Prevalência de infecções hospitalares e fatores de risco intrínsecos e extrínsecos em pediatria, nos hospitais universitários de Uberlândia e do Rio de Janeiro

Abstract

Hospital infections in pediatrics represent one of the most relevant public health problems in the modern world, especially in the poorest countries. In the 1970s, after the first International Conference on Hospital Infections, efforts have been made, particularly in the United States by the CDC / NNISS: “Center for Disease Control / National Nosocomial Infection Surveillance System”, based in Atlanta, with the aim of diagnosing , control and prevent these infections. In mid-1986, a widely debatable and perfectable methodology appeared in search of norms and criteria to be standardized by these agencies, aimed at monitoring these infections in American hospitals. These previously selected hospitals aggregate data obtained from surveys carried out by the Hospital Infection Control Commissions (CCIH) in a database and, subsequently, these are sent to CDC / NNISS, which currently has the largest source of data originated from epidemiological surveillance of hospital infections in the United States. In Brazil, the first Hospital Infection Control Commissions (CCIHs) emerged at the end of the 1970s, however, it was only in 1983, through Ordinance 196 dictated by the Ministry of Health, that there was a more comprehensive standardization of aspects related to the situation of hospital infections in Brazil, advocating the mandatory creation of Hospital Infection Control Commissions in Brazilian hospitals. In this ordinance, controlled notification of hospital infections through passive data search was considered mandatory. Such methodology (passive search), although considered inefficient, remained as a standard methodology for a long period, until some institutions for initiativesIX themselves started to use the methodology for active search of data in the surveillance of nosocomial infections, with adaptations to the Brazilian reality. On 09/04/1992, Ordinance 930 of the Ministry of Health came into force, replacing the previous one, contemplating the methodology for active search: prospective, retrospective and prevalence, instead of the methodology for passive search of data, as it is considered inadequate when used in isolation. According to Brazilian criteria, a hospital infection is one acquired after the patient's admission and which manifests itself during hospitalization, or even after discharge when it can be related to hospitalization. It also usually includes infections acquired by health professionals, companions, visitors and volunteers, when related to their activity or permanence in the hospital environment. More than 5% of patients in American hospitals are affected by hospital infections each year. In other countries, such as Brazil, prevalence studies conducted by the World Health Organization (WHO), showed rates ranging from 3 to 20%, with average values ​​of 9%. The additional cost of such infections is extremely high per inpatient, based on the initial treatment costs. The type and quality of care offered to hospitalized patients is directly related to the possibility of acquiring hospital infection. Hygienic and sanitary conditions in hospitals, added to the risk factors inherent to patients such as malnutrition due to chronic malnutrition, immunocompromise of different causes, the extremes of age (newborns / elderly), the underlying diseases in each patient, associated to the propaedeutic and / or therapeutic invasive extrinsic risk factors (“Devices”), characterize the profile of a situation inX crisis that deserves priority attention in Brazilian health services. The abusive and indiscriminate use of antimicrobials (empiricism) and immunosuppressive drugs predisposes patients (and also health professionals) to colonization of the skin, upper respiratory tract and intestine by multiresistant pathogens to antimicrobials and transmitted in the hospital environment, causing a ecological and epidemiological imbalance in the microbiota because it involves strains such as S. aureus MRSA, Enterococcus spp., Pseudomonas aeruginosa, Enterobacter spp. and Serratia marcescens, among others, with a high resistance spectrum, and yet, there is a predisposition to the acquisition of serious infections, by patients hospitalized anywhere in the world.