Saberes e práticas dos profissionais do bloco operatório na prevenção da infeção por microrganismos multirresistentes / Knowledge and practices of operating room professionals in the prevention of infection by multidrug-resistant microorganisms

As infeções associadas aos cuidados de saúde (IACS) representam um dos principais fatores que afetam a qualidade dos cuidados de saúde, sendo crescente a dimensão assumida pelas infeções por microrganismos multirresistentes (MMR), para as quais contribuem, entre outros, o uso inadequado de antibióticos e a transmissão cruzada de microrganismos. Para controlar o agravamento do problema é essencial o conhecimento e a adoção de boas práticas de prevenção e controlo de infeção pelos profissionais. Tendo presente a importância desta problemática, o presente estudo teve como objetivo analisar os conhecimentos e as práticas dos profissionais do Bloco Operatório (BO) na prevenção da infeção por MMR. Trata-se de um estudo descritivo-correlacional, com uma amostra de disponíveis de 144 profissionais e tendo como instrumento de colheita de dados o questionário construído para o estudo. A colheita de dados decorreu entre 1 de maio a 30 de junho de 2016, no BO de um hospital central. A amostra é maioritariamente constituída por enfermeiros (49,3%) e médicos (42,4%). Predominou o sexo feminino (63,9%). A média de idades foi de 36,78±8,66 anos, predominou a licenciatura como habilitação literária (75,0%) e o tempo de serviço no BO com média de 9,57±7,20 anos. Foi realizada formação sobre prevenção e controlo de infeção por MMR por 43,8% dos profissionais, maioritariamente em Serviço (49,2%). Quando se comparam os resultados obtidos entre médicos e enfermeiros, não se observam diferenças estatisticamente significativas quanto aos conhecimentos globais (t=0,799; gl=130; sig=0,426), verificando-se, no entanto, diferenças estatisticamente significativas em domínios heterogéneos. Relativamente às práticas, observa-se que, globalmente, os enfermeiros atribuem mais importância às medidas de prevenção e controlo de infeção e às medidas de isolamento do que os médicos, evidenciando práticas mais favoráveis (t=4,43; gl=109,28; sig=0,00). Da análise de associação, observou-se relação entre os conhecimentos e as opiniões, e os conhecimentos e as atitudes, verificando-se que, mais conhecimentos correspondem a opiniões mais favoráveis e a melhores práticas na prevenção e controlo de infeção por MMR. Como conclusão, maioritariamente os profissionais demostraram um nível de conhecimentos razoável, valorizando as medidas de prevenção e controlo da transmissão cruzada de MMR.

Infections associated to health care (IACS) represent one of the main factors contributing to the health care quality, as the dimension assumed by infections caused by multi-resistant microorganisms (MMR) keep increasing. Infections are caused by the inadequate use of antibiotics and the cross-transmission of microorganisms, among others. In order to control the seriousness of this problem, it is essential for the professionals to acquire the knowledge and adopt good practices to prevent and control infections. Keeping in mind the importance of this issue, the purpose of the current survey was to analyse the professionals' knowledge and practices of the Operating Theatre (BO) to prevent the infection caused by MMR. This is a descriptive-correlational survey, with a sample constituted by 144 professionals using a questionnaire, made on purpose for this study, to collect all data. The survey took place from May 1st to June 30th of 2016, in a central hospital's BO. The sample is constituted mostly by nurses (49,3%) and doctors (42,4%), being the female sex the predominant one (63,9%). The average age was of 36,78±8,66 years, mainly with a university degree (75,0%), and with an average of 9,57±7,20 years working at the BO. The training on prevention and control of the infection by MMR was done by 43,8% of the professionals, most of which on Duty (49,2%). When comparing the results obtained between doctors and nurses, no statistically significant differences are detected concerning general knowledge (t=0,799; gl=130; sig=0,426). However, some statistically major differences are observed in heterogeneous fields. Regarding the practices, it is generally observed that nurses give more importance to the prevention measures and infection control, and to the isolation measures, than the doctors, showing evidence of more favourable practices (t=4,43; gl=109,28; sig=0,0). From the association analysis, it was apparent the connection between knowledge and opinions, and between knowledge and attitudes, showing that an increase in knowledge would lead to more favourable opinions and better practices in the prevention and control of infection by MMR. To sum up, most of the professionals showed a reasonable level of knowledge and became more concerned about the prevention and control measures of the MMR cross-transmission.

PTSD and depression following armed robbery: patterns of appearance and impact on absenteeism and use of health care services.

Armed robbery is a sudden, life-threatening event affecting the victims' mental health. Posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) in this population have rarely been studied. The objectives of the study were to assess the occurrence of PTSD and MDD in victims of armed robbery, and to evaluate occupational functioning and use of health care services. Eighty-six convenience store employees, victims of armed robbery, were evaluated within days after the robbery, and 1 and 3 months after. A validated diagnostic interview (SCID-I) was used. Data about sick leave, absenteeism, and use of health care services were collected. The total number of individuals who had PTSD, MDD, or both at any time during the 3 months following the robbery was 1 (2%), 4 (6%), and 5 (8%), respectively, showing that comorbid PTSD-MDD is as frequent as or even more frequent than either disorder in isolation. Individuals with PTSD (with or without comorbid MDD) reported more absenteeism (η(2) (p) = .25) and more medical visits (η(2) (p) = .12) following the robbery. Clinicians and management resources personnel must be alert to the possibility that both PTSD and MDD, either alone or comorbid, can develop in victims of armed robbery.

Guess what: Chronic 13q14.3+/CD5-/CD23+ lymphocytic leukemia in blood and t(11;14)(q13;q32)+/CD5+/CD23- mantle cell lymphoma in lymph nodes!

We report a case of a patient with two B-cell lymphoproliferative disorders: CD5(-)/CD23(+) B-cell chronic lymphocytic leukemia and CD5(+)/CD23(-) mantle cell lymphoma. These disorders were diagnosed simultaneously based on flow cytometry, immunohistochemistry, fluorescence in situ hybridization, and polymerase chain reaction-based molecular studies. The B-cell lymphocytic leukemia clone predominated in the blood and bone marrow, whereas the mantle cell clone predominated in lymph nodes.