This report describes a survey of microbiology laboratories (n = 467) serving Brazilian hospitals with ≥10 intensive care beds and/or involved in the government health care adverse event reporting ...system. Coordinators were interviewed and laboratories classified as follows: Level 0 (no minimal functioning conditions-85.4% of laboratories); Level 1 (minimal functioning conditions but inadequate execution of basic routine-6.7%); Level 2 (minimal functioning conditions and adequate execution of basic routine but no adequate procedures for quality control-5.8%); Level 3 (minimal functioning conditions, adequate execution of basic routine, and adequate procedures for quality control, but no direct communication with the infection control department-0.9%); Level 4 (minimal functioning conditions, adequate execution of basic routine, adequate procedures for quality control, and direct communication with infection control, but no available advanced resources-none); and Level 5 (minimal functioning conditions, adequate execution of basic routine, adequate procedures for quality control, direct communication with infection control, and available advanced resources-0.9%). Twelve laboratories did not perform Ziehl-Neelsen staining; 271 did not have safety cabinets; and >30% without safety cabinets had automated systems. Low quality was associated with serving hospitals not participating in government adverse-event program; private hospitals; nonteaching hospitals; and those outside state capitals. Results may reflect what occurs in many other countries where defining priorities is important due to limited resources.
The authors developed a comparative study of the various methods of assessment of immune response to Hepatitis B vaccine. Eighty-six health care professionals underwent a vaccination programme with ...three doses of plasma-derived vaccine against Hepatitis B (H-B-Vax, Merck, Sharp & Dohme) given intra-muscularly. Assessment of immune response was carried out three months after the end of the programme, by radioimmunoassay (RIA) and enzymeimmunoassay (EIA). The results showed that the semi-quantitative assessment of Anti-HBs antibodies by RIA or EIA was perfectly comparable to the reference method (quantitative determination of antibodies by RIA). In view of these findings, the authors suggest a standardization of assessment of immune response to the vaccine, thus permitting correct planning of booster doses and easier comparison between different studiesOs autores realizaram estudo comparativo dos diferentes métodos de avaliação da resposta à vacina contra hepatite B. Foram estudados 86 indivíduos, profissionais da área de saúde, que foram submetidos a esquema de vacinação com três doses de vacina plasmática contra hepatite B (H-B-Vax, Merck, Sharp & Dohme), aplicadas por via intramuscular. A avaliação da resposta imunológica à vacina foi realizada três meses após o término do esquema, através tanto de radioimunoensaio como enzimaimunoensaio. Os resultados obtidos demonstraram que a avaliação semi-quantitativa dos anticorpos anti-HBs por enzimaimunoensaio é perfeitamente superponível ao método de referência, que é a determinação quantitativa de anticorpos por radioimunoensaio. Tendo em vista estes achados, os autores propõem uma padronização da avaliação da resposta à vacina, com o objetivo de predizer a ocasião das doses de reforço e tornar os diferentes estudos comparáveis entre si
Este artículo describe una encuesta realizada en Brasil en laboratorios de microbiología (n = 467) que prestaban servicio a hospitales que contaban al menos con 10 camas de cuidados intensivos. Se ...entrevistó a los coordinadores y los laboratorios se clasificaron de la siguiente manera: nivel 0 (sin condiciones de funcionamiento mínimas: 85,4% de los laboratorios), nivel 1 (condiciones de funcionamiento mínimas pero ejecución inadecuada del trabajo habitual básico: 6,7%), nivel 2 (condiciones de funcionamiento mínimas y ejecución adecuada del trabajo habitual básico, pero sin procedimientos de control de calidad apropiados: 5,8%), nivel 3 (condiciones de funcionamiento mínimas, ejecución adecuada del trabajo habitual básico y procedimientos de control de calidad apropiados, pero sin comunicación directa con el departamento de control de infecciones: 0,9%), nivel 4 (condiciones de funcionamiento mínimas, ejecución adecuada del trabajo habitual básico, procedimientos de control de calidad apropiados y comunicación directa con el departamento de control de infecciones, pero sin recursos avanzados disponibles: ningún laboratorio) y nivel 5 (condiciones de funcionamiento mínimas, ejecución adecuada del trabajo habitual básico, procedimientos de control de calidad apropiados, comunicación directa con el departamento de control de infecciones y recursos avanzados disponibles: 0,9%). Doce laboratorios no realizaban la tinción de Ziehl-Neelsen, 271 no contaban con cámaras de seguridad biológica, y más de 30% de los laboratorios que carecían de cámaras de seguridad biológica tenían sistemas automatizados. La escasa calidad se asoció a la falta de participación en el programa gubernamental de notificación de acontecimientos adversos, a los hospitales privados, a los hospitales no docentes y a la ubicación de los hospitales fuera de las capitales de los estados. Los resultados pueden reflejar lo que ocurre en muchos otros países con recursos limitados, donde es importante definir las prioridades. Palabras clave Laboratorios de hospital; encuestas de la atención de la salud; garantía de la calidad de atención de salud; téchnicas microbiológicas; indicadores de calidad de la atención de la salud; Brasil. This report describes a survey of microbiology laboratories (n = 467) serving Brazilian hospitals with greater than or equal to 10 intensive care beds and/or involved in the government health care adverse event reporting system. Coordinators were interviewed and laboratories classified as follows: Level 0 (no minimal functioning conditions--85.4% of laboratories); Level 1 (minimal functioning conditions but inadequate execution of basic routine--6.7%); Level 2 (minimal functioning conditions and adequate execution of basic routine but no adequate procedures for quality control--5.8%); Level 3 (minimal functioning conditions, adequate execution of basic routine, and adequate procedures for quality control, but no direct communication with the infection control department--0.9%); Level 4 (minimal functioning conditions, adequate execution of basic routine, adequate procedures for quality control, and direct communication with infection control, but no available advanced resources--none); and Level 5 (minimal functioning conditions, adequate execution of basic routine, adequate procedures for quality control, direct communication with infection control, and available advanced resources--0.9%). Twelve laboratories did not perform Ziehl-Neelsen staining; 271 did not have safety cabinets; and >30% without safety cabinets had automated systems. Low quality was associated with serving hospitals not participating in government adverse-event program; private hospitals; nonteaching hospitals; and those outside state capitals. Results may reflect what occurs in many other countries where defining priorities is important due to limited resources. Key words Laboratories, hospital; health care surveys; quality assurance, health care; microbiological techniques; quality indicators, health care; Brazil.
Este articulo describe una encuesta realizada en Brasil en laboratorios de microbiologia (n = 467) que prestaban servicio a hospitales que contaban al menos con 10 camas de cuidados intensivos. Se ...entrevisto a los coordinadores y los laboratorios se clasificaron de la siguiente manera: nivel 0 (sin condiciones de funcionamiento minimas: 85,4% de los laboratorios), nivel 1 (condiciones de funcionamiento minimas pero ejecucion inadecuada del trabajo habitual basico: 6,7%), nivel 2 (condiciones de funcionamiento minimas y ejecucion adecuada del trabajo habitual basico, pero sin procedimientos de control de calidad apropiados: 5,8%), nivel 3 (condiciones de funcionamiento minimas, ejecucion adecuada del trabajo habitual basico y procedimientos de control de calidad apropiados, pero sin comunicacion directa con el departamento de control de infecciones: 0,9%), nivel 4 (condiciones de funcionamiento minimas, ejecucion adecuada del trabajo habitual basico, procedimientos de control de calidad apropiados y comunicacion directa con el departamento de control de infecciones, pero sin recursos avanzados disponibles: ningun laboratorio) y nivel 5 (condiciones de funcionamiento minimas, ejecucion adecuada del trabajo habitual basico, procedimientos de control de calidad apropiados, comunicacion directa con el departamento de control de infecciones y recursos avanzados disponibles: 0,9%). Doce laboratorios no realizaban la tincion de Ziehl-Neelsen, 271 no contaban con camaras de seguridad biologica, y mas de 30% de los laboratorios que carecian de camaras de seguridad biologica tenian sistemas automatizados. La escasa calidad se asocio a la falta de participacion en el programa gubernamental de notificacion de acontecimientos adversos, a los hospitales privados, a los hospitales no docentes y a la ubicacion de los hospitales fuera de las capitales de los estados. Los resultados pueden reflejar lo que ocurre en muchos otros paises con recursos limitados, donde es importante definir las prioridades. Palabras clave Laboratorios de hospital; encuestas de la atencion de la salud; garantia de la calidad de atencion de salud; technicas microbiologicas; indicadores de calidad de la atencion de la salud; Brasil. This report describes a survey of microbiology laboratories (n = 467) serving Brazilian hospitals with greater than or equal to 10 intensive care beds and/or involved in the government health care adverse event reporting system. Coordinators were interviewed and laboratories classified as follows: Level 0 (no minimal functioning conditions--85.4% of laboratories); Level 1 (minimal functioning conditions but inadequate execution of basic routine--6.7%); Level 2 (minimal functioning conditions and adequate execution of basic routine but no adequate procedures for quality control--5.8%); Level 3 (minimal functioning conditions, adequate execution of basic routine, and adequate procedures for quality control, but no direct communication with the infection control department--0.9%); Level 4 (minimal functioning conditions, adequate execution of basic routine, adequate procedures for quality control, and direct communication with infection control, but no available advanced resources--none); and Level 5 (minimal functioning conditions, adequate execution of basic routine, adequate procedures for quality control, direct communication with infection control, and available advanced resources--0.9%). Twelve laboratories did not perform Ziehl-Neelsen staining; 271 did not have safety cabinets; and >30% without safety cabinets had automated systems. Low quality was associated with serving hospitals not participating in government adverse-event program; private hospitals; nonteaching hospitals; and those outside state capitals. Results may reflect what occurs in many other countries where defining priorities is important due to limited resources. Key words Laboratories, hospital; health care surveys; quality assurance, health care; microbiological techniques; quality indicators, health care; Brazil.
ABSTRACT IN SPANISH: Este artículo describe una encuesta realizada en Brasil en laboratorios de microbiología (n = 467) que prestaban servicio a hospitales que contaban al menos con 10 camas de ...cuidados intensivos. Se entrevistó a los coordinadores y los laboratorios se clasificaron de la siguiente manera: nivel 0 (sin condiciones de funcionamiento mínimas: 85,4% de los laboratorios), nivel 1 (condiciones de funcionamiento mínimas pero ejecución inadecuada del trabajo habitual básico: 6,7%), nivel 2 (condiciones de funcionamiento mínimas y ejecución adecuada del trabajo habitual básico, pero sin procedimientos de control de calidad apropiados: 5,8%), nivel 3 (condiciones de funcionamiento mínimas, ejecución adecuada del trabajo habitual básico y procedimientos de control de calidad apropiados, pero sin comunicación directa con el departamento de control de infecciones: 0,9%), nivel 4 (condiciones de funcionamiento mínimas, ejecución adecuada del trabajo habitual básico, procedimientos de control de calidad apropiados y comunicación directa con el departamento de control de infecciones, pero sin recursos avanzados disponibles: ningún laboratorio) y nivel 5 (condiciones de funcionamiento mínimas, ejecución adecuada del trabajo habitual básico, procedimientos de control de calidad apropiados, comunicación directa con el departamento de control de infecciones y recursos avanzados disponibles: 0,9%). Doce laboratorios no realizaban la tinción de Ziehl-Neelsen, 271 no contaban con cámaras de seguridad biológica, y más de 30% de los laboratorios que carecían de cámaras de seguridad biológica tenían sistemas automatizados. La escasa calidad se asoció a la falta de participación en el programa gubernamental de notificación de acontecimientos adversos, a los hospitales privados, a los hospitales no docentes y a la ubicación de los hospitales fuera de las capitales de los estados. Los resultados pueden reflejar lo que ocurre en muchos otros países con recursos limitados, donde es importante definir las prioridades. // ABSTRACT IN ENGLISH: This report describes a survey of microbiology laboratories (n = 467) serving Brazilian hospitals with >10 intensive care beds and/or involved in the government health care adverse event reporting system. Coordinators were interviewed and laboratories classified as follows: Level 0 (no minimal functioning conditions - 85.4% of laboratories); Level 1 (minimal functioning conditions but inadequate execution of basic routine - 6.7%); Level 2 (minimal functioning conditions and adequate execution of basic routine but no adequate procedures for quality control - 5.8%); Level 3 (minimal functioning conditions, adequate execution of basic routine, and adequate procedures for quality control, but no direct communication with the infection control department - 0.9%); Level 4 (minimal functioning conditions, adequate execution of basic routine, adequate procedures for quality control, and direct communication with infection control, but no available advanced resources - none); and Level 5 (minimal functioning conditions, adequate execution of basic routine, adequate procedures for quality control, direct communication with infection control, and available advanced resources - 0.9%). Twelve laboratories did not perform Ziehl-Neelsen staining; 271 did not have safety cabinets; and >30% without safety cabinets had automated systems. Low quality was associated with serving hospitals not participating in government adverse-event program; private hospitals; nonteaching hospitals; and those outside state capitals. Results may reflect what occurs in many other countries where defining priorities is important due to limited resources.
We report 4 patients with glomerulonephritis (GN) associated with hepatitis C virus (HCV) infection seen between August 1993 and July 1996. Two of them were male and median age was 41 years. Anti-HCV ...was detected by enzyme-immunoassay and HCV-RNA by PCR. Serum cryoglobulins, 24-hour proteinuria, and erythrocyte dismorphism were also determined. Viremia, cryoglobulinemia, hematuria and proteinuria were observed in all patients. Liver biopsies revealed inflammatory activity in 3 cases, and renal biopsies revealed membranoproliferative glomerulonephritis in 3 patients and mesangial proliferative glomerulonephritis in 1 patient. Two patients are on specific therapy for HCV infection (IFN in combination with ribavirin) and have presented clinical and laboratory improvement. The occurrence of active liver disease and viremia concurrent with urinary alterations suggests viral involvement in renal disease, a conclusion supported by the by improvement of urinary alterations observed after treatment for HCV. We conclude that the search for viral markers in patients with GN is important since their detection could change the therapeutic approach.
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