RESUMEN Introducción: La bacteriemia asociada a dispositivos intravasculares en neonatos con patología quirúrgica abdominal constituye una de las infecciones nosocomiales más frecuentes. Objetivo: Determinar la frecuencia de bacteriemias relacionadas a dispositivos vasculares en neonatos con patología quirúrgica gastrointestinal en un servicio de neonatología entre 2019- 2021. Materiales y métodos: Estudio observacional, retrospectivo. Muestra constituida por fichas clínicas de pacientes con patologías quirúrgicas seleccionadas (atresia esofágica, atresia intestinal, gastrosquisis, onfalocele, malformación anorrectal, enfermedad de Hirschsprung), expuestos a dispositivos intravasculares que presentaron bacteriemia. Se utilizó estadística descriptiva. Resultados: Se incluyeron 99 neonatos, 17 presentaron bacteriemias, (total 29 eventos de bacteriemias relacionada a catéteres). 53% de sexo masculino, media del peso al nacer: 2615 g (1500 a 3550 g); media de edad gestacional: 36,5 semanas. La atresia intestinal fue la malformación congénita más frecuente (35.2%). Entre los factores de riesgo asociados, el 47% de los pacientes requirieron 2 o más cirugías mayores; el tiempo medio de ARM varió de 2 a 104 días (media 23.8 días); 100% recibieron NPT, 52.9% por >28 días. Los dispositivos vasculares centralizados fueron utilizados por >28 días en el 52.9 % de los casos, (media 54,5 días). El tiempo de estancia hospitalaria fue >28 días en el 88.2% y la letalidad fue del 47%. El total de días de uso de catéter fue: 2350. Se identificaron 29 infecciones asociadas al uso de los catéteres, siendo la tasa de incidencia de 12,3 por 1000 días de exposición de catéter venoso central y 29% por paciente expuesto. Los agentes etiológicos más frecuentes fueron: Staphylococcus coagulasa negativo (62%), K. pneumoniae 17,2% y C. albicans 10,4%. Conclusión: La bacteriemia asociada a dispositivos vasculares en RN con patologías quirúrgicas gastrointestinales presentó elevada incidencia. Se deben implementar y supervisar medidas estratégicas de prevención que permitan mejorar el pronóstico y calidad de vida a estos pacientes.

ABSTRACT Introduction: Bacteremia associated with intravascular devices in neonates with abdominal surgical pathology is one of the most frequent nosocomial infections. Objective: To determine the frequency of bacteremia related to vascular devices in neonates with gastrointestinal surgical pathology in a neonatology service between 2019-2021. Materials and methods: Observational, retrospective study. Sample consisting of clinical records of patients with selected surgical pathologies (esophageal atresia, intestinal atresia, gastroschisis, omphalocele, anorectal malformation, Hirschsprung disease), exposed to intravascular devices who presented bacteremia. Descriptive statistics were used. Results: 99 neonates were included, 17 presented bacteremia, (total 29 events of catheter-related bacteremia). 53% male, mean birth weight: 2615 g (1500 to 3550 g); Mean gestational age: 36.5 weeks. Intestinal atresia was the most frequent congenital malformation (35.2%). Among the associated risk factors, 47% of patients required 2 or more major surgeries; the mean time of MRV varied from 2 to 104 days (mean 23.8 days); 100% received TPN, 52.9% for >28 days. Centralized vascular devices were used for >28 days in 52.9% of cases (mean 54.5 days). The length of hospital stay was >28 days in 88.2% and the fatality rate was 47%. The total number of days of catheter use was: 2350. Twenty-nine infections associated with the use of catheters were identified, with an incidence rate of 12.3 per 1000 days of central venous catheter exposure and 29% per exposed patient. The most frequent etiologic agents were: coagulase-negative Staphylococcus (62%), K. pneumoniae 17.2% and C. albicans 10.4%. Conclusion: Bacteremia associated with vascular devices in newborns with gastrointestinal surgical pathologies presented a high incidence. Strategic prevention measures should be implemented and monitored to improve the prognosis and quality of life of these patients.

Resumen Las infecciones relacionadas con catéteres representan una significativa fuente de morbilidad, mortalidad y prolongación de la estancia hospitalaria. El diagnóstico bacteriológico puede abordarse mediante diversas metodologías. Este estudio tuvo como objetivo evaluar la sensibilidad y especificidad de las técnicas comúnmente empleadas en el laboratorio de microbiología. Se analizaron 180 catéteres por medio de las técnicas de Maki, sonicación (técnica de Sherertz) y vórtex (técnica de Brun-Buisson). Cada técnica fue aplicada en primer, segundo y tercer lugar, en un orden sistemático. La sensibilidad y especificidad del método de Maki fueron del 67% y 75% respectivamente, mientras que para las técnicas cuantitativas de Brun-Buisson y Sherertz fueron del 78% y 83%, y del 56% y 88% respectivamente. Se observó que la técnica de Brun-Buisson funcionó mejor cuando se aplicó en primer lugar, la de Sherertz en segundo lugar y la de Maki en tercer lugar.

Abstract Catheter-related infections represent a significant source of morbidity, mortality and prolongation of hospital stay. Bacteriological diagnosis can be approached using various methodologies. This study aimed at evaluating the sensitivity and specificity of the techniques commonly used in the microbiology laboratory. One hundred and eighty catheters were analysed using the Maki, sonication (Sherertz technique) and vortex (Brun-Buisson technique) techniques. Each technique was applied first, second and third, in a systematic order. The sensitivity and specificity of the Maki method were 67% and 75% respectively, while for the Brun-Buisson and Sherertz quantitative techniques they were 78% and 83%, and 56% and 88% respectively. It was observed that the Brun-Buisson technique performed best when applied first, the Sherertz technique second, and the Maki technique third.

Resumo As infecções relacionadas ao cateter representam uma fonte significativa de morbidade, mortalidade e prolongamento da internação hospitalar. O diagnóstico bacteriológico pode ser abordado por meio de diversas metodologias. Este estudo teve como objetivo avaliar a sensibilidade e especificidade das técnicas comumente utilizadas no laboratório de microbiologia. Foram analisados 180 cateteres pelas técnicas de Maki, sonicação (técnica de Sherertz) e vórtice (técnica de Brun-Buisson). Cada técnica foi aplicada em primeiro, segundo e terceiro lugar, em ordem sistemática. A sensibilidade e especificidade do método Maki foram de 67% e 75% respectivamente, enquanto que para as técnicas quantitativas de Brun-Buisson e Sherertz foram de 78% e 83%, e de 56% e 88% respectivamente. Observou-se que a técnica de Brun-Buisson teve melhor desempenho quando aplicada em primeiro lugar, a de Sherertz em segundo e a de Maki em terceiro.

Resumen Introducción: Las infecciones del torrente sanguíneo asociadas a catéter (ITS/AC) son eventos prevenibles y potencialmente fatales, comunes en el contexto del cuidado de pacientes críticos. A mediados de 2018 se presentó un incremento en la tasa de incidencia de ITS/AC en una institución colombiana de alta complejidad, obligando a realizar intervenciones inmediatas para lograr una reducción de estas cifras. Objetivo: Evaluar la efectividad del método de mejoramiento continuo de la calidad (MCC) para la reducción de la tasa de incidencia de ITS/AC en un hospital universitario en Bogotá, Colombia. Métodos: Estudio longitudinal, prospectivo, en el que se implementa una intervención multifacética siguiendo la metodología de MCC. El proyecto se desarrolló en un hospital universitario de alta de complejidad de Bogotá, Colombia, entre julio de 2018 y diciembre de 2019. Se realizaron consecutivamente un análisis de causa raíz, priorización de factores contribuyentes, recuperación de ideas de mejora, construcción de la estrategia y priorización del plan de implementación. Resultados: El método de MCC permitió la detección de zonas susceptibles de presentación de errores en la inserción de catéteres y su mantenimiento en la Institución, además permitió priorizar las áreas por intervenir mediante ciclos consecutivos de prueba para las ideas de mejora. Se logró la reducción y sostenibilidad de la ITS/AC asociada a inserción luego de tres meses de iniciar las intervenciones, logrando valores de cero. La implementación de ideas de mejora dirigidas a reducir los eventos relacionados con el mantenimiento de catéteres también logró reducirlos a cero hasta la terminación del periodo de observación de este estudio. Conclusiones: Es factible implementar MCC en contextos como el aquí presentado para reducir de manera eficiente las ITS/AC.

Abstract Introduction: Central Line-Associated Bloodstream Infections (CLABSI) are preventable and potential fatal events, frequent in critical patient care. By mid-2018 an increase was noted in the incidence rate of CLABSI at a high complexity institution in Colombia, demanding immediate interventions to lower those numbers. Objective: To assess the effectiveness of the continuous quality improvement methodology (CQI) to lower the incidence rate of CLABSI at a university hospital in Bogotá, Colombia. Methods: Longitudinal, prospective study implementing a multifaceted intervention in accordance with the CQI methodology. The project was developed at a high complexity university hospital in Bogotá, Colombia, between July 2018 and December 2019. A root cause analysis was consecutively conducted prioritizing contributing factors, gathering ideas for improvement, building a strategy and prioritizing the implementation plan. Results: The CQI methodology enabled the identification of areas susceptible of catheter insertion and management errors at the institution; additionally, it allowed for the prioritization of the areas requiring intervention through consecutive test cycles for improvement ideas. The reduction and sustainability of insertion-related CLABSI was accomplished three months after the start of the interventions, achieving a zero value. The implementation of improvement ideas aimed at reducing the events associated with catheter maintenance was also able to reduce the incidence to zero, until the end of the period of observation of the study. Conclusions: It is feasible to implement CQI in settings similar to the one herein described, in order to efficiently reduce CLABSIs.

RESUMEN Objetivo: Verificar el efecto de la intervención educativa TIV-Disinfect (Terapia Intravenosa-Desinfección) en el conocimiento de los profesionales de enfermería de Unidades de Internación Pediátrica. Método: Estudio cuasiexperimental, con una muestra dependiente de 65 profesionales de enfermería de Unidades de Internación Pediátrica. Se utilizó un cuestionario con preguntas objetivas sobre la desinfección de dispositivos venosos, aplicado como pre y post test. Recolección realizada en dos Hospitales Públicos del Sur de Brasil, entre abril y julio de 2022. Para el análisis de los datos se utilizó estadística descriptiva y prueba de McNemar. Resultados: Hubo diferencia estadísticamente significativa entre el pre y postest en cuanto a las variables sobre desinfección pasiva, desinfectantes y materiales recomendados, fricción y secado. Se observó una menor frecuencia de alternativas incorrectas después de la intervención. Conclusión: La intervención educativa tuvo un efecto positivo. Se observaron mejores resultados en el conocimiento de los profesionales de enfermería sobre la desinfección de dispositivos venosos, además de permitir a los profesionales reforzar conocimientos ya consolidados. Esta intervención puede ser utilizada como herramienta de actualización y/o capacitación continua de los profesionales de enfermería, visando la seguridad de los pacientes pediátricos y de las prácticas de cuidado. Objetivo TIVDisinfect TIV Disinfect Terapia IntravenosaDesinfección Intravenosa Desinfección Intravenosa-Desinfección Pediátrica Método cuasiexperimental 6 venosos test Brasil 2022 McNemar Resultados pasiva recomendados secado Conclusión positivo consolidados yo o cuidado 202 20 2

RESUMO Objetivo: Verificar o efeito da intervenção educativa TIV-Disinfect (Terapia Intravenosa-Desinfetar) no conhecimento de profissionais de enfermagem de Unidades de Internação Pediátrica. Método: Estudo quase-experimental, com amostra dependente de 65 profissionais de enfermagem de Unidades de Internação Pediátrica. Utilizou-se questionário com questões objetivas quanto a desinfecção de dispositivos venosos, aplicado como pré e pós-teste. Coleta realizada em dois Hospitais Públicos do Sul do Brasil, entre abril e julho de 2022. Para análise de dados, utilizou-se estatística descritiva e teste de McNemar. Resultados: Verificou-se diferença estatisticamente significativa entre o pré e o pós-teste quanto às variáveis sobre desinfecção passiva, desinfetantes e materiais recomendados, fricção e secagem. Notou-se frequência menor de alternativas incorretas após a intervenção. Conclusão: A intervenção educativa teve efeito positivo. Observou-se melhores resultados no conhecimento dos profissionais de enfermagem acerca do saber sobre desinfecção de dispositivos venosos, assim como permitiu reforçar conhecimentos já consolidados dos profissionais. Esta intervenção pode ser utilizada como ferramenta para atualização e/ou formação continuada de profissionais de enfermagem, visando a segurança do paciente pediátrico e da prática assistencial. Objetivo TIVDisinfect TIV Disinfect Terapia IntravenosaDesinfetar Intravenosa Desinfetar Intravenosa-Desinfetar Pediátrica Método quaseexperimental, quaseexperimental quase experimental, experimental quase-experimental 6 Utilizouse Utilizou se venosos pósteste. pósteste pós teste. Brasil 2022 dados utilizouse utilizou McNemar Resultados Verificouse Verificou passiva recomendados secagem Notouse Notou Conclusão positivo Observouse Observou eou ou assistencial 202 20 2

ABSTRACT Objective: To verify the effect of the educational intervention TIV-Disinfect (Intravenous Therapy-Disinfect) on the knowledge of nursing professionals in pediatric inpatient units. Method: Quasi-experimental study, with a dependent sample of 65 nursing professionals from pediatric inpatient units. A questionnaire with objective questions regarding the disinfection of venous devices was used, and pre- and post-tests were applied. Data collection was conducted in two public hospitals in southern Brazil, between April and July 2022. For data analysis, descriptive statistics and McNemar's test were used. Results: There was a statistically significant difference between the pre- and post-tests regarding variables of passive disinfection, and recommended antiseptics and materials, rubbing and drying. A lower frequency of incorrect alternatives was noted after the intervention. Conclusion: The educational intervention had a positive effect. Better results were observed in the knowledge of nursing professionals regarding the disinfection of venous devices, as well as allowing the professionals to reinforce already consolidated knowledge. This intervention can be used as a tool for updating and/or continuing training of nursing professionals, aiming at the safety of pediatric patients and care practices. Objective TIVDisinfect TIV Disinfect Intravenous TherapyDisinfect Therapy Therapy-Disinfect units Method Quasiexperimental Quasi experimental study 6 pre posttests post tests applied Brazil 2022 analysis McNemars McNemar s Results materials drying Conclusion andor or practices 202 20 2

ABSTRACT Objective: To evaluate the risk factors for healthcare-related infections during the COVID-19 pandemic in intensive care units, to investigate the impact of COVID-19 on Central Line-Associated Bloodstream Infection, Catheter-Associated Urinary Tract Infection, and ventilator-associated pneumonia, and to describe healthcare-associated infections in the waves of the COVID-19 pandemic. Methods: This nested case-control study was conducted in a 137-bed adult medical/surgical intensive care unit at a private hospital in São Paulo, Brazil, between January 11, 2019, and May 21, 2022. Case patients were identified using the Nosocomial Infection Control Committee database and control patients were identified using the intensive care unit's EPIMED system. For the analysis of risk factors, the chi-square test, multiple logistic regression model, and Kaplan-Meier method were used to identify independent risk factors, considering p<0.05. Results: The Case Group consisted of 189 healthcare-associated infections, including ventilator-associated pneumonia (61.4%), Central Line-Associated Bloodstream Infection (30.1%), Catheter-Associated Urinary Tract Infection (8.5%), and the Control Group consisted of 6,834 patients. The independent risk factors were COVID-19 infection (OR=2.84, 95%CI=1.92–4.23, p<0.01), length of stay in intensive care greater than 14 days (OR=3.15, 95%CI=1.95–5.14, p<0.01), length of hospital stay greater than 30 days (OR=3.64, 95%CI=2.44–5.51, p<0.01), and patients who were in the third wave (OR=1.72, 95%CI=1.05–2.91, p=0.04). Ventilator-associated pneumonia was the only healthcare-related infection for which COVID-19 infection was an independent risk factor (OR=3.32, 95%CI=1.92–5.94, p<0.01). Conclusion: COVID-19 and length of hospital stay were independent risk factors for healthcare-associated infections, and only ventilator-associated pneumonia was affected by the COVID-19 pandemic. Objective healthcarerelated healthcare related COVID19 COVID 19 COVID-1 units LineAssociated Line Associated CatheterAssociated Catheter ventilatorassociated ventilator associated healthcareassociated Methods casecontrol case 137bed bed 137 medicalsurgical medical surgical Paulo Brazil 11 2019 21 2022 s system chisquare chi square test model KaplanMeier Kaplan Meier p005 p 0 05 p<0.05 Results 18 61.4%, 614 61.4% , 61 4 (61.4%) 30.1%, 301 30.1% 1 (30.1%) 8.5%, 85 8.5% 8 5 (8.5%) 6834 6 834 6,83 OR=2.84, OR284 OR 2 84 (OR=2.84 95CI192423 CI 95 92 23 95%CI=1.92–4.23 p<0.01, p001 p<0.01 01 p<0.01) OR=3.15, OR315 3 15 (OR=3.15 95CI195514 95%CI=1.95–5.14 OR=3.64, OR364 64 (OR=3.64 95CI244551 44 51 95%CI=2.44–5.51 OR=1.72, OR172 72 (OR=1.72 95CI105291 91 95%CI=1.05–2.91 p=0.04. p004 p=0.04 . 04 p=0.04) Ventilatorassociated Ventilator OR=3.32, OR332 32 (OR=3.32 95CI192594 94 95%CI=1.92–5.94 p<0.01. Conclusion COVID1 COVID- 13 201 202 p00 p<0.0 61.4 (61.4% 30.1 (30.1% 8.5 (8.5% 683 83 6,8 OR=2.84 OR28 (OR=2.8 95CI19242 9 95%CI=1.92–4.2 OR=3.15 OR31 (OR=3.1 95CI19551 95%CI=1.95–5.1 OR=3.64 OR36 (OR=3.6 95CI24455 95%CI=2.44–5.5 OR=1.72 OR17 7 (OR=1.7 95CI10529 95%CI=1.05–2.9 p=0.0 OR=3.32 OR33 (OR=3.3 95CI19259 95%CI=1.92–5.9 20 p0 p<0. 61. (61.4 30. (30.1 8. (8.5 68 6, OR=2.8 OR2 (OR=2. 95CI1924 95%CI=1.92–4. OR=3.1 OR3 (OR=3. 95CI1955 95%CI=1.95–5. OR=3.6 95CI2445 95%CI=2.44–5. OR=1.7 OR1 (OR=1. 95CI1052 95%CI=1.05–2. p=0. OR=3.3 95CI1925 95%CI=1.92–5. p<0 (61. (30. (8. OR=2. (OR=2 95CI192 95%CI=1.92–4 OR=3. (OR=3 95CI195 95%CI=1.95–5 95CI244 95%CI=2.44–5 OR=1. (OR=1 95CI105 95%CI=1.05–2 p=0 95%CI=1.92–5 p< (61 (30 (8 OR=2 (OR= 95CI19 95%CI=1.92– OR=3 95%CI=1.95– 95CI24 95%CI=2.44– OR=1 95CI10 95%CI=1.05– p= (6 (3 ( OR= (OR 95CI1 95%CI=1.92 95%CI=1.95 95CI2 95%CI=2.44 95%CI=1.05 95CI 95%CI=1.9 95%CI=2.4 95%CI=1.0 95%CI=1. 95%CI=2. 95%CI=1 95%CI=2 95%CI= 95%CI

RESUMEN Introducción: Más de dos millones de personas en el mundo reciben tratamiento sustitutivo renal; la infección sanguínea representa una amenaza significativa, siendo la segunda causa de muerte en estos pacientes. La tasa de supervivencia depende en gran medida del tipo de acceso vascular utilizado. Objetivo: Determinar las complicaciones en pacientes con catéter de hemodiálisis en relación al sitio de inserción. Materiales y Métodos: Estudio de cohorte prospectivo, analítico, con medición de la frecuencia de complicaciones de pacientes con catéter de hemodiálisis a nivel yugular y femoral. Las variables se obtuvieron de los expedientes clínicos de pacientes internados ≥18 años. Resultados: Se incluyeron 203 pacientes, 66,01% masculinos; una edad media de 52 ± 15 años. 123 pacientes portaban catéter yugular y 80 pacientes, femoral. La curación se realizó cada 3 ± 5 días. La duración media de catéteres antes de signos de infección fue 4 ± 4 semanas en femorales y 9 ± 12 semanas en yugulares. Las bacterias gram positivas predominaron en los hemocultivos; aquellos con acceso femoral presentaron bacteriemia en mayor porcentaje. El cultivo de punta de catéter presentó una baja sensibilidad. Pacientes con catéter femoral presentaron mayor frecuencia de complicaciones. De las complicaciones infecciosas, la más frecuente fue el choque séptico en los portadores de catéteres femorales 57,50% vs los yugulares 4,88%. Otros: endocarditis, 7,32% en yugulares vs 2,50% en femorales; y finalmente la espondilodiscitis, con un 7,50% en femorales. La mortalidad fue mayor en aquellos con catéter femoral, 35% vs 8,94% en yugulares. Conclusión: Se ha evidenciado que el catéter femoral presenta mayor incidencia de complicaciones como choque séptico y bacteriemia, directamente relacionado con mayor tasa de mortalidad.

ABSTRACT Introduction: More than two million people in the world receive renal replacement treatment; Blood infection represents a significant threat, being the second cause of death in these patients. The survival rate depends largely on the type of vascular access used. Objective: Determine complications in patients with hemodialysis catheter in relation to the insertion site. Materials and Methods: Prospective, analytical cohort study, measuring the frequency of complications in patients with hemodialysis catheters at the jugular and femoral levels. The variables were obtained from the clinical records of hospitalized patients ≥18 years of age. Results: 203 patients were included, 66.01% male; an average age of 52 ± 15 years. 123 patients had a jugular catheter and 80 patients had a femoral catheter. Healing was carried out every 3 ± 5 days. The mean duration of catheters before signs of infection was 4 ± 4 weeks in femoral and 9 ± 12 weeks in jugular. Gram-positive bacteria predominated in blood cultures; those with femoral access had bacteremia in a higher percentage. Catheter tip culture had low sensitivity. Patients with a femoral catheter had a higher frequency of complications. Of the infectious complications, the most frequent was septic shock in those with femoral catheters 57.50% vs jugular catheters 4.88%. Others: endocarditis, 7.32% in jugular vs 2.50% in femoral; and finally spondylodiscitis, with 7.50% in femoral bones. Mortality was higher in those with a femoral catheter, 35% vs. 8.94% in jugular catheters. Conclusion: It has been shown that the femoral catheter has a higher incidence of complications such as septic shock and bacteremia, directly related to a higher mortality rate.

ABSTRACT Introduction: The use of central venous catheters for hemodialysis is associated with a higher incidence of infectious complications, leading Clinical Practice Guidelines to recommend various strategies to reduce such complications, with no clear indication of the dressing to use for catheter exit site care. Objectives: To compare the infection rate related to the catheter exit site using two different protocols: dressing with 2% chlorhexidine gluconate versus 2% chlorhexidine solution, both covered with self-adhesive semi-permeable polyurethane dressing for central venous catheters used in hemodialysis. Material and Method: An experimental, controlled, randomized study was conducted in hemodialysis patients with central venous catheters to compare two care protocols. The control group received a 2% chlorhexidine solution covered with a self-adhesive semi-permeable polyurethane dressing, while the intervention group received a dressing with 2% chlorhexidine gluconate. Socio-clinical and infection-related data were collected, and descriptive and inferential analyses were performed. Results: A total of 50 patients were studied, with 25 in each group. The intervention group had two exit site infections, while the control group had twelve cases (OR: 0.176, 95% CI: 0.039-0.790; p=0.013). The intervention group had one case of bacteremia compared to two cases in the control group (OR: 0.533, 95% CI: 0.048-5.892; p=ns). Conclusion: Dressing with 2% chlorhexidine gluconate is a protective measure against exit site infection compared to dressing with 2% chlorhexidine solution and polyurethane dressing.

RESUMEN Introducción: El uso de catéteres venosos centrales para hemodiálisis se relaciona con un mayor desarrollo de complicaciones infecciosas, por lo que las Guías de Práctica Clínica recomiendan diferentes estrategias para disminuir dichas complicaciones, sin indicación clara sobre el apósito a utilizar en la cura del orificio de salida. Objetivos: Comparar la tasa de infecciones relacionadas con el catéter de dos pautas de cura del orificio de salida del catéter venoso central de hemodiálisis: apósito con gluconato de clorhexidina al 2% frente a clorhexidina en solución al 2%, cubierta con apósito de poliuretano semipermeable autoadhesivo. Material y Método: Estudio experimental, controlado, aleatorizado en pacientes en hemodiálisis a través de catéter venoso central para comparar dos pautas de cura, grupo control: clorhexidina en solución al 2% cubierta con apósito de poliuretano semipermeable autoadhesivo y grupo intervención: apósito con gluconato de clorhexidina al 2%. Se recogieron datos socioclínicos y relacionados con las complicaciones infecciosas. Se realizó un análisis descriptivo e inferencial.. Resultados: Se estudiaron 50 pacientes, 25 en cada grupo. El grupo intervención presentó dos infecciones del orificio de salida y el grupo control, presentó doce casos (OR: 0,176, IC 95%: 0,039-0,790; p=0,013). El grupo intervención presentó un caso de bacteriemia frente a dos episodios del grupo control (OR: 0,533, IC 95%: 0,048-5,892; p=ns). Conclusión: La cura con apósito con gluconato de clorhexidina al 2% es una medida protectora frente a la infección del orificio de salida en comparación con la cura con clorhexidina en solución al 2% y apósito de poliuretano.

Resumen Las infecciones del torrente sanguíneo asociadas a los cuidados de la salud constituyen una de las principales causas de morbilidad y mortalidad. La infección relacionada con catéteres vasculares es su fuente principal. Las bacterias Gram positivas, especialmente Staphylococcus spp., constituyen uno de los agentes etiológicos más frecuentes. Objetivo: evaluar la actividad inhibitoria del AP7121 sobre la adherencia de Staphylococcus aureus en catéteres vasculares. Se utilizó la cepa productora de biofilm S. aureus ATCC 35556 (SA). Se estimó CIMAP7121 para SA, se inocularon segmentos de 20 mm de catéter vascular (n = 3) con 104 UFCmL-1 de SA. Se probaron tres esquemas diferentes (A: simultáneo, B: anterior y C: después del desafío bacteriano) utilizando 1 x CIMAP7121. Se incluyeron grupos de control en cada esquema. La CIMAP7121 fue 0,48 mg/L. Con los esquemas A y B se logró una reducción de 2 logaritmos que representa una disminución del 99 % de células viables. El tratamiento posterior a la exposición con AP7121 (esquema C) produjo una reducción de 1 logaritmo que representa una disminución del 90 % de células viables. Estos resultados sugieren una rápida actividad antimicrobiana de AP7121 que podría ser beneficiosa para reducir la adherencia bacteriana en catéteres vasculares.

Abstract Healthcare-associated bloodstream infections are the leading cause of morbidity and mortality in hospitalized patients. Vascular catheter-related infection is its main source. Gram-positive bacteria, mainly Staphylococcus spp., are the most prevalent etiological agents. Our aim was to assess the inhibitory activity of the AP7121 on the Staphylococcus aureus adherence in vascular catheters. The biofilm-producer strain S. aureus ATCC 35556 (SA) was used. MIC AP7121 for SA was performed using 20 mm segments of the vascular catheter (n = 3) were inoculated with 104 UFC∙mL-1 of SA. Three different treatment schemes (A: simultaneous, B: previous, and C: following bacterial challenge) using 1 x MIC AP7121 were tested. Control groups were included in each scheme. The MICAP7121 was 0.48 mg/L. A reduction of 2log10 representing a decrease of 99 % of viable SA cells was achieved with schemes A and B. The post-challenge treatment with AP7121 (scheme C) produced a reduction of 1log10 representing a 90 % decrease of viable SA cells. The results observed in this work suggest an AP7121 fast-antimicrobial activity that could be beneficial to reduce bacterial adherence on medical devices such as vascular catheters.

RESUMEN La endocarditis por Candida es una enfermedad grave asociada con tasas de mortalidad elevadas. Candida parapsilosis se identifica con frecuencia como un patógeno que afecta usuarios de drogas intravenosas y está comúnmente relacionada con infecciones nosocomiales, principalmente debido a su capacidad para formar biopelículas en catéteres u otros cuerpos extraños. Se presenta un caso inusual de endocarditis por Candida parapsilosis que afecta la válvula tricúspide nativa en un paciente masculino de 35 años con enfermedad renal crónica en etapa terminal (Etapa V), quien tenía una sospecha de infección fúngica relacionada con el catéter cervical izquierdo. El paciente recibió tratamiento con caspofungina y se sometió a la extirpación de un tumor verrugoso en la válvula tricúspide. A pesar de enfrentar complicaciones posoperatorias, el paciente fue dado de alta con tratamiento de fluconazol y se programó un seguimiento. La endocarditis por Candida presenta un desafío clínico que requiere un enfoque multidisciplinario y un manejo personalizado debido a su ocurrencia infrecuente y una tasa de mortalidad más alta en comparación con la endocarditis bacteriana.

ABSTRACT Candida endocarditis is a severe disease associated with high mortality rates. Candida parapsilosis is frequently identified as the causative pathogen in intravenous drug users and is commonly associated with nosocomial infections, primarily due to its ability to form biofilms on catheters or other foreign bodies. Here, we present a rare case of Candida parapsilosis endocarditis affecting the native tricuspid valve in a 35-year-old male patient with end-stage chronic kidney disease (Stage V), who had a suspected fungal infection related to the left cervical catheter. The patient received treatment with caspofungin and underwent excision of a verrucous tumor on the tricuspid valve. Despite encountering postoperative complications, the patient was discharged on fluconazole treatment and scheduled for follow-up. Candida endocarditis poses a clinical challenge that necessitates a multidisciplinary approach and tailored management due to its infrequent occurrence and higher mortality rate compared to bacterial endocarditis.

ABSTRACT Introduction: Hemodialysis catheter dysfunction compromises dialysis adequacy and may limit catheter survival. Strategies to prevent hemodialysis catheter dysfunction include catheter locks, generally either with heparin or citrate. Methods: Our hemodialysis unit converted to locking all central venous hemodialysis catheters with sodium citrate 4% instead of heparina 5000 U/mL. A retrospective analysis compared the outcomes of the 6 months prior and after the conversion. The compared outcomes were incidence of catheter thrombosis, catheter-related infection, flow-related catheter exchange rate, dialysis efficiency measured by Kt/V and catheter dysfunction. Results: Twenty-three patients were included. Between the two audit periods, the rate of catheter thrombosis was 0 (0 per 1000 catheter days) and 7 (2.78 per 1000 catheter days) during the heparin and citrate period respectively (p=0.109). The number of catheter exchanges due to catheter dysfunction was 0 (0 per 1000 catheter days) during the heparin period and just 1 (0.39 per 1000 catheter days) during the citrate period (p=0.317). Dialysis adequacy measured by KT/V was 1.54 (0.39) in the heparin group and 1.54 (0.35) in the citrate group (p=0.465). Catheter dysfunction was recorded in 146 sessions (12.3%) in the heparin period and in 159 sessions (14,7%) in the citrate period (p=0.234). There were no catheter related infections in either group. Conclusion: There was a 58% cost reduction associated with catheter-locking therapy between the heparin period and the citrate period. This cost reduction included the costs associated with alteplase use. Besides the financial advantages in switching to citrate locking, there are other potential advantages, namely the minimization of heparin related side effects or limitations.

RESUMEN Objetivo: identificar aplicaciones móviles sobre terapia intravenosa y prevención de la infección del torrente sanguíneo asociada a catéteres. Método: prospección tecnológica, con búsqueda de datos en Bases de Patentes y Almacenes Virtuales, la recolección de datos ocurrió de mayo a agosto de 2021. Criterios de inclusión: aplicaciones móviles centradas en la Terapia Intravenosa; aplicaciones móviles centradas en la prevención de la infección del torrente sanguíneo, el análisis se realizó de forma cualitativa comparativa, reconociendo las funciones desarrolladas por las aplicaciones y su potencial de uso en la práctica clínica. Resultados: Se seleccionaron 19 aplicaciones y se organizaron en temas: aplicaciones para ayudar en el cateterismo; aplicaciones para el mantenimiento del cateterismo; aplicaciones sobre la prevención de la infección de transmisión sanguínea; y aplicación sobre el diagnóstico de la infección de transmisión sanguínea asociada al cateterismo. Conclusión: la identificación de pocas aplicaciones sobre el tema sirve de estímulo para la construcción de nuevas aplicaciones. Objetivo catéteres Método tecnológica Virtuales 2021 inclusión Intravenosa comparativa clínica Resultados 1 temas cateterismo Conclusión 202 20 2

RESUMO Objetivo: identificar aplicativos móveis sobre terapia intravenosa e prevenção de infecção de corrente sanguínea associada ao cateter. Método: prospecção tecnológica, com busca dos dados nas Bases de Patentes e Lojas Virtuais, a coleta dos dados ocorreu de maio a agosto de 2021. Critérios de inclusão: aplicativos móveis voltados para a Terapia Intravenosa; aplicativos móveis voltados para a prevenção de infecção de corrente sanguínea, a análise foi realizada de forma qualitativa comparativa, reconhecendo as funções desenvolvidas pelos aplicativos e seus potenciais para utilização na prática clínica. Resultados: 19 aplicativos foram selecionados e organizados em temáticas: aplicativos para auxiliar no cateterismo; aplicativos para manutenção de cateter; aplicativos sobre prevenção de infecção de corrente sanguínea; e aplicativo sobre diagnóstico de infecção de corrente sanguínea associada ao cateter. Conclusão: a identificação de poucos aplicativos sobre a temática serve de fomento para construção de novos aplicativos. Objetivo cateter Método tecnológica Virtuais 2021 inclusão Intravenosa comparativa clínica Resultados 1 temáticas cateterismo Conclusão 202 20 2

ABSTRACT Objective: to identify mobile applications on intravenous therapy and prevention of catheter-associated bloodstream infection. Method: technological prospection, with data search in Patent Bases and Virtual Stores, data collection occurred from May to August 2021. Inclusion criteria: mobile applications focused on Intravenous Therapy; mobile applications focused on the prevention of bloodstream infection. The analysis was carried out in a qualitative comparative way, recognizing the functions developed by the applications and their potential for use in clinical practice. Results: 19 applications were selected and organized into themes: applications to assist in catheterization; applications for catheter maintenance; applications on bloodstream infection prevention; and applications on diagnosis of catheter-associated bloodstream infection. Conclusion: The identification of few apps on the theme serves to promote the construction of new apps. Objective catheterassociated associated Method prospection Stores 2021 criteria Therapy way practice Results 1 themes catheterization maintenance Conclusion 202 20 2

RESUMEN Objetivos: analizar la producción de conocimiento a partir de artículos de investigación sobre la efectividad de los protocolos de enfermería para reducir la estancia de una sonda vesical y la tasa de infección del tracto urinario relacionada con el catéter en adultos y ancianos hospitalizados. Métodos: revisión integradora de tres artículos completos, en las bases de datos MEDLINE Complete (EBSCO), Scopus y Web of Science, del 01/01/2015 al 26/04/2021. Resultados: los tres protocolos redujeron las tasas de infección y, de la revisión/síntesis de sus conocimientos, surgió un cuerpo de evidencia de nivel IV para componer el proceso de atención de enfermería, con el objetivo de reducir la permanencia de sonda vesical y la infección asociada. Consideraciones Finales: este proceso reúne evidencias científicas para apoyar la elaboración de protocolos de enfermería y, consecuentemente, la realización de ensayos clínicos sobre su efectividad en la reducción de la infección por sonda vesical permanente. Objetivos hospitalizados Métodos completos EBSCO, EBSCO , (EBSCO) Science 01012015 01 2015 01/01/201 26042021 26 04 2021 26/04/2021 Resultados revisiónsíntesis síntesis conocimientos asociada Finales consecuentemente permanente (EBSCO 0101201 0 201 01/01/20 2604202 2 202 26/04/202 010120 20 01/01/2 260420 26/04/20 01012 01/01/ 26042 26/04/2 0101 01/01 2604 26/04/ 010 01/0 260 26/04 01/ 26/0 26/

ABSTRACT Objectives: to analyze the production of knowledge in research articles about the effectiveness of nursing protocols for reducing indwelling urinary catheter dwell time and catheter-associated urinary tract infection rate in hospitalized adult and older patients. Methods: an integrative review of three full articles, available in the MEDLINE Complete - EBSCO, Scopus and Web of Science databases, from 01/01/2015 to 04/26/2021. Results: the three protocols reduced infection rates, and from the review/synthesis of their knowledge, a level IV body of evidence emerged to compose the nursing care process aimed at reducing indwelling urinary catheter dwell time and catheter-associated urinary tract infection. Final Considerations: this process gathers scientific evidence to support the elaboration of nursing protocols and, consequently, the conduction of clinical trials on its effectiveness in reducing urinary tract infection by indwelling urinary catheter. Objectives catheterassociated associated patients Methods EBSCO databases 01012015 01 2015 01/01/201 04262021 04 26 2021 04/26/2021 Results rates reviewsynthesis synthesis Considerations consequently 0101201 0 201 01/01/20 0426202 2 202 04/26/202 010120 20 01/01/2 042620 04/26/20 01012 01/01/ 04262 04/26/2 0101 01/01 0426 04/26/ 010 01/0 042 04/26 01/ 04/2 04/

RESUMO Objetivos: analisar a produção do conhecimento de artigos de pesquisas acerca da efetividade de protocolos de enfermagem para redução do tempo de permanência de sonda vesical de demora e da taxa de infecção do trato urinário relacionada ao cateter em pacientes adultos e idosos hospitalizados. Métodos: revisão integrativa de três artigos na íntegra, nas bases de dados MEDLINE Complete (EBSCO), Scopus e Web of Science, no período de 01/01/2015 a 26/04/2021. Resultados: os três protocolos reduziram as taxas de infecção, e, da revisão/síntese de seu conhecimento, emergiu um corpo de evidências de nível IV para compor o processo de cuidar de enfermagem, visando à redução da permanência do cateter e da infecção associada. Considerações Finais: esse processo reúne evidências científicas para subsidiar a elaboração de protocolos de enfermagem e, consequentemente, a condução de ensaios clínicos sobre sua eficácia na redução de infecção do trato urinário por sonda vesical de demora. Objetivos hospitalizados Métodos íntegra EBSCO, EBSCO , (EBSCO) Science 01012015 01 2015 01/01/201 26042021 26 04 2021 26/04/2021 Resultados revisãosíntese síntese associada Finais consequentemente (EBSCO 0101201 0 201 01/01/20 2604202 2 202 26/04/202 010120 20 01/01/2 260420 26/04/20 01012 01/01/ 26042 26/04/2 0101 01/01 2604 26/04/ 010 01/0 260 26/04 01/ 26/0 26/

Abstract Background Infection is the most frequent complication of central venous catheters used for hemodialysis. Objectives The purpose of this study was to the determine the central venous catheter-related infection rate at a dialysis center in the Brazilian state of Amazonas and to identify risk factors and the microbiological profile of the infections. Methods This was an observational study with prospective data collection over a 12-month period by chart analysis and face-to-face interviews with patients undergoing hemodialysis using central venous catheters at a dialysis center. Results 96 central venous catheters were analyzed in 48 patients. 78 of these were non-tunneled central venous catheters (81.3%) and 18 were tunneled central venous catheters (18.7%), 53.1% of the catheters were exchanged because of infection and blood cultures were obtained from 35.2% of the patients who had catheter-related infections. Gram-negative bacteria were isolated from five of the nine blood cultures in which there was bacterial growth and Gram-positive bacteria were isolated from the other four. The most commonly isolated bacteria was Staphylococcus hominis, found in 22.2% of positive blood cultures. Conclusion The overall hemodialysis venous catheter infection rate was 10.1 episodes/1000 catheter days, 15.1 episodes/1000 catheters days in non-tunneled catheters and 3.3 episodes/1000 catheters days in tunneled catheters. The infection predisposing factors identified were use of non-tunneled catheters and having 2 hemodialysis sessions per week. Regarding the microbiological profile, over half of the bacteria isolated were Gram-negative.

Resumo Contexto Infecção é a complicação mais frequente do uso de cateter venoso central em hemodiálise. Objetivo O propósito do trabalho foi determinar a taxa de incidência de infecções de cateteres venosos centrais para hemodiálise em um centro de diálise no estado do Amazonas, bem como seus fatores preditivos, além de traçar o perfil microbiológico dessas infecções. Métodos Trata-se de um estudo observacional, com dados coletados mensalmente e de forma prospectiva, por meio de entrevista e análise de prontuários de pacientes submetidos a hemodiálise por meio de cateteres venosos centrais em um centro de diálise durante um período de 12 meses. Resultados Foram analisados 96 cateteres venosos centrais, de 48 pacientes. Do total, foram 78 cateteres venosos não tunelizados (81,3%) e 18 cateteres venosos tunelizados (18,7%). Dos cateteres acompanhados, 53,1% foram trocados por motivo de infecção, sendo realizada hemocultura de 35,2% dos pacientes que apresentaram infecção de cateter. Quanto ao perfil microbiológico, das nove hemoculturas positivas, em cinco foram isoladas bactérias gram-negativas, e em quatro foram isoladas bactérias gram-positivas. A bactéria mais frequentemente isolada foi a Staphylococcus hominis, presente em 22,2% das hemoculturas positivas. Conclusão A taxa de incidência global de infecção de cateteres venosos centrais foi de 10,1 episódios por 1.000 dias de cateter, sendo de 15,1 nos cateteres não tunelizados e de 3,3 nos cateteres tunelizados. Os fatores preditivos identificados foram o uso de cateter venoso central não tunelizado e a realização de duas sessões de diálise semanais. Quanto ao perfil microbiológico, pouco mais da metade das bactérias isoladas foram gram-negativas.

ABSTRACT Objective: To develop digital technology for patient and family integration into the Intensive Care Unit care team, aiming to subsidize decision-making for the prevention of infections related to healthcare. Method: Methodological research of technological production in three phases: pre-production, production, and post-production in a teaching hospital in southern Brazil. Sixteen intensive care unit nurses participated. Results: The research produced six videos: general guidelines on the Intensive Care Unit, Preventing infections: hand hygiene; Pneumonia associated with mechanical ventilation; Catheter-associated primary bloodstream infection; Catheter-related urinary tract infection. Final considerations: The proposed technology was developed and aims to assist nurses in bringing patients and families closer to the routines of the intensive care environment to provide safety in the contact of the patient of intensive care units with family members and in the active participation for the prevention of infections related to healthcare.

RESUMO Objetivo: Desenvolver tecnologia digital para integração de paciente e família à equipe de cuidados da Unidade de Terapia Intensiva, visando subsidiar a tomada de decisão para prevenção das infecções relacionadas à assistência à saúde. Método: Pesquisa metodológica, de produção tecnológica, em três fases: pré-produção; produção; pós-produção, em hospital de ensino no Sul do Brasil. Participaram 16 enfermeiros de Unidade de Terapia Intensiva. Resultados: Produziram-se seis vídeos: Orientações gerais sobre Unidade de Terapia Intensiva; Prevenindo infecções: higienização das mãos; Pneumonia associada à ventilação mecânica; Infecção primária da corrente sanguínea associada ao cateter; Infecção do trato urinário relacionada ao cateter. Considerações finais: A tecnologia proposta foi desenvolvida e visa auxiliar enfermeiros na aproximação de pacientes e familiares às rotinas do ambiente de cuidados intensivos, para proporcionar segurança no contato do paciente de Unidades de Terapia Intensiva com familiares e na participação ativa para prevenção de infecções relacionadas à assistência à saúde.

RESUMEN Objetivo: Desarrollar tecnología digital para integración de paciente y familia al equipo de cuidados de Unidad de Cuidados Intensivos, objetivando subsidiar a la toma de decisión para prevención de infecciones relacionadas a la atención de salud. Método: Investigación metodológica, de producción tecnológica, en tres etapas: preproducción; producción; postproducción, en hospital de enseñanza en el Sur Brasileño. Participaron 16 enfermeros de Unidad de Cuidados Intensivos. Resultados: Producidos seis vídeos: Orientaciones generales sobre Unidad de Cuidados Intensivos; Previniendo infecciones: higiene de manos; Neumonitis relacionada a ventilación mecánica; Infección primaria de la corriente sanguínea y Infección del tracto urinario relacionadas al catéter. Consideraciones finales: La tecnología propuesta desarrollada objetiva auxiliar enfermeros en el acercamiento de pacientes y familiares a rutinas del ambiente de cuidados intensivos, para proporcionar seguridad en el contacto del paciente de Unidades de Cuidados Intensivos con familiares y participación activa para prevención de infecciones relacionadas a la atención de salud.