Impact of the I-DECIDED Tool to Improve Peripheral Intravenous Catheter Care in Paediatrics: Interrupted Time-Series Study.

AIM: To determine whether the I-DECIDED assessment and decision tool enhances peripheral intravenous catheter assessment, care and decision-making in paediatrics. DESIGN: Quasi-experimental, interrupted time-series study. METHODS: An interrupted time-series study was conducted in a paediatric inpatient unit at a public teaching hospital in Brazil. The participants were patients aged less than 15 years old with a peripheral intravenous catheter, and their parents or guardians. Data were collected between January and July 2023, encompassing six time points, three pre-intervention and three post-intervention. Evaluation data were based on the I-DECIDED tool, including idle devices, dressings, complications, patient/family awareness, hand hygiene, disinfection and documentation. RESULTS: We conducted 585 peripheral intravenous catheter observations, with 289 in the pre-intervention phase and 296 in the post-intervention phase, inserted in 65 hospitalised children, 30 in the pre-intervention phase and 35 in the post-intervention phase. After the intervention, reductions were observed in the number of idle catheters, substandard dressings and complications. Patients and family members reported an increase in device assessment, hand hygiene and peripheral intravenous catheter disinfection. Additionally, there was an increase in documentation of decision-making performed by nurses and nursing technicians/assistants. CONCLUSION: Implementation of the I-DECIDED assessment and decision tool in a paediatric unit significantly improved the assessment, care and decision-making regarding peripheral intravenous catheters. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Opportunity to enhance practice standards, elevate the quality of care provided to paediatric patients, contribute to improved patient outcomes, advance evidence-based practice in vascular access management and enhance patient experience through increased involvement in care. IMPACT: To influence clinical practice and healthcare policies aimed at improving peripheral intravenous catheter care and patient safety in paediatric settings. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution to the design of this study.

Adsorption and ion exchange of toxic metals by Brazilian clays: clay selection and studies of equilibrium, thermodynamics, and binary ion exchange modeling.

In this study, four Brazilian clays (Bofe, Verde-lodo, commercial Fluidgel, and expanded commercial vermiculite) were evaluated for their adsorptive capacity and removal percentage in relation to different toxic metals (Ni2+, Cd2+, Zn2+, and Cu2+). The best results were obtained by expanded vermiculite, with cadmium removal reaching values of 95%. The most promising clay was modified by the sodification process, and the metal cadmium was used to evaluate the ion exchange process. The clays expanded vermiculite (EV) and VNa-sodified vermiculite were evaluated by equilibrium study at 25, 35, and 45 °C. At 25 °C, EV obtained a maximum adsorption capacity of 0.368 mmol/g and sodified vermiculite 0.480 mmol/g, which represents an improvement of 30.4% in modified clay capacity. At 45 °C, the sodified vermiculite reached 0.970 mmol/g adsorption capacity. The Langmuir, Redlich-Peterson Freundlich, and Dubinin-Raduskevich models were adjusted to the results. Langmuir provided the best fit among the models. The thermodynamic quantities (ΔS, ΔH, and ΔG) demonstrated that the process is spontaneous and endothermic and the metal is captured by physisorption and chemisorption in the studied temperature range. For the ion exchange equilibrium, the binary Langmuir and binary Langmuir-Freundlich models were adjusted to the expanded vermiculite and sodified vermiculite isotherms, respectively. Both models were predictive. Thermal analysis indicated good heat resistance even after material modification. The apparent and real densities demonstrated that after each treatment or contamination, the clayey material undergoes contraction in its structure. An improved efficiency of the adsorbent was found after sodification.

Utilization of local pressure devices in pain management during injections: scoping review.

OBJECTIVE: to map scientific evidence regarding the use of local pressure devices in pain relief during injection procedures in patients. METHODS: scoping review, following the recommendations of the JBI Manual for Evidence Synthesis and PRISMA-ScR, with searches conducted in the PubMed, EMBASE, CINAHL, LILACS, and PsycINFO databases, without temporal restrictions and with a cutoff date of March 2023. RESULTS: a total of 1,514 studies were identified, with 20 articles included in the final sample. The ShotBlocker® device was utilized during subcutaneous and intramuscular injections in children and adults, proving beneficial in reducing pain, anxiety, and fear associated with the procedure. FINAL CONSIDERATIONS: the ShotBlocker® is a low-cost, easy-to-use device that can enhance nursing clinical practice during painful procedures. However, studies involving the Brazilian Pikluc® device are scarce. Further research involving both local pressure devices is recommended.

PiccPed® app impact on nurses' knowledge to prevent adverse events for peripherally inserted central catheters (PICC) in pediatric and neonatal healthcare: A quasi-experimental study.

BACKGROUND: The PiccPed® health application was developed to support clinical decision-making in peripherally inserted central catheter (PICC) management. We aimed to evaluate its impact on nurses' knowledge regarding the prevention of PICC-associated adverse events in pediatrics and neonatology. METHODS: A quasi-experimental, pre-post intervention study, was conducted with a dependent/paired sample of pediatric and neonatal nurses from two tertiary hospitals in South Brazil. Data were collected from October 2022 to January 2023 across three phases: pre-, intervention (use of the PiccPed®) and post-test. Study outcomes were a knowledge test (15 questions) of evidence-based PICC maintenance procedures, and PiccPed® app time spent and screens used. RESULTS: A total of 56 nurses completed the study. The post-test mean score was significantly higher (12/15; standard deviation (SD) 1.9) in comparison with the pre-test (mean 9/15; SD 2.2). The change in scores was significantly higher for nurses without postgraduate qualifications, in comparison to those with (Mean Difference 1.26; p = 0.039). Each minute using the app resulted in a significant increase of 0.04 points (95% confidence interval 0.01-0.08; p = 0.014) on the mean post-test score (10.94 points). CONCLUSION: The research demonstrated that PiccPed® enhances nurses' learning regarding the prevention of adverse events associated with PICC maintenance in pediatrics and neonatology. APPLICATION TO PRACTICE: The app can be safely and effectively used for training and continuing education of nurses who care for children and neonates with PICCs.

Factors associated with the disinfection of devices attached to peripheral intravenous catheters performed by the nursing team in pediatric units.

Background: Peripheral intravenous catheterization, as well as drug administration through it, represents one of the most performed procedures by the Nursing team and, for that, precautions need to be adopted to offer harm-free care. Objective: To verify the association of Nursing professionals' work shift and training time with proper disinfection of intravenous catheter devices in pediatric units. Methods: A cross-sectional and analytical study conducted between June and August 2021 in three hospitalization units of a Pediatric Hospital. The inclusion criterion was drug administration via peripheral intravenous catheters performed by Nursing professionals. The data were analyzed according to inferential statistics, adopting p ≤ .05 as significance level. Results: There were a total of 385 observations of drug administration procedures. The device was not disinfected in 60.3% of the cases, there was no friction at the suitable time in 86.3%, and the disinfectant was not allowed to dry in 72.5%. The work shift exerted no influence on performance of the disinfection procedure (p = .376). However, longer training time was associated with a lower rate in performing such procedure (p < .001). Conclusion: Performing friction below the recommended time can cause a false sense of prevention of catheter-associated bloodstream infection; therefore, training sessions and strategies for adherence to the disinfection procedures should be considered, mainly for professionals with more training time.

I-decided®-brazil: cross-cultural adaptation of an assessment and decision-making tool for peripheral intravenous catheter / I-decided®-brasil: adaptación transcultural de una herramienta de evaluación y toma de decisiones para catéteres intravenosos periféricos / I-decided®-brasil: adaptação transcultural da ferramenta de avaliação e tomada de decisão para cateter intravenoso periférico

ABSTRACT Objective: to translate and adapt the I-DECIDED® Tool to Portuguese and Brazilian context. Method: this methodological research used Beaton's framework for the translation and cross-cultural adaptation process, which occurred in five stages: initial translation; synthesis of translations; back-translation; committee of experts; and pre-testing. It was carried out from July to December 2022. For data analysis, the Content Validity Index and Cronbach's alpha were used. Results: from a committee of experts, the adapted version of I-DECIDED® obtained satisfactory semantic, idiomatic, experiential and conceptual equivalence when compared to the original version, reaching a Content Validity Index of 0.94. In pre-testing, 60 nurses participated, and the reliability of the adapted tool was 0.83. Conclusion: the translation and cross-cultural adaptation process of I-DECIDED® was carried out and provides Brazilian professionals with an assessment and decision-making tool in relation to peripheral intravenous catheters aligned with patient safety.

RESUMEN Objetivo: traducir y adaptar la herramienta I-DECIDED® al idioma portugués y al contexto brasileño. Método: esta investigación metodológica utilizó el marco de Beaton para el proceso de traducción y adaptación transcultural, que ocurrió en cinco etapas: traducción inicial; síntesis de traducciones; traducción inversa; comité de expertos; y prueba previa. Se realizó de julio a diciembre de 2022. Para el análisis de los datos se utilizó el Índice de Validez de Contenido y el alfa de Cronbach. Resultados: con base en el comité de expertos, la versión adaptada de I-DECIDED® obtuvo equivalencia semántica, idiomática, experiencial y conceptual satisfactoria respecto al original, alcanzando un Índice de Validez de Contenido de 0,94. En el pretest participaron 60 enfermeros y la confiabilidad de la herramienta adaptada fue de 0,83. Conclusión: se realizó el proceso de traducción y adaptación transcultural de la I-DECIDED® que brinda a los profesionales brasileños una herramienta de evaluación y toma de decisiones en relación a los catéteres intravenosos periféricos alineados con la seguridad del paciente.

RESUMO Objetivo: traduzir e adaptar a Ferramenta I-DECIDED® para o idioma português e contexto brasileiro. Método: pesquisa metodológica que utilizou o referencial de Beaton para o processo de tradução e adaptação transcultural, que ocorreu em cinco etapas: tradução inicial, síntese das traduções, tradução reversa, comitê de especialistas e pré-teste. Realizado no período de julho a dezembro de 2022. Para análise de dados, foram utilizados o Índice de Validade de Conteúdo e Alpha de Cronbach. Resultados: a partir do Comitê de Especialistas, a versão adaptada da Ferramenta I-DECIDED® obteve satisfatória equivalência semântica, idiomática, experiencial e conceitual quando comparada à original, atingindo o Índice de Validade de Conteúdo de 0,94. No pré-teste, participaram 60 enfermeiros e a confiabilidade da Ferramenta adaptada foi de 0,83. Conclusão: o processo de tradução e adaptação transcultural da Ferramenta I-DECIDED® foi realizado e disponibiliza aos profissionais brasileiros uma ferramenta de avaliação e tomada de decisão em relação ao cateter intravenoso periférico alinhada à segurança do paciente.

Utilization of local pressure devices in pain management during injections: scoping review / Uso de dispositivos de presión local en el manejo del dolor durante las inyecciones: revisión de alcance / Utilização de dispositivos de pressão local no manejo da dor durante injeções: revisão de escopo

ABSTRACT Objective: to map scientific evidence regarding the use of local pressure devices in pain relief during injection procedures in patients. Methods: scoping review, following the recommendations of the JBI Manual for Evidence Synthesis and PRISMA-ScR, with searches conducted in the PubMed, EMBASE, CINAHL, LILACS, and PsycINFO databases, without temporal restrictions and with a cutoff date of March 2023. Results: a total of 1,514 studies were identified, with 20 articles included in the final sample. The ShotBlocker® device was utilized during subcutaneous and intramuscular injections in children and adults, proving beneficial in reducing pain, anxiety, and fear associated with the procedure. Final considerations: the ShotBlocker® is a low-cost, easy-to-use device that can enhance nursing clinical practice during painful procedures. However, studies involving the Brazilian Pikluc® device are scarce. Further research involving both local pressure devices is recommended.

RESUMEN Objetivo: mapear evidencia científica sobre el uso de dispositivos de presión local en el alivio del dolor durante la aplicación de inyecciones en pacientes. Métodos: revisión de alcance, siguiendo las recomendaciones del Manual JBI para Síntesis de Evidencia y PRISMA-ScR, con búsqueda en las bases de datos PubMed, EMBASE, CINAHL, LILACS y PsycINFO, sin restricciones temporales y con fecha límite hasta marzo de 2023. Resultados: se identificaron un total de 1,514 estudios, con 20 artículos incluidos en la muestra final. El dispositivo ShotBlocker® se utilizó durante las inyecciones subcutáneas e intramusculares en niños y adultos, demostrando ser beneficioso en la reducción del dolor, la ansiedad y el miedo asociados con el procedimiento. Consideraciones finales: el ShotBlocker® es un dispositivo de bajo costo y fácil manejo que puede mejorar la práctica clínica de enfermería durante procedimientos dolorosos. Sin embargo, los estudios sobre el dispositivo brasileño Pikluc® son escasos. Se recomienda realizar estudios con ambos dispositivos de presión local.

RESUMO Objetivo: mapear evidências científicas acerca da utilização de dispositivos de pressão local no alívio da dor durante a aplicação de injeções em pacientes. Métodos: revisão de escopo, conforme recomendações do JBI Manual for Evidence Synthesis e PRISMA-ScR, com busca nas bases PubMed, EMBASE, CINAHL, LILACS e PsycINFO, sem recorte temporal e data limite até março de 2023. Resultados: foram encontrados 1.514 estudos, sendo incluídos 20 artigos na amostra final. O dispositivo ShotBlocker® foi utilizado durante a aplicação de injeções subcutânea e intramuscular em crianças e adultos, sendo benéfico na redução da dor, da ansiedade e do medo associados ao procedimento. Considerações finais: o ShotBlocker® é um dispositivo de baixo custo e fácil manuseio a ser utilizado para aprimorar a prática clínica da Enfermagem durante a realização de procedimentos dolorosos. Contudo, estudos com o dispositivo brasileiro Pikluc® são escassos. Recomenda-se a realização de estudos com ambos os dispositivos de pressão local.

Biosorption of europium and erbium from aqueous solutions using crosslinked sericin-alginate beads.

Critical metals such as rare earths are essential for important industrial applications and for producing high-tech materials. Currently, the development of alternative and non-conventional biomaterials has gained significant interest. This work investigated the use of crosslinked sericin-alginate-based natural polymeric particles for the removal of rare earths from water. Affinity tests showed that sericin-alginate/polyethylene glycol diglycidyl ether had the highest potential for capturing europium (0.258 mmol/g and 94.33%) and erbium (0.259 mmol/g and 94.55%). Next, erbium was selected based on the affinity with sericin-alginate/polyethylene glycol diglycidyl to investigate the effect of dose/pH, biosorption kinetics, isothermal equilibrium, desorption/reuse, and selectivity. The effect of dose and pH showed that 8.0 g/L (95.91%) and pH 5.0 (97.53%) were more efficient in capturing erbium. The biosorption kinetics showed that the equilibration time was reached within 210 min. The PSO and EMTR models effectively represented the kinetics data. The isothermal equilibrium revealed that the maximum uptake capacity for erbium was 0.641 mmol/g. The isothermal curves better fit the Dubinin-Radushkevich (55 °C) and Langmuir (25 and 40 °C) models. Thermodynamic quantitates indicated that erbium uptake was spontaneous, governed by entropic changes, and endothermic. The recovery of Er3+ was greater than 98% and the reuse of the eluent in the cycles enriched the Er3+ load 10-times (1.0 to 9.91 mmol/L). The beads also showed better performance for capturing Er3+ and Eu3+ with other coexisting ions. Characterization analyzes revealed the ion exchange mechanism between Ca2+/Er3+ prevailed in the Er3+ removal. Thus, the results pointed out that crosslinked sericin-alginate can be used as an alternative and promising biosorbent to remove and recover rare earths.

Aplicativos sobre terapia intravenosa e prevenção de infecção de corrente sanguínea associada ao cateter: prospecção tecnológica / Applications on intravenous therapy and catheter-associated bloodstream infection prevention: technology prospection / Aplicaciones en terapia intravenosa y prevención de infecciones del torrente sanguíneo asociadas a catéteres: prospección tecnológica

RESUMO Objetivo: identificar aplicativos móveis sobre terapia intravenosa e prevenção de infecção de corrente sanguínea associada ao cateter. Método: prospecção tecnológica, com busca dos dados nas Bases de Patentes e Lojas Virtuais, a coleta dos dados ocorreu de maio a agosto de 2021. Critérios de inclusão: aplicativos móveis voltados para a Terapia Intravenosa; aplicativos móveis voltados para a prevenção de infecção de corrente sanguínea, a análise foi realizada de forma qualitativa comparativa, reconhecendo as funções desenvolvidas pelos aplicativos e seus potenciais para utilização na prática clínica. Resultados: 19 aplicativos foram selecionados e organizados em temáticas: aplicativos para auxiliar no cateterismo; aplicativos para manutenção de cateter; aplicativos sobre prevenção de infecção de corrente sanguínea; e aplicativo sobre diagnóstico de infecção de corrente sanguínea associada ao cateter. Conclusão: a identificação de poucos aplicativos sobre a temática serve de fomento para construção de novos aplicativos.

ABSTRACT Objective: to identify mobile applications on intravenous therapy and prevention of catheter-associated bloodstream infection. Method: technological prospection, with data search in Patent Bases and Virtual Stores, data collection occurred from May to August 2021. Inclusion criteria: mobile applications focused on Intravenous Therapy; mobile applications focused on the prevention of bloodstream infection. The analysis was carried out in a qualitative comparative way, recognizing the functions developed by the applications and their potential for use in clinical practice. Results: 19 applications were selected and organized into themes: applications to assist in catheterization; applications for catheter maintenance; applications on bloodstream infection prevention; and applications on diagnosis of catheter-associated bloodstream infection. Conclusion: The identification of few apps on the theme serves to promote the construction of new apps.

RESUMEN Objetivo: identificar aplicaciones móviles sobre terapia intravenosa y prevención de la infección del torrente sanguíneo asociada a catéteres. Método: prospección tecnológica, con búsqueda de datos en Bases de Patentes y Almacenes Virtuales, la recolección de datos ocurrió de mayo a agosto de 2021. Criterios de inclusión: aplicaciones móviles centradas en la Terapia Intravenosa; aplicaciones móviles centradas en la prevención de la infección del torrente sanguíneo, el análisis se realizó de forma cualitativa comparativa, reconociendo las funciones desarrolladas por las aplicaciones y su potencial de uso en la práctica clínica. Resultados: Se seleccionaron 19 aplicaciones y se organizaron en temas: aplicaciones para ayudar en el cateterismo; aplicaciones para el mantenimiento del cateterismo; aplicaciones sobre la prevención de la infección de transmisión sanguínea; y aplicación sobre el diagnóstico de la infección de transmisión sanguínea asociada al cateterismo. Conclusión: la identificación de pocas aplicaciones sobre el tema sirve de estímulo para la construcción de nuevas aplicaciones.

Ion exchange and adsorption of cadmium from aqueous media in sodium-modified expanded vermiculite.

The use of mineral clays as alternative adsorbent has received attention due to their physicochemical characteristics, superficial negative charge, abundance of vermiculite (especially in Brazil), low cost, and chemical composition, which allows the material modification to increase the adsorptive capacity. This manuscript evaluated the use of expanded vermiculite (EV) and sodium-modified vermiculite (VNa) in the adsorption and ion exchange of Cd2+ ions. The sodification was successfully carried out making the ion exchange capacity greater in the modified clay, confirmed by EDX, cation exchange capacity (CEC), DRX, and FTIR analysis. The CEC was 210 and 233 mEq/100 g for the EV and VNa, respectively, with 97.8% exchangeable ion (Na+) in the VNa. FTIR spectra showed small variations in the groups related to ion exchange and XRD analysis indicated changes in the distance of the layers with loss of crystallinity after clay modification, which was recovered after cadmium adsorption. The kinetics became faster with an equilibrium time of 10 min for VNa and 45 min for EV. Cd2+ removal by vermiculite above 99% was achieved. Pseudo-second order model best described the kinetics, in which the resistance to mass transfer in external film is the limiting step of the process and, once this resistance is overcome, the ion exchange happens quickly. Despite the decrease in surface area after sodification, the adsorptive capacity increased 158% in the sodified adsorbent, from 0.107 mmol/g for EV to 0.276 mmol/g for VNa, under the evaluated conditions.

Personal protective equipment in hospital nursing care: a scoping review / Equipo de protección personal en la atención hospitalaria de enfermería: revisión de alcance / Equipamentos de proteção individual na assistência hospitalar de enfermagem: revisão de escopo

ABSTRACT Objective: to analyze the scientific production on the use of Personal Protective Equipment by Nursing professionals during the care provided in the hospital environment. Method: this is a scoping review, based on the 2020 Joanna Briggs Institute Manual and guided by PRISMA-PCR. PUBMED, EMBASE, CINAHL, LILACS, BDENF, SCOPUS and WEB of SCIENCE were used as databases, choosing a search period corresponding to the last 20 years. Data collection took place from September to October 2021. The study protocol is available in the Open Science Framework: https://osf.io/7d8q9/files/. Studies on the use of Personal Protective Equipment in direct care provided by the Nursing team in hospitals were included; and those that addressed reviews, theses and dissertations in other settings were excluded, as well as studies not available in full. Results: the sample consisted of 26 documents. The items most cited and with the highest adherence in the studies were procedure gloves, while use of goggles was the least mentioned. The following stand out among the factors that facilitate PPE use by nurses: interpersonal relationships, knowledge, workload, standardization of guidelines, and participation of the care team in management decisions. Conclusion: the need to educate the professionals using behavioral knowledge as a strategy, as well as maintenance of communication in the sectors to avoid contamination, the influence of workload and the standardization of guidelines are necessary in the hospital health services to increase health professionals' engagement towards the biosafety practices.

RESUMEN Objetivo: analizar la producción científica sobre el uso del Equipo de Protección Personal en profesionales de Enfermería durante la atención provista en el ámbito hospitalario. Método: revisión de alcance basada en el Manual del Joanna Briggs Institute de 2020 y guiada por PRISMA-PCR. Se utilizaron las bases de datos PUBMED, EMBASE, CINAHL, LILACS, BDENF, SCOPUS y WEB of SCIENCE, eligiéndose los últimos 20 años como período de búsqueda. Los dados fueron recolectados de septiembre a octubre de 2021. El protocolo del estudio se encuentra disponible en Open Science Framework: https://osf.io/7d8q9/files/. Se incluyeron estudios sobre el uso del Equipo de Protección Personal en la atención directa provista por el equipo de Enfermería en hospitales y se excluyó a los que tenían como tema revisiones, tesis y disertaciones en otros ámbitos, al igual que estudios no disponibles en formato de texto completo. Resultados: la muestra estuvo compuesta por 26 documentos. Los elementos de protección más citados y con mayor adhesión en los estudios fueron los guantes de procedimiento, mientras que las gafas protectoras fueron las menos mencionadas. Entre los factores que facilitan el uso del PPE en los profesionales de Enfermería se destacan las relaciones interpersonales, el conocimiento, la carga de trabajo, la estandarización de las pautas y la participación del equipo asistencial en las decisiones gerenciales. Conclusión: la necesidad de educar a los profesionales empleando como estrategia el conocimiento conductual, mantener la comunicación entre los sectores para para evitar la contaminación, la influencia de la carga de trabajo, y la estandarización de las pautas son medidas necesarias en los servicios de salud hospitalaria para mejorar el nivel de compromiso de los profesionales de la salud con las prácticas de bioseguridad.

RESUMO Objetivo: analisar a produção científica sobre o uso de equipamento de proteção individual pelos profissionais da enfermagem durante a assistência no âmbito hospitalar. Método: trata-se de uma revisão de escopo, baseada no Manual Institute Joanna Briggs de 2020 e norteado pelo PRISMA-PCR. Utilizou-se como base de dados PUBMED, EMBASE, CINAHL, LILACS, BDENF, SCOPUS e WEB of SCIENCE, sendo o período de busca escolhido nos últimos 20 anos. A coleta de dados ocorreu de setembro a outubro de 2021. Protocolo de estudo disponível em Framework: https://osf.io/7d8q9/files/. Foram incluídos estudos sobre o uso dos Equipamentos de Proteção Individual na assistência direta da equipe de enfermagem nos hospitais e excluídos aqueles que abordassem em outros cenários, revisões, teses, dissertações e estudos não disponíveis na íntegra. Resultados: a amostra foi composta por 26 documentos. O equipamento mais citado e com maior adesão nos estudos foram as luvas de procedimento, enquanto que o uso dos óculos foi o menor. Dos fatores que facilitam o uso dos EPIs pelos enfermeiros destacam-se as relações interpessoais, conhecimento, carga de trabalho, padronização das diretrizes e participação da equipe assistencial nas decisões gerenciais. Conclusão: a necessidade de educação dos profissionais utilizando como estratégia o conhecimento comportamental, a manutenção da comunicação nos setores para evitar a contaminação, a influência da carga de trabalho, a padronização das diretrizes são necessárias nos serviços de saúde hospitalar para aumentar o engajamento dos profissionais de saúde às práticas de biossegurança.

Compreensão de estudantes de enfermagem sobre as Redes de Atenção à Saúde / Nursing undergraduates' understanding of Health Care Networks / Comprensión de los estudiantes de enfermería sobre las Redes de Atención a la Salud

Objetivo: analisar a compreensão de estudantes de graduação em enfermagem sobre as Redes de Atenção à Saúde. Método: estudo descritivo e exploratório, qualitativo, realizado com 27 estudantes em Enfermagem de uma universidade federal do sul do Brasil, por meio de entrevistas semiestruturadas realizadas entre agosto e setembro de 2018. Resultados: foi evidenciado o conhecimento dos estudantes em relação ao conceito e objetivo das Redes de Atenção à Saúde, a identificação de fragilidades na comunicação e a falta de conhecimento do usuário como obstáculos na efetivação das mesmas, a dificuldade em ver a atuação do enfermeiro dentro dos variados serviços das redes e a percepção sobre a fragmentação do processo de formação. Conclusão: o estudo contribui para a discussão sobre a inclusão dos estudantes nas Redes de Atenção à Saúde, com intuito de superar as exigências educacionais que buscam favorecer a efetivação do Sistema Único de Saúde e das Redes de Atenção à Saúde.

Objective: to examine undergraduate nursing students' understanding of Health Care Networks (HCNs). Method: in this exploratory, qualitative descriptive study, semi-structured interviews were conducted with 27 Nursing students at a federal University in southern Brazil between August and September 2018. Results: the interviews revealed that the students' knowledge related to the HCNs' concept and purpose, beyond the communication weaknesses and users' lack knowledge as obstacles to effective HCNs, the difficulty in seeing nurses' roles in the various network services, and perceived fragmentation in the training process. Conclusion: the study contributed to discussion of inclusion of students in HCRs, with a view to meeting the educational requirements designed to favor implementation of the national health system (SUS) and the HCNs.

Objetivo: analizar la comprensión de los estudiantes de enfermería de pregrado sobre las redes de atención de la salud (HCN). Método: en este estudio exploratorio, cualitativo descriptivo, se realizaron entrevistas semiestructuradas a 27 estudiantes de Enfermería de una Universidad federal del sur de Brasil entre agosto y septiembre de 2018. Resultados: las entrevistas revelaron que los conocimientos de los estudiantes relacionados con el concepto y propósito, más allá de las debilidades de comunicación y la falta de conocimiento de los usuarios como obstáculos para una HCN eficaz, la dificultad para ver el rol de las enfermeras en los distintos servicios de la red y la fragmentación percibida en el proceso de formación. Conclusión: el estudio contribuyó a la discusión de la inclusión de los estudiantes en las HCR, con miras a cumplir con los requisitos educativos diseñados para favorecer la implementación del Sistema Nacional de Salud (SUS) y las HCN.

Estratégias para o fortalecimento da cultura de segurança em unidades de terapia intensiva / Strategies for strengthening safety culture in intensive care units / Estrategias para el fortalecimiento de la cultura de seguridad en unidades de cuidados intensivos

Objetivo: identificar estratégias de promoção que contribuam para o fortalecimento da cultura de segurança do paciente em unidades de terapia intensiva. Método: estudo qualitativo, descritivo, realizado com cinco médicos, cinco enfermeiros e 24 técnicos de enfermagem atuantes em unidades de terapia intensiva de duas instituições hospitalares do sul do Brasil em 2016. A coleta dos dados foi realizada por meio de entrevistas semiestruturadas e o tratamento, pela análise textual discursiva. A pesquisa foi aprovada por Comitê de Ética em Pesquisa. Resultados: emergiram três categorias: implementação de protocolos de segurança do paciente; envolvimento institucional e multiprofissional; e segurança do paciente na educação permanente. Conclusão: os profissionais de saúde consideram a implementação de protocolos na assistência à saúde, a inclusão da temática da segurança na educação permanente e o envolvimento da instituição, bem como da equipe multiprofissional, como as principais estratégias para promover e fortalecer a cultura de segurança do paciente.

Objective: identify promotion strategies that contribute to strengthening patient safety culture in intensive care units. Method: in this qualitative, descriptive study, data were collected in 2016 by semi-structured interviews of five physicians, five nurses and 24 nursing technicians working in intensive care units at two hospitals in southern Brazil, and analyzed using discursive textual analysis. The study was approved by the research ethics committee. Results: three categories emerged: implementation of patient safety protocols; institutional and multi-professional involvement and patient safety in continuing professional development. Conclusion: health personnel considered the implementation of health care protocols, the inclusion of safety as a topic in continued professional development and the involvement of both the institution and the multi-professional team to be the main strategies for promoting and strengthening patient safety culture.

Objetivo: identificar estrategias de promoción que contribuyan al fortalecimiento de la cultura de seguridad del paciente en unidades de cuidados intensivos. Método: estudio cualitativo, descriptivo, realizado junto a cinco médicos, cinco enfermeros y 24 técnicos de enfermería que trabajan en unidades de cuidados intensivos de dos instituciones hospitalarias del sur de Brasil, en 2016. La recolección de los datos se realizó por medio de entrevistas semiestructuradas y el tratamiento de los datos por el análisis textual discursivo. La investigación fue aprobada por Comité de Ética en Investigación. Resultados: surgieron tres categorías: implementación de protocolos de seguridad del paciente; participación institucional y multiprofesional y seguridad del paciente en la educación permanente. Conclusión: los profesionales de la salud consideran la implementación de protocolos en la asistencia a la salud, la inclusión de la temática de la seguridad en la educación permanente y la participación de la institución, así como del equipo multiprofesional, como las principales estrategias para promover y fortalecer la cultura de seguridad del paciente.

Tratamento de efluentes de lavanderia hospitalar por processo oxidativo avançado: UV/H2O2 / Wastewater treatment of hospital laundry by advanced oxidation process: UV/H 2 O 2

RESUMO O objetivo deste trabalho foi avaliar o tratamento de efluentes de lavanderia hospitalar por processo oxidativo avançado UV/H2O2. O planejamento fatorial 32 foi empregado de modo a avaliar a influência do pH e da dosagem de peróxido na eficiência do tratamento. Os experimentos de foto-oxidação foram realizados com efluentes coletados na lavanderia do Hospital Universitário Regional de Maringá (HUM). Resultados relativos à caracterização do efluente e às reduções de parâmetros físico-químicos: cor, turbidez, demanda biológica de oxigênio (DBO), surfactantes e a quantificação de coliformes totais e termotolerantes, também são apresentados neste trabalho. Foram testados três valores de pH - 5, 7 e 9 - e três dosagens de peróxido de hidrogênio nas razões de [DQO]:[H2O2] - 1:0,5, 1:2,5 e 1:5. Os melhores resultados foram alcançados com o tratamento realizado em pH 9 e razão [DQO]:[H2O2] de 1:2,5. As eficiências de remoção da demanda química de oxigênio (DQO) e de surfactantes foram, em média, de 60,3 e 98%, respectivamente, porém o tratamento não se mostrou eficiente na redução de cor e turbidez, demonstrando a necessidade de se acoplar tratamentos complementares para a redução de tais parâmetros.

ABSTRACT The objective of this work was to evaluate the treatment of hospital laundry effluents by advanced oxidation process UV/H2O2. Factorial design 32 was employed to investigate the influence of pH and peroxide dosage on treatment efficiency. The photo-oxidation experiments were performed with effluents collected in the laundry of the Regional University Hospital of Maringá (HUM). Physicochemical parameters of effluent color, turbidity, BOD, surfactants and quantification of total and thermotolerant coliforms are presented in this study. Three values ​​of pH - 5, 7 and 9 - and three dosages of hydrogen peroxide with [COD]:[H2O2] ratios of 1:0.5, 1:2.5 and 1:5 (w:w) were tested. The best results were achieved with the treatment performed at pH 9 and ratio [COD]:[H2O2] of 1:2.5. The average removal efficiencies of COD and surfactants were 60.3 and 98%, respectively. However, the treatment was not efficient in reducing color and turbidity, demonstrating the need to combine complementary treatments for the reduction of such parameters.

Patient safety culture in intensive care units: perspective of health professionals. / Cultura de segurança em unidades de terapia intensiva: perspectiva dos profissionais de saúde.

OBJECTIVE: To identify the patient safety culture in intensive care units. METHOD: This qualitative, exploratory-descriptive study was conducted with five physicians, five nurses and 24 nursing technicians working in the intensive care units of two hospitals in the South of Brazil: one public and one philanthropic. Semi-structured interviews were held in September and October 2016 and analyzed using discursive textual analysis. RESULTS: Two categories emerged: Perception of error and Error management. CONCLUSION: The professionals acknowledge the existence of errors in health care and assign their occurrence to individual failures and failures accruing from the organizational system but support a non-punitive culture of safety and encourage collective learning.

Cultura de segurança em unidades de terapia intensiva: perspectiva dos profissionais de saúde / Cultura de seguridad en unidades de terapia intensiva: perspectiva de los profesionales de salud / Patient safety culture in intensive care units: perspective of health professionals

Resumo OBJETIVO Conhecer a cultura de segurança do paciente em unidades de terapia intensiva. MÉTODO Estudo qualitativo, exploratório-descritivo, realizado com cinco médicos, cinco enfermeiros e 24 técnicos de enfermagem atuantes em unidades de terapia intensiva de duas instituições hospitalares do sul do Brasil, uma pública e uma filantrópica. Realizaram-se entrevistas semiestruturadas no período de setembro e outubro de 2016, analisadas por meio da análise textual discursiva. RESULTADOS Emergiram duas categorias: Percepção sobre o erro e Gestão do erro. CONCLUSÃO Evidenciou-se que os profissionais reconhecem a existência do erro na assistência à saúde e atribuem a sua ocorrência a falhas individuais e do sistema organizacional, além de estimularem uma cultura não punitiva e o aprendizado coletivo.

Resumen OBJETIVO Conocer la cultura de seguridad del paciente en unidades de terapia intensiva. MÉTODO Estudio cualitativo, exploratorio-descriptivo, realizado con cinco médicos, cinco enfermeros y 24 técnicos de enfermería actuantes en unidades de terapia intensiva de dos instituciones hospitalarias del sur de Brasil, una pública y una filantrópica. Se realizaron entrevistas semiestructuradas en el período de septiembre y octubre de 2016, analizadas por medio del análisis textual discursivo. RESULTADOS Surgieron dos categorías: Percepción sobre el error y Gestión del error. CONCLUSIÓN Se evidenció que los profesionales reconocen la existencia del error en la asistencia a la salud y atribuyen su ocurrencia a fallas individuales y del sistema organizacional, además de estimular una cultura no punitiva y el aprendizaje colectivo.

Abstract OBJECTIVE To identify the patient safety culture in intensive care units. METHOD This qualitative, exploratory-descriptive study was conducted with five physicians, five nurses and 24 nursing technicians working in the intensive care units of two hospitals in the South of Brazil: one public and one philanthropic. Semi-structured interviews were held in September and October 2016 and analyzed using discursive textual analysis. RESULTS Two categories emerged: Perception of error and Error management. CONCLUSION The professionals acknowledge the existence of errors in health care and assign their occurrence to individual failures and failures accruing from the organizational system but support a non-punitive culture of safety and encourage collective learning.

Extrato hidroalcoolico da casca do pequi (Caryocar brasiliense) em ratos submetidos à aplicação de doxorrubicina / Hydro alcoholic extract of pequi peel (Caryocar brasiliense) in rats submitted to the application of doxorubicin

O objetivo deste estudo foi avaliar o efeito antioxidante do extrato hidroalcoolico da casca do pequi (EHCP) em ratos após a administração de doxorrubicina (DOX). Foram utilizados ratos da raça Wistar, distribuídos em quatro grupos, sendo que os animais do G1 (n=6) receberam água e solução salina (grupo controle), G2 (n=7) EHCP e solução salina, G3 (n=7) água e DOX e G4 (n=6) EHCP e DOX. O EHCP foi administrado por gavagem durante 10 dias aos ratos dos grupos G2 e G4 e água aos dos G1 e G3. DOX na dose de 10mg kg-1 e solução salina 0,9% foram administradas por via intravenosa no dia sete após o início do experimento aos animais de G3 e G4 e aos de G1 e G2, respectivamente. Foram avaliados peso e taxa de mortalidade. Dez dias após o início do experimento, foi avaliada a concentração sérica de creatina quinase MB (CK-MB), troponina e mioglobina, e os ratos foram submetidos à eutanásia e à avaliação anatomopatológica. Não houve diferença entre os tratamentos quanto ao peso dos animais (P<0,05). Com relação à taxa de mortalidade, houve aumento no grupo 2 (P<0,05). Os resultados do teste qualitativo para a detecção de CK-MB, troponina I e mioglobina nos quatro grupos foram negativos e não foram observadas alterações macroscópicas nos órgãos dos ratos dos diferentes grupos. Constatou-se necrose tubular aguda multifocal de intensidade moderada a acentuada nas regiões cortical e medular nos rins de todos os ratos avaliados. A DOX em dose única de 10mg kg-1 e via intravenosa não promove alterações cardíacas em ratos e o EHCP nas condições avaliadas aumenta o índice de mortalidade em ratos, o que pode estar relacionado a substâncias tóxicas presentes na casca desse fruto.

The objective of this study was to evaluate the antioxidant effect of the hydroalcoholic extract of pequi peel (HEPP) in rats after administration of doxorubicin (DOX). Were used 26 Wistar rats divided into four groups, which G1 (n=6) received water and saline solution (control group), G2 (n=7) HEPP and saline solution, G3 (n=7) water and DOX, and G4 (n=6) HEPP and DOX. The HEPP was administered by gavage for 10 days to G2 and G4 and water to G1 and G3. DOX and saline solution were administered intravenously on day seven after the start of the experiment, with the DOX (10mg kg-1) applied in G3 and G4, and saline solution 0.9% in G1 and G2. Were evaluated weight and mortality rate. Ten days after the start of the experiment were evaluated creatina kinase MB (CK-MB), troponin and myoglobin, and the rats were euthanized and evaluated morphologically. There was no difference between treatments in weight of animals (P>0.05). About the mortality rate an increase in group 2 was showed (P<0.05). The results of the qualitative test for the detection of CK-MB, troponin I and myoglobin in the four groups were negative and there were no macroscopic changes in different rat's organs of different groups. Multifocal and moderate to severe acute tubular necrosis in cortical and medullary regions of the kidneys was observed in all rats studied. DOX intravenous and in a one dose of 10mg kg-1 don't induce cardiac changes in rats and the HEPP in conditions here evaluated increase the rate of mortality of rats, which may be related to toxic substances in the peel of this fruit.