RESUMO Objetivo A pneumonia pneumocócica é uma causa significativa de morbimortalidade entre adultos. Desta maneira, o objetivo principal deste estudo foi avaliar a mortalidade intra-hospitalar e os custos relacionados à doença adquirida em adultos. Métodos Este estudo transversal utilizou prontuários de pacientes adultos com pneumonia pneumocócica internados em um hospital universitário no Brasil, de outubro de 2009 a abril de 2017. Todos os pacientes com idade ≥ 18 anos e diagnosticados com pneumonia pneumocócica foram incluídos. Dados como os fatores de risco, a internação em unidade de terapia intensiva, o tempo de internação, a mortalidade hospitalar e os custos diretos e indiretos foram analisados. Resultados No total, 186 pacientes foram selecionados. A taxa média de mortalidade intra-hospitalar foi de 18% para adultos com idade < 65 anos e 23% para os idosos (≥ 65 anos). A pneumonia pneumocócica bacterêmica acometeu 20% dos pacientes em ambos os grupos, principalmente por doença respiratória crônica (OR ajustada: 3,07; IC95%: 1,23‐7,65; p < 0,01). Após levantamento das internações ocorridas no período de sete anos de tratamento, verificou-se que os custos diretos e indiretos totais anuais foram de US$ 28.188 para adultos < 65 anos (US$ 1.746 per capita) e US$ 16.350 para os idosos (US$ 2.119 per capita). Conclusão A pneumonia pneumocócica continua sendo uma importante causa de morbimortalidade entre adultos, afetando significativamente os custos diretos e indiretos. Esses resultados sugerem a necessidade de estratégias de prevenção para todos os adultos, especialmente para pacientes com doenças respiratórias crônicas.

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Infection control teams collect and produce information on epidemiologic surveillance for prevention of Healthcare Associated Infections (HAIs). Value Stream Mapping (VSM) is a Lean method for developing process through flow efficiency. The aim of the study was to use VSM to identify opportunities for improvement in the infection control department. Flow of information and infection control activities were reviewed using VSM and a questionnaire, where time required for each task was measured. The actual VSM went through multidisciplinary analysis and an ideal VSM was created without considering resource limits. The ideal VSM was reviewed to identify the improvements easily implemented and the ones that would require more time or resources. The actual VSM analysis addressed work overload for Key Performance Indicators (KPI) production, data management (fragmentation, access and redundant work, storage, time between tasks, time typing) and tasks performed retrospectively, when less information is available and with no opportunity to correct protocol deviation. The implementation of the ideal VSM provided a faster and more efficient HAIs analysis, London protocol for HAI cases and surgical prophylaxis evaluation became real time tasks, and all surgical surveillance was improved. A mobile app was proposed as an intervention and became a long-term project. If completely implemented, the ideal VSM would result in 15.7 less work hours/month, having the working time optimized for patient care. VSM is an important tool for epidemiologic surveillance in infection control allowing better data management, continuous workflow, and new information production with potentially fewer work hours.

RNA viruses, such as influenza and respiratory syncytial virus (RSV), are common causes of lower airway infections. Rapid tests (antigen-based by immunochromatographic and molecular technique - RIT and RMT, respectively) with good diagnostic accuracy directly impacts the quality of patient care and hospitalization costs. This study aims to evaluate the implementation of point of care PCR compared to rapid antigen-based tests for influenza and RSV in the emergency department.Methods: Prospective cross section study in an Emergency Room (ER) from August to September 2019, where all patients with influenza like illness went through RIT and RMT. The patients were divided in a model of four clinical scenarios to evaluate cost and isolation time in the ER.Results: 424 patients were included in the study. RIT showed sensitivity of only 40% compared with RMT (100% specificity; PPV 100%; NPV 68,7%), causing 103 patients to mistakenly leave respiratory isolation, raising biological risk in the ER. Fast results from RMT led negative patients to leave isolation early (262:10 less hours of isolation), allowing cost reduction of USD 1.921,20. Nonetheless, RMT had higher cost than RIT in all clinical scenarios with an increase of USD 12.788,90 (69,9% of cost related to tests and isolation precautions). Conclusion: RIT was a more affordable test but can’t be used to exclude disease and was associated with higher biological risk to the hospital setting. RMT had better diagnostic performance with faster results, allowing for less isolation time per patient tested.