Multi-resistant gram-negative rods are important pathogens in intensive care units (ICU), cause high rates of mortality, and need infection control measures to avoid spread to another patients. This study was undertaken prospectively with all of the patients hospitalized at ICU, Anesthesiology of the Hospital São Paulo, using the ICU component of the National Nosocomial Infection Surveillance System (NNIS) methodology, between March 1, 1997 and June 30, 1998. Hospital infections occurring during the first three months after the establishment of prevention and control measures (3/1/97 to 5/31/97) were compared to those of the last three months (3/1/98 to 5/31/98). In this period, 933 NNIS patients were studied, with 139 during the first period and 211 in the second period. The overall rates of infection by multi-resistant microorganisms in the first and second periods were, respectively, urinary tract infection: 3.28/1000 patients/day; 2.5/1000 patients/day; pneumonia: 2.10/1000 patients/day; 5.0/1000 patients/day; bloodstream infection: 1.09/1000 patients/day; 2.5/1000 patients/day. A comparison between overall infection rates of both periods (Wilcoxon test) showed no statistical significance (p = 0.067). The use of intervention measures effectively decreased the hospital bloodstream infection rate (p < 0.001), which shows that control measures in ICU can contribute to preventing hospital infections.

The first report of occupational acquisition of HIV appeared in 1984, and, by June, 1997, the Centers for Disease Control and Prevention (CDC) had reported 52 documented cases of sero-conversion following occupational exposure to HIV-1 by health care workers of those cases. 47 (90.3%) were exposed to blood. The most frequent type of accident reported was percutaneous needlestick injury. Prospective studies have estimated that the risk of HIV transmission following percutaneous exposure to infected blood is 0.3% (Confidence Interval 95% = 0.2% to 0.5%). Following a mucous membrane exposure, the risk is 0.09% (CI 95% = 0.006% to 0.5%). The risk of hepatitis B acquisition ranges from 6% to 30%, and hepatitis C acquisition, 3% to 10%. Since 1992, the São Paulo Hospital's Hospital Infection Prevention and Control Service (SPCIH) has notified and treated all workers exposed to accidents involving biological materials. In the last six years, we have handled approximately 1,300 cases of reported accidents, of which 90% were percutaneous, most involving needlesticks. Such cases were frequently caused by the inadequate disposal and recapping of needles. In these accidents, 20% of the source patients were HIV positive, 10% were hepatitis C positive, and 7.6% were hepatitis B positive. This review summarizes the guidelines for a standardized response when dealing with accidents involving health care workers. Transmission of hepatitis B and HIV can be reduced if adequate preventive measures are taken in advance. If proper prophylaxis is not being done, it should be initiated immediately.

A profilaxia antimicrobiana é uma das medidas de controle da infecção da ferida cirúrgica. Mesmo com os princípios básicos hoje bem estabelecidos, cerca de 40% das indicações habituais de profilaxia são inadequadas e um dos erros mais comuns está relacionado à duração, em geral superior a 48 horas. Ajustes na profilaxia, além de favorecer sua eficácia na prevenção da infecção cirúrgica, provavelmente contribuiriam para reduzir a pressão seletiva sobre a emergência de bactérias resistentes e custos hospitalares. A simples instituição de uma rotina de antibiótico-profilaxia não garante a adesão dos cirurgiões para adequação do uso de antimicrobianos. No presente estudo, uma intervenção foi realizada na Disciplina de Gastroenterologia Cirúrgica da Universidade Federal de São Paulo - Escola Paulista de Medicina, com a implantação de uma rotina de profilaxia, com a supervisão direta de um infectologista. Os objetivos deste estudo foram avaliar a adequação do uso do antibiótico profilático e seu efeito sobre a infecção cirúrgica pós-operatória. Foi considerada adequada a profilaxia com duração menor ou igual a 24 horas. Dos 318 procedimentos cirúrgicos realizados nos períodos pré e pós-intervenção, em 67,9% foi usado um antibiótico profilático. A intervenção reduziu o uso inadequado de antibiótico de 46,3% para 20,4% (χ² = 15,59; p < 0,05). Infecção do sítio cirúrgico ocorreu em 35,8% dos procedimentos, não se observando modificação deste índice com a adequação da antibiótico-profilaxia. A participação do infectologista é importante na difícil tarefa de racionalizar o uso dos antimicrobianos em nível hospitalar.

Antibiotic prophylaxis is an important measure for the control of surgical site infection. Its principles are well establish in the literature. However, at least 40% of the indications for prophylaxis are inadequate. One of the most common errors is related to the duration of the prophylaxis, which is frequently greater than 48 hours. Adjustments made in prophylaxis would not only decrease surgical site infection rates, but also contribute to the reduction of the selection of resistant bacteria in hospitals and reduce costs. The establishment of prophylaxis routine does not guarante the correct use of antibiotics by surgeons. This study was conducted in the Disciplina de Gastroenterologia Cirúrgica of the Universidade Federal de São Paulo - Escola Paulista de Medicina. The aim of the study were to evaluate the adequate use of the prophylactic antibiotic and its effect on the surgical site infection rate. Antibiotic utilization for 24 hours or less was considered adequate. Of the 318 surgical procedures performed before and after the implementation of the study; 67.9% were followed by the use of prophylactic antibiotic. There was a reduction of inadequate use of antibiotic from 46.3% to 20.4% (χ2 15.59; p < 0.005). Infection of the surgical site occurred in 35.8% of the procedures. No significant change in this percentage was observed with the correct use of prophylactic antibiotic.