter stay in a hospital. Stroke patients may struggle for dignity as being dependent on other people has impact on the patients’ self-image. In all, stroke patients are very specific patient group and considered vulnerable from emotional aspect. Therefore study findings from other patient groups in the area of ethical problems cannot be transferred to the stroke patients. This master’s thesis consists of two parts. The first part is the literature review of patients’ dignity in hospital care. The literature defined dignity and described factors promoting and reducing it. The results were ambiguous and thus a clear understanding was not able to create. That was the basis for the second part of the master’s thesis, the empirical study. This part aimed to develop theoretical construction to explore the realization of stroke patients’ dignity in hospital care. The data of the second part was collected by interviewing 16 stroke patients and analyzed using the constant comparison of Grounded Theory. The result was ‘The Theory of Realization of Stroke Patients’ Dignity in Hospital Care’ which is described not only in this master’s thesis but also as a scientific article. The theory consists of the core category, four generic elements and five specific types on realization. The core category emerged as ‘dignity in a new situation’. After a stroke, dignity is defined in a new way which is influenced by the generic elements: life history, health history, individuality and a stroke. Stroke patient’s dignity is realized through five specific types on realization: person related dignity type, control related dignity type, independence related dignity type, social related dignity type and care related dignity type. The theory points out possible special characteristics of stroke patients’ dignity in control related dignity type and independence related dignity type. Before implementing the theory, the relation between the core category, generic elements and specific types on realization needs to be studied further.

Escuta analítica no hospital geral: : implicações com o desejo do analista

Partindo da experiência na enfermaria de um hospital-escola1, do confronto com o status-quo do trabalho dos psicólogos em hospitais e da avaliação da literatura sobre a clínica psicanalítica em hospital, esta pesquisa se propôs a buscar avanços frente a uma questão específica: a escuta psicanalítica no trabalho em enfermarias de hospital geral e as implicações dessa prática com o desejo do psicanalista. Foram entrevistados quinze psicólogos declaradamente de orientação psicanalítica, vinculados a unidades de internação e com experiência mínima de dois anos de trabalho em hospital geral. As entrevistas foram abertas e semi-estruturadas, com o intuito de contemplar de maneira uniforme a coleta de informações de cunho mais objetivo, assim como de facilitar a pertinência ao tema de estudo. A interpretação dos dados foi realizada à luz do referencial clínico psicanalítico (freud-lacaniano), sendo que tal interpretação nos permitiu identificar uma importante interação entre os impasses, presentes na instituição hospitalar, da prática clínica psicanalítica com questões pessoais e de formação do profissional, interação que se vincula à postura de trabalho adotada no hospital. Reafirmamos, através desta pesquisa, a possibilidade de fazer uso de uma escuta analítica no trabalho com pacientes internados, a qual está sempre voltada para as manifestações do inconsciente ao longo da fala, e na qual a direção do tratamento é a emergência do sujeito do inconsciente.

Anticorpos contra o vírus rábico em seres humanos com atividades no Hospital Veterinário da Universidade Federal de Mato Grosso. Cuiabá, MT, Brasil

Uma caracterização do perfil sorológico de 102 indivíduos com constantes atividades no Hospital Veterinário da Universidade Federal de Mato Grosso foi realizada por meio de fichas epidemiológicas e provas sorológicas para titulação de anticorpos contra o vírus da raiva, no período de novembro de 1999 a novembro de 2000. Dessas pessoas, 27 tinham sido vacinadas em esquema de pré-exposição e 75 não tinham recebido nenhum esquema de vacinação anti-rábica. Os resultados deste estudo puderam classificar os indivíduos em diferentes grupos (G1, G2, G3 e G4). As 19 (18,6%) pessoas do grupo G1, previamente vacinadas contra raiva, apresentaram titulação abaixo de 0,5 UI/mL; no grupo G2, as 8 (7,8%) pessoas, também previamente vacinadas, apresentaram títulos superiores a 0,5UI/mL; no grupo G3, as 67 (65,6%) pessoas, não vacinadas contra o vírus rábico, apresentaram titulação abaixo de 0,5UI/mL; e finalmente no grupo G4, as 8 (7,8%) pessoas, que nunca receberam esquema vacinal, apresentaram títulos acima de 0,5UI/mL. Os resultados obtidos demonstraram que existe necessidade de avaliação epidemiológica e acompanhamento sorológico. de pessoas submetidas a vacinação anti-rábica pré-exposição em hospitais veterinários.

O diálogo entre trabalhadores em saúde e usuários: análise do processo de comunicação praticado em um hospital público sob a ótica das tensões sociais

Pós-graduação em Comunicação - FAAC