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.

Initial nipple damages in breastfeeding women: analysis of photographic images and clinical associations / Lesiones tempranas del pezón derivadas de la lactancia materna: análisis de imágenes fotográficas y asociaciones clínicas / Lesões mamilares precoces decorrentes da amamentação: análise de imagens fotográficas e associações clínicas

ABSTRACT Objective: to analyze the initial nipple damage degree by breastfeeding practice and to associate findings with clinical manifestations of breastfeeding women. Methods: a retrospective, cross-sectional study with primary data and photographic images database from two randomized clinical trials. Photographic images were analyzed by two independent evaluators using the Nipple Trauma Score. For analysis, the chi-square, Mann-Whitney tests and Kappa coefficient were applied. Results: 115 breastfeeding women and their respective 186 photographic images were analyzed. The degree of agreement of evaluators using the Nipple Trauma Score was 93.6%. The nipple pain score during breastfeeding was moderate and compromised more than 25% of the nipple surface area. Conclusions: assistance to breastfeeding women should prioritize nipple pain intensity instead of the nipple damage size.

RESUMEN Objetivo: analizar el grado de afectación tisular en las lesiones tempranas del pezón resultantes de la lactancia materna y asociar los hallazgos con las manifestaciones clínicas de las mujeres que amamantan. Métodos: estudio retrospectivo, transversal, con datos primarios y banco de imágenes fotográficas de dos ensayos clínicos aleatorizados. Las imágenes fotográficas fueron analizadas por dos evaluadores independientes, utilizando el Nipple Trauma Score. Para el análisis se aplicaron las pruebas de Chi-Cuadrado, Mann-Whitney y coeficiente Kappa. Resultados: se analizaron 115 mujeres lactantes y sus respectivas 186 imágenes fotográficas. El grado de acuerdo de los evaluadores utilizando el Nipple Trauma Score fue del 93,6%. El nivel de dolor en el pezón durante la lactancia es moderado y existe presencia de lesiones del pezón con más del 25% de la superficie del pezón comprometida. Conclusiones: la asistencia a la mujer lactante debe priorizar el nivel de dolor que presenta en detrimento del tamaño de la lesión del pezón.

RESUMO Objetivo: analisar o grau de comprometimento tecidual das lesões mamilares precoces decorrentes da amamentação e associar achados com as manifestações clínicas de mulheres em amamentação. Métodos: estudo retrospectivo, transversal, envolvendo o uso de dados primários e de banco de imagens fotográficas provenientes de dois ensaios clínicos randomizados. Imagens fotográficas foram analisadas por duas avaliadoras independentes a partir do instrumento Nipple Trauma Score. Para análise, aplicou-se os testes Qui-Quadrado, Mann-Whitney e coeficiente Kappa. Resultados: foram analisadas 115 lactantes e respectivas 186 imagens fotográficas. O grau de concordância das avaliadoras pelo instrumento Nipple Trauma Score foi de 93,6%. O nível de dor mamilar encontrado durante as mamadas é moderado e há presença de lesões mamilares com mais de 25% de área da superfície do mamilo comprometida. Conclusões: a assistência a mulheres que amamentam deve priorizar o nível de dor apresentado em detrimento do tamanho da lesão mamilar.

Initial nipple damages in breastfeeding women: analysis of photographic images and clinical associations.

OBJECTIVE: to analyze the initial nipple damage degree by breastfeeding practice and to associate findings with clinical manifestations of breastfeeding women. METHODS: a retrospective, cross-sectional study with primary data and photographic images database from two randomized clinical trials. Photographic images were analyzed by two independent evaluators using the Nipple Trauma Score. For analysis, the chi-square, Mann-Whitney tests and Kappa coefficient were applied. RESULTS: 115 breastfeeding women and their respective 186 photographic images were analyzed. The degree of agreement of evaluators using the Nipple Trauma Score was 93.6%. The nipple pain score during breastfeeding was moderate and compromised more than 25% of the nipple surface area. CONCLUSIONS: assistance to breastfeeding women should prioritize nipple pain intensity instead of the nipple damage size.

Demographic profile, training and practical experience of professionals performing peripheral intravenous catheterization in brazil / Perfil demográfico, formación y experiencia práctica de los profesionales que realizan cateterismo intravenoso periférico en brasil / Perfil demográfico, formação e experiência prática de profissionais executantes da cateterização intravenosa periférica no brasil

ABSTRACT Objective: to describe the demographic profile, training and practical experience of professionals who perform peripheral intravenous catheterization in Brazil. Method: this is a descriptive cross-sectional study, carried out in the five macroregions of Brazil with 2,584 nursing professionals who worked in direct care of patients undergoing peripheral intravenous catheterization, using a questionnaire containing professional demographic characteristics, training and experience. Data collection took place between July 2021 and May 2022. Descriptive statistics, one-way ANOVA test, Pearson's chi-square test for k independent samples and Tukey's multiple comparison test and adjusted residuals were used. Results: most nursing professionals resided in the southeast macro-region and were women. The mean age of nurses was 39.52 (±8.74) years, technicians, 39.66 (±9.22), and nursing assistants, 40.61 (±10.57). The mean training time for nurses was 11.83 (±8.18) years, for nursing technicians, 10.81 (±7.62), and for nursing assistants, 11.19 (±8.33). During the training process, most professionals received lessons in pharmacology, vascular access devices and venous catheterization. The mean number of devices inserted by nurses, in a 12-hour shift, was lower than the mean inserted by technicians and nursing assistants. Conclusion: nurses are not recognized as professionals legally responsible for the peripheral intravenous catheterization procedure, and intravenous therapy implementation is predominantly carried out by technicians and nursing assistants. The training process is incipient.

RESUMEN Objetivo: describir el perfil demográfico, la formación y la experiencia práctica de los profesionales que realizan cateterismo intravenoso periférico en Brasil. Método: estudio transversal descriptivo, realizado en las cinco macrorregiones de Brasil con 2.584 profesionales de enfermería que actuaban en el cuidado directo de pacientes sometidos a cateterismo intravenoso periférico, mediante un cuestionario que contiene las características demográficas, formación y experiencia de los profesionales. La recolección de datos se realizó entre julio de 2021 y mayo de 2022. Se utilizó estadística descriptiva, prueba ANOVA de 1 vía, Chi-Cuadrado T de Pearson para k muestras independientes y prueba de comparación múltiple de Tukey y residuos ajustados. Resultados: la mayoría de los profesionales de enfermería residían en la macrorregión Sudeste y eran mujeres. La edad media de los enfermeros fue de 39,52 (±8,74) años, de los técnicos, de 39,66 (±9,22) años, y de los auxiliares de enfermería, de 40,61 (±10,57) años. El tiempo medio de formación de los enfermeros fue de 11,83 (±8,18) años, de los técnicos de enfermería, de 10,81 (±7,62) años, y de los auxiliares de enfermería, de 11,19 (±8,33) años. Durante el proceso de formación, la mayoría de los profesionales recibieron lecciones de farmacología, dispositivos de acceso vascular y cateterismo venoso. El promedio de dispositivos insertados por enfermeros, en un turno de 12 horas, fue inferior al promedio insertado por técnicos y auxiliares de enfermería. Conclusión: los enfermeros no son reconocidos como profesionales legalmente responsables del procedimiento de cateterismo intravenoso periférico y la implementación de la terapia intravenosa es realizada predominantemente por técnicos y auxiliares de enfermería. El proceso de formación es incipiente.

RESUMO Objetivo: descrever o perfil demográfico, formação e a experiência prática de profissionais que realizam a cateterização intravenosa periférica no Brasil. Método: estudo transversal descritivo, realizado nas cinco macrorregiões do Brasil com 2.584 profissionais de enfermagem que atuavam no cuidado direto de pacientes submetidos à cateterização intravenosa periférica, utilizado um questionário contendo características demográficas, formação e experiência dos profissionais. A coleta ocorreu entre julho de 2021 e maio de 2022. Empregou-se estatística descritiva, Teste de Anova 1 Fator, Teste do Qui Quadrado de Pearson para k amostras independentes e Teste de comparações múltiplas de Tukey e resíduos ajustados. Resultados: a maior parte dos profissionais de enfermagem residiam na macrorregião sudeste, eram mulheres. A média de idade dos enfermeiros foi de 39,52 (±8,74) anos, dos técnicos de 39,66 (±9,22) anos e dos auxiliares de enfermagem de 40,61 (±10,57) anos. O tempo médio de formação dos enfermeiros foi igual a 11,83 (±8,18) anos, dos técnicos de enfermagem 10,81 (±7,62) anos e auxiliares de enfermagem 11,19 (±8,33) anos. Durante o processo formativo a maioria dos profissionais recebeu aulas de farmacologia, dispositivos de acesso vascular e cateterização venosa. O número médio de dispositivos inseridos por enfermeiros, em turno de 12 horas, foi inferior à média inserida por técnicos e auxiliares de enfermagem. Conclusão: enfermeiros não se reconhecem como profissionais legalmente responsáveis pelo procedimento de cateterização intravenosa periférica e a implementação da terapia intravenosa é predominantemente realizada pelos técnicos e auxiliares de enfermagem. O processo formativo é incipiente.

Factors associated with changes in plantar pressure of people with peripheral diabetic neuropathy.

Abstract: Diabetic neuropathy is one of the main complications of Diabetes Mellitus, which can lead to loss of protective sensation, motor, and plantar pressure alteration, generating deformities, abnormal gait and mechanical trauma to the feet. Objective: to evaluate the distribution of plantar pressure, sensorimotor changes, balance and associated factors to plantar pressure changes in people with peripheral diabetic neuropathy. Method: Cross-sectional study conducted with individuals registered in the primary public health service of a city in the east of São Paulo - Brazil. The sample was composed by people with Diabetes Mellitus and Peripheral Neuropathy identified by the Michigan Screening Instrument. It were investigated variables such as sensory-motor changes, static and dynamic plantar pressure using baropodometry and balance using the Berg scale. A significance level of 5% was adopted for all tests used. Results: Of the 200 individuals evaluated, 52.55% had no plantar protective sensitivity, the static evaluation did not demonstrated changes in the peak of plantar pressure, however in the dynamics the mean in the right foot was 6.0 (±2) kgf/cm2 and 6,7 (±1.62) kgf/cm2 on the left foot, the center of static pressure on the right foot was lower (10.55 ± 3.82) than on the left foot (11.97 ± 3.90), pointing hyper plantar pressure. The risk of falling was high, ranging from 8 to 56 points, with an average of 40.9 (±10.77). Conclusion: The absence of protective plantar sensitivity, increased pressure, biomechanical changes lead to loss of balance and are predictive of complications in the feet due to diabetic neuropathy.

Influence of Peripherally Inserted Central Catheters With Proximal Valves on Red Blood Cell Hemolysis During Transfusion.

The aim of this study was to verify the occurrence of hemolysis after infusion of packed red blood cells (PRBCs) in 12 peripherally inserted central catheters (PICCs) with a proximal valve, according to size and infusion rate. This was an experimental in vitro study performed under laboratory-controlled conditions, and the sample was composed of 12 PICCs with proximal valves (3F and 4F catheter). Twelve type A+ aliquots from 10 PRBCs were analyzed preinfusion and postinfusion according to PICC size and infusion rate. Hemolysis markers, total hemoglobin (g/dL), hematocrit (%), free hemoglobin (g/dL), potassium (mmol/L), lactate dehydrogenase (U/L), and rate of hemolysis (%) were studied. Data were analyzed using analysis of variance and Bonferroni multiple comparison tests. After the infusions in 3F PICCs, an increase was seen in rate of hemolysis (P = .003) and free hemoglobin (P = .014), in addition to a reduction in total hemoglobin (P = .002), with significant influence of minimum and maximum flow rates on the rate of hemolysis. The study finding indicated that the smaller catheter size and the infusion rate influenced variations in some hemolysis markers, but the alterations observed in the hemolysis markers would not contraindicate the infusion of PRBCs by 3F and 4F PICCs with proximal valves.

Elaboration and validation of an algorithm for treating peripheral intravenous infiltration and extravasation in children.

OBJECTIVE: to elaborate and validate the content and appearance of an algorithm for treating infiltration and extravasation of non-chemotherapy drugs and solutions administered to children. METHOD: a methodological study of the technology formulation and validation type. To elaborate the algorithm, a bibliographic review was carried out to list the scientific evidence on the treatment of infiltration and extravasation. Content and appearance validation was in charge of 14 specialists in pediatric nursing, using the Delphi technique, adopting a value equal to or greater than 0.80 as Content Validation Index. RESULTS: the algorithm was validated in the third evaluation by the judges, reaching a Global Content Validation Index of 0.99, being composed by the perception of the occurrence of the complication; discontinuation of intravenous therapy infusion; verification of signs and symptoms; measurement of edema; application of an infiltration and extravasation assessment scale and conduits to be used according to the characteristics of the fluid administered and the type of complication. CONCLUSION: the algorithm was validated and can be used in a practical and objective way by health professionals, in order to promote safety in the care of hospitalized children, with regard to reducing harms caused by infiltration and extravasation.

Elaboration and validation of an algorithm for treating peripheral intravenous infiltration and extravasation in children / Elaboração e validação de algoritmo para tratamento de infiltração e extravasamento intravenosos periféricos em crianças / Elaboración y validación de un algoritmo para el tratamiento de la infiltración y extravasación intravenosa periférica en niños

Objective: to elaborate and validate the content and appearance of an algorithm for treating infiltration and extravasation of non-chemotherapy drugs and solutions administered to children. Method: a methodological study of the technology formulation and validation type. To elaborate the algorithm, a bibliographic review was carried out to list the scientific evidence on the treatment of infiltration and extravasation. Content and appearance validation was in charge of 14 specialists in pediatric nursing, using the Delphi technique, adopting a value equal to or greater than 0.80 as Content Validation Index. Results: the algorithm was validated in the third evaluation by the judges, reaching a Global Content Validation Index of 0.99, being composed by the perception of the occurrence of the complication; discontinuation of intravenous therapy infusion; verification of signs and symptoms; measurement of edema; application of an infiltration and extravasation assessment scale and conduits to be used according to the characteristics of the fluid administered and the type of complication. Conclusion: the algorithm was validated and can be used in a practical and objective way by health professionals, in order to promote safety in the care of hospitalized children, with regard to reducing harms caused by infiltration and extravasation.

Objetivo: elaborar e validar o conteúdo e a aparência de um algoritmo para tratamento de infiltração e extravasamento de medicamentos não quimioterápicos e soluções administradas em crianças. Método: estudo metodológico do tipo elaboração e validação de tecnologia. Para elaboração do algoritmo, realizou-se revisão bibliográfica para elencar as evidências científicas sobre o tratamento de infiltração e extravasamento. A validação do conteúdo e aparência ocorreu com 14 especialistas em enfermagem pediátrica, a partir da técnica Delphi, adotando-se como Índice de Validação de Conteúdo desejável os valores iguais ou superiores a 0,80. Resultados: o algoritmo foi validado na terceira avaliação pelos juízes, atingindo Índice de Validação de Conteúdo Global de 0,99, sendo composto por percepção da ocorrência da complicação; descontinuação da infusão da terapia intravenosa; verificação dos sinais e sintomas; mensuração do edema; aplicação de escala de avaliação de infiltração e extravasamento e condutas a serem utilizadas mediante a característica do fluido administrado e tipo de complicação. Conclusão: o algoritmo foi validado e pode ser usado de maneira prática e objetiva pelos profissionais de saúde, com o intuito de promover a segurança no cuidado da criança hospitalizada, no que tange à redução de danos provocados pela infiltração e extravasamento.

Objetivo: desarrollar y validar el contenido y la apariencia de un algoritmo para el tratamiento de la infiltración y extravasación de medicamentos no quimioterápicos y soluciones administrados a niños. Método: estudio metodológico de formulación y validación de tecnología. Para la elaboración del algoritmo, se realizó una revisión de la literatura para enumerar la evidencia científica sobre el tratamiento de la infiltración y extravasación. La validación de contenido y apariencia se dio con 14 especialistas en enfermería pediátrica, utilizando la técnica Delphi, adoptando como Índice de Validación de Contenido deseable valores iguales o superiores a 0,80. Resultados: el algoritmo fue validado en la tercera evaluación por los jueces, alcanzando un Índice de Validación de Contenido Global de 0,99, compuesto por la percepción de la existencia de la complicación; interrupción de la infusión de terapia intravenosa; verificación de signos y síntomas; medición del edema; aplicación de escala de evaluación de infiltración y extravasación y conducta según las características del líquido administrado y el tipo de complicación. Conclusión: el algoritmo ha sido validado y puede ser utilizado de forma práctica y objetiva por los profesionales de la salud, con el fin de promover la seguridad en la atención de los niños hospitalizados, en lo que respecta a la reducción de los daños causados por infiltración y extravasación.

Central Venous Catheter bundle: professional knowledge and behavior in adult Intensive Care Units. / Bundle de Cateter Venoso Central: conhecimento e comportamento de profissionais em Unidades de Terapia Intensiva adulto.

OBJECTIVE: To evaluate knowledge and behavior of professionals in Intensive Care Units regarding the actions recommended in the bundle on preventing central venous catheter-related bloodstream infection. METHOD: Cross-sectional descriptive quantitative study, conducted in three Intensive Care Units. The data were collected through a face-to-face questionnaire applied to health professionals. The software R 3.3.1 was used for data analysis. RESULTS: Two-hundred and ninety-two professionals participated. Regarding knowledge, the hand hygiene item presented a higher level both for the insertion (92.46%) and maintenance (97.27%) moments. Usage of chlorhexidine as an antiseptic, followed by alcohol (47.94%) and providing a date for hub or connectors (19.87%) were the least known items. As for behavior, the professionals reported: using always the correct attire for catheter insertion (84.25%), never waiting for the antiseptic to dry before catheter insertion (25.34%) and never cleaning hub or connectors with 70% alcohol (23.86%). CONCLUSION: Results show that the professionals' knowledge and behavior regarding the central venous catheter bundle present deficiencies, revealing the importance of promoting training programs for this knowledge domain.

Compliance to empirical contact precautions for multidrug-resistant microorganisms.

Health care-associated infections impact patient morbidity and mortality, and institutions adopt evidence-based measures to prevent and control such infections. In this study, professionals were observed during patient care under empirical contact precautions. A total of 243 observations were performed in which 39.5% complied with all measures. The positivity rate of surveillance cultures was 38.36%, and adherence to the measures in patients with colonization was 43.1%.

Bundle de Cateter Venoso Central: conhecimento e comportamento de profissionais em Unidades de Terapia Intensiva adulto / Bundle de Catéter Venoso Central: conocimiento y comportamiento de los profesionales en Unidades de Cuidados Intensivos de adultos / Central Venous Catheter bundle: professional knowledge and behavior in adult Intensive Care Units

RESUMO Objetivo Avaliar conhecimento e comportamento dos profissionais de Unidades de Terapia Intensiva quanto às ações recomendadas no bundle de prevenção de infecção de corrente sanguínea relacionada ao cateter venoso central. Método Estudo transversal, descritivo, com abordagem quantitativa, realizado em três Unidades de Terapia Intensiva. Os dados foram coletados por meio de questionário aplicado face-a-face com profissionais de saúde. Utilizou-se o software R 3.3.1 para análise dos dados. Resultados Participaram 292 profissionais. Quanto ao conhecimento, o item higienização das mãos apresentou maior nível tanto no momento da inserção (92,46%) como na manutenção (97,27%). O uso do degermante clorexidina, seguido por alcoólico (47,94%) e datar hub ou conectores (19,87%) foram os itens de menor conhecimento. Quanto ao comportamento, os profissionais relataram: sempre usar a paramentação correta para inserção do cateter (84,25%), nunca esperar a secagem do antisséptico antes de inserir o cateter (25,34%) e nunca realizar limpeza do hub ou conectores com álcool 70% (23,86%). Conclusão Os resultados demonstram que o conhecimento e comportamento dos profissionais em relação ao bundle de cateter venoso central apresentam fragilidades, revelando a importância de incentivar programas de capacitação nesta área do conhecimento.

RESUMEN Objetivo Evaluar el conocimiento y el comportamiento de los profesionales de la Unidad de Cuidados Intensivos en relación con las acciones recomendadas en el bundle de prevención de la infección del torrente sanguíneo relacionada con el catéter venoso central. Método Estudio descriptivo transversal, con enfoque cuantitativo, realizado en tres Unidades de Cuidados Intensivos. Los datos se reunieron mediante un cuestionario presencial aplicado a profesionales de la salud. Se utilizó el software R 3.3.1 para el análisis de los datos. Resultados Participaron 292 profesionales. En cuanto al conocimiento, el tema de la higiene de las manos presentó un nivel más alto tanto en el momento de la inserción (92,46%) como en el mantenimiento (97,27%). El uso del antiséptico clorhexidina, seguido por el alcohol (47,94%) y la datación de hub o conectores (19,87%) fueron los elementos de menor conocimiento. En cuanto a la conducta, los profesionales informaron: siempre usar la vestimenta correcta para la inserción del catéter (84,25%), nunca esperar a que el antiséptico se seque antes de insertar el catéter (25,34%) y nunca limpiar el hub o los conectores con alcohol al 70% (23,86%). Conclusión Los resultados muestran que el conocimiento y el comportamiento de los profesionales en relación con el bundle sobre el catéter venoso central presentan debilidades, lo que revela la importancia de fomentar programas de formación en esta área de conocimiento.

ABSTRACT Objective To evaluate knowledge and behavior of professionals in Intensive Care Units regarding the actions recommended in the bundle on preventing central venous catheter-related bloodstream infection. Method Cross-sectional descriptive quantitative study, conducted in three Intensive Care Units. The data were collected through a face-to-face questionnaire applied to health professionals. The software R 3.3.1 was used for data analysis. Results Two-hundred and ninety-two professionals participated. Regarding knowledge, the hand hygiene item presented a higher level both for the insertion (92.46%) and maintenance (97.27%) moments. Usage of chlorhexidine as an antiseptic, followed by alcohol (47.94%) and providing a date for hub or connectors (19.87%) were the least known items. As for behavior, the professionals reported: using always the correct attire for catheter insertion (84.25%), never waiting for the antiseptic to dry before catheter insertion (25.34%) and never cleaning hub or connectors with 70% alcohol (23.86%). Conclusion Results show that the professionals' knowledge and behavior regarding the central venous catheter bundle present deficiencies, revealing the importance of promoting training programs for this knowledge domain.

Effects of Blood Transfusion Sets on Red Blood Cell Hemolysis.

This experimental randomized study compared the effects of macrodrop and microdrop blood transfusion sets on red blood cell (RBC) hemolysis. Twenty units of packed RBCs from different donors were infused through 48 infusion sets from 2 manufacturers at infusion rates of 10 and 100 mL/h. Pre- and postinfusion analysis was performed to determine total hemoglobin (g/dL), hematocrit (%), free hemoglobin (g/dL), potassium (mmol/L), haptoglobin (g/L), and degree of hemolysis (%). The results demonstrated that the level of free hemoglobin (P < .001) and degree of hemolysis (P < .001) increased postinfusion. A higher degree of hemolysis was noted when the RBCs were infused at a rate of 10 mL/h through a microdrop blood transfusion set.

Strategies for preventing ventilator-associated pneumonia: an integrative review.

OBJECTIVE: to identify studies about strategies for prevention of ventilator-associated pneumonia deployed in health services and classify their level of evidence. METHOD: integrative review of the literature, in 7 databases, which included the following descriptors: Prevention and Control AND Pneumonia Ventilator-Associated AND Intensive Care Units AND Bundle AND Patient Care. RESULTS: twenty-three scientific productions were included. Of the preventive measures identified, 9 (39.1%) correspond from three to five strategies. The most frequent were: 22 (95.6%) lying with head elevated, 19 (82.6%) oral hygiene with chlorhexidine and 14 (60.8%) reduction of sedation whenever possible. FINAL CONSIDERATION: the application of measures based on scientific evidence is proven to be effective when carried out in conjunction, impacting the reduction of the incidence of ventilator-associated pneumonia.

Strategies for preventing ventilator-associated pneumonia: an integrative review / Estrategias para la prevención de la neumonía asociada a la ventilación mecánica: revisión integrativa / Estratégias para prevenção de pneumonia associada à ventilação mecânica: revisão integrative

ABSTRACT Objective: to identify studies about strategies for prevention of ventilator-associated pneumonia deployed in health services and classify their level of evidence. Method: integrative review of the literature, in 7 databases, which included the following descriptors: Prevention and Control AND Pneumonia Ventilator-Associated AND Intensive Care Units AND Bundle AND Patient Care. Results: twenty-three scientific productions were included. Of the preventive measures identified, 9 (39.1%) correspond from three to five strategies. The most frequent were: 22 (95.6%) lying with head elevated, 19 (82.6%) oral hygiene with chlorhexidine and 14 (60.8%) reduction of sedation whenever possible. Final Consideration: the application of measures based on scientific evidence is proven to be effective when carried out in conjunction, impacting the reduction of the incidence of ventilator-associated pneumonia.

RESUMEN Objetivo: identificar estudios sobre estrategias de prevención de neumonía asociadas a la ventilación mecánica implantadas en servicios de salud y clasificar el nivel de evidencia de los mismos. Método: revisión integrativa de la literatura, en 7 bases de datos, que incluyó los siguientes descriptores: Prevention and Control AND Pneumonia Ventilator-Associated AND Intensive Care Units AND Bundle AND Patient Care. Resultados: Se incluyeron 23 producciones científicas. Entre los conjuntos de medidas de prevención identificados, 9 (39,1%) contemplan entre tres a cinco estrategias. Fueron las más frecuentes: el decúbito elevado, 22 (95,6%); la higiene oral con clorhexidina, 19 (82,6%); y la reducción de la sedación siempre que sea posible, 14 (60,8%). Consideraciones Finales: La aplicación de medidas basadas en evidencias científicas es comprobadamente eficaz cuando se aplica en conjunto, impactando en la reducción de la densidad de incidencia de neumonía asociada a la ventilación mecánica.

RESUMO Objetivo: identificar estudos acerca de estratégias de prevenção de pneumonia associada à ventilação mecânica implantadas em serviços de saúde e classificar o nível de evidência destes. Método: revisão integrativa da literatura, em sete bases de dados, incluindo os seguintes descritores: "Prevention and Control AND Pneumonia Ventilator-Associated AND Intensive Care Units AND Bundle AND Patient Care". Resultados: foram incluídas 23 produções científicas. Dentre os conjuntos de medidas de prevenção identificados, nove (39,1%) contemplam de três a cinco estratégias. As mais frequentes foram: decúbito elevado - 22 (95,6%); higiene oral com clorexidina - 19 (82,6%); e redução da sedação sempre que possível - 14 (60,8%). Considerações Finais: a aplicação de medidas baseadas em evidências científicas são comprovadamente eficazes quando aplicadas em conjunto, impactando na redução da densidade de incidência de pneumonia associada à ventilação mecânica.

Marcadores de hemólise em concentrado de hemácias administrados por cateter central de inserção periférica não valvulado* / Marcadores de hemólisis en concentrado de eritrocitos administrados por catéter central de inserción periférica sin válvula* / Hemolysis markers of blood administered in non-valved peripherally inserted central catheter*

Resumo Objetivo: Identificar as variações nos níveis de marcadores de hemólise em CH administrados por CCIP segundo o calibre do cateter. Método: Estudo experimental realizado em laboratório com condições de temperatura e umidade controladas. A amostra teve 36 alíquotas de sangue de 10 bolsas de hemácias com tipo de sangue A+; infusão de gravidade foi utilizada em seis CCIP de 3Fr (French) e seis de 4Fr, totalizando 12 experimentos divididos em três tempos: basal, fluxo livre e fluxo controlado. Analisou-se grau de hemólise, valores totais e livres de hemoglobina, desidrogenase láctica e potássio. Resultados: Houve aumento da média de hemoglobina livre (p=0,01) e grau de hemólise (p=0,01) após infusão de fluxo livre, com média de elevação de 0,04 de potássio (p<0,01) e redução de hemoglobina total (p=0,01) em fluxo controlado. O concentrado de hemácias aplicadas em 4Fr CCIP teve média de elevação de grau de fluxo. O CCIP de 3Fr teve aumento médio significante em grau de hemólise (p=0,03) e hemoglobina livre (p=0,01) após controle do fluxo. Conclusão: O CCIP de 4Fr foram associados a maiores mudanças nos marcadores de hemólise. Maior dimensão do calibre pode proporcionar fluxo turbulento, contribuindo para um maior choque entre as hemácias.

Resumen Objetivo: Identificar las variaciones de los niveles de marcadores de hemólisis en CE administrados por CCIP según el calibre del catéter. Método: Estudio experimental realizado en laboratorio en condiciones de temperatura y humedad controladas. La muestra tenía 36 alícuotas de sangre de 10 bolsas de eritrocitos con tipo de sangre A+; fue utilizada infusión por gravedad en seis CCIP de 3 FR (French) y seis de 4 FR, un total de 12 experimentos divididos en tres tiempos: basal, flujo libre y flujo controlado. Se analizó el nivel de hemólisis, valores totales y libres de hemoglobina, deshidrogenasa láctica y potasio. Resultados: Hubo un aumento del promedio de hemoglobina libre (p=0,01) y nivel de hemólisis (p=0,01) después de infusión de flujo libre, con promedio de elevación de 0,04 de potasio (p<0,01) y reducción de hemoglobina total (p=0,01) en flujo controlado. El concentrado de eritrocitos aplicados en 4 FR CCIP tuvo promedio de elevación de nivel de flujo. El CCIP de 3 FR tuvo un aumento promedio significativo en nivel de hemólisis (p=0,03) y hemoglobina libre (p=0,01) después de control de flujo. Conclusión: El CCIP de 4 FR fue asociado a mayores cambios en los marcadores de hemólisis. Mayor dimensión del calibre puede proporcionar flujo turbulento, lo que contribuye a un mayor choque entre los eritrocitos.

Abstract Objective: To evaluate the change in hemolysis markers in packed red blood cells, administered by gravity infusion in non-valved PICC lines, according to different sizes. Methods: Experimental study carried out in laboratory under controlled conditions of temperature and humidity. The sample had 36 blood aliquots from 10 packed red blood cells bags with A positive blood type; gravity infusion was used in six 3 French (Fr) PICC and in six 4Fr PICC, totaling 12 experiments divided in three moments: Basal, Free Flow and Controlled Flow. Degree of hemolysis, total and free hemoglobin values, lactic dehydrogenase and potassium were analyzed. Results: There was an average increase of free hemoglobin (p=0.01) and degree of hemolysis (p=0.01) after Free Flow infusion, with 0.04 average elevation of potassium (p<0.01) and decrease of total hemoglobin (p=0.01) in Controlled Flow. The packed red blood cells infused in 4Fr PICC had average elevation of degree of hemolysis (p=0.03) in Free Flow, and potassium (p=0.03) and degree of hemolysis (p=0.05) in the Controlled Flow. The 3Fr PICC had significant average increase in the degree of hemolysis (p=0.03) and free hemoglobin (p=0.01) after flow control. Conclusion: The 4Fr PICC were associated to higher changes in hemolysis markers. We infer that the larger size can provide a turbulent flow, contributing to a larger clash among red blood cells.

Boas práticas na prevenção de pneumonia associada à ventilação mecânica / Buenas prácticas en la prevención de la neumonía asociada a la ventilación mecánica / Good practices in the prevention of ventilator-associated pneumonia

Resumo Objetivo: Avaliar a adesão dos profissionais de saúde a um conjunto de boas práticas de prevenção de Pneumonia Associada à Ventilação Mecânica, índice de conformidade às medidas individuais e associação de características clínicas dos pacientes e adesão ao conjunto de boas práticas com a pneumonia. Métodos: Estudo de coorte prospectivo realizado em uma Unidade de Terapia Intensiva de um hospital universitário no período de maio de 2017 a outubro de 2017. A amostra foi composta por pacientes internados no período do estudo, que preencheram os critérios de inclusão, a coleta de dados foi realizada por meio de consulta a prontuários. Resultados: O item com maior adesão foi a avaliação diária da sedação e redução sempre que possível, 81 (91,0%), seguido da troca do circuito a cada 7 dias, 76 (82,6). A manutenção da pressão do cuff entre 20 e 30 mm H2O foi o item com menor adesão 22 (23,9%). A adesão ao conjunto completo apresentou conformidade em 20 (21,7%) das oportunidades. O estudo mostrou que quanto maior a adesão às medidas de boas práticas, menor é o risco de Pneumonia Associada à Ventilação Mecânica, porém não foi um dado estatisticamente significante. Os pacientes cirúrgicos e em uso de ventilação mecânica apresentaram maior risco de desenvolver PAV (p= 0,05). Conclusão: A Pneumonia Associada à Ventilação Mecânica pode trazer grave repercussão para o paciente, a aplicação de medidas com embasamento científico é fundamental, a fim de se prevenir a ocorrência deste agravo, que é uma das mais frequentes infecções relacionadas à assistência à saúde dentro das Unidades de Terapia Intensiva brasileiras.

Resumen Objetivo: Evaluar la adhesión de los profesionales de salud a un conjunto de buenas prácticas de prevención de Neumonía Asociada a la Ventilación Mecánica, índice de conformidad con las medidas individuales y asociación de características clínicas de los pacientes y adhesión al conjunto de buenas prácticas con la neumonía. Métodos: Estudio de cohorte prospectivo realizado en una Unidad de Terapia Intensiva de un hospital universitario durante el periodo de mayo de 2017 a octubre de 2017. La muestra ha sido formada por pacientes ingresados durante el periodo del estudio y que cumplieron los criterios de inclusión. La recolección de datos fue hecha a través de consulta a archivos. Resultados: El ítem de mayor adhesión fue la evaluación diaria de la sedación y reducción siempre que posible, 81 (91,0%), seguido del cambio del circuito cada 7 días, 76 (82,6). El mantenimiento de la presión del cuff entre 20 y 30 mm H2O fue el ítem con menor adhesión 22 (23,9%). La adhesión al conjunto completo presentó conformidad en 20 (21,7%) de las oportunidades. El estudio mostró que cuanto mayor la adhesión a las medidas de buenas prácticas, menor el riesgo de Neumonía Asociada a la Ventilación Mecánica; sin embargo no es un dato estadísticamente significante. Los pacientes quirúrgicos y en uso de ventilación mecánica presentaron mayor riesgo de desarrollar PAV (p= 0,05). Conclusión: Neumonía Asociada a la Ventilación Mecánica puede traer una grave repercusión al paciente. La aplicación de medidas con embasamiento científico es fundamental para evitar la ocurrencia de este agravio, que es una de las más frecuentes infecciones relacionadas con la asistencia a la salud dentro de las Unidades de Terapia Intensiva brasileñas.

Abstract Objective: To evaluate the compliance of health professionals with a set of good practices for the prevention of Ventilator-Associated Pneumonia, compliance index to individual measures and association of clinical characteristics of patients and compliance with the set of good practices with pneumonia. Methods: A prospective cohort study conducted at an Intensive Care Unit of a university hospital from May 2017 to October 2017. The sample consisted of patients hospitalized during the study period, who met the inclusion criteria. Data collection was performed through review of medical records. Results: The item with the highest compliance was the daily assessment of sedation and reduction 81 (91.0%) whenever possible, followed by circuit changes every 7 days, 76 (82.6%). The maintenance of cuff pressure between 20- and 30-mm H2O was the item with the lowest compliance 22 (23.9%). Compliance with the complete set showed adherence in 20 (21.7%) of opportunities. This study showed that the greater compliance with good practice measures, the lower the risk of Ventilator-Associated Pneumonia, but it was not statistically significant data. Surgical and mechanical ventilation patients had a higher risk of developing VAP (p=0.05). Conclusion: Ventilator-Associated Pneumonia can cause serious repercussions for patients. Thus, the application of measures with scientific basis is fundamental to prevent the occurrence of this event, which is one of the most frequent infections related to health care within Brazilian Intensive Care Units.

Evaluation of the use of therapeutic footwear in people with diabetes mellitus - a scoping review.

Foot ulcers are one of the major complications of Diabetes Mellitus and are associated with increasing rates of morbidity and mortality. It is estimated that 2% of diabetic patients present lesions in the feet, with relapse rates between 30% and 40% in the first year after healing of the first ulcerations. Therapeutic footwear is one of the main strategies to prevent foot ulceration. OBJECTIVES: To identify in the literature aspects related to the recommendation of health professionals and the use of therapeutic footwear by patients with Diabetes Mellitus. MATERIALS AND METHODS: Scoping review of literature in the Scopus, Scielo, Pubmed and Cochrane databases, using diabetic foot crosswords and therapeutic footwear. RESULTS: Twenty-six articles were included in this review. The majority was systematic reviews (46.15%) with published date from 2016 (38.5%). Of the 26 articles included, 10 (38.5%) referred to adherence to the use of footwear, 10 (38.5%) the difficulty to evaluate the effectiveness of the intervention and 6 (23.0%) to changes in the balance and biomechanics patterns In the studies, the use of therapeutic footwear is linked to the reduction of the risk of ulceration or its recurrence in people with diabetes who already have diabetic neuropathy as chronic complication of the disease. CONCLUSIONS: Therapeutic footwear for diabetics was able to produce significant reductions of peak plantar pressure in static and dynamic analysis, being more efficient than a common footwear, and could contribute to the prevention of injuries associated with diabetic foot.

Levels of Hemolysis Markers in Erythrocyte Concentrates Administered Using a Syringe Infusion Pump.

Syringe infusion pumps (SIPs) led to major advances in infusion therapy and were gradually applied to the transfusion of packed red blood cells (RBCs), raising questions about possible cell damage. The objectives of this study were to determine levels of hematocrit (%), total hemoglobin (g/dL), free hemoglobin (g/dL), lactate dehydrogenase (units/L), potassium (mmol/L), the degree of hemolysis (%) of RBCs infused by an SIP, and to investigate the influence of the infusion rate. The experimental study comprised 14 RBCs, 3 SIPs, and infusion rates of 5, 10, and 20 mL/h. The results showed total hemoglobin reduction (P = .003), and increased free hemoglobin and hemolysis (P <.001) were identified. The conclusion reached was that RBCs presented changes in free hemoglobin and degree of hemolysis.

Contaminação de preparação alcóolica para higienização das mãos em unidade de cuidados intensivos pediátricos / Contamination of alcohol preparations for hand hygiene in a pediatric intensive care unit / Contaminación de preparación alcohólica para la higienización de las manos en unidad de cuidados intensivos pediátricos

Objetivo: verificar a contaminação microbiológica de frascos de álcool gel utilizados para higienização das mãos em uma unidade de cuidados intensivos pediátricos (UCIP), segundo o local do frasco e o tempo de permanência no leito. Método: Estudo exploratório e análise microbiológica de 140 amostras provenientes da tampa, bico e conteúdo interno de frascos de álcool gel instalados nos leitos de uma UCIP de um hospital universitário de São Paulo. A coleta de dados ocorreu entre maio e junho de 2013, após a aprovação pelo Comitê de Ética e Pesquisa (parecer 0440/11). Resultados: dentre as culturas realizadas, 54(38,6%) evidenciaram crescimento bacteriano, com predominância na tampa em todos os tempos de coleta. Foram identificadas espécies de Staphylococcus coagulase negativa, Pseudomonas aeruginosa e Acinetobacter baumannii. Conclusão: frascos de álcool gel podem se tornar colonizados durante utilização em unidades de internação, devendo receber atenção especial quanto ao processo de limpeza.

Objective: to ascertain microbiological contamination of alcohol gel bottles used for hand hygiene in a pediatric intensive care unit (PICU), by bottle location and time installed in bed. Method: exploratory study and microbiological analysis of 140 samples from lid, spout and internal content of alcohol gel bottles installed on PICU beds at a university hospital in São Paulo. Data was collected from May to June 2013, after approval by the Research Ethics Committee (No. 0440/11). Results: of the cultures, 54 (38.6%) showed bacterial growth, predominantly on the lid at all sampling times. The species identified were Staphylococcus coagulase-negative, Pseudomonas aeruginosa and Acinetobacter baumannii. Conclusion: alcohol gel bottles can become colonized during use in inpatient units and should receive special attention as regards the cleaning process.

Objetivo: determinar la contaminación microbiológica de frascos de gel de alcohol utilizados para higienización de manos en unidad de cuidados intensivos pediátricos (UCIP), de acuerdo a la ubicación del frasco y el tiempo de permanencia en el lecho. Método: un estudio exploratorio con análisis microbiológico de 140 muestras provenientes de la tapa, tubo de salida y contenido interno de los frascos de gel de alcohol instalados en los lechos de una UCIP de un hospital universitario en Sao Paulo. La recolección de datos ocurrió entre mayo y junio de 2013, después de la aprobación del Comité de Ética de Investigación (Dictamen 0440/11). Resultados: entre los cultivos realizados, 54 (38,6%) mostraron crecimiento bacteriano, especialmente en la tapa, en todos los tiempos de recolección. Se encontraron especies de Staphylococcus coagulasa negativo, Pseudomonas aeruginosa y Acinetobacter baumannii. Conclusión: los frascos de gel de alcohol pueden volverse colonizados durante su uso en las unidades de hospitalización y deben recibir una atención especial en el proceso de limpieza.

COMMUNICATION AND PATIENT SAFETY IN THE CHANGE-OF-SHIFT NURSING REPORT IN NEONATAL INTENSIVE CARE UNITS / LA COMUNICACIÓN Y LA SEGURIDAD DEL PACIENTE EN EL CAMBIO DE TURNO EN LAS UNIDADES DE CUIDADOS INTENSIVOS NEONATALES / COMUNICAÇÃO E SEGURANÇA DO PACIENTE NA PASSAGEM DE PLANTÃO EM UNIDADES DE CUIDADOS INTENSIVOS NEONATAIS

Estudo quantitativo, descritivo-exploratório, com objetivo de identificar fatores relacionados à segurança do paciente quanto à comunicação no processo de passagem de plantão das equipes de enfermagem. Realizado entre abril e maio de 2012, com 70 profissionais de enfermagem de três unidades de cuidados intensivos neonatais, através de instrumento validado sobre passagem de plantão. Para análise dos dados, utilizaram-se os testes Qui-Quadrado e t-Student. Os resultados demonstraram que os fatores que podem comprometer a segurança do paciente durante a passagem de plantão devido à interrupção e, assim, causando possível perda de importantes informações para a assistência segura, foram atrasos, saídas antecipadas, realização de cuidados e conversas paralelas. Os enfermeiros possuíam melhor percepção desses fatores, e profissionais com menor tempo de formação referiram mais informações relacionadas à "condição clínica do paciente", "medicações" e "cuidados gerais/procedimentos", não sendo uma condição comum a todos. Portanto, há indicativos de comunicação segura, tornando-se necessários treinamentos e protocolos específicos.

Estudio cuantitativo, descriptivo/exploratorio, para identificar factores asociados con la seguridad del paciente en la comunicación del cambio de turno de grupos de enfermería. Realizado entre abril/mayo de 2012, con 70 profesionales del equipo de enfermería de tres unidades de cuidados intensivos neonatales, con formulario validado con informaciones del cambio de turno. Los datos se analizaron con pruebas chi-cuadrado y t de Student. Los resultados demostraron que los factores que pueden comprometer la seguridad del paciente durante el cambio de turno produjeron retrasos, salidas anticipadas, realización de cuidados y conversaciones paralelas. Los enfermeros tenían una mejor percepción de estos factores en comparación con los técnicos. Profesionales con formación inicial mencionaron más informaciones: "la condición clínica del paciente", "drogas", "cuidados generales/procedimientos." Se puede concluir que hay indicios para la comunicación segura, incluso con el conocimiento limitado de la seguridad del paciente y la comunicación en el cambio de turno, por lo que es necesaria formación y protocolos específicos.

Quantitative descriptive-exploratory research, aiming to identify the factors related to patient safety concerning the communication on the shift change process of nursing teams. The research was conducted between April and May 2012 with 70 nursing team professionals from three Neonatal Intensive Care Units, using a validated tool about the shift change. For data analysis, Chi-Square and Student's t-tests were used. The results showed that the factors that could endanger patient safety during the shift change were delays, early departures, nursing procedures/care and side talk. The nurses had better perception of these factors when compared with nursing assistants. Professionals with shorter training reported more information related to "patients' clinical conditions", "drugs/medicines" and "nursing care/procedures". Therefore, there are pictures for safe communication, even with the incipient knowledge about patient safety and communication on shift reports, being necessary trainings and specific protocols.