Bentlin Maria Regina, Rugolo Ligia M S S, Ferrari Ligia S L
Hospital das Clínicas, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil.
Hospital das Clínicas, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil.
J Pediatr (Rio J). 2015 Mar-Apr;91(2):168-74. doi: 10.1016/j.jped.2014.07.004. Epub 2014 Nov 6.
To understand the practices related to late-onset sepsis (LOS) in the centers of the Brazilian Neonatal Research Network, and to propose strategies to reduce the incidence of LOS.
This was a cross-sectional descriptive multicenter study approved by the Ethics Committee. Three questionnaires regarding hand hygiene, vascular catheters, and diagnosis/treatment of LOS were sent to the coordinator of each center. The center with the lowest incidence of LOS was compared with the others.
All 16 centers answered the questionnaires. Regarding hand hygiene, 87% use chlorhexidine or 70% alcohol; alcohol gel is used in 100%; 80% use bedside dispensers (50% had one dispenser for every two beds); practical training occurs in 100% and theoretical training in 70% of the centers, and 37% train once a year. Catheters: 94% have a protocol, and 75% have a line insertion team. Diagnosis/treatment: complete blood count and blood culture are used in 100%, PCR in 87%, hematological scores in 75%; oxacillin and aminoglycosides is the empirical therapy in 50% of centers. Characteristics of the center with lowest incidence of LOS: stricter hand hygiene; catheter insertion and maintenance groups; use of blood culture, PCR, and hematological score for diagnosis; empirical therapy with oxacillin and aminoglycoside.
The knowledge of the practices of each center allowed for the identification of aspects to be improved as a strategy to reduce LOS, including: alcohol gel use, hand hygiene training, implementation of catheter teams, and wise use of antibiotic therapy.
了解巴西新生儿研究网络各中心与晚发性败血症（LOS）相关的做法，并提出降低LOS发病率的策略。
这是一项经伦理委员会批准的横断面描述性多中心研究。向每个中心的协调员发送了三份关于手卫生、血管导管以及LOS诊断/治疗的问卷。将LOS发病率最低的中心与其他中心进行比较。
所有16个中心都回答了问卷。关于手卫生，87%使用洗必泰或70%酒精；100%使用酒精凝胶；80%使用床边分配器（50%每两张床有一个分配器）；100%的中心进行实践培训，70%进行理论培训，37%的中心每年培训一次。导管：94%有方案，75%有置管团队。诊断/治疗：100%使用全血细胞计数和血培养，87%使用聚合酶链反应（PCR），75%使用血液学评分；50%的中心经验性治疗使用苯唑西林和氨基糖苷类药物。LOS发病率最低的中心的特点：更严格的手卫生；导管插入和维护小组；使用血培养、PCR和血液学评分进行诊断；使用苯唑西林和氨基糖苷类药物进行经验性治疗。
了解每个中心的做法有助于确定作为降低LOS策略需要改进的方面，包括：酒精凝胶的使用、手卫生培训、导管团队的实施以及明智地使用抗生素治疗。
