Mindfulness-based intervention for college faculties and students in Brazil.

Background: Teacher and students' stress has been a challenge in education. An approach to stress reduction is mindfulness training. The Mindfulness-based stress reduction (MBSR) has been used to improve the condition of individuals with various health outcomes. The aim of this study was to examine whether MBSR may improve depression, well-being, and perceived stress of Brazilian college faculty and students. Methods: MBSR was performed with college faculty and students from Centro Universitario de Belo Horizonte (UniBH). Participants answered questionnaires (Psychological General Well-Being Index, Perceived Stress Scale, and Beck Depression Index) at the beginning and end of the intervention. A control group of teachers also answered the questionnaires but did not participate in the MBSR intervention. Statistical analyses were performed using paired Student's t-test (P < 0.05 significance). Results: The MBSR intervention positively impacted all conditions measured in the questionnaires in faculty and students who attended the intervention. Faculty and students in the control group had shown conditions being maintained or worsened. Discussion: The MBSR was effective as faculty and students from the experimental group exhibited improvement in general well-being, depression levels, and perceived stress after attending the intervention.

Retrieval of Enterobacteriaceae drug targets using singular value decomposition.

MOTIVATION: The identification of potential drug target proteins in bacteria is important in pharmaceutical research for the development of new antibiotics to combat bacterial agents that cause diseases. RESULTS: A new model that combines the singular value decomposition (SVD) technique with biological filters composed of a set of protein properties associated with bacterial drug targets and similarity to protein-coding essential genes of Escherichia coli (strain K12) has been created to predict potential antibiotic drug targets in the Enterobacteriaceae family. This model identified 99 potential drug target proteins in the studied family, which exhibit eight different functions and are protein-coding essential genes or similar to protein-coding essential genes of E.coli (strain K12), indicating that the disruption of the activities of these proteins is critical for cells. Proteins from bacteria with described drug resistance were found among the retrieved candidates. These candidates have no similarity to the human proteome, therefore exhibiting the advantage of causing no adverse effects or at least no known adverse effects on humans. CONTACT: rita_silverio@hotmail.com. SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

Endotoxins in surgical instruments of hip arthroplasty.

OBJECTIVE: To investigate endotoxins in sterilized surgical instruments used in hip arthroplasties. METHOD: A descriptive exploratory study conducted in a public teaching hospital. Six types of surgical instruments were selected, namely: acetabulum rasp, femoral rasp, femoral head remover, chisel box, flexible bone reamer and femoral head test. The selection was based on the analysis of the difficulty in removing bone and blood residues during cleaning. The sample was made up of 60 surgical instruments, which were tested for endotoxins in three different stages. The EndosafeTM Gel-Clot LAL (Limulus Amebocyte Lysate method) was used. RESULT: There was consistent gel formation with positive analysis in eight instruments, corresponding to 13.3%, being four femoral rasps and four bone reamers. CONCLUSION: Endotoxins in quantity ≥0.125 UE/mL were detected in 13.3% of the instruments tested. OBJETIVO: Investigar endotoxinas em instrumentais cirúrgicos esterilizados empregados em artroplastias do quadril. MÉTODO: Estudo exploratório, descritivo, desenvolvido em um hospital público de ensino. Foram selecionados seis tipos de instrumentais, a saber: raspa acetabular, raspa femural, saca-cabeça de fêmur, formão box, fresa de fêmur e cabeça de prova de fêmur. A seleção foi feita a partir da análise da dificuldade para a remoção de resíduos de sangue e osso durante a limpeza. A amostra foi constituída por 60 instrumentais cirúrgicos, que foram testados para endotoxinas em três momentos distintos. Foi utilizado o método de gel-clot pelo Limulus Amebócito Lisado (LAL) Endosafe(tm). RESULTADO: Houve formação de gel consistente com análise positiva em oito instrumentais, o que corresponde a 13,3%, sendo quatro raspas de fêmur e quatro fresas de fêmur. CONCLUSÃO: Foram detectadas endotoxinas em quantidade ≥0,125 UE/mL em 13,3% dos instrumentais testados.

COVID-19 Computed tomography patterns in renal replacement therapy patients.

INTRODUCTION: Lung diseases are common in patients with end stage kidney disease (ESKD), making differential diagnosis with COVID-19 a challenge. This study describes pulmonary chest tomography (CT) findings in hospitalized ESKD patients on renal replacement therapy (RRT) with clinical suspicion of COVID-19. METHODS: ESKD individuals referred to emergency department older than 18 years with clinical suspicion of COVID-19 were recruited. Epidemiological baseline clinical information was extracted from electronic health records. Pulmonary CT was classified as typical, indeterminate, atypical or negative. We then compared the CT findings of positive and negative COVID-19 patients. RESULTS: We recruited 109 patients (62.3% COVID-19-positive) between March and December 2020, mean age 60 ± 12.5 years, 43% female. The most common etiology of ESKD was diabetes. Median time on dialysis was 36 months, interquartile range = 12-84. The most common pulmonary lesion on CT was ground glass opacities. Typical CT pattern was more common in COVID-19 patients (40 (61%) vs 0 (0%) in non-COVID-19 patients, p < 0.001). Sensitivity was 60.61% (40/66) and specificity was 100% (40/40). Positive predictive value and negative predictive value were 100% and 62.3%, respectively. Atypical CT pattern was more frequent in COVID-19-negative patients (9 (14%) vs 24 (56%) in COVID-19-positive, p < 0.001), while the indeterminate pattern was similar in both groups (13 (20%) vs 6 (14%), p = 0.606), and negative pattern was more common in COVID-19-negative patients (4 (6%) vs 12 (28%), p = 0.002). CONCLUSIONS: In hospitalized ESKD patients on RRT, atypical chest CT pattern cannot adequately rule out the diagnosis of COVID-19.

Construction and validation of instrument to assess the quality of infection control programs.

OBJECTIVE: To build and validate an instrument to assess hospital infection control programs. METHOD: Methodological study that was developed in seven stages. The instrument items were categorized into the structure, process and result components. 10 expert judges participated, who evaluated the psychometric properties and validated the content using the Likert scale. The pre-test was carried out with 98 health professionals, from April to July 2018. For reliability analysis, Cronbach's alpha test was used. RESULTS: Regarding the content validity index, the score made by expert judges ranged from 0.777 to 1.00, with mean of 0.902 (± 0.076). The Cronbach's alpha test showed good internal consistency of the items (0.82). CONCLUSION: An instrument to assess hospital infection control programs was developed and validated, which showed good reliability and can be efficiently used at national level.

Pain response and symptoms in photorefractive keratectomy: mechanical de-epithelization compared with transepithelial ablation.

PURPOSE: To compare postoperative pain and discomfort between mechanical and transepithelial photorefractive keratectomies. METHODS: This prospective comparative study included 190 eyes of 95 patients with hyperopia (up to +4.00 D), astigmatism (up to -5.00 D), and myopia (up to -8.00 D) who underwent mechanical photorefractive keratectomy in one eye and transepithelial photorefractive keratectomy in the contralateral eye using Wavelight Allegretto EX500 excimer laser. The patients were unaware of the side treated with each technique. The interval between operations in the same patient was 15-30 days. Both eyes had similar refraction before surgery, with a maximum of 15-µm difference in ablation. Postoperative questionnaires were administered on days 1 and 7 to assess the patients' level of discomfort (0=no discomfort to 5=extreme discomfort) with the following symptoms: pain, burning sensation, itchiness, tearing, photophobia, eye redness, foreign body sensation, and eyelid swelling. Patients were also asked about which method they preferred. RESULTS: The sample consisted of 61 women (64.21%) and 34 men (35.79%). The mean (SD) patient age was 31.66 (6.69) years (range, 22-54 years). On postoperative day 1, the patients reported significantly less discomfort in terms of pain (1.9 ± 1.74 vs 2.5 ± 1.83; p=0.017), burning sensation (1.8 ± 1.56 vs 2.5 ± 1.68; p=0.004), tearing (2.3 ± 1.71 vs 3.1 ± 1.69; p=0.001), and foreign body sensation (1.9 ± 1.77 vs 2.5 ± 1.86; p=0.024) in the eye that received mechanical photorefractive keratectomy than in the eye that received transepithelial photorefractive keratectomy. No significant differences were found between the mechanical and transepithelial photorefractive keratectomies on postoperative day 7. Fifty-nine patients (62.10%) preferred mechanical photorefractive keratectomy, while 32 (33.68%) preferred transepithelial photorefractive keratectomy. Four patients (4.22%) expressed no preference. CONCLUSIONS: Our results showed that pain scores were significantly lower in the mechanical photorefractive keratectomy-treated eyes than in the transepithelial photorefractive keratectomy-treated eyes on postoperative day 1, which may have provided greater patient comfort after surgery and led patients to prefer the mechanical photorefractive keratectomy technique.

Quality of the hospital infection control programs: an integrative review.

OBJECTIVE: To analyze the quality of health in relation to the components of structure, process, and outcome in actions for the prevention and control of infections. METHOD: An integrative literature review in the LILACS, Web of Science, Scopus, and SciELO databases. The time delimitation covered articles published between January 2009 and May 2019. RESULTS: The final sample consisted of 10 articles published, mainly in Scopus (60%), and in Web of Science (30%). The structural elements varied among the study countries, suggesting opportunities for improvement of organizational characteristics and human resources. Regarding the process of the implemented routines, inconsistencies were found to comply with the guidelines. The result component was not emphasized among the studies included in the review. CONCLUSION: The quality of hospital infection control programs has yet to be improved among the health services, highlighting the need for investment in the structure, process, and outcome components.

Epidemiological profile of healthcare-associated infections caused by Carbapenemase-producing Enterobacteriaceae.

OBJECTIVE: To study the epidemiological profile of Healthcare-associated Infections caused by Enterobacteria which carry the Klebsiella pneumoniae Carbapenemase gene (blaKPC) in the hospital environment. METHOD: A descriptive study was conducted in a private hospital in Belo Horizonte, MG, Brazil, which included all patients with infections caused by Enterobacteriaceae which carry the Klebsiella pneumoniae Carbapenemase gene. The data were collected by the Automated System of Hospital Infection Control and analyzed by descriptive statistics by the Epi Info 7 program. RESULTS: Eighty-two (82) patients participated in the study. Klebsiella pneumoniae was the most frequent species (68%) isolated in blood (30%), bronchoalveolar lavage (22%) and urine (18%), while catheter-associated bloodstream infection (30%) predominated regarding topography. A case fatality rate of 62% is highlighted in evaluating the outcome. CONCLUSION: The resistance genes spread rapidly, limiting the antimicrobial options for treating infectious diseases. The epidemiological profile of Healthcare-Associated Infections found in this study can be prevented by prevention and infection control programs.

COVID-19 Computed tomography patterns in renal replacement therapy patients / Padrões de tomografia computadorizada da COVID-19 em pacientes em terapia renal substitutiva

ABSTRACT Introduction: Lung diseases are common in patients with end stage kidney disease (ESKD), making differential diagnosis with COVID-19 a challenge. This study describes pulmonary chest tomography (CT) findings in hospitalized ESKD patients on renal replacement therapy (RRT) with clinical suspicion of COVID-19. Methods: ESKD individuals referred to emergency department older than 18 years with clinical suspicion of COVID-19 were recruited. Epidemiological baseline clinical information was extracted from electronic health records. Pulmonary CT was classified as typical, indeterminate, atypical or negative. We then compared the CT findings of positive and negative COVID-19 patients. Results: We recruited 109 patients (62.3% COVID-19-positive) between March and December 2020, mean age 60 ± 12.5 years, 43% female. The most common etiology of ESKD was diabetes. Median time on dialysis was 36 months, interquartile range = 12-84. The most common pulmonary lesion on CT was ground glass opacities. Typical CT pattern was more common in COVID-19 patients (40 (61%) vs 0 (0%) in non-COVID-19 patients, p < 0.001). Sensitivity was 60.61% (40/66) and specificity was 100% (40/40). Positive predictive value and negative predictive value were 100% and 62.3%, respectively. Atypical CT pattern was more frequent in COVID-19-negative patients (9 (14%) vs 24 (56%) in COVID-19-positive, p < 0.001), while the indeterminate pattern was similar in both groups (13 (20%) vs 6 (14%), p = 0.606), and negative pattern was more common in COVID-19-negative patients (4 (6%) vs 12 (28%), p = 0.002). Conclusions: In hospitalized ESKD patients on RRT, atypical chest CT pattern cannot adequately rule out the diagnosis of COVID-19.

RESUMO Introdução: Doenças pulmonares são comuns em pacientes com doença renal em estágio terminal (DRET), dificultando o diagnóstico diferencial com COVID-19. Este estudo descreve achados de tomografia computadorizada de tórax (TC) em pacientes com DRET em terapia renal substitutiva (TRS) hospitalizados com suspeita de COVID-19. Métodos: Indivíduos maiores de 18 anos com DRET, encaminhados ao pronto-socorro com suspeita de COVID-19 foram incluídos. Dados clínicos e epidemiológicos foram extraídos de registros eletrônicos de saúde. A TC foi classificada como típica, indeterminada, atípica, negativa. Comparamos achados tomográficos de pacientes com COVID-19 positivos e negativos. Resultados: Recrutamos 109 pacientes (62,3% COVID-19-positivos) entre março e dezembro de 2020, idade média de 60 ± 12,5 anos, 43% mulheres. A etiologia mais comum da DRET foi diabetes. Tempo médio em diálise foi 36 meses, intervalo interquartil = 12-84. A lesão pulmonar mais comum foi opacidades em vidro fosco. O padrão típico de TC foi mais comum em pacientes com COVID-19 (40 (61%) vs. 0 (0%) em pacientes sem COVID-19, p < 0,001). Sensibilidade 60,61% (40/66), especificidade 100% (40/40). Valores preditivos positivos e negativos foram 100% e 62,3%, respectivamente. Padrão atípico de TC foi mais frequente em pacientes COVID-19-negativos (9 (14%) vs. 24 (56%) em COVID-19-positivos, p < 0,001), enquanto padrão indeterminado foi semelhante em ambos os grupos (13 (20%) vs. 6 (14%), p = 0,606), e padrão negativo foi mais comum em pacientes COVID-19-negativos (4 (6%) vs. 12 (28%), p = 0,002). Conclusões: Em pacientes com DRET em TRS hospitalizados, um padrão atípico de TC de tórax não pode excluir adequadamente o diagnóstico de COVID-19.

Advanced Cardiac Life Support Courses: live actors do not improve training results compared with conventional manikins.

PRIMARY OBJECTIVE: To determine whether using live actors to increase the reality of the scenario improves knowledge retention in Advanced Cardiac Life Support (ACLS) Courses. MAIN SECONDARY OBJECTIVES: To determine the effects of age, time since graduation from nursing or medicine, sex, medical specialty, and workplace in knowledge retention. METHODS: From December 2004 to October 2005, 19 selected ACLS courses were divided at random in two groups: group A (ACLS courses with conventional manikins plus live actors) and group B (ACLS courses with conventional manikins). The live actors vocalized appropriately to create more realistic scenarios. The participants' relevant theoretical knowledge was assessed before the course (pre-test), immediately after the course (post-test), and 6 months after the course (final-test). RESULTS: Four hundred and thirty-five participants were recruited and allocated at random allocated to either group A or B. Overall, the data of 225 participants (51.7%; 111 in group A and 114 in group B) who completed the entire sequence of pre-, post-, and final-tests were analysed. On univariate analysis, the use of live actors, workplace, gender, and healthcare provider profession did not affect pre-, post-, and final-test results (p>0.1). The results in all three tests correlated negatively with time since medical or nursing graduation (95% C.I. -0.53 to -0.17, -0.43 to -0.2, and -0.42 to -0.11, respectively, p<0.05) and age (and 95% C.I. -0.56 to -0.21, -0.42 to -0.2, and -0.38 to -0.07, respectively, p<0.05). CONCLUSION: The use of live actors did not affect knowledge retention in this group. Older age and a longer period since graduation were associated with the worst scores and the lowest levels of knowledge retention.

Qualidade das práticas de profissionais dos programas de controle de infecção no Brasil: estudo transversal / Calidad de las prácticas de profesionales en programas de control de infecciones en Brasil: un estudio transversal / The quality of professional practices in infection control programs in Brazil: a cross-sectional study

RESUMO Objetivo Analisar a qualidade das práticas de profissionais dos programas de controle de infecção em relação aos componentes de estrutura, processo e resultado. Método Trata-se de um estudo de abordagem quantitativa, do tipo descritivo e transversal realizado em 114 serviços de controle de infecção hospitalar das cinco regiões oficiais do Brasil. Coletaram-se os dados por meio de um instrumento estruturado, cujas propriedades psicométricas foram validadas previamente. O tratamento dos dados foi realizado pela análise de componentes principais e o teste não paramétrico Kruskal-Wallis. Resultados O melhor índice de qualidade dos programas de controle de infecção foi atribuído à região Sul, aos hospitais que continham 300 leitos ou mais, aos que utilizavam o critério National Healthcare Safety Network para vigilância das infecções e aos locais que realizavam busca ativa prospectiva como método de vigilância. Conclusão e implicações para a prática O índice de qualidade dos programas de controle de infecção está relacionado à localização, ao tamanho do hospital e ao método adotado para vigilância de infecções. A criação de um índice de qualidade, até então inédito em estudos nacionais, chama atenção para o desempenho precário dos serviços de saúde.

RESUMEN Objetivo Analizar la calidad de las prácticas de los profesionales de los programas de control de infecciones en relación con los componentes de estructura, proceso y resultado. Método Se trata de un estudio cuantitativo, descriptivo y transversal realizado en 114 servicios de control de infecciones hospitalarias de las cinco regiones oficiales de Brasil. Los datos fueron recolectados mediante un instrumento estructurado, cuyas propiedades psicométricas fueron previamente validadas. El tratamiento de los datos se realizó mediante el análisis de componentes principales y la prueba no paramétrica de Kruskal-Wallis. Resultados El mejor índice de calidad de los programas de control de infecciones se atribuyó a la región Sur, a los hospitales que tenían 300 camas o más, a los que utilizaron el criterio de National Healthcare Safety Network para la vigilancia de infecciones y a los locales que realizaban las búsquedas prospectivas activas como el método de vigilancia. Conclusión e implicaciones para la práctica La calidad de los programas de control de infecciones está relacionada con la ubicación, el tamaño del hospital y el método adoptado para la vigilancia de infecciones. La creación de un índice de calidad, hasta ahora inédito en los estudios brasileños, llama la atención sobre el precario desempeño de los servicios de salud.

ABSTRACT Objective To analyze the quality of professional practices in infection control programs regarding structure, process, and outcome. Method This is a quantitative, descriptive, and cross-sectional study carried out in 114 hospital infection control services in the five official regions of Brazil. The data were collected using a structured instrument whose psychometric properties were previously validated. Data treatment was performed by principal component analysis and non-parametric Kruskal-Wallis test. Results The best quality index of infection control programs was attributed to the South region, to hospitals that had 300 beds or more, to those that used the National Healthcare Safety Network criterion for infection surveillance and to places that carried out an active prospective search as their surveillance method. Conclusion and implications for practice: The quality of infection control programs is related to hospital location, size, and infection surveillance method. The creation of a quality index, hitherto unheard of in Brazilian studies, draws attention to the precarious performance of health services.

Thirty-day unplanned readmission after spine surgery: analysis of 650 cases / Readmissão não planejada em 30 dias após cirurgias da coluna: análise de 650 casos / Reingreso no planificado a los 30 días después de cirugías de la columna: análisis de 650 casos

ABSTRACT: Objective: Postoperative readmission rates can be used to assess hospital care quality. The rates of unplanned readmission within 30 days after spine surgery are variable in the literature, and no studies have evaluated such rates in a single Latin American center. This study aimed to assess the rate of unplanned hospital readmission within 30 days after a spine surgery at a single Brazilian institution and to identify possible risk factors. Methods: Patients who underwent spine surgery at a single private hospital between January 2018 and December 2020 were retrospectively analyzed, and those with unplanned readmissions within 30 days of discharge were identified. Risk factors were determined, and the reoperation rate was assessed. Results: 650 patients were included in the analysis, and 74 (11.28%) were readmitted within 30 days after surgery. Higher readmission rates were observed after vertebroplasty and surgeries involving spinal or bone tumors. The risk factors found in the series were older age, longer hospital stays, higher ASA scores, instrumented surgeries, diabetes mellitus, and surgeries involving primary or secondary spinal tumors. The most common causes of unplanned readmission were infection and pain. Of the readmissions, 28.37% required a return to the operating room. Conclusions: This study suggests infection and pain management were the most common causes of unplanned readmission after spine surgery. Strategies to improve perioperative and postoperative care are required to reduce unplanned readmissions. Level of Evidence III; Retrospective Comparative Study.

RESUMO: Objetivo: As taxas de readmissão pós-operatórias podem ser usadas para avaliação da qualidade assistencial hospitalar. As taxas de readmissão não planejada em 30 dias após cirurgias de coluna são variáveis na literatura, e não há estudos avaliando tais taxas em centros únicos da América Latina. Este estudo teve como objetivo avaliar as taxas de readmissões não planejadas em 30 dias após cirurgias de coluna em uma única instituição brasileira e identificar possíveis fatores de risco. Métodos: Pacientes submetidos a cirurgias de coluna em um único hospital privado entre janeiro de 2018 e dezembro de 2020 foram avaliados retrospectivamente, e aqueles readmitidos dentro de 30 dias foram identificados. Fatores de risco foram determinados e a taxa de reoperação foi avaliada. Resultados: 650 pacientes foram incluídos na análise, e 74 (11,28%) foram readmitidos dentro de 30 dias após a cirurgia. Maiores taxas de readmissão foram observadas após vertebroplastia e cirurgias envolvendo tumores espinhais ou tumores ósseos. Os fatores de risco encontrados em nossa série foram idade mais elevada, maior tempo de hospitalização, maior escore ASA, cirurgias com instrumentação, diabetes mellitus e cirurgias envolvendo tumores vertebrais primários ou secundários. As causas mais comuns de readmissão não planejada foram infecção e dor. Dentre os pacientes reinternados, 28,37% necessitaram de reoperação. Conclusões: Este estudo sugere que infecção e manejo de dor foram as causas mais comuns de readmissão não planejada após cirurgias de coluna. Estratégias para melhorar os cuidados pre e pós-operatórios são necessárias para reduzir readmissões não planejadas. Nível de Evidência III; Estudo Retrospectivo Comparativo.

RESUMEN: Objetivo: Las tasas de reingreso después de la cirugía de columna son variables y ningún estudio ha evaluado tales tasas en un solo centro latinoamericano. Este estudio tuvo como objetivo evaluar la tasa de reingreso hospitalario no planificado dentro de los 30 días posteriores a la cirugía de columna en una sola institución brasileña e identificar posibles factores de riesgo. Métodos: Se analizaron retrospectivamente los pacientes que se sometieron a cirugía de columna en un solo hospital entre enero de 2018 y diciembre de 2020, y se identificaron aquellos con reingresos no planificados dentro de los 30 días posteriores al alta. Se determinaron los factores de riesgo y se evaluó la tasa de reoperación. Resultados: En el análisis se incluyeron un total de 650 pacientes, y 74 (11,28%) reingresaron dentro de los 30 días posteriores a la cirugía. Se observaron tasas de reingreso más altas después de la vertebroplastia y las cirugías que involucraron tumores espinales u óseos. Los factores de riesgo encontrados en nuestra serie fueron la edad avanzada, la estancia hospitalaria más prolongada, las puntuaciones ASA más altas, las cirugías instrumentadas, la diabetes mellitus y las cirugías de tumores espinales. Las causas más frecuentes de reingreso fueron la infección y el dolor. De los reingresos, el 28,37% requirieron volver al quirófano. Conclusiones: Este estudio sugiere que la infección y el manejo del dolor fueron las causas más comunes de reingreso. Se requieren estrategias para mejorar la atención perioperatoria y posoperatoria y así reducir las readmisiones no planificadas. Nivel de Evidencia III; Estudio comparativo retrospectivo.

Pacientes com lesões crônicas em membros inferiores, atendidos em hospital particular: estudo de prevalência / Patients with chronic lower-limb lesions, seen in a private hospital: a prevalence study / Pacientes con lesiones crónicas en extremidades inferiores, atendidos en un hospital privado: un estudio de prevalencia

Objetivo: Avaliar a população acometida de lesões, atendida em serviço de atenção a feridas crônicas em ambulatório de hospital particular. Método: Estudo descritivo, transversal e analítico. A amostra foi de 320 pacientes com lesões, atendidas neste serviço. Os dados foram coletados via prontuários eletrônicos. Foi calculado taxa de prevalência de lesões de membros inferiores, frequências absoluta e relativa para a descrição das variáveis coletadas, média e desvio padrão. Resultados: A maioria era do sexo feminino, de cor branca, casada, aposentada, com idade média de 68,2 anos, com sobrepeso e portando lesão única. A maior parte tinha úlcera venosa, seguida de lesão em pé diabético e lesão arterial. O restante (lesões em outros locais) somou 33,4%. A prevalência de lesões em membros inferiores foi de 66%. Conclusão: A prevalência de lesão em membros inferiores foi alta, porém na população estudada não havia pacientes hígidos, uma vez que todos apresentavam alguma lesão. (AU).

Objective: To evaluate the population affected by injuries, seen in a service for the care of chronic wounds in an outpatient clinic of a private hospital. Method: Descriptive, cross-sectional, and analytical study. The sample consisted of 320 patients with injuries. Data were collected through the electronic medical records. Calculation of the prevalence rate of lower limb injuries and of absolute and relative frequencies were used to describe the variables collected and mean and standard deviation. Results: The majority was female, white, married, retired, with a mean age of 68.2 years, overweight and with a single lesion. Most had venous ulcers, followed by diabetic foot injury and arterial injury. The remainder totaled 33.4%. The prevalence of lower limb injuries was 66%. Conclusion: The prevalence of injuries in the lower limbs was high, and in the studied population there were no healthy patients since all had some type of chronic injury. (AU).

Objetivo: Evaluar la población afectada por lesiones, tratada en servicio de atención crónica de heridas en un hospital privado. Método: Estudio descriptivo, transversal y analítico. La muestra consistió en 320 pacientes con lesiones. Los datos se obtuvieron de registros médicos electrónicos Fue utilizado cálculo de tasa de prevalencia de lesiones de extremidades inferiores y frecuencias absolutas y relativas para la descripción de las variables recogidas y la media y la desviación estándar. Resultados: La mayoría era mujer, blanca, casada, jubilada, con edad media de 68,2 años, con sobrepeso y portando una sola lesión. La mayoría tenía úlcera venosa, seguida de lesiones de pie diabético y lesiones arteriales. El resto totalizo 33,4%. La prevalencia de lesiones en las extremidades inferiores fue del 66%. Conclusión: La prevalencia de lesiones en las extremidades inferiores fue alta, y en la población estudiada no había pacientes sanos, ya que todos tenían algún tipo de lesión. (AU).

Construction and validation of instrument to assess the quality of infection control programs / Construcción y validación del instrumento para evaluar la calidad de los programas de control de infecciones / Construção e validação de instrumento para avaliação da qualidade dos programas de controle de infecção

ABSTRACT Objective: To build and validate an instrument to assess hospital infection control programs. Method: Methodological study that was developed in seven stages. The instrument items were categorized into the structure, process and result components. 10 expert judges participated, who evaluated the psychometric properties and validated the content using the Likert scale. The pre-test was carried out with 98 health professionals, from April to July 2018. For reliability analysis, Cronbach's alpha test was used. Results: Regarding the content validity index, the score made by expert judges ranged from 0.777 to 1.00, with mean of 0.902 (± 0.076). The Cronbach's alpha test showed good internal consistency of the items (0.82). Conclusion: An instrument to assess hospital infection control programs was developed and validated, which showed good reliability and can be efficiently used at national level.

RESUMEN Objetivo: Construir y validar un instrumento para evaluar los programas de control de infecciones hospitalarias. Método: Estudio metodológico desarrollado en siete etapas. Los ítems del instrumento se clasificaron en componentes de estructura, proceso y resultado. Participaron 10 jueces expertos, quienes evaluaron las propiedades psicométricas y validaron el contenido utilizando la escala Likert. La prueba previa se llevó a cabo con 98 profesionales de la salud, de enero a marzo de 2018. Para el análisis de confiabilidad, se utilizó la prueba alfa de Cronbach. Resultados: En cuanto al índice de validez de contenido, la calificación realizada por jueces expertos varió de 0.777 a 1.00, con un promedio de 0.902 (± 0.076). La prueba alfa de Cronbach mostró una buena consistencia interna de los ítems (0,82). Conclusión: Se desarrolló y validó un instrumento para evaluar los programas de control de infecciones hospitalarias, que mostró una buena fiabilidad y se puede utilizar de manera eficiente a nivel nacional.

RESUMO Objetivo: Construir e validar um instrumento de avaliação dos programas de controle de infecção hospitalar. Método: Estudo metodológico que foi desenvolvido em sete etapas. Os itens do instrumento foram categorizados nos componentes de estrutura, processo e resultado. Participaram 10 juízes especialistas que avaliaram as propriedades psicométricas e validaram o conteúdo através da escala de Likert. O pré-teste foi realizado com 98 profissionais de saúde, no período de abril a julho de 2018. Para análise de confiabilidade utilizou-se o teste alfa de Cronbach. Resultados: Em relação ao índice de validade de conteúdo, a pontuação feita pelos juízes especialistas variou de 0,777 a 1,00, com média de 0,902 (±0,076). O teste alfa de Cronbach evidenciou boa consistência interna dos itens (0,82). Conclusão: Foi elaborado e validado instrumento de avaliação dos programas de controle de infecção hospitalar, que apresentou boa confiabilidade, podendo ser utilizado de forma eficiente em nível nacional.

Efficacy and effectivity of UVC for disinfection of hospital materials of COVID-19 patients / Eficácia e efetividade do UVC para desinfecção de materiais hospitalares de pacientes com COVID-19 / Eficacia y efectividad de UVC para desinfección de material hospitalario de pacientes con COVID-19

Background and Objectives: After the beginning of the COVID-19 pandemic, more effective and efficient means were needed to disinfect hospital materials. The objective of our study is to evaluate the in vitro efficacy and the economic effectiveness of type C ultraviolet (UVC) irradiation for disinfection of materials used in the care of COVID-19 patients. Methods. Four bipartite Cled plates were inoculated with suspensions of 10,000 CFU/mL of Escherichia coli and Staphylococcus aureus strains, exposed to two 18W lamps, placed inside a laminar flow and incubated for quantitative growth assessments. The germicidal equipment was built: the "UVC box" was developed with two 18W lamps for use in materials returned to pharmacy and a "UVC closet" with two 60W lamps for surgical gowns exposure. The economic effectiveness was evaluated by comparing inventory costs with quarantine of materials versus UVC usage costs. Results. Microbiological inactivation in the plates started after 4 minutes with an efficiency close to 100% at 8 minutes. The "UVC box" reduced the time to release the material from 9 days to immediately, generating savings of approximately R$ 68,400, and the "UVC closet" changed the use of surgical gowns to 0.7/patient, compared to the usual of 1.5, generating savings of nearly 3,000 reais/month. The cost of installation and maintenance was R$ 1,500. Conclusions. The efficacy and effectiveness of the UVC system was proven, as well as the economy promoted by its installation.(AU)

Justificativa e Objetivos: Após o início da pandemia de COVID-19, meios mais efetivos e eficazes foram necessários para desinfetar materiais hospitalares. Este trabalho visa avaliar a eficácia in vitro e a efetividade econômica de luz ultravioleta tipo C (UVC) para desinfecção de materiais usados em pacientes com COVID-19. Métodos: Quatro placas bipartidas de Cled foram inoculadas com suspensões de 10.000 ufc/mL de cepas de Escherichia coli e Staphylococcus aureus, expostas a duas lâmpadas de 18W, colocadas dentro de um fluxo laminar e incubadas para avaliações quantitativas de crescimento. O equipamento germicida foi construído: uma "caixa UVC" com duas lâmpadas de 18W para materiais da farmácia e um "armário UVC" com duas lâmpadas 60W para exposição de capotes. A efetividade econômica foi avaliada comparando os custos de estoque, com quarentena de materiais versus custos de uso da UVC. Resultados: A inativação microbiológica nas placas se iniciou a partir de 4 minutos, com eficácia próxima a 100% aos 8 minutos. A "caixa de UVC" reduziu o tempo para liberação do material de 9 dias para imediato, gerando uma economia de aproximadamente R$ 68.400,00, e o "armário de UVC" alterou o uso de capotes para 0,7/paciente, comparado ao uso habitual de 1,5, gerando uma economia de 3.000 reais/mês. O custo de instalação e manutenção foi de R$ 1.500,00. Conclusão: Foi comprovada a eficácia e efetividade dos sistemas UVC, além da economia promovida por sua instalação.(AU)

Justificación y Objetivos. Después del inicio de la pandemia de COVID-19, se necesitaron medios más efectivos y eficientes para desinfectar los materiales hospitalarios. El artículo tiene como objetivo evaluar la eficacia in vitroy la efectividad económica de la luz ultravioleta tipo C (UVC) para desinfección de materiales utilizados en la atención al paciente con COVID-19. Métodos. Cuatro placas partidas Cledfueron inoculadas consuspensiones de 10,000 UFC/mL de cepas de Escherichia coliy Staphylococcusaureus, expuestas a dos lámparas de 18W, colocadas dentro del flujo laminar e incubadas para evaluaciones cuantitativas de crecimiento. Se construyó el equipo germicida: una "caja UVC" con dos lámparas de 18W para materiales de farmacia y un "armario UVC" con dos lámparas de 60W para exponerlas batas. La efectividad económica se evaluó comparando los costos de inventario con la cuarentena de materiales, versus loscostos de uso de UVC. Resultados. La inactivación microbiológica en las placas se inició a los 4 minutos con una eficiencia cercana al 100% a los 8 minutos. La "caja UVC" redujoeltiempo de liberacióndel material de 9 días a una liberación inmediata, economizando aproximadamente R$ 68.400 y el "armario UVC" cambióel uso de batas a 0,7/paciente, frente al uso habitual de 1,5, economizando aproximadamente 3.000 reales/mes. El costo de instalación y mantenimiento fue R$1.500. Conclusiones. La efectividad y eficaciadel sistema UVC fue comprobada, además de los resultados en la economía por su instalación.(AU)

Length of preoperative hospital stay: a risk factor for reducing surgical infection in femoral fracture cases.

OBJECTIVE: To analyze infections of the surgical site among patients undergoing clean-wound surgery for correction of femoral fractures. METHODS: This was a historical cohort study developed in a large-sized hospital in Belo Horizonte. Data covering the period from July 2007 to July 2009 were gathered from the records in electronic medical files, relating to the characteristics of the patients, surgical procedures and surgical infections. The risk factors for infection were identified by means of statistical tests on bilateral hypotheses, taking the significance level to be 5%. Continuous variables were evaluated using Student's t test. Categorical variables were evaluated using the chi-square test, or Fisher's exact test, when necessary. For each factor under analysis, a point estimate and the 95% confidence interval for the relative risk were obtained. In the final stage of the study, multivariate logistic regression analysis was performed. RESULTS: 432 patients who underwent clean-wound surgery for correcting femoral fractures were included in this study. The rate of incidence of surgical site infections was 4.9% and the risk factors identified were the presence of stroke (odds ratio, OR = 5.0) and length of preoperative hospital stay greater than four days (OR = 3.3). CONCLUSION: To prevent surgical site infections in operations for treating femoral fractures, measures involving assessment of patients' clinical conditions by a multiprofessional team, reduction of the length of preoperative hospital stay and prevention of complications resulting from infections will be necessary.

OBJETIVO: Analisar as infecções de sítio cirúrgico em pacientes submetidos a cirurgias limpas para correção de fraturas de fêmur. MÉTODOS: Estudo tipo coorte histórica desenvolvido em um hospital de grande porte de Belo Horizonte. A coleta dos dados foi feita nos registros dos prontuários eletrônicos, de julho de 2007 a julho de 2009. Foram coletados dados referentes às características dos pacientes, dos procedimentos cirúrgicos e das infecções cirúrgicas. Os fatores de risco para infecção foram identificados por meio de testes estatísticos de hipóteses bilaterais, considerando nível de significância de 5%. As variáveis contínuas foram avaliadas por teste t de Student. As variáveis categóricas foram analisadas por meio de teste de qui-quadrado ou exato de Fisher, quando necessário. Para cada fator sob análise, foi obtida uma estimativa pontual e por intervalos de confiança de 95% para o risco relativo. Na última etapa do trabalho, foi feita uma análise multivariada (regressão logística). RESULTADOS: Foram incluídos neste estudo 432 pacientes submetidos a cirurgias limpas de correção de fratura de fêmur. A taxa de incidência de ISC foi de 4,9% e os fatores de risco identificados foram a presença de acidente vascular cerebral (razão das chances ­ OR = 5) e período de internação até a cirurgia acima de quatro dias (OR = 3,3). CONCLUSÃO: Para a prevenção das infecções de sítio cirúrgico (ISC) das cirurgias de fraturas de fêmur serão necessárias medidas que envolvam a equipe multiprofissional na avaliação das condições clínicas dos pacientes, redução do tempo de internação até a cirurgia e prevenção das complicações decorrentes das infecções.

Factores de riesgo para Infecciones relacionadas con la Asistencia Sanitaria causadas por Enterobacteriaceae productoras de Klebsiella pneumoniae carbapenemase: un estudio de caso control / Risk factors for Healthcare-Associated Infections caused by KPC-producing Enterobacteriaceae: a case-control study / Fatores de risco para Infecções relacionadas à Assistência à Saúde causadas por Enterobacteriaceae produtoras de Klebsiella pneumoniae carbapenemase: um estudo de caso controle

OBJETIVO: Evaluar los factores de riesgo para infecciones relacionadas con la asistencia sanitaria causadas por Enterobacteriaceae productoras de carbapenemas. MÉTODO: Este es un estudio retrospectivo de casos y controles que consistió en una muestra de 82 pacientes infectados y 164 controles, totalizando 246 pacientes. La recopilación de datos se realizó entre enero y mayo de 2017 mediante la búsqueda en el Sistema Automatizado de Control de Infecciones Hospitalarias y en los registros electrónicos de pacientes. RESULTADOS: Pacientes previamente colonizados con microorganismos gramnegativos (OR: 10.7, 95% CI: 2-60, p = 0.007), con cáncer (OR: 20.8, 95% CI: 4-120, p < 0.001), utilizando una catéter de doble luz (OR: 30.5, 95% CI: 2-382, p = 0.008), con lesión por presión (OR: 136.2, 95% CI: 11- 1623, p < 0.001) y permanecer en la Unidad de Cuidados Intensivos (OR: 1.4, 95% CI: 1.2-1.6, p <0.001) fueron más propensos a desarrollar infecciones causadas por Enterobacteriaceae productoras de carbapenemas que el grupo control. El área bajo la curva ROC mostró un buen rendimiento general (0,99; IC 95%: 0,992-0,998) del modelo de regresión logística final. CONCLUSIÓN: La colonización previa, el cáncer, el uso de catéteres de doble luz, la lesión por presión y la estadía en la UCI fueron factores de riesgo muy importantes para la adquisición de infecciones en el entorno hospitalario

OBJECTIVE: To evaluate the risk factors for healthcare-associated infections caused by Klebsiella pneumoniae carbapenemase producing Enterobacteriaceae. METHOD: This is a retrospective case-control study that consisted of a sample of 82 infected patients and 164 controls, totaling 246 patients. Data collection was performed between January and May 2017 through search in the Automated Hospital Infection Control System and in the electronic patient records. RESULTS: Patients previously colonized with gram-negative microorganisms (OR: 10.7, 95% CI: 2-60, p = 0.007), with cancer (OR: 20.8, 95% CI: 4-120, p < 0.001), using a double lumen catheter (OR: 30.5, 95% CI: 2-382, p = 0.008), with pressure injury (OR: 136.2, 95% CI: 11- 1623, p < 0.001) and Intensive Care Unit stay (OR: 1.4, 95% CI: 1.2-1.6, p <0.001) had a greater chance of developing Healthcare-associated Infections caused by KPC-producing Enterobacteriaceae than the control group. The area under the ROC curve showed a good overall performance (0.99, 95% CI: 0.992-0.998) of the final logistic regression model. CONCLUSION: Previous colonization, cancer, double lumen catheter use, pressure injury and ICU stay were very important risk factors for the acquisition of infections in the hospital environment

OBJETIVO: Avaliar os fatores de risco para infecções relacionadas à assistência à saúde causadas por Enterobactérias produtoras de Klebsiella pneumoniae carbapenemase. MÉTODO: Estudo de caso-controle, retrospectivo que foi composto por uma amostra de 82 pacientes infectados e 164 controles, totalizando 246 pacientes. A coleta de dados foi realizada entre janeiro e maio de 2017, por meio de busca no Sistema Automatizado de Controle de Infecção Hospitalar e nos prontuários eletrônicos dos pacientes. RESULTADOS: Pacientes previamente colonizados com microrganismos gram-negativos (OR: 10,7, IC 95%: 2-60, p = 0,007), com câncer (OR: 20,8, IC 95%: 4-120, p < 0,001), utilizando cateter de duplo lúmen (OR: 30,5, IC 95%: 2-382, p = 0,008), com lesão por pressão (OR: 136,2, IC 95%: 11-1623, p < 0,001) e internação na Unidade de Terapia Intensiva (OR: 1,4, IC 95%: 1,2-1,6, p < 0,001) tiveram maior chance de desenvolver infecções relacionadas à assistência à saúde causadas por Enterobactérias produtoras de Klebsiella pneumoniae carbapenemase quando comparadas ao grupo controle. A área sob a curva ROC apresentou um bom desempenho geral do modelo final de regressão logística (0,99, IC95%: 0,992-0,998). CONCLUSÃO: Colonização prévia, câncer, uso de cateter de duplo lúmen, lesão por pressão e permanência na UTI foram fatores de risco muito importantes para a aquisição de infecções no ambiente hospitalar

Profile of hip arthroplasty patients in a teaching hospital.

OBJECTIVE: to characterize the epidemiological profile of patients undergoing hip replacement, primary or revisional. METHODS: we conducted a retrospective, descriptive study, including hip arthroplasties performed from January 2009 to June 2012 in a Belo Horizonte teaching hospital, Minas Gerais State - MG, Brazil. Data were analyzed using descriptive statistics. RESULTS: orthopedic procedures represented 45% of the operations at the hospital in the period, 1.4% hip arthroplasties. There were 125 hip replacements, 85 total, 27 partial and 13 reviews. Among the patients, 40% were male and 60% were female. Age ranged between 20 and 102 years, mean and median of 73 and 76 years, respectively. The most frequent diagnosis (82%) was femoral neck fracture by low-energy trauma caused by falling form standing position. In 13 revision operations, 12 required removal of the prosthesis. The infectious complication led to revision in 54% of the time, followed by dislocation (15%), peri-prosthetic fracture (15%) and aseptic loosening (15%). The infection etiologic agent was identified in 43% of occasions. The average length of the prosthesis to a revision operation was eight months. CONCLUSION: patients undergoing hip arthroplasty are elderly, with femoral neck fracture caused by falling form standing position, affecting more women. The incidence of hip prosthesis loosening was 10%. The main cause of the infection was loosening. The incidence of revisional hip arthroplasty was 10% and the incidence of hospital mortality in patients undergoing hip arthroplasty was 7.2%.

Quality of the hospital infection control programs: an integrative review / Calidad de los programas de control de infecciones hospitalarias: revisión integradora / Qualidade dos programas de controle de infecção hospitalar: revisão integrativa

ABSTRACT Objective: To analyze the quality of health in relation to the components of structure, process, and outcome in actions for the prevention and control of infections. Method: An integrative literature review in the LILACS, Web of Science, Scopus, and SciELO databases. The time delimitation covered articles published between January 2009 and May 2019. Results: The final sample consisted of 10 articles published, mainly in Scopus (60%), and in Web of Science (30%). The structural elements varied among the study countries, suggesting opportunities for improvement of organizational characteristics and human resources. Regarding the process of the implemented routines, inconsistencies were found to comply with the guidelines. The result component was not emphasized among the studies included in the review. Conclusion: The quality of hospital infection control programs has yet to be improved among the health services, highlighting the need for investment in the structure, process, and outcome components.

RESUMEN Objetivo: Analizar la calidad de la salud en relación con los componentes de estructura, proceso y resultado en las acciones para la prevención y control de infecciones. Método: Revisión bibliográfica integradora en bases de datos LILACS, Web of Science, Scopus y SciELO. La delimitación temporal abarcó artículos publicados entre enero de 2009 y mayo de 2019. Resultados: La muestra final consistió en 10 artículos publicados, principalmente en Scopus (60%) y Web of Science (30%). Los elementos estructurales variaron entre los países del estudio, lo que sugiere oportunidades para mejorar las características de la organización y los recursos humanos. Con respecto al proceso de las rutinas implementadas, se advirtieron inconsistencias para cumplir con las pautas. El componente de resultados no se enfatizó entre los estudios incluidos en la revisión. Conclusión: La calidad de los programas de control de infecciones hospitalarias aún no se ha mejorado entre los servicios de salud, razón por la cual, se destaca la necesidad de invertir en los componentes de estructura, proceso y resultados.

RESUMO Objetivo: Analisar a qualidade em saúde em relação aos componentes de estrutura, processo e resultado nas ações de prevenção e controle de infecções. Método: Revisão integrativa da literatura nas bases de dados da LILACS, Web of Science, Scopus e SciELO. A delimitação temporal abrangeu artigos publicados entre janeiro de 2009 e maio de 2019. Resultados: A amostra final foi de 10 artigos publicados, principalmente no Scopus (60%) e na Web of Science (30%). Os elementos estruturais variaram entre os países de estudo, sugerindo oportunidades de melhoria das características organizacionais e dos recursos humanos. Em relação ao processo das rotinas implantadas, foram encontradas inconsistências ao cumprimento das diretrizes. O componente resultado não obteve ênfase entre os estudos incluídos na revisão. Conclusão: A qualidade dos programas de controle de infecção hospitalar ainda precisa ser aprimorada entre os serviços de saúde, destacando a necessidade de investimentos nos componentes de estrutura, processo e resultado.