Effect of perioperative hypothermia on surgical site infection in abdominal surgery: A prospective cohort study.

AIM: To estimate the incidence rates of surgical site infection and identify the independent effect of perioperative hypothermia on the incidence of this type of infection in patients undergoing abdominal surgery. BACKGROUND: Around the world, surgical site infection is a frequent complication in surgical patients, mainly causing increased morbidity and mortality rates and health service costs. DESIGN: A prospective cohort study. METHODS: The 484 patients were recruited from a large private philanthropic hospital in the state of São Paulo, Brazil, from July 2016 to May 2017. Crude and adjusted models were constructed for the hypothermia indicators to assess the effect of this exposure on surgical site infection. RESULTS: The incidence rate of surgical site infection was 20.25% (n = 98). The attributable fraction to exposed to hypothermia was >40%. A greater probability of developing surgical site infection (relative risk = 1.89) was found for patients who experienced body temperatures <36.0°C (from entry time into the operating room until the end of the surgery) for more than five hypothermic episodes or longer than 75 min. CONCLUSION: Perioperative hypothermia was an independent risk factor for surgical site infection. SUMMARY STATEMENT: What is already known about this topic? Around the world, surgical site infection is a complication that leads to damage to the patient and increased costs for the health services. Despite recent advances in surgical techniques, surgical site infection remains one of the most frequent complications in abdominal surgery. Perioperative hypothermia can increase the incidence rates of surgical site infection. There is evidence that perioperative hypothermia is associated with surgical site infection in abdominal surgery, but most studies were conducted in developed countries using retrospective designs. What this paper adds? Perioperative hypothermia was identified as an independent risk factor for surgical site infection in patients undergoing abdominal surgery. The attributable fraction to the exposed indicated that, if the main exposure of interest (perioperative hypothermia) could be prevented during surgical anaesthetic procedures, more than 40% of surgical site infection cases would be avoided. The classification of the American Society of Anaesthesiologists was independently associated with the surgical site infection and presented a dose-response effect among its categories. Spinal anaesthesia served as an independent protective factor for surgical site infection. The implications of this paper: The health service managers need to be aware of potential cost-savings associated with perioperative hypothermia prevention as a measure to reduce the incidence of surgical site infection. During the perioperative period, health professionals need to implement effective measures to maintain patients' normothermia, promoting improved care and surgical patient safety. In this context, the nurse's role is fundamental. Future research projects using a prospective design and developed to address the reality of developing countries can contribute to the strengthening and consistency of the findings with a view to a global understanding of the surgical site infection problem.

Barriers to research utilization influencing patient safety climate: A cross-sectional study.

AIMS: This study aimed to investigate the influence of barriers to the use of research results in the practice of nurses on patient safety perception. BACKGROUND: The use of research results in clinical practice promotes safe care, increases quality and reduces the possibility of adverse events. DESIGN: This is a cross-sectional study. METHODS: The sample consisted of 207 nurses from three public university hospitals in the state of Minas Gerais, Brazil from March 2017 to November 2018. They answered a questionnaire with professional characteristics, The Barriers Scale and Safety Attitudes Questionnaire. Descriptive analysis, Student's t test, Pearson correlation and multiple linear regression were used for data analysis. RESULTS: The findings showed most nurses had unfavourable competencies for implementing research results in practice. As barrier scores for the use of research results in practice increase, safety climate scores decrease. Taking a training course on the use of research results in clinical practice and organization characteristics, limitations of the setting were statistically significant, constituting factors that influence the perception of the safety climate. CONCLUSION: Investments in education are needed for health professionals to be aware of evidence-based practice and how to use evidence to impact decision-making outcomes, strengthening safety outcomes in health services.

Dressings for the central venous catheter to prevent infection in patients undergoing hematopoietic stem cell transplantation: a systematic review and meta-analysis.

PURPOSE: To identify the most effective dressing for covering long-term central venous catheter exit site to prevent catheter-related infections and skin irritation in patients undergoing hematopoietic stem cell transplantation. METHODS: Systematic Review. The search was performed in the following electronic databases: CINAHL, Cochrane Library CENTRAL, EMBASE, LILACS, PubMed, Scopus, and Web of Science. Google Scholar was used for the gray literature search. RESULTS: Seven studies were included which tested different arrangements of dressings: sterilized gauze and adhesive tape with a transparent polyurethane film (n = 2), transparent polyurethane film with a different replacement interval frequency (n = 2), transparent polyurethane film with and without chlorhexidine released continuously by the dressing at the site of intravascular catheter insertion (n = 2), and dressings vs. no dressings (n = 1). The meta-analysis for catheter-related infection prevention showed no difference between type of dressing (RR 1.76, [95% CI 0.82; 3.75], I2 0%) and for the replacement frequency at different intervals (RR 1.04, [95% CI 0.67; 1.61], I2 0%). The meta-analysis for skin irritation evaluated the transparent polyurethane film replacement frequency and indicated that a longer dressing replacement interval (10 to 15 days) reduces the risk of developing this outcome (RR 0.71, 0.52; 0.96, 95% CI, I2 24%). CONCLUSIONS: Regarding the type of the dressing, there is no evidence indicating the best dressing. Although there is no evidence available for the ideal replacement frequency, the risk to develop skin irritation is reduced in longer dressing replacements intervals.

Surgical safety checklist: benefits, facilitators, and barriers in the nurses' perspective. / Lista de verificação de segurança cirúrgica: benefícios, facilitadores e barreiras na perspectiva da enfermagem.

OBJECTIVE: To identify the benefits, facilitators and barriers in the implementation of the surgical safety checklist, according to the reports of nurses working in the hospital surgical center. METHOD: Cross-sectional study with 91 nurses in 25 hospitals in two municipalities of Paraná. Between the years 2015 and 2016, two structured instruments were used to collect data. For the analysis, Fisher's exact or Chi-Square test was used. RESULTS: The implementation of the checklist brought benefits to the patient, surgical team and hospitals. Regarding the facilitators, the results presented a statistically significant difference between the groups in the items offering education (p=0.006) and acceptance by surgeons (p=0.029). In the barriers, the lack of administrative (p=0.006) and management (p=0.041) support, absence of the patient safety nucleus (p=0.005), abruptly introduced list (p=0.001) and absence of education (p<0.001). CONCLUSION: The evidence generated allowed to identify the benefits, facilitators and barriers in the implementation of the checklist in the national context.

Chronic Liver Disease Questionnaire as a Tool to Evaluate the Quality of Life in Liver Transplant Candidates.

INTRODUCTION:: The advanced stage of liver disease causes impairments in the quality of life due to the physiological symptoms, besides the social and emotional stress. The aim of this study was to evaluate the quality of life of candidates for liver transplantation in specialized center in the interior of the state of São Paulo, Brazil. METHODS:: An observational study was carried out, with a quantitative approach. The sample was of convenience with the participation of 50 candidates for liver transplantation. Demographic characterization data, clinical data, and the Chronic Liver Disease Questionnaire were used to evaluate the quality of life. RESULTS:: The majority of the participants were male (68%), married (76%), with an average age of 55.7 years and average income of 2 to 3 minimum wages (42%). The main cause of liver disease was alcoholism (34%), mean time on the waiting list was 247.8 days, and mean model for end-stage liver disease was 20.5 points. The mean quality of life score was 2.9 points (standard deviation = 1.0) and the analysis of the 6 domains showed greater impairment of fatigue (2.2), activity (2.7), and concern (2.9) and better evaluation of systemic symptoms (3.4) and emotion (3.3). CONCLUSION:: Quality of life is impaired in most of the participants, indicating the need for greater attention and evaluation in the physical, mental, and social scope of this clientele.

Surgical count process: evidence for patient safety. / Processo de contagem cirúrgica: evidências para a segurança do paciente.

OBJECTIVE: To analyze the surgical count process according to reports of nurses working in surgical centers of a city in the state of São Paulo. METHODS: Cross-sectional study with a sample of 55 nurses. Data collection occurred from August to December 2013, with application of an instrument submitted to face and content validation, composed of data on variables regarding characteristics of nurses, hospital, and surgical count process. RESULTS: Fifty-two (94.5%) nurses reported that the surgical count process was carried out in their workplaces. A statistically significant association was found between the surgical count process and the type of institution (P=0.046), and between the presence of a surgical technologist and the processes for counting surgical instruments (P<0.001) and sponges (P=0.016). CONCLUSION: The results found contributed to understand how, by whom, and when the surgical count process was carried out in the studied hospital.

Surgical count process for prevention of retained surgical items: an integrative review.

AIMS AND OBJECTIVES: To analyse the evidence reported in the literature concerning the surgical count process for surgical sponges, surgical instruments and sharps and to identify knowledge gaps for future research on the surgical count process. BACKGROUND: The surgical count process stands out among the practices advocated by the World Health Organization to ensure surgical safety. The literature indicates that this practice should be performed in all surgical processes. However, surgical items are still retained. DESIGN: Integrative review. METHODS: The literature search was conducted in the PubMed, CINAHL and LILACS databases and included studies on the surgical count process published in English, Spanish and Portuguese from January 2003-December 2013. RESULTS: A total of 28 primary studies were included in the sample, allowing the knowledge on the surgical count process to be summarised and grouped into three categories: risk factors for retained surgical items, how the surgical count process should be performed in the intraoperative period and the accompanying technologies that collaborate to improving the manual count process. CONCLUSIONS: The correct implementation of the surgical count process by the perioperative nurse may contribute to preventing retained surgical items, thereby improving surgical patient safety. RELEVANCE TO CLINICAL PRACTICE: Nurses can use this review to assist in decision-making directed towards preparing, updating and implementing a reliable system for the surgical count process based on recent evidence because the perioperative nurse plays a key role in the implementation of this practice in health services.

[Composition of the electrocautery smoke: integrative literature review]. / Composição da fumaça produzida pelo bisturi elétrico: revisão integrativa da literature.

OBJECTIVE: To identify the composition of the smoke produced by electrocautery use during surgery. METHOD: Integrative review with search for primary studies conducted in the databases of the US National Library of Medicine National Institutes of Health, Cumulative Index to Nursing and Allied Health Literature, and Latin American and Caribbean Health Sciences, covering the studies published between 2004 and 2014. RESULTS: The final sample consisted of 14 studies grouped into three categories, namely; polycyclic aromatic hydrocarbons, volatile compounds and volatile organic compounds. CONCLUSION: There is scientific evidence that electrocautery smoke has volatile toxic, carcinogenic and mutagenic compounds, and its inhalation constitutes a potential chemical risk to the health of workers involved in surgeries.

Information needs of family caregivers regarding liver transplant candidates. / Necessidades de informação do cuidador familiar de candidatos ao transplante de fígado.

Objective To assess the information needs of family caregivers of candidates on the waiting list for a liver transplant. Methods It is a cross-sectional study conducted in a transplant center in São Paulo State in the period between April and October of 2012. For the assessment of information needed, an instrument submitted to face and content value was used. The caregivers put 10 subjects in order according to their importance and the amount of interest they had in learning about each, prior to the transplant their family member would be subjected to. Sociodemographic characteristics were also recorded. For data analysis, descriptive statistics were used. Results 42 families participated in the study. The information need about liver disease complications, complications after transplantation and care needed after surgery had higher averages. Conclusions Knowing the information needs of caregivers is important to plan teaching-learning strategies aimed at improving assistance to patients and families in transplant programs.

Photoeducation and photoprotection among liver transplant candidates: a cross-sectional study.

The incidence of skin cancer after liver transplant ranges from 3% to 16%, considerably higher than that observed in the general population. Skin cancer causes 25% of deaths in patients who have survived more than 3 years after liver transplant. The objective of this study was to identify differences regarding the level of sun exposure, knowledge of potential risk factors, and photoprotection measures among liver transplant candidates and recipients. We carried out a prospective cross-sectional study with 100 patients enrolled at a liver transplant program in a Brazilian center. The patients were interviewed and received oral information regarding skin care and sun exposure. Results reveal that measures of photoprotection and photoeducation are more prevalent among recipients than among candidates. High degrees of solar exposure were observed more frequently among candidates, although recipients showed better knowledge about the risks of sun exposure. Educational actions concerning skin cancer prevention should be part of the guidelines given by the multidisciplinary team to the liver transplant patients, in particular, by the nursing team.

Risk factors for the development of surgical site infection in bariatric surgery: an integrative review of literature.

OBJECTIVE: to evaluate evidence on risk factors for the development of surgical site infection in bariatric surgery. METHOD: integrative review. The search for primary studies was performed in four databases. The sample consisted of 11 surveys. The methodological quality of the included studies was assessed using tools proposed by the Joanna Briggs Institute. Data analysis and synthesis were performed in a descriptive manner. RESULTS: surgical site infection rates ranged from 0.4% to 7.6%, considering the results of primary studies, in which patients underwent laparoscopic surgery. In surveys of participants undergoing surgical procedures with different approaches (open, laparoscopic or robotic), infection rates ranged from 0.9% to 12%. Regarding the risk factors for the development of this type of infection, antibiotic prophylaxis, female sex, high Body Mass Index and perioperative hyperglycemia are highlighted. CONCLUSION: conducting the integrative review generated a body of evidence that reinforces the importance of implementing effective measures for the prevention and control of surgical site infection, by health professionals, after bariatric surgery, promoting improved care and patient safety in the perioperative period.

[Information needs of liver transplant candidates: the first step of the teaching-learning process]. / Necessidades de informação de candidatos ao transplante de fígado: o primeiro passo do processo ensino-aprendizagem.

'Information need' is defined as a deficiency of information or skill related to a domain of life that is relevant to the patient. This study's objective was to identify the information needs of candidates on the waiting list for a liver transplant. This is a descriptive study and was conducted at a transplant center in the State of São Paulo-Brazil. The sample consisted of 55 patients and data were collected from March to June 2009. The results showed higher average scores for information needs concerning the preoperativeperiod. Identifying the information needs of liver transplant candidates is important to planning the teaching-learning process.

Use of the International Classification for Nursing Practice in the construction of a care protocol.

OBJECTIVES: to describe the use of the International Classification for Nursing Practice (ICNP®) in the construction of a nursing care protocol for children undergoing hematopoietic stem cell transplantation. METHODS: experience report. RESULTS: nursing problems were defined based on complications identified in a previous study; later, the ICNP® enabled the organization and systematization of childcare. The care protocol consists of 40 nursing problems, with their human needs affected, diagnoses and nursing interventions. The axes Focus, Judgment, Location, Action, Means, Time, and Client were used in the elaboration of diagnoses and interventions proposed in the protocol. Final Considerations: the use of the classification allowed the establishment of nursing interventions compatible with the needs of the child undergoing transplantation, providing support for the care protocol. It made it possible to encourage the use of classification in this context, contribute to patient safety and strengthen professional practice.

Construction of a nursing care protocol for children in post-hematopoietic stem cell transplantation.

OBJECTIVE: To construct a nursing care protocol for children in post-hematopoietic stem cell transplantation. METHOD: Methodological research carried out from January to September 2019, in three steps: (a) integrative review (nursing care was identified); (b) theoretical structuring and organization of healthcare based on the Theory of Basic Human Needs and on the International Classification for Nursing Practice (supplementing the review data); and (c) development of a protocol in the three previously mentioned stages. Analysis of the understanding of the protocol's items/care was performed by three specialist nurses. RESULTS: The care protocol consists of 40 nursing problems and is organized in accordance with the psychobiological, psychosocial, and psycho-spiritual needs of children undergoing transplantation, integrating practical and guidance care. CONCLUSION: The care protocol is an important technology for nursing care to transplanted children, aimed to prevent and manage transplantation complications.

Identification of people for palliative care in primary health care: integrative review. / Identificação de pessoas para cuidados paliativos na atenção primária: revisão integrativa.

This article aims to analyze the evidence available in the literature on the process of identifying adults and elderly people who can benefit from palliative care (PC) in primary health care (PHC). This is an integrative literature review carried out in PubMed, CINAHL, LILACS, Web of Science, and Embase. Eight studies were selected, in which different instruments and methods were distinguished with the purpose of identifying people who can benefit from PC in the context of PHC. The incorporation of these instruments into clinical practice is urgent in order to increase the reach and effectiveness of the services offered by health professionals, considering the current demographic and epidemiological profile that points to the increase of people with a potential need for PC. Different instruments have been successfully used to identify PC in the context of PHC. However, some have weaknesses, such as the fact that they only allow the identification of people with oncological diseases, leaving out other health conditions, which reinforces the need for further studies on this topic.

O objetivo deste artigo é analisar as evidências disponíveis na literatura sobre o processo de identificação de pessoas adultas e idosas que podem se beneficiar dos cuidados paliativos na atenção primária à saúde. Trata-se de revisão integrativa da literatura realizada nas bases de dados PubMed, CINAHL, LILACS, Web of Science e Embase. Foram selecionados oito estudos, nos quais foram distinguidos diferentes instrumentos com o propósito de identificar as pessoas que podem se beneficiar dos cuidados paliativos no contexto da atenção primária à saúde. A incorporação desses instrumentos na prática clínica é urgente, para aumentar o alcance e a efetividade dos serviços oferecidos pelos profissionais de saúde, considerando o perfil demográfico e epidemiológico atual que aponta para o aumento de pessoas com potencial necessidade de cuidados paliativos. Diferentes instrumentos têm sido utilizados com sucesso na identificação do cuidado paliativo no contexto da atenção primária à saúde. No entanto, alguns possuem fragilidades, como o fato de permitirem a identificação apenas das pessoas com doenças oncológicas, deixando de fora as demais condições de saúde, o que reforça a necessidade de mais estudos sobre esta temática.

Perceived self-efficacy among liver transplant candidates and recipients.

Self-efficacy is defined as one's belief that one can perform the necessary behaviors to achieve one's goals. This belief is one of the most powerful motivational predictors of how well a person will perform at almost any endeavor. Limited information is available, however, about self-efficacy in the organ transplantation population. This study aimed to identify the self-efficacy belief among liver transplant candidates and recipients and compare these results with demographic characteristics. The authors analyzed 100 patients who were candidates and recipients for liver transplantation in a Brazilian center. The average self-efficacy score for the candidates was significantly lower than for the recipients. Future investigation is necessary to explore possible interventions to be taken before and after liver transplantation that could influence self-efficacy of the organ transplantation patients.

[Hypothermia in the intraoperative period: can it be avoided?]. / Hipotermia no período intra-operatório: é possível evitá-la?

The objective of this study was to identify what measures are taken to prevent hypothermia in the intraoperative period. This is a non-experimental, descriptive-exploratory prospective study. To do this, a data collection instrument was developed, which was submitted to appearance and content validations. The sample consisted of 70 patients. The measure that was most commonly used in the operation room was the passive skin heating, such as using cotton sheets (11.4%) and bandaging the patient's lower limbs (14.3%). There was only one occurrence of active skin heating (1.4%). Results show there is a need to implement effective interventions to prevent hypothermia, and nurses play an important role in this context, as patient safety and avoiding complications due to the surgical anesthetic procedure are nursing care goals.

Support surfaces for intraoperative pressure injury prevention: systematic review with meta-analysis.

OBJECTIVE: to evaluate evidence on effectiveness support surfaces for pressure injury prevention in the intraoperative period. METHOD: systematic review. The search for primary studies was conducted in seven databases. The sample consisted of 10 studies. The synthesis of the results was carried out descriptively and through meta-analysis. RESULTS: when comparing low-tech support surfaces with regular care (standard surgical table mattress), the meta-analysis showed that there is no statistically significant difference between the investigated interventions (Relative Risk = 0.88; 95%CI: 0.30-2.39). The Higgins inconsistency test indicated considerable heterogeneity between studies (I2 = 83%). The assessment of the certainty of the evidence was very low. When comparing high-tech and low-tech support surfaces, the meta-analysis showed that there is a statistically significant difference between the interventions studied, with high-tech being the most effective (Relative Risk = 0.17; 95%CI: 0.05-0.53). Heterogeneity can be classified as not important (I2 = 0%). The assessment of certainty of evidence was moderate. CONCLUSION: the use of high-tech support surfaces is an effective measure to prevent pressure injuries in the intraoperative period.

Nursing care for patients in post-transplantation of hematopoietic stem cells: an integrative review.

OBJECTIVES: to analyze the available evidence on the nursing care provided to patients after hematopoietic stem cell transplantation. METHODS: integrative review with the search for primary studies in four databases and a virtual health library. A broad search strategy was used, including research published in English, Brazilian Portuguese, or Spanish, between 2008 and 2018, totaling a sample of 42 studies. RESULTS: the studies were grouped into three categories: multiple nursing care (n=19), first-line care (n=18), and self-management of care (n=5). CONCLUSIONS: nursing care is critical, comprising patients' physical, psychological and social aspects. It occurs in hospital and home contexts, mainly involving technical actions and health guidance. The evidence identified provide subsidies for decision-making; however, most studies are of the non-experimental type, indicating the need for conducting intervention research.

Effectiveness of cutaneous warming systems on temperature control: meta-analysis.

AIM: This paper is a report of a meta-analysis to identify the effectiveness of different types of cutaneous warming systems in temperature control for patients undergoing elective surgery. BACKGROUND: Hypothermia is a common and serious complication of surgery. Different cutaneous warming systems are used to prevent hypothermia during surgery but there have been no previous meta-analyses of the effectiveness of different warming systems in controlling temperature. DATA SOURCES: We conducted a search of the CINAHL (2000 to April 2009), Medline (2000 to April 2009), Embase (2000 to April 2009) and the Cochrane Register of Controlled Trials (2000 to April 2009) databases for randomized controlled trials published in English, Spanish and Portuguese. The primary outcome measure of interest was core body temperature. METHODS: A systematic review incorporating meta-analysis was carried out. RESULTS: From 329 papers, 23 trials compared warming systems. Forced-air warming systems had a strong tendency towards superior temperature control over passive insulation via cotton blankets (mean difference: 0.29 degrees C; 95% confidence interval: -0.02 to 0.59, three trials 292 patients) and radiant warming systems (mean difference: 0.16 degrees C; 95% confidence interval: -0.01 to 0.33, three trials, 161 patients). However, circulating water garments tended to be more effective than forced-air warming systems (mean difference: -0.73 degrees C; 95% confidence interval: -1.51 to 0.05, I(2) = 97%; four trials, 198 patients). Pooled results approached statistical significance and indicated clinically meaningful differences in temperature control. CONCLUSION: Current evidence suggests that circulating water garments offer better temperature control than forced-air warming systems, and both are more effective than passive warming devices.