title: Epidemiology of healthcare-associated infections among patients from a hemodialysis unit in southeastern Brazil.
abstract: Patients submitted to hemodialysis are at a high risk for healthcare-associated infections (HAI). Presently there are scarce data to allow benchmarking of HAI rates in developing countries. Also, most studies focus only on bloodstream infections (BSI) or local access infections (LAI). Our study aimed to provide a wide overview of HAI epidemiology in a hemodialysis unit in southeastern Brazil. We present data from prospective surveillance carried out from March 2010 through May 2012. Rates were compared (mid-p exact test) and temporally analyzed in Shewhart control charts for Poisson distributions. The overall incidence of BSI was 1.12 per 1000 access-days. The rate was higher for patients performing dialysis through central venous catheters (CVC), either temporary (RR=13.35, 95% CI=6.68-26.95) or permanent (RR=2.10, 95% CI=1.09-4.13), as compared to those with arteriovenous fistula. Control charts identified a BSI outbreak caused by Pseudomonas aeruginosa in April 2010. LAI incidence was 3.80 per 1000 access-days. Incidence rates for other HAI (per 1000 patients-day) were as follows: upper respiratory infections, 1.72; pneumonia, 1.35; urinary tract infections, 1.25; skin/soft tissues infections, 0.93. The data point out to the usefulness of applying methods commonly used in hospital-based surveillance for hemodialysis units.
authors.affiliation: Comissão de Controle de Infecção Relacionada à Assistência em Saúde, Hospital das Clínicas da Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, City of Botucatu, Brazil. Electronic address: eduara.cciras@gmail.com.
authors.forename: Silvia Eduara Kennerly de
authors.initials: SE
authors.lastname: Albuquerque
authors.affiliation: Comissão de Controle de Infecção Relacionada à Assistência em Saúde, Hospital das Clínicas da Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, City of Botucatu, Brazil; Departamento de Doenças Tropicais e Diagnóstico por Imagem, Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, City of Botucatu, Brazil.
authors.forename: Ricardo de Souza
authors.initials: Rde S
authors.lastname: Cavalcante
authors.affiliation: Disciplina de Nefrologia, Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, City of Botucatu, Brazil.
authors.forename: Daniela
authors.initials: D
authors.lastname: Ponce
authors.affiliation: Comissão de Controle de Infecção Relacionada à Assistência em Saúde, Hospital das Clínicas da Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, City of Botucatu, Brazil; Departamento de Doenças Tropicais e Diagnóstico por Imagem, Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, City of Botucatu, Brazil.
authors.forename: Carlos Magno Castelo Branco
authors.initials: CM
authors.lastname: Fortaleza
mesh_terms: D001938:Brazil / Q000453:epidemiology; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D015994:Incidence; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects*
keywords: Bloodstream infections; Catheter-related infections; Hemodialysis; Infection control