title: Structure for prevention of health care-associated infections in Brazilian hospitals: A countrywide study.
abstract: BACKGROUND
  Minimal structure is required for effective prevention of health care-associated infection (HAI). The objective of this study was to evaluate the structure for prevention of HAI in a sample of Brazilian hospitals.
  
  
  METHODS
  This was a cross-sectional study from hospitals in 5 Brazilian regions (n = 153; total beds: 13,983) classified according to the number of beds; 11 university hospitals were used as reference for comparison. Trained nurses carried out the evaluation by using structured forms previously validated. The evaluation of conformity index (CI) included elements of structure of the Health Care-Associated Prevention and Control Committee (HAIPCC), hand hygiene, sterilization, and laboratory of microbiology.
  
  
  RESULTS
  The median CI for the HAIPCC varied from 0.55-0.94 among hospital categories. Hospitals with >200 beds had the worst ratio of beds to sinks (3.9; P < .001). Regarding alcoholic product for handrubbing, the worst ratio of beds to dispensers was found in hospitals with <50 beds (6.4) compared with reference hospitals (3.3; P < .001). The CI for sterilization services showed huge variation ranging from 0.0-1.00. Reference hospitals were more likely to have their own laboratory of microbiology than other hospitals.
  
  
  CONCLUSIONS
  This study highlights the need for public health strategies aiming to improve the structure for HAI prevention in Brazilian hospitals.
authors.affiliation: Department of Collective Health Nursing, School of Nursing of University of São Paulo, São Paulo, Brazil. Electronic address: padoveze@usp.br.
authors.forename: Maria Clara
authors.initials: MC
authors.lastname: Padoveze
authors.affiliation: Department of Infectious Diseases, Botucatu School of Medicine, State University of São Paulo, Botucatu, Brazil.
authors.forename: Carlos Magno Castelo Branco
authors.initials: CM
authors.lastname: Fortaleza
authors.affiliation: Special Clinical Microbiology Laboratory, Infectious Diseases Discipline, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Carlos
authors.initials: C
authors.lastname: Kiffer
authors.affiliation: Laboratory of Research in Bacterial Resistance, Center for Experimental Research, Clinical Hospital of Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Afonso Luís
authors.initials: AL
authors.lastname: Barth
authors.affiliation: Department of Infectious Diseases, Federal University of Pará, Belém do Pará, Brazil.
authors.forename: Irna Carla do Rosário Souza
authors.initials: IC
authors.lastname: Carneiro
authors.affiliation: Epidemiology and Infection Control Department, Pequeno Principe Hospital, Curitiba, Brazil.
authors.forename: Heloisa Ilhe Garcia
authors.initials: HI
authors.lastname: Giamberardino
authors.affiliation: Department of Community Health, Faculty of Medicina, Federal University of Ceará, Ceará, Brazil.
authors.forename: Jorge Luiz Nobre
authors.initials: JL
authors.lastname: Rodrigues
authors.affiliation: Clinical Microbiology Discipline, Federal University of Paraíba, João Pessoa, Brazil.
authors.forename: Lauro
authors.initials: L
authors.lastname: Santos Filho
authors.affiliation: Hospital Infection Control Committee, Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brazil.
authors.forename: Maria Júlia Gonçalves
authors.initials: MJ
authors.lastname: de Mello
authors.affiliation: Department of Nursing, Pontifical Catholic University, Goias, Brazil.
authors.forename: Milca Severino
authors.initials: MS
authors.lastname: Pereira
authors.affiliation: Microbiology, Biomedical Sciences Institute, Uberlândia Federal University, Uberlândia, Brazil.
authors.forename: Paulo
authors.initials: P
authors.lastname: Gontijo Filho
authors.affiliation: Núcleo de Vigilância Hospitalar, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
authors.forename: Mirza
authors.initials: M
authors.lastname: Rocha
authors.affiliation: Division of Infectious Diseases, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Eduardo Alexandrino Servolo
authors.initials: EA
authors.lastname: de Medeiros
authors.affiliation: Division of Infectious Diseases, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Antonio Carlos Campos
authors.initials: AC
authors.lastname: Pignatari
mesh_terms: D001938:Brazil / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D063373:Hand Hygiene; D006295:Health Resources; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data; D006761:Hospitals / Q000592:standards; D006801:Humans; D017053:Infection Control; D007755:Laboratories, Hospital; D008829:Microbiology; D013242:Sterilization
keywords: Hand hygiene; Hospital infection control program; Hospital infections; Infection control; Public health; Sterilization