Waste management in non-hospital emergency units.

OBJECTIVE: to analyze waste management in urgency and emergency non-hospital health care service units. METHOD: Epidemiological cross-sectional study undertaken at three Non-Hospital Emergency Units. The data were collected using systematic observation, registered daily in a spreadsheet and checklist, and analyzed through descriptive statistics. RESULTS: the generation of waste varied from 0.087 to 0.138 kg per patient per day. Waste management showed inadequacies in all stages, especially in the separation stage. Infectious waste was found together with common waste, preventing recycling, and piercing and cutting objects were mixed with waste from different groups, increasing the risk of occupational accidents. CONCLUSION: the study reveals the lack of an institutional waste management policy, as demonstrated by the failure of operational stages, involving problems related to management, physical structure, material and human resources at the units. This is relevant for health care units, considering the quality of patient care and its interface with sustainability.

[Critical incident technique and its nursing use: an integrative literature review]. / Técnica de incidente crítico e seu uso na Enfermagem: revisão integrativa da literatura.

Integrative literature review conducted in the databases LILACS, MEDLINE and SciELO from 2000 to 2010 to synthesize knowledge produced in nursing studies using the critical incident technique and identify the use and applicability of this technique as methodological framework. A total of 17 papers were found and Brazil stood out with 76.5% of the studies. Analysis and characterization according to the three elements of the technique were identified in 76.0% of the papers. The category 'analysis of iatrogenic events' caused by health workers stood out in the use of the critical incident technique. The integrative review enabled to synthesize scientific knowledge on this subject and revealed its large contribution to the improvement of health and nursing care.

Eficácia da estufa de Pasteur como equipamento esterilizante em consultórios odontológicos / Efficacy of the pasteur oven as sterilization equipment in dental offices

Este estudo objetivou avaliar a eficácia do uso da estufa de Pasteur, como equipamento esterilizante, em consultórios odontológicos, por meio de monitoramento biológico. Para esta avaliação foram consideradas: adequação no carregamento dos materiais no equipamento, tempo/temperatura utilizados e manutenção preventiva da estufa. Os dados foram coletados em 101 consultórios odontológicos, no Distrito Central de Goiânia-GO, Brasil, por meio de observação, entrevista e realização de teste com indicador biológico. Os resultados demonstraram não-padronização de algumas condutas preconizadas pelo Ministério da Saúde (MS), para esterilização dos artigos em estufa, e positividade do teste biológico em 46 (45,5 por cento) dos ciclos testados. Os fatores intervenientes, com maior significância, relativos às falhas da esterilização foram: ausência do termômetro acessório para o controle da temperatura dos ciclos e a inobservância das relações tempo/temperatura recomendados para o ciclo de esterilização, por calor seco.

This study was aimed at assessing the efficacy of the use of the Pasteur oven as sterilization equipment in dental offices through biological monitoring. For this assessment were taken into account how adequately the material is loaded into the equipment; time/temperature used; and preventive maintenance of the oven. The data were collected in 101 dental offices in the Central District of Goiânia, in the State of Goiás, through observation, interviews and performance of tests with biological indicator. The results showed a lack of standardization of some of the procedures recommended by the Ministry of Health for sterilization of items in the oven, and positive results of the biological test in 46 (45.5 percent) of the tested cycles. The intervening factors with most significance regarding sterilization problems were: absence of an accessory thermometer to control the cycles' temperature and non-observance of the time/temperature relations recommended for the sterilization cycle through dry heat.

Este estudio tuvo como objetivo evaluar la eficacia de la estufa de Pasteur, como equipamiento esterilizante, en consultorios odontológicos, por medio del monitoreo biológico. Para esta evaluación se consideraron: adecuación en el cargamento de los materiales en el equipamiento, tiempo/temperatura utilizados y mantenimiento preventivo de la estufa. Los datos fueron obtenidos en 101 consultorios de odontología, en el Distrito Central de Goiânia-Goiás-Brasil, por medio de la observación y la entrevista, así como la realización de un test con indicador biológico. Los resultados demostraron la no patronización de algunas conductas preconizadas por el Ministerio de Salud (MS), para la esterilización de los artículos en estufa, y la prueba biológica positiva en 46 (45,5 por ciento) de los ciclos probados. Los factores de mayor intervención significativa, relativos a las fallas de la esterilización fueron: ausencia del termómetro accesorio para el control de la temperatura de los ciclos y la no observación de las relaciones tiempo/temperatura recomendadas para el ciclo de esterilización, por el calor seco.

Higienização das mãos: o ensino e a prática entre graduandos na área da saúde / Hand washing: teaching and practice among undergraduate health sector students

Estudo realizado com graduandos do último ano/semestre da área da saúde de Instituições de Ensino Superior (IES) em Goiás/2005, com objetivo de verificar a compreensão destes acerca da higienização das mãos (HM), identificar a contribuição das IES na formação dos alunos sobre esta temática, identificar fatores que favorecem a adesão à HM e verificar a disponibilidade de recursos materiais para HM nos Estabelecimentos de Assistência à Saúde (EAS) utilizados como cenários de prática. Observados os aspectos éticos, os dados foram obtidos pela aplicação de questionário, previamente avaliado, e processados no programa Epiinfo (CDC, 2004), quando indicado, aplicado o teste qui-quadrado. Participaram do estudo 777 graduandos (68,0%); dos cursos de Biomedicina, Enfermagem, Farmácia, Fisioterapia, Fonoaudiologia, Medicina, Odontologia e Terapia Ocupacional. Houve discordância entre o entendimento sobre HM e a adesão. Embora tenhamos evidenciado que as IES tenham abordado este tema durante a formação dos profissionais, isto não foi suficiente para alterar a práxis

This study was undertaken with students during their last year/semester of health sector studies at Higher Education Institutions (HEI), in Goiás State/2005. It aimed to verify the understanding of these students about hands washing (HW), identify the contribution of the HEI to the students' education on this theme, identify factors that favor the practice of HW, and verify the availability of material resources for HW at Health Assistance Establishments (HAE) used as practice scenarios. After observing ethical aspects, the data was obtained through a previously-evaluated questionnaire, and processed using Epi Info software (CDC, 2004), when the chi-square test was applied. 777 students took part (68.0%) in the study, belonging to the following courses: Biomedicine, Nursing, Pharmacy, physiotherapy, phonoaudiology, Medicine, Dentistry and Occupational Therapy. There was a noticeable difference between the understanding on HW and actual practice. Although we evidenced that HEIs have approached this subject during the educational process, this was not enough to modify the practice

Nurses' understanding of standard precautions at a public hospital in Goiania - GO, Brazil.

Standard Precautions (SP) are effective strategies to prevent and control nosocomial infections. This study aimed to verify nurses' understanding about standard precaution measures. Data were collected through interviews, followed by content analysis in accordance with Bardin. Eighty-two nurses took part in this study, 75.6% of whom understand SP as protective measures: for professionals (11.0%); for both professionals and patients (52.4%); for patient care independently of the diagnosis (7.3%); for patients with diagnosed infection (9.8%). Other nurses indicated SP as human care (4.9%) and only as Individual Protection Equipment (IPE) (11.0%). Most participants' understanding points to favorable cognitive adaptation to the daily implementation of SP. However, reductionist and even mistaken perceptions about their range persist, which makes the social function of these measures vulnerable.

Hand hygiene: The impact of incentive strategies on adherence among healthcare workers from a newborn intensive care unit.

We carried out a before-after non-controlled intervention study to assess the impact of different handwashing strategies in health care workers at a neonatal ICU in Goiânia - Goiás, Brazil. All ethical aspects were considered. Data was collected by using a check list in order to register hand hygiene opportunities during six months. Three strategies were elaborated together with the hospital team. We observed 1358 handwashing opportunities. Incentive strategies caused a small impact on the increase of adherence to hand hygiene during and after the implementation period. However, we noticed that this increase mainly occurred after the procedures were realized. On the whole, adherence levels were similar before (62.2%) and after (61.6%) the procedures. The study showed that health care workers were more worried about individual risks.

[Occupational accidents with biohazards: the perception of the injured worker]. / Acidentes ocupacionais com material biológico: a percepção do profissional acidentado.

This qualitative research aims at identifying the perception of health care workers of different categories from a specialized institution in emergency health service in the city of Goiânia regarding the context involving biohazard accidents. Firstly, 382 workers were given a questionnaire in order to identify those who had experienced an accident, 39 of which also took part in an interview addressing the general aspects of the accidents. Among the main accident causes to be highlighted are: unattention, non-adherence to preventive measures, patient's severity and hurry. Among the experienced feelings the main ones are: inconfidence, fear of contamination, rage, and even calmness. Half reported no consequence resulted from the accident. Data points to the need of self-worth concerning the worker's health and also of programs aiming at occupational safety enhancement.

[Items sterilized in humid heat: validation of the storage system]. / Artigos esterilizados em calor úmido: validação do sistema de guarda.

We aimed at identifying the period of validity of the sterilization of items by humid heat, taking into account the conditions of sterilization and storage. The validation was carried out by means of microbiological tests performed with instruments in the same load and evaluated in 0, 7, 10, 15, and 25 days. 30% of the instruments in each package were analysed and put in a Mueller Hinton solution and incubated at 37 degrees C for 72 hours. The reading was accomplished taking into consideration how dark the solution was. Out of the samples evaluated in nine loads, none showed microbiological growth. It was concluded that, although sterilization and storage conditions of the material were not fully in accordance with parameters recommended by the literature, the sterilization happened and was maintained for a period of 25 days.

Evaluation of central supply units in public dental medicine colleges in Brazil.

A guarantee of quality of all steps involved in processing dental materials is essential to achieve security. A descriptive study was made of how Public Dental Medicine Colleges in Brazil process critical materials and determine the patterns of physical, chemical and biological control in their use of hot air ovens and autoclaves to sterilize these materials. The data were obtained with a questionnaire, sent by mail and analyzed with the software EPI-INFO 6.04. Among the 40 Brazilian public Dental Medicine Colleges, only 16 returned the questionnaire. In eight of these, the individuals responsible for the materials and sterilization center had a college degree in a human health field. In 14 institutions, the students were responsible for the cleaning of the instruments, but in six of these they did so outside of the materials and sterilization center. Both the autoclave and the dry heat oven were the method of choice in 13 of the 16 schools. The sterilization routine was routinely monitored by 11 of the institutions. Chemical control through the tape test in the autoclave was used by 13 of the schools, three institutions reported preventive maintenance, and biological indicators were used by seven of the 16 schools. Autoclaves are widely used because of the degree of biological security that this method offers, however physical, chemical and biological controls have not been routinely implemented by most of the institutions.

Perfil sócio-demográfico e avaliação funcional de idosos atendidos por uma equipe de saúde da família na periferia de Goiânia, Goiás / Socio-demographic profile and functional status of elderly attended by a family team of the periphery of Goiânia, Goiás

Investigar o perfil sócio-demográfico e a capacidade funcional dos idosos atendidos por uma equipe de saúde da família. Durante novembro de 2001 a maio de 2002, todos os indivíduos (N=107) com 60 anos ou mais foram entrevistados e avaliados através das Escalas de Barthel e Lawton para dependência nas atividades de vida diária (AVDs) e instrumentais de vida diária (AIVDs). A maioria dos idosos tinha entre 60 a 69 anos, residia com familiares e possuía rendimento inferior a um salário mínimo. Praticamente a metade dos idosos não sabia ler e escrever. Do total de idosos, 40,9 por cento eram dependentes para as AVDs e 58 por cento para as AIVDs. A análise dos fatores de risco revelou que a idade, acuidade visual diminuída, doenças associadas, depressão e equilíbrio e mobilidade prejudicados foram estatisticamente associados à dependência dos idosos (P<0,05). As escalas Barthel e de Lawton são de baixo custo e de fácil execução pelos profissionais de saúde e, oferecem subsídios para o planejamento de ações de saúde efetivas. Os resultados subsidiarão as ações de saúde junto à comunidade de idosos atendida pela equipe de saúde.

[Teaching infection control: a theoretical and practical essay]. / O ensino do controle de infecção: um ensaio teórico-prático.

This article contains reflections concerning infection prevention and control measures starting from the adherence of health professionals to prevention measures. It points out worrisome environment-related aspects stemming from the use of disposable materials in spite of the benefits that they represent in terms of safety and reduction of operational costs, among others. All these issues are presented as a challenge to infection control teaching in the education of health professionals. Some guiding presuppositions are also presented.