The role of primary care in the prevention and control of healthcare associated infections

Abstract

Little research has been conducted to date on the role of primary health care (PHC) in the prevention of healthcare associated infections (HCAIs). The present article is a theoretical study of the principle of primum non nocere and aims to promote reflection on the role of PHC in HCAI prevention with emphasis on practical recommendations. The indirect and direct roles of PHC in HCAI prevention are debated in light of this guiding principle. With respect to the indirect role of PHC, we discuss the issues of hospital-centrism and ambulatory care-sensitive conditions. The article outlines a number of challenges faced by health services related to PHC's direct role in HCAI prevention, highlights seven key components of HCAI prevention programmes within the PHC sphere and provides practical recommendations for HCAI control and prevention. DESCRIPTORES RESUMENEl rol de la Atención Primaria a la Salud (APS) en la prevención de Infecciones Relacionadas con la Asistencia a la Salud (IRAS) rara vez se discute en la literatura. El presente artículo tiene como meta desarrollar un estudio teórico con base en el principio Primum non nocere, trayendo a la luz una reflexión acerca del papel de la APS en la prevención de IRAS con énfasis en las recomendaciones de prácticas. Los roles indirecto y directo de la APS en la prevención de IRAS se debaten teniendo en cuenta este principio orientador. En el rol indirecto de la APS se discuten el tema del hospitalocentrismo y los internamientos por condiciones sensibles a la atención primaria. Con respecto al rol directo se apuntan los retos a superarse. Se señalan siete componentes esenciales para el desarrollo de un programa de prevención de IRAS en la APS y las respectivas recomendaciones. DESCRIPTORSInfección hospitalaria Seguridad del paciente Atención Primaria de Salud Enfermería en salud comunitaria Modelos teóricos

Ureolytic Biomineralization Reduces Proteus mirabilis Biofilm Susceptibility to Ciprofloxacin

“…The normal clinical approach to the lack of efficacy of antimicrobials against CAUTIs involving biomineralization is to replace the catheter, which significantly improves infection control outcomes (4,44). However, catheter replacement is not desirable as a primary means of controlling CAUTIs, because it causes patient discomfort, incurs health risks when blocked catheters are not removed promptly, and requires significant effort on the part of health care providers (45). Further, CAUTIs are often found to recur chronically (46), especially in long-term care, suggesting that recalcitrant biomineralized biofilms occur outside the catheter itself (12) and provide a nidus for catheter reinfection.…”

Knowledge about precautions in Primary Health Care: tool validation

“…Among the ways of prevention of HCAI enshrined worldwide, is the adoption of measures known as Standard Precautions (StanP) and Specific Precautions (SpeP) (3)(4) , which aim to reduce the risk of transmission of microorganisms to patients and professionals. StanP is a measure that should be used with all patients regardless of the occurrence of a suspected or confirmed diagnosis, and includes Hands Hygiene (HH), use of Personal Protective Equipment (PPE), respiratory label, physical area care, environment and waste management (5)(6)(7) . SpeP is an additional measure that should be used when StanP is not enough to stop the transmission of pathogens through contact, droplet or aerosol.…”

“…SpeP is an additional measure that should be used when StanP is not enough to stop the transmission of pathogens through contact, droplet or aerosol. In Primary Health Care (PHC), the most common situations requiring SpeP are: pulmonary or laryngeal tuberculosis and varicella (aerosols), influenza (droplets), scabies and multiple drug resistant microorganisms (contact) (5) . It is well known that adherence to such measures is still a challenge among health professionals (8)(9) .…”

“…In PHC, however, this risk of HCAI is unknown, which is considered concerning, since it is one of the great entry points of the health system in the country, in addition to the diversity of actions that take place there. Performing invasive procedures, such as administration of medication, vaccination and dressings, is part of the PHC routine; the control and search of patients with infectious diseases such as tuberculosis; in addition to the first outbreak care, such as influenza A, for example (5) . Another situation that is increasingly frequent and still little investigated, but observed empirically, is the transfer of care from patients who are discharged from hospital with multiple drug resistant microorganisms and continue their care in PHC.…”

“…The achievement of this is also justified by the relevance of HCAI transmission in PHC, the rare epidemiological reports on this population (5) , the acknowledged deficit of adherence to StanP and SpeP by health professionals in general (11) , the difficulty of comparison between the results of the few recent studies in this care setting (12)(13)(14)(15)(16) and the limited availability of assessment tools (17)(18) , which have not yet been validated.…”