Medical Research Essentials. Rania Esteitie. Edward W.
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Research 101: Descriptive statistics
Christina A. Starting out in Statistics. Patricia de Winter. Martha L. Carlos Franco-Paredes. Max Miller. Chester W. Applied Epidemiology and Biostatistics. Giuseppe La Torre. All methodologies are presented with sufficient detail for interested researchers or graduate students. This book has a vast list of citations and is an excellent reference for statisticians performing oncology research in the pharmaceutical industry or in other settings, and for graduate students in biostatistics or in related fields.
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Stay on CRCPress. Preview this Book. Add to Wish List. Close Preview. Toggle navigation Additional Book Information. Only recently, the Brazilian Health Surveillance Agency ANVISA published a manual 17 addressing the cleaning and disinfection of surfaces, a fact that shows a great advancement in the field.
Various studies indicated that the ATP monitoring is an important tool to inspect levels of cleanliness 3 , 10 , 12 , Additionally, as opposed to the visual test, the ATP method is not subjective and also has an advantage over the microbiological methods that require from 24 to 48 hours to provide results. There is another consideration in regard to the cleaning and disinfection routine performed in the unit: the cleaning process was performed only once a day. Hence, the question is: would more frequent cleanings show more promising results?
Researchers 6 , 10 , 12 , 18 monitoring the disinfection of surfaces using bioluminescence adenosine triphosphate and aerobic cultures show that cleaning and disinfection protocols are often disregarded. The risk of acquiring MRSA was examined by researchers 20 and a relationship between the hands of health workers and the area occupied by an infected or colonized patient was found. It is worth noting that the hands of healthcare workers remain the main route of cross-infection transmission, if strict aseptic measures are not followed.
Therefore, attention should be paid to highly contaminated sites that may compound the risk of infection even with appropriate adherence to hand hygiene 4 , 9 , It is no surprise that patients, healthcare workers, and visitors transfer secretions, oils, skin cells and organic matter to hospital surfaces. Through this physical contact, a film composed of inorganic salts, organic matter, and microorganisms accumulate over time and, presumably, facilitates the growth and transmission of viable microorganisms throughout the environment Hence, the systematic implementation of cleaning and disinfection protocols for surfaces along with an assessment of their efficiency afterwards is justifiable 2 - 3 , 5 , 12 , In conclusion, as visual inspection alone does not provide reliable information about the risk of transmitting infections to patients, the surfaces in healthcare facilities should be assessed regarding the efficacy of cleaning processes.
Fluorescent gel and visual assessment help to verify adherence to cleaning and disinfection protocols, while methods that monitor bio load ATP and microbiological provide a more relevant indication regarding the risk of infection and efficiency of the sanitizers used. Additionally, such regimens should accurately interpret results to foresee clinical risks in a timely manner. This study has some limitations, including the fact that the aerobic colonies on surfaces were not quantified, which would improve indicators of the quality of the cleaning and disinfection procedures.
The study was performed in a single unit, which restricts generalization to other units in the same facility. There was a reduced number of samples for each surface due to limited financial resources and, finally, this study does not clarify the relationship of the presence of MSRA on surfaces with the risk of transmission to patients and healthcare workers.
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Further studies are required to determine objectively whether standardized cut-off values of the microbiological test and ATP analysis are accurate for the classification of surfaces in healthcare facilities as clean and also to clarify aspects related to the technique of friction or rubbing with a cloth, its frequency, and whether it is associated or not with other inputs such as disinfectants, especially in regard to the antimicrobial action on some multi-resistant microorganisms. Evidence that contaminated surfaces contribute to the transmission of hospital pathogens and an overview of strategies to address contaminated surfaces in hospital settings.
Am J Infect Control. Condition of cleanliness of surfaces close to patients in an intensive care unit. Comparison of fluorescent marker systems with 2 quantitative methods of assessing terminal cleaning practices. Infect Control Hosp Epidemiol. Dancer SJ.
Statistical methods for hospital monitoring with R
Importance of the environment in meticillin resistant Staphylococcus aureus acquisition: the case for hospital cleaning. Lancet Infect Dis. Impact of an environmental cleaning intervention on the presence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci on surfaces in intenstive care unit rooms.