title: Evaluating the quality of outbreak reports on health care-associated infections in São Paulo, Brazil, during 2000-2010 using the ORION statement findings and recommendations.
abstract: BACKGROUND
  The standard of outbreak reports must be improved to a level where they are robust enough to properly influence preventive strategies. We aimed to verify compliance with mandatory outbreak notification, describing epidemiologic characteristics and management, and evaluating the quality of outbreak reports on health care-associated infections in São Paulo State, Brazil.
  
  
  METHODS
  A systematic search was carried out on PubMed, the Latin American and Caribbean Health Sciences Literature database, Embase, Outbreak Database, the Annals of Brazilian Conferences on Healthcare-Associated Infection Prevention and Infectious Diseases, and reports from the São Paulo State Hospital Infection Division. The quality of reports was evaluated according to the Outbreak Reports and Intervention studies of Nosocomial Infection (ORION) statement guidelines.
  
  
  RESULTS
  A total of 87 outbreak reports were identified; however, only 15 outbreaks (17.2%) were reported to the São Paulo State Hospital Infection Division. Bloodstream infection and neonatal intensive care units were mostly implicated (23% and 19.5%, respectively). Quality, evaluated according to ORION statement recommendations, was generally poor. The ORION categories of Background, Objectives, Participants, Setting, Infection-Related Outcomes, and Generality were properly described in 32.2%, 74.7%, 2.3%, 46%, 2.3%, and 12.6% of reports, respectively. Interventions and Culture-Typing were described with details in 51.9% and 55.2% of outbreak reports, respectively.
  
  
  CONCLUSIONS
  Our findings pointed out the need for strategies to improve competence in outbreak reports, and the ORION statement guidelines may help in this matter. Efforts to promote confidence and consequent compliance with mandatory notification of outbreak reports are essential.
authors.affiliation: Department of Collective Health Nursing, School of Nursing, University of São Paulo, São Paulo, Brazil.
authors.forename: Amanda Luiz Pires
authors.initials: AL
authors.lastname: Maciel
authors.affiliation: São Paulo State Health Department, Centro de Vigilância Epidemiológica Prof Alexandre Vranjac, Hospital Infection Division, São Paulo, Brazil.
authors.forename: Denise Brandão
authors.initials: DB
authors.lastname: de Assis
authors.affiliation: São Paulo State Health Department, Centro de Vigilância Epidemiológica Prof Alexandre Vranjac, Hospital Infection Division, São Paulo, Brazil.
authors.forename: Geraldine
authors.initials: G
authors.lastname: Madalosso
authors.affiliation: São Paulo State Health Department, Centro de Vigilância Epidemiológica Prof Alexandre Vranjac, Hospital Infection Division, São Paulo, Brazil. Electronic address: padoveze@usp.br.
authors.forename: Maria Clara
authors.initials: MC
authors.lastname: Padoveze
mesh_terms: D001938:Brazil; D003428:Cross Infection; D004196:Disease Outbreaks; D019983:Guideline Adherence; D006302:Health Services Research; D006801:Humans; D019221:Mandatory Reporting; D011787:Quality of Health Care; D012308:Risk Management / Q000592:standards*
keywords: Cross-infection; Disease outbreak