Assessment of peripheral venous catheters microbiota and its association with phlebitis.

BACKGROUND: Peripheral venous catheters (PVCs) remain the primary mode of short-term venous access for managing intravenous fluid, obtaining blood samples, and peripheral parenteral nutrition. They may get contaminated and require regular monitoring to prevent complications. This study evaluated the occurrence of phlebitis and its associated-clinical and microbiological indicators. METHODS: The frequency of phlebitis was evaluated in hospitalized patients of both medical and surgical fields. Subsequently, the dichotomous association between the presence of phlebitis and the clinical aspects was investigated. In parallel, the bacterial contamination of PVCs was assessed through culture-based methods, microscopy observation, and 16S rRNA gene sequencing. RESULTS: Approximately one in four patients presented phlebitis (28.4%). The most frequent symptom was erythema at access site, with or without pain, corresponding to Score 1 on the phlebitis scale (17.9%). Colonization of both lumen and external surface of PVC was observed in 31.3% of the samples. Staphylococcus and Pseudomonas were the most isolated bacterial genera on the PVC surface. No significant association was observed between the presence of phlebitis and the clinical aspects, as well as the presence of microorganisms. CONCLUSION: Microorganism were present on both internal and external PVC surface, without being associated to phlebitis.

The implications of healthcare professionals wearing jewelry on patient care biosafety: observational insights and experimental approaches.

The use of jewelry among healthcare professionals poses a risk of cross contamination due to potential bacterial accumulation and spread. Through a mixed-method design, this study first analyzed the implications of healthcare professionals wearing jewelry on patient care biosafety as well as on the residual bacterial load of hands and rings after hand hygiene. Firstly, an observational prevalence study to verify whether nursing professionals wear personal accessories during healthcare assistance was carried out. Second, an experimental design involving intentional contamination and hygiene of the hands, with and without a ring, was conducted. The bacterial load of both hands and rings was measured by counting colony forming units. The observational study showed that nursing workers frequently wear jewelry during healthcare assistance. Nonetheless, the experimental study did not indicate differences in bacterial contamination between hands with and without a ring, despite the hand hygiene procedure applied. In conclusion, many nursing workers wear jewelry in the workplace. Although hands with and without a ring exhibited similar microbial load, rings appeared as a potential source of bacterial contamination, reinforcing the need to remove jewelry during working hours. Hand hygiene using alcohol, or soap and water significantly decreased the bacterial load on the participants' hands, with handwashing proving to be the most efficient method for removing intentional contamination.

Late postoperative complications in surgical patients: an integrative review.

OBJECTIVE: to identify the main complications in the late postoperative period of surgical patients. METHOD: an integrative review from the CINAHL, LILACS, Science direct, Web of Science, SCOPUS, Europe PMC, and MEDLINE databases. Descriptors and keywords were combined without language or time restriction. RESULTS: ten primary studies were included. Infectious complications were the most common, especially surgical site infection, pneumonia and urinary tract infection. The presence of complications was linked to increased mortality, need for reoperations and worse survival. Few studies report on monitoring frequency, follow-up time and/or when complications started to be observed. CONCLUSION: infectious complications were the most prevalent postoperatively. The scarcity of guidelines that guide the monitoring of complications regarding monitoring frequency, follow-up time and classification makes it difficult to establish an overview of them and consequently propose intervention strategies.

Biosafety of Non-Return Valves for Infusion Systems in Radiology.

Cross-infection in contrast injectors is still a subject under discussion with little understanding. This study evaluated the biosafety of non-return valves (NRVs). Initially, the maximum pressure during backflow of intact and disrupted flexible diaphragms (FDs) from NRVs, as well as the functionality of connectors with NRVs were verified. The performance of air columns interposed by water in connectors with NRVs was analyzed, and the diffusion distance of crystal violet through connectors with NRVs was measured. The efficacy of NRVs as a barrier to bacterial contamination from backflow was evaluated. Finally, a clinical study of bacteriological contamination from syringes was conducted. There were differences among the maximum tolerated pressure by intact and disrupted FDs. Disrupted FDs showed no failures in the functionality of connectors with NRVs based on the lack of air bubbles released. Air columns could move through connectors with NRVs with intact and disrupted FDs. The longest diffusion distance of crystal violet was 6 cm of connector length, and NRVs showed efficacy as a barrier to bacterial contamination. In the clinical study, there was no bacterial growth in any of the evaluated samples. In conclusion, biosafety depends on the functionality of NRVs as well as proper practical clinical performance.

Jalecos em têxteis de poliéster agem como barreira contra fluidos e bactérias? / ¿Batas médicas de telas de poliéster actúan como barrera contra fluidos y bacterias? / Do white coats on polyester fabrics act as a barrier against fluids and bacteria?

Resumo Objetivo Avaliar tecidos de poliéster quanto à função de barreira física contra fluidos e bactérias. Métodos Trata-se de uma pesquisa experimental laboratorial in vitro realizada em três etapas: avaliação do tempo de passagem de fluido através dos tecidos, cronometrado desde o início do escoamento do fluido até a formação e queda da última gota; determinação microbiológica da carga bacteriana presente no fluido, após a sua passagem através dos tecidos; e análise das características estruturais dos tecidos por meio de microscopia eletrônica de varredura. Os dados foram submetidos aos testes de normalidade e ao teste de U de Mann-Whitney, com nível de significância de a=5%. Resultados as comparações dos tempos obtidos na primeira etapa entre os dois tipos de tecidos utilizados demonstraram diferença estatística ( p <0,001). Com relação à avaliação microbiológica, não foi observada diferença entre as cargas bacterianas após a passagem do fluido através dos tecidos, tanto para Staphylococcus aureus ( p =0,056) quanto para Pseudomonas aeruginosa ( p= 0,320). A análise por microscopia eletrônica de varredura evidenciou diferenças estruturais entre os tecidos, no entanto não foi constatada a presença bacteriana na superfície dos tecidos. Conclusão Ambos os tecidos de poliéster empregados para confecção de jalecos não apresentaram função de barreira física contra fluidos e bactérias. Assim, os resultados nos permitem especular que o jaleco de poliéster ao entrar em contato com fluidos corporais pode possibilitar a contaminação do profissional.

Resumen Objetivo Evaluar telas de poliéster con relación a la función de barrera física contra fluidos y bacterias. Métodos Se trata de un estudio experimental de laboratorio in vitro realizado en tres etapas: evaluación del tiempo de pasaje del fluido a través de las telas, cronometrado desde el inicio del derrame del fluido hasta la formación y caída de la última gota; determinación microbiológica de la carga bacteriana presente en el fluido después del pasaje a través de las telas; y análisis de las características estructurales de las telas mediante microscopio electrónico de barrido. Con los datos obtenidos se realizaron las pruebas de normalidad y la prueba U de Mann-Whitney, con nivel de significación de a=5%. Resultados La comparación de los tiempos obtenidos en la primera etapa entre los dos tipos de telas utilizados demostró diferencia estadística ( p <0,001). Respecto a la evaluación microbiológica, no se observó diferencia entre las cargas bacterianas después del pasaje del fluido a través de las telas, tanto de Staphylococcus aureus ( p =0,056) como de Pseudomonas aeruginosa ( p= 0,320). El análisis mediante microscopio electrónico de barrido constató diferencias estructurales entre las telas; sin embargo, no se observó la presencia bacteriana en la superficie de las telas. Conclusión Las dos telas de poliéster empleadas para la confección de batas médicas no presentan función de barrera física contra fluidos y bacterias. De esta forma, los resultados nos permiten suponer que la bata médica de poliéster, al entrar en contacto con fluidos corporales, puede posibilitar la contaminación del profesional.

Abstract Objective To evaluate polyester fabrics as physical barrier function against fluids and bacteria. Methods This is an in vitro experimental laboratory research carried out in three stages: evaluation of the length of time for the fluid to pass through the fabrics, timed from the beginning of the fluid flow until the formation and fall of the last drop; microbiological determination of the bacterial load in the fluid, after its passage through the fabrics; and analysis of the structural characteristics of the fabrics by scanning in electron microscopy. The data were submitted to normality tests and the Mann-Whitney U test, with a significance level of a=5%. Results Comparisons of length of time in the first stage between the two types of fabrics used showed a statistical difference ( p <0.001). Regarding the microbiological evaluation, there was no difference among bacterial loads after the fluid passed through the fabrics, both for Staphylococcus aureus ( p =0.056) and Pseudomonas aeruginosa ( p =0.320). The analysis by scanning electron microscopy showed structural differences between the fabrics, however, there were no bacteria on the fabric surface. Conclusion Both polyester fabrics used to make white coats did not work as a physical barrier against fluids and bacteria. Thus, the results allowed us to speculate that the polyester coat when in contact with body fluids may allow contamination of the professional.

Late postoperative complications in surgical patients: an integrative review / Complicaciones postoperatorias tardías en pacientes quirúrgicos: revisión integradora / Complicações no pós-operatório tardio em pacientes cirúrgicos: revisão integrativa

ABSTRACT Objective: to identify the main complications in the late postoperative period of surgical patients. Method: an integrative review from the CINAHL, LILACS, Science direct, Web of Science, SCOPUS, Europe PMC, and MEDLINE databases. Descriptors and keywords were combined without language or time restriction. Results: ten primary studies were included. Infectious complications were the most common, especially surgical site infection, pneumonia and urinary tract infection. The presence of complications was linked to increased mortality, need for reoperations and worse survival. Few studies report on monitoring frequency, follow-up time and/or when complications started to be observed. Conclusion: infectious complications were the most prevalent postoperatively. The scarcity of guidelines that guide the monitoring of complications regarding monitoring frequency, follow-up time and classification makes it difficult to establish an overview of them and consequently propose intervention strategies.

RESUMEN Objetivo: identificar las principales complicaciones que ocurren en el postoperatorio tardío de los pacientes quirúrgicos. Método: revisión integradora de CINAHL, LILACS, Science Direct, Web of Science, SCOPUS, Europe PMC y MEDLINE. Descriptores y palabras clave fueron combinadas sin restricción de idioma o tiempo. Resultados: se incluyeron diez estudios primarios. Las complicaciones infecciosas fueron las más comunes, especialmente la infección del sitio quirúrgico, la neumonía y la infección del tracto urinario. La presencia de complicaciones se relacionó con un aumento de la mortalidad, la necesidad de reoperaciones y una peor supervivencia. Pocos estudios informan sobre la frecuencia de monitoreo, el tiempo de seguimiento y/o cuándo comenzaron a observarse complicaciones. Conclusión: las complicaciones infecciosas fueron las más frecuentes después de la operación. La escasez de pautas que guían la vigilancia de las complicaciones con respecto a la frecuencia de monitoreo, el tiempo de seguimiento y la clasificación hace que sea difícil establecer una visión general de las mismas y, en consecuencia, proponer estrategias de intervención,

RESUMO Objetivo: identificar as principais complicações ocorridas no pós-operatório tardio de pacientes cirúrgicos. Método: revisão integrativa a partir das bases CINAHL, LILACS, Science Direct, Web of Science, SCOPUS, Europe PMC e MEDLINE. Combinaram-se descritores e palavras-chave, sem restrição de idioma ou tempo. Resultados: dez estudos primários foram incluídos. As complicações infecciosas foram as mais comuns, com destaque para infecção do sitio cirúrgico, pneumonia e infecção urinária. A presença de complicações esteve ligada ao aumento na mortalidade, necessidade de reoperações e pior sobrevida. Poucos estudos relatam a frequência de monitoramento, tempo de seguimento e/ou quando as complicações começaram a serem observadas. Conclusão: as complicações infecciosas foram as mais prevalentes no pós-operatório. A escassez de diretrizes que guiem a vigilância das complicações no que concerne a frequência de monitoramento, tempo de seguimento e classificação dificulta estabelecer um panorama das mesmas e consequentemente propor estratégias de intervenção.

Desinfecção com biguanida polimérica e as implicações na manutenção da segurança ambiental / Disinfection with polymeric biguanide and the implications for maintaining environmental safety

A manutenção do ambiente de saúde biologicamente seguro incorpora continuamente produtos e novas tecnologias pautados na isenção de riscos e em conhecimento técnico científico. Nesse sentido, a utilização de agentes químicos para o controle do crescimento microbiano configura-se como uma estratégia para reduzir o risco biológico associado às superfícies, uma vez que são apontadas como reservatórios de microrganismos e, portanto, podem influenciar na cadeia de contaminação cruzada. Este estudo tem por objetivo fornecer evidências para o uso do polihexametileno biguanida (PHMB) e, assim, contribuir para a efetividade dos procedimentos de limpeza e desinfecção das superfícies ambientais. Trata-se de um estudo desenvolvido em duas fases, uma caracterizada como revisão integrativa da literatura a outra como experimental in vitro, a fim de avaliar a atividade antimicrobiana do PHMB por meio das técnicas de Poço de Difusão em dupla camada de ágar, Diluição Inibitória Máxima (DIM) e contagem das Unidades Formadoras de Colônia (UFC). Com relação à revisão integrativa, observou-se escassez de evidências científicas, referentes ao uso do PHMB na desinfecção de superfície ambiental em serviços de saúde nas principais bases de dados. O PHMB, nas análises microbiológicas, demonstrou-se eficaz contra cepas padrão de Staphylococcus aureus e Pseudomonas aeruginosa, apresentando resultados semelhantes e/ou superiores aos do hipoclorito de sódio e detergente enzimático. Na desinfecção da superfície de aço inoxidável, contaminada intencionalmente por Pseudomonas aeruginosa, não houve diferenças entre os resultados do PHMB e da solução alcoólica a 70%(p/v), no entanto, para Staphylococcus aureus, observou-se que o PHMB foi mais eficaz na redução da carga microbiana quando comparado com a solução alcoólica a 70%(p/v). Concluindo, os resultados apresentados instigam-nos a desenvolver futuras pesquisas acerca do uso do PHMB em superfícies ambientais nos serviços de saúde, contribuindo, assim, com evidências científicas sobre o tema e promovendo o uso de forma segura

The maintenance of the biologically safe health environment continuously incorporate products and new technologies based on risk exemption and on techno-scientific knowledge. In this sense, the use of chemical agents for controlling microbial growth configure itself as a strategy to reduce the biological risk associated to surfaces, once they are pointed out as reservoirs of microorganisms and, then, can influence a chain of cross-contamination. This study aims to provide evidences for the use of polyhexamethylene biguanide (PHMB) and, therefore, to contribute to the effectivity of the cleaning and disinfection procedures of environmental surfaces. It is a study developed in two stages, one characterized as integrative literature review and the other as in vitro experimental, in order to evaluate the antimicrobial activity of PHMB through Diffusion-Well on double-layer agar techniques, Maximum Inhibitory Dilution (MID) and counting of Colony Forming Units (CFU). As to integrative review, the lack of scientific evidences was observed, regarding the use of PHMB in disinfection of environmental surface in health care on the main databases. PHMB, in microbiological analyses, proved to be effective against standard strains of Staphylococcus aureus and Pseudomonas aeruginosa, presenting similar and/or superior results to sodium hypochlorite and enzymatic detergent. In stainless-steel surface disinfection, intentionally contaminated by Pseudomonas aeruginosa, there were no differences between the results of PHMB and alcoholic solution at 70%w/v, however, for Staphylococcus aureus, it was observed that PHMB was more effective to reduce microbial load when compared with alcoholic solution at 70%w/v. To conclude, the presented results instigate us to develop future researches about the use of PHMB on environmental surfaces in health care, contributing, thus, with scientific evidences about the topic and promoting the use in a safe way

Patient safety and infection control: bases for curricular integration.

OBJECTIVE: To analyze curricular integration between teaching of patient safety and good infection prevention and control practices. METHOD: Integrative review, designed to answer the question: "How does curricular integration of content about 'patient safety teaching' and content about 'infection prevention and control practices' occur in undergraduate courses in the health field?". The following databases were searched for primary studies: CINAHL, LILACS, ScienceDirect, Web of Science, Scopus, Europe PMC and MEDLINE. RESULTS: The final sample consisted of 13 studies. After content analysis, primary studies were grouped into two subject categories: "Innovative teaching practices" and "Curricular evaluation. CONCLUSION: Patient safety related to infection prevention and control practices is present in the curriculum of health undergraduate courses, but is not coordinated with other themes, is taught sporadically, and focuses mainly on hand hygiene.

Patient safety and infection control: bases for curricular integration / Seguridad del paciente y control de infección: bases para la integración curricular / Segurança do paciente e controle de infecção: bases para a integração curricular

ABSTRACT Objective: To analyze curricular integration between teaching of patient safety and good infection prevention and control practices. Method: Integrative review, designed to answer the question: "How does curricular integration of content about 'patient safety teaching' and content about 'infection prevention and control practices' occur in undergraduate courses in the health field?". The following databases were searched for primary studies: CINAHL, LILACS, ScienceDirect, Web of Science, Scopus, Europe PMC and MEDLINE. Results: The final sample consisted of 13 studies. After content analysis, primary studies were grouped into two subject categories: "Innovative teaching practices" and "Curricular evaluation. Conclusion: Patient safety related to infection prevention and control practices is present in the curriculum of health undergraduate courses, but is not coordinated with other themes, is taught sporadically, and focuses mainly on hand hygiene.

RESUMEN Objetivo: Analizar, partiendo de la literatura, la integración curricular entre enseñanza sobre seguridad del paciente y buenas prácticas de prevención y control de infección. Método: Revisión integrativa orientada a responder la pregunta: "¿Cómo sucede la integración curricular entre los contenidos 'enseñanza sobre seguridad del paciente' y 'prácticas de prevención y control de infección' en cursos de grado en salud?". Se utilizaron las bases CINAHL, LILACS, Science Direct, Web of Science, SCOPUS, Europe PMC y Medline para recuperar estudios primarios. Resultados: Muestra compuesta por trece estudios. Luego de análisis de contenido, los estudios primarios fueron subdivididos en dos categorías temáticas: "Prácticas de enseñanza innovadoras" y "Evaluación Curricular". Conclusión: La seguridad del paciente respecto de prácticas de prevención y control de infección, a pesar de contemplarse en los currículos de cursos de grado en salud, es enseñada de modo puntual, diluido y desarticulado, con foco predominante en la higiene de las manos.

RESUMO Objetivo: Analisar, a partir da literatura, a integração curricular entre o ensino da segurança do paciente e as boas práticas de prevenção e o controle de infecção. Método: Revisão integrativa, com vistas à responder a seguinte questão: "Como ocorre a integração curricular entre os conteúdos 'ensino da segurança do paciente' e 'práticas de prevenção e controle de infecção' nos cursos de graduação em saúde?". Utilizou-se as bases CINAHL, LILACS, Science direct, Web of Science, SCOPUS, Europe PMC, e Medline para recuperar os estudos primários. Resultados: 13 estudos compuseram a amostra. Após uma análise de conteúdo, os estudos primários foram subdivididos em duas categorias temáticas: "Práticas de ensino inovadoras" e "Avaliação Curricular". Conclusão: A segurança do paciente, relacionada às práticas de prevenção e controle da infecção, embora contemplada nos currículos de ensino de graduação em saúde, é ensinada de forma pontual, diluída e desarticulada, focadas predominantemente na higiene das mãos.

Aquisição teórico-prática de tópicos relevantes à segurança do paciente: dilemas na formação de enfermeiros / Theoretical-practical acquisition of topics relevant to patient safety: dilemmas in the training of nurses / Adquisición teórico-práctico de tópicos relevantes sobre seguridad del paciente: dilemas en la formación de enfermeros

Objetivo: Investigar conteúdos relacionados à segurança do paciente, contemplados nos currículos de cursos de graduação em Enfermagem de duas Instituições de Ensino Superior brasileiras. Método: Estudo descritivo, tipo survey, realizado com 119 alunos de cursos de Enfermagem (Licenciatura e Bacharelado), no período de agosto a setembro de 2016. Os tópicos investigados foram baseados no Patient safety curriculum guide: multi-professional edition. De posse dos dados, realizaram-se análises univariadas e bivariadas. Resultados: Dos 46 conteúdos investigados no questionário, dois tiveram escores elevados de não obtenção em atividades teóricas e/ou práticas, que são: "Cultura de culpa" e "Infecção comunitária". Alunos da Licenciatura e Bacharelado referiram maior aquisição em aulas teóricas (p = 0,012), enquanto os do Bacharelado atribuíram de forma equivalente teoria e prática (p = 0,013). Conclusão: Os conteúdos estiveram contemplados, em sua maioria, na abordagem teórica e prática, ao menos uma vez no decorrer do curso. No entanto, quando se tratou de conteúdos ligados a aspectos socioculturais relacionados à segurança do paciente registraram-se escores menores.