ICARO BOSZCZOWSKI
Projetos de Pesquisa
Unidades Organizacionais
PAHC, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/49 - Laboratório de Protozoologia, Hospital das Clínicas, Faculdade de Medicina
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/49 - Laboratório de Protozoologia, Hospital das Clínicas, Faculdade de Medicina
9 resultados
Resultados de Busca
Agora exibindo 1 - 9 de 9
- A surveillance program for long-term central venous access-associated infections in outpatient chemotherapy services(2023) FREIRE, Maristela P.; ASSIS, Denise Brandao; CARLESSE, Fabianne; BELIZARIO, Juliana De Cassia; GERMANO, Priscila Costa Pimentel; VIROLLI, Juliana Monteiro; TURDO, Anna Claudia; RODRIGUES, Beatriz Quental; MACIEL, Amanda Luiz Pires; GONCALVES, Priscila; BOSZCZOWSKI, Icaro; ABDALA, Edson; LEVIN, Anna S.Objective: In this study, we described the first results of a surveillance system for infections associated with long-term central venous catheters (LT-CVC) in patients under outpatient chemotherapy. Design: This was a multicentric, prospective study. Setting: Outpatient chemotherapy services. Participants: The study included 8 referral cancer centers in the State of Sao Paulo. Intervention: These services were invited to participate in a newly created surveillance program for patients under chemotherapy. Several meetings were convened to share previous experiences on LT-CVC infection surveillance and to define the surveillance method. Once the program was implemented, all bloodstream infection (LT-CVC BSIs), tunnel infection, and exit-site infections associated with LT-CVC were reported. Data from January to May 2021 were analyzed. The median monthly number of chemotherapy sessions per clinic was 925 (IQR, 270-5,855). We used Poisson regression to analyze the association of rates with the characteristics of the services. Results: In total, 107 LT-CVC infections were reported, of which 95% were BSIs, mostly associated with totally implantable devices (76%). Infections occurred a median of 4 days after the last catheter manipulation and 116 after the LT-CVC insertion. Also, 102 microorganisms were isolated from LT-CVC BSIs; the most common pathogen was Staphylococcus epidermidis, at 22%. Moreover, 44 infections (44%) fulfilled the criteria for CVC-related LT-CVC BSI and 27 infections (27%) met the criteria for mucosal barrier injury. The 1-year cumulative LT-CVC BSI rate was 1.94 per 1,000 CVC days of use. The rates were higher in public hospitals (IRR, 6.00; P < .001) and in hospitals that already had in place surveillance for LT-CVC infections (IRR, 2.01; P < .01). Conclusion: Our study describes an applicable surveillance method for infections in cancer outpatients using LT-CVC.
- Carbapenem-resistant Enterobacteriaceae in patients admitted to the emergency department: prevalence, risk factors, and acquisition rate(2017) SALOMAO, M. C.; GUIMARAES, T.; DUAILIBI, D. F.; PERONDI, M. B. M.; LETAIF, L. S. H.; MONTAL, A. C.; ROSSI, F.; CURY, A. P.; DUARTE, A. J. S.; LEVIN, A. S.; BOSZCZOWSKI, I.Background: Carbapenem-resistant Enterobacteriaceae (CRE) have been reported worldwide and are associated with high mortality rates. Intestinal colonization acts as a reservoir and fosters exchange of resistance mechanisms. Aim: To investigate the prevalence of patients harbouring CRE on hospital admission, risk factors associated, and the acquisition rate within the emergency department (ED). Methods: This was a cross-sectional survey with 676 patients consecutively admitted to the ED study during the months of May to July 2016. A questionnaire was performed and rectal swabs were collected from patients on admission, for culture and for multiplex real-time polymerase chain reaction (PCR). If the patient was hospitalized for more than one week in the ED, samples were taken again to determine the acquisition rate of CRE. Findings: Forty-six patients were colonized; all positive PCR were Klebsiella pneumoniae carbapenemase. The acquisition rate was 18%. Previous exposure to healthcare in the last year, liver disease, and use of antibiotics in the last month were risk factors for colonization. Six patients with no previous exposure to healthcare were CRE-colonized on admission, suggesting transmission of CRE within the community. Conclusion: Screening of high-risk patients on admission to the ED is a strategy to early identify CRE carriage and may contribute to control CRE dissemination.
- Implementation of tailored interventions in a statewide programme to reduce central line-associated bloodstream infections(2018) ASSIS, D. B.; MADALOSSO, G.; PADOVEZE, M. C.; LOBO, R. D.; OLIVEIRA, M. S.; BOSZCZOWSKI, I; SINGER, J. M.; LEVIN, A. S.Background: There have been few studies exploring implementation strategies to central line-associated bloodstream infections (CLABSIs) in low- or middle-income countries. Aim: To implement tailored interventions to reduce CLABSI rates in adult intensive care units. Methods: The implementation strategy of the State Health Department was performed in Sao Paulo State, Brazil, over two cycles. Cycle 1 (56 hospitals) was exploratory and cycle 2 (77 hospitals) was designed to confirm the hypothesis generated by the first cycle, with three phases each (pre-intervention, intervention, post-intervention). Cycles included: evaluation of healthcare workers' knowledge, observation of practices, and CLABSI rates monthly report. In cycle 1, a log-normal mixed model was used to select variables significantly associated with the reduction of CLABSI. In cycle 2, CLABSI rates were evaluated. Findings: Healthcare workers' practices improved after intervention. In cycle 1, reduction of CLABSI rates was more pronounced in hospitals with initial CLABSI rates >7.4 per 1000 catheter-days (P < 0.001) and those that introduced the use of peripherally inserted central catheters (P= 0.01). For hospitals with high CLABSI initial rates, simulation demonstrated that the rates were expected to decrease by 36% (95% CI: 9-63), no matter the type of intervention. In cycle 2, there was an overall decrease in CLABSI rates during the intervention period; whereas the mean rate fell further post-intervention, rates at the 90th percentile increased. Conclusion: The implementation strategy may have had an effect on infection rates independently of the specific interventions implemented; however, the sustainability of reduction in the post-intervention period remains a challenge.
- Healthcare Professionals Perception of Mobile Phone Usage and Hand Hygiene Adhesion in Intensive Care Units(2020) SANCHEZ, Evelyn; PERDIGAO-NETO, Lauro; SANTOS, Sania Alves dos; RIZEK, Camila; GOMEZ, Maria Renata; MARTINS, Roberta; OLIVEIRA, Gaspar de; GUIMARAES, Thais; BOSZCZOWSKI, Icaro; ROSSI, Flavia; FREIRE, Maristela; LEVIN, Anna; COSTA, Silvia Figueiredo; FARREL, Marina
- Staphylococcus spp Resistance to Chlorhexidine: Is There Any Impact Related to the Routine Use for Hand Hygiene?(2020) BOSZCZOWSKI, Icaro; MINAMI, William Kazumassa; BARALDI, Marcia; MARCHI, Ana Paula; SANTOS, Sania Alves dos; SCHMITT, Cristiane; MACIEL, Amanda Luiz Pires; ZANI, Maria Eduarda Rufino; SOUZA, Leticia Muniz; SOUZA, Nicole Soares de; COSTA, Silvia Figueiredo
- Characterization of epidemiological surveillance systems for healthcare-associated infections (HAI) in the world and challenges for Brazil(2014) NOGUEIRA JUNIOR, Cassimiro; MELLO, Debora Silva de; PADOVEZE, Maria Clara; BOSZCZOWSKI, Icaro; LEVIN, Anna Sara; LACERDA, Rubia AparecidaSurveillance systems for healthcare-associated infections (HAI) are essential for planning actions in prevention and control. Important models have been deployed in recent decades in different countries. This study aims to present the historical and operational characteristics of these systems and discuss the challenges for Brazil. Various models around the world have drawn on the experience of the United States, which pioneered this process. In Brazil, several initiatives have been launched, but the country still lacks a full national information system on HAI, thus indicating the need to promote action strategies, strengthen the role of States in communication between the Federal and local levels, pursue a national plan to organize surveillance teams with the necessary technological infrastructure, besides updating the relevant legislation for dealing with these challenges. Such measures are essential in the Brazilian context for the unified surveillance of HAI, aimed at healthcare safety and quality.
- Barriers and Facilitators to Improving Hospital Cleanliness in a Brazilian Hospital(2020) MACIEL, Amanda Luiz Pires; BARALDI, Marcia Maria; BOSZCZOWSKI, Icaro; BEZERRA, Janaina Alves; PIASTRELLI, Filipe; CAMACHO, Eduardo Fernandes; SCHMITT, Cristiane
- Point Prevalence Surveys and Customized Interventions Are Good Strategies to Improve Antimicrobial Use: The Brazilian Experience(2020) PORTO, Ana Paula Matos; BOSZCZOWSKI, Icaro; VERSPORTEN, Ann; PAUWELS, Ines; THAIS, Thais; GIRAO, Evelyne; ESTEVES, Patricia; RODRIGUES, Cristhieni; CARRILHO, Claudia; FERRAZ, Tiago Luiz; CAPOBIANCO, Jaqueline; DONINI, Camila; COUTINHO, Rosane; GOOSSENS, Herman; COSTA, Silvia Figueiredo
- Evaluation of adenosine triphosphate test for cleaning assessment of gastroscopes and the effect on workload in a busy endoscopy center(2018) SCHMITT, Cristiane; MACIEL, Amanda Luiz Pires; BOSZCZOWSKI, Icaro; SILVA, Thais Pereira da; NEVES, Eliane Aparecida Job; ROSSINI, Giulio Fabio; RIZEK, Camila; COSTA, Silvia Figueiredo; LOURENCO, Rogerio Ferreira; ALFA, Michelle J.Objective: Using adenosine triphosphate (ATP) tests to assess manual cleaning of gastroscopes and to determine the associated workload in a busy endoscopy unit. Methods: Patient-used gastroscopeswere sampled before and after cleaning to assess ATP levels, bioburden, and protein. Samples were collected by flushing 20 mL of sterile water through the biopsy port to the distal end. Time spent for reprocessing and performing the ATP test was recorded. Results: Twenty-four samples were collected from 10 gastroscopes. After manual cleaning, 14/24 (58.3%) samples had no microbial growth (mean, 21 colony-forming units/cm(2)), and in 22/24 (91.7%) samples the protein was undetectable (mean, 0.04 mu g/cm(2)). ATP test was above the cutoff (200 relative light units [RLU]) in 17/24 (70.8%) samples (mean, 498 RLU). After the second cleaning, 11/17 (64.7%) gastroscopes still failed the ATP test (mean, 321.2 RLU). The mean time spent to perform manual cleaning and ATP tests was 16 and 8 minutes, respectively. Hence, each test increased the length of time for cleaning plus testing cleanliness by 50%. Conclusion: Further studies regarding the optimal cutoff for ATP tests are needed. ATP tests for cleaning monitoring are easy to perform and provide immediate feedback to the team. However, the increased workload needs to be considered.