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30 September, São Paulo- Brazil 1 ABSTRACTS 17TH CONGRESS OF INTERNATIONAL FEDERATION OF INFECTION CONTROL 27 – 30 SEPTEMBER, SÃO PAULO- BRAZIL 2 IFIC BOARD Maria Clara Padoveze Terrie B. Lee - Chair Anna Sara S. Levin Nagwa Khamis - Secretary Claudia Vallone Silva Egil Lingaas - Treasurer Daniel Wagner de C. Lima Santos Board Members Eduardo A. S. de Medeiros Anne-Marie Andersen Eliane Molina Birgit Ross Ícaro Boszczowski Donna Moralejo Julia Yaeko Kawagoe Jeanne Pfeiffer Kazuko Uchikawa Graziano Biljana Carevic Luci Correa Ndegwa Linus Kirimi Maria Beatriz G. de Souza Dias Carolina Giuffré Rosana Richtmann Po-Ren Hsueh Silvia Figueiredo Costa Ex-Officio Members Silvia Fonseca Judith Richards - Chair Conference Organising Thais Guimarães Committee Vera Lucia Borrasca Michael A. Borg - Chair Conferences Scientific Program Committee LOCAL COMMITTEE ORGANIZING Kathryn Suh - Editor IJIC Maria Clara Padoveze – President of the Congress APECIH BOARD Ícaro Boszczowski – President of Organizer Maria Clara Padoveze - Chair Committee Daniel Wagner de Castro Lima Santos - Vice- Aurivan Andrade de Lima – Treasurer Chair Lourdes das Neves Miranda – Treasurer Juliana Oliveira da Silva - 1st Secretary Adenilde Andrade da Silva Cristiane Schmitt - 2nd Secretary Alessandra Santana Destra Silvia Figueiredo Costa - 3rd Secretary Angela Figueiredo Sola Aurivan Andrade de Lima - 1st Treasurer Camila de Almeida Silva Mirian de Freitas Dal Ben Corradi - 2nd Treasurer Carlos Magno Castelo B. Fortaleza Adenilde Andrade da Silva - 3rd Treasurer Cristiane Schmitt Board Members Daniel Wagner de C. Lima Santos Fernando Gatti de Menezes Denise Brandao de Assis Márcia Valadão Albernaz Fernando Gatti de Menezes Carlos Magno Castelo Branco Fortaleza Geraldine Madalosso Alessandra Santana Destra Arruda Glaucia Fernanda Varkulja Régia Damous Fontenele Feijó Juliana Oliveira da Silva Camila de Almeida Silva Mirian de Freitas Dalben Corradi Sarita Scorzoni Lessa Paula Marques de Vidal Angela Figueiredo Sola Regia Damous Fontenelle Feijo Sarita Scorzoni Lessa Silvia Figueiredo Costa LOCAL SCIENTIFIC COMMITTEE Thais Guimarães Carlos Magno Castelo Branco Fortaleza Funding: National Council for Scientific and Technological Development (CNPq), Process number 441478/2016-6 and São Paulo Research Foundation (FAPESP), Process number 2017/14374-0 3 ORAL PRESENTATION [45] The impact of healthcare-associated infections after patients’ discharge: a matched- cohort study EMÍLIA CAROLINA OLIVEIRA DE SOUZA; SEBASTIÃO PIRES FERREIRA FILHO; KASYS MEIRA GERVATAUSKAS; MATHEUS RAGAZZO LEME; CARLOS MAGNO CASTELO BRANCO FORTALEZA BOTUCATU SCHOOL OF MEDICINE, STATE UNIVERSITY OF SÃO PAULO (UNESP), BOTUCATU, SÃO PAULO STATE, BRAZIL. INTRODUCTION/OBJECTIVES: Previous studies with retrospective design documented high rates of readmission of patients discharged after treating a Healthcare-Associated Infection (HCAI). The objective of our study was to investigate prospectively the medical and social impact of HCAIs on patients discharged from a tertiary-care hospital in inner São Paulo State, Brazil.METHODS: We present preliminary results of a matched-cohort study that included patients discharged from the teaching hospital of Botucatu School of Medicine (450 beds). We enrolled 26 subjects who had HCAI, alongside with 48 controls. Subjects were followed with weekly telephone calls for up to 24 weeks. We addressed the need for medical consultations, the number of medications prescribed, the dependency on family caregivers, hospital readmissions, and the time taken to return to work or to usual activities. Univariate statistical tests included Chi-square and Mann-Whitney tests, when appropriate. Multivariable Cox regression models for readmission and return to work/usual activities were adjusted for age, gender and the Charlson comorbidity index.RESULTS: Overall, 38.5% of HCAI cases and 16.7% controls were readmitted during follow-up (p<0.001). The adjusted Hazard Ratio (aHR) for readmission of HCAI cases was 12.26 (95% Confidence Interval [CI], 2.65-56.81). Cases also took longer to return to work or usual activities (median 20 versus 4 weeks, p<0.001; aHR=0.29, 95%CI=0.16-0.51), had greater number of medications prescribed at discharge (median 5 versus 3.5, p=0.002) and medical consultations during follow-up (median 4.5 versus 2, p=0.007). Finally, 19.2% of HCAI subjects (versus none of the controls) had a family member who quitted job in order be a caregiver (p=0.004). CONCLUSIONS: HCAIs continue to impact on health conditions, autonomy and family dynamics after patients’ discharge. 4 [85] Ventilator-associated event - VAE might not detect traditional VAP MARIA CLAUDIA STOCKLER ALMEIDA; FABIANA AGENA; CATERINE SELY OLIVEIRA; LUIS MARCELO MALBOUISSON HOSPITAL DAS CLÍNICAS DA FACULDADE DE MEDICINA DA UNIVERSIDADE DE SÃO PAULO (USP), SÃO PAULO, BRAZIL. Objective: To determine the incidence of the ventilator-associated events (VAEs) and its relation to days to extubation, days to ICU discharge, days to hospital discharge and mortality rate. And to compare VAEs findings to traditional ventilator-associated pneumonia (VAP). Methods: This study was conducted in a postoperative ICU at a tertiary teaching hospital - São Paulo – Brazil. We prospectively collected the novel VAE (VAE Calculator Ver. 3.0) and radiographic, clinical and laboratory data to confirm traditional VAP, between August 2014 and August 2015. Results: 138 patients, > 18 years, with MV longer than 2 calendar days were included, which corresponded to 151 episodes of MV. We found 4 (2.6%) VAEs (1.99 per 1,000 VD), 2 (1.3%) infection-related ventilator-associated complications (IVACs) (0.98 per 1,000 VD) and 13 (8.6%) traditional VAPs (6.37 per 1,000 VD). Both VAEs and VAPs had the modified CPIS > 6. The mean SAPS III was 59.5 (SD + 13.2) and the expected mortality rate 47.0% (17.6 – 72.2). VAEs compared to non-VAEs were not associated to days to ICU discharge (16 d; IQR 8-36.5 vs 10 d; IQR 6-20; p=0.29), hospital discharge (22 d; IQR 8-39 vs 15 d; IQR 7-31; p=0.75) or death (3% vs 88%; p=0.48), but were associated with days to extubation (14d; IQR 8 – 20 vs 5 d; IQR 3-12; p=0.03). VAPs compered to non VAPs were not associated to days to ICU discharge (16 d; IQR 11-23 vs 10 d; IQR 6-19; p=0.29) or death (5% vs 86%; p=0.22), but they were associated with days to extubation (12 d; IQR 7 – 18 vs 5 d; IQR 3-11; p=0.01) and hospital discharge (37 d; IQR 11-52 vs 15 d; IQR 7-30; p=0.04). Conclusions: VAE surveillance is less time-consuming and objective. VAP surveillance is less accurate and prone to bias. They detect different subset of patients. Larger studies are needed to define VAE as a marker of ICU quality on MV patients, as a marker of prevention practices of adverse events on MV patients and its metrics for benchmarking in our setting. 5 [90] Risk factors for community MRSA colonization in patients admitted to a hospital in Rio de Janeiro MARCOS PINHEIRO1; FERNANDA SAMPAIO CAVALCANTE2; DENNIS CARVALHO FERREIRA3; ANA CAROLINA FONSECA GUIMARÃES4; KATIA REGINA NETTO SANTOS4; SIMONE ARANHA NOUER1 1.HOSPITAL UNIVERSITÁRIO CLEMENTINO FRAGA FILHO, UNIVERSIDADE FEDERAL DO RIO DE JANEIRO; 2. CAMPUS MACAÉ, UNIVERSIDADE FEDERAL DO RIO DE JANEIRO; 3. UNIVERSIDADE VEIGA DE ALMEIDA; 4. INSTITUTO DE MICROBIOLOGIA PAULO DE GOES, RIO DE JANEIRO, BRAZIL. The rise of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), resulting in an increased incidence and severity of staphylococcal infections, has reinforced the interest of its epidemiology. One of the prevention strategies recommended is the surveillance cultures at hospital admission for colonized patients. However, when they are expensive, they require substantial resources not including the public hospital network. It was conducted a cross-sectional study to determine the prevalence of MRSA in admitted and case-control patients to identify risk factors for colonization of MRSA. Patients with up to 72 hours of admission, collected nasal swabs cultures and test to identify resistance to methicillin. Staphylococcal Chromosome Cassette mec (SCCmec) genotypic tests were performed in the isolates and characterized by pulsed field gel electrophoresis (PFGE). Among the total of 702 patients which had collected sample, 180 (25.6%) isolated S. aureus, 21 (11.7%) identified as MRSA and 159 (88.3%) as MSSA. The risk factors for MRSA colonization were: antibiotic used in the last 03 days (OR 0.20, CI 95% 0.45-1.03), bed linen (OR 0.34, 95% CI 0, 10-1,03), shared towels (OR 6.01 CI 95%, 1.90-21.44), collective sports practice (OR 0.14, CI 95%, 0.02- 1.06), (OR 0.20 CI 95%, 0.44-1.02) and hospitalization for more than r 3 days in the last year (OR 0.07 CI 95%, 0.01-0.26). The typing of the 21 samples identified as MRSA revealed that 15 (71.4%) samples had SCCmec IV, three (14.3%) had SCCmec II, two (9.5%) had SCCmec III and one (4,8%) had a non-typable cassette. PFGE in 20 of 21 MRSA samples revealed 12 different genotypic profiles. The knowledge of epidemiology supported by the results of this study on MRSA may potentiate treatment strategies, hospital and community control surveillance. 6 [177] Impact of multimodal strategies in reducing healthcare associated infections (HAI) MARCIA MARIA BARALDI1; CRISTIANE SCHMITT1; LIGIA MARIA ABRAAO1; AMANDA LUIZ PIRES MACIEL2; LUCIANA GOUVEA A. SOUZA1; PAULA ALMEIDA1; EDUARDO CAMACHO1; ÍCARO BOSZCZOWSKI1 1.OSWALDO CRUZ GERMAN HOSPITAL; 2. SCHOOL OF NURSING, UNIVERSITY OF SÃO PAULO, BRAZIL. introduction: implementing multimodal strategies (MS) represents a substantial action that might help reducing rates of HAI. objective: to highlight the impact of MS to increase the hand hygiene (HH) adhesion rate and the prevention of bloodstream infection incidence (BSI). method: prospective study conducted between april 2013 and may 2016 in a tertiary hospital in the city of São Paulo. interventions were applied in the context1 - HH and context 2 BSI.
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