Bathing with wipes impregnated with chlorhexidine gluconate to prevent central line-associated bloodstream infection in critically ill patients: A systematic review with meta-analysis.

BACKGROUND: Recommendations for different types of bathing to prevent central line-associated bloodstream infections (CLABSI) are still divergent. The objective of this study was to verify whether bed bathing with wipes impregnated with 2% chlorhexidine (CHG) compared to conventional bed bathing is more effective in preventing CLABSI. METHODS: Systematic review of the literature by consulting the electronic databases PubMed/Medline, Embase, CINAHL, Scopus, and Web of Science from the date of inception until July 1, 2023, with no language or time restrictions. RESULTS: A total of 84,462 studies were examined, of which 6 were included in the meta-analysis. Data from 20,188 critical care patients included in primary studies were analyzed. The meta-analysis found that bed bathing with wipes impregnated with 2% CHG reduced the risk of CLABSI by 48% compared to conventional bed bathing (risk ratio 0.52; 95% confidence interval, 0.37-0.73), and this is moderate-quality evidence. The reduction in length of stay in the intensive care unit and length of hospital stay as well as the risk of death were not significantly different between the study groups. Whether bed bathing with 2% CHG-impregnated wipes increases the occurrence of skin reactions is unclear. CONCLUSIONS: This meta-analysis provides moderate-quality evidence that daily bathing with 2% CHG-impregnated wipes is safe and helps prevent CLABSI among adult intensive care unit patients.

Effects of Intensive Blood Glucose Control on Surgical Site Infection for Liver Transplant Recipients: A Randomized Controlled Trial.

BACKGROUND: The evidence supporting intensive blood glucose control to prevent surgical site infections (SSIs) among liver transplant recipients is insufficient. We aimed to assess the effects of postoperative intensive blood glucose control (IBGC) against standard blood glucose control (SBGC) on the incidence of SSIs among adult liver transplant recipients. METHODS: We performed a randomized controlled trial (ClinicalTrials.gov identifier NCT03474666). The IBGC target was 80 to 130 mg/dL, and the SBGC target was below 180 mg/dL. Analyses were made on an intention-to-treat basis. RESULTS: Of the 41 recipients enrolled onto the trial, 20 were randomly allocated to the IBGC group and 21 to the SBGC group. There were no significant differences in SSIs among recipients allocated to either group (relative risk [RR], 0.78; 95% confidence interval [CI], 0.21-2.88; P = .69). Mean (SD) blood glucose levels were significantly lower in the IBGC group in the 24-hour period after surgery (145.0 [20.7] mg/dL and 230.2 [51.6] mg/dL; P = .001). While there were fewer episodes of hypoglycemia in the IBGC group, this was not statistically significant. There were no episodes of severe hypoglycemia in either group. Hyperglycemia and severe hyperglycemia were significantly more frequent in the SBGC group (RR, 0.70; 95% CI, 0.52-0.93; P = .001 and RR, 0.07; 95% CI, 0.01-0.48; P = .001, respectively). Length of hospital stay was significantly shorter for recipients in the IBGC group (13.1 [5.5] days vs 19.3 [12.1] days; P = .04). CONCLUSIONS: Although this small trial did not find intensive control reduced SSI, it was associated with lower blood glucose levels, fewer episodes of hyperglycemia and severe hyperglycemia, and shorter length of hospital stay.

Safety in the practice of decontaminating filtering facepiece respirators: A systematic review.

BACKGROUND: Considering the new SARS-CoV-2 pandemic and the potential scarcity of material resources, the reuse of personal protective equipment such as filtering facepiece respirators (FFRs) for N95 filtering or higher is being discussed, mainly regarding the effectiveness and safety of cleaning, disinfection and sterilization processes. AIM: To analyze the available evidence in the literature on the safety in processing FFRs. METHODS: A systematic review conducted by searching for studies in the following databases: PubMed, CINAHL, LILACS, CENTRAL, EMBASE, Web of Science, and Scopus. RESULTS: Forty studies were included in this review. The disinfectant/sterilizing agents most frequently tested at different concentrations and exposure periods were ultraviolet irradiation, vaporized hydrogen peroxide and steam sterilization. Microbial reduction was assessed in 21 (52.5%) studies. The only disinfectants/sterilizers that did not caused degradation of the material-integrity were alcohol, electric cooker, ethylene oxide, and peracetic acid fogging. Exposure to ultraviolet irradiation or microwave generated-steam resulted in a nonsignificant reduction in filter performance. CONCLUSION: There is a complex relationship between the FFR raw materials and the cycle conditions of the decontamination methods, evidencing the need for validating FFRs by models and manufacturers, as well as the process. Some methods may require additional tests to demonstrate the safety of FFRs for use due to toxicity.

Perfil Clínico dos Pacientes Diagnosticados com Covid-19 Internados em uma Unidade de Terapia Intensiva / Clinical Profile of Patients Diagnosed with Covid-19 Admitted to an Intensive Care Unit / Perfil clínico de los pacientes con diagnóstico de Covid-19 ingresados en una unidad de cuidados intensivos

Objetivo: descrever o perfil clínico, principais alterações laboratoriais e hemodinâmicas entre pacientes acometidos por Covid-19 internados na unidade de terapia intensiva de um hospital universitário da região dos Campos Gerais - Paraná. Método: Estudo de coorte retrospectivo. A amostra foi constituída por prontuários de pacientes internados na unidade de terapia intensiva cujo resultado do teste Polymerase Chain Reaction foi positivo para Covid-19. O quadro clínico foi analisado durante 10 dias desde a admissão na unidade. A coleta de dados foi obtida por meio do acesso ao prontuário eletrônico. O estudo foi aprovado por um Comitê de Ética em Pesquisa. Resultados: Predominaram pacientes do sexo masculino com faixa etária de 48 a 57 anos. Destacam-se o uso de ventilação mecânica, relação PaO2 FiO2 menor que 200, caracterizado como síndrome do desconforto respiratório agudo. Conclusão: A caracterização do perfil clínico contribuiu para a compreensão da fisiopatologia da doença e discussão com estudos semelhantes

Objective: to describe the clinical profile, main laboratory and hemodynamic changes among patients with Covid-19 admitted to the intensive care unit of a university hospital in the region of Campos Gerais - Paraná. Method: This is a historical cohort. The sample consisted of medical records of patients admitted to the intensive care unit whose Polymerase Chain Reaction test result was positive for Covid-19. The clinical picture was analyzed for 10 days from admission to the unit. Data collection was obtained through access to the electronic medical record. The study was approved by a Research Ethics Committee. Results: There was a predominance of male patients aged from 48 to 57 years. The use of mechanical ventilation stands out, with a PaO2 FiO2 ratio lower than 200, characterized as acute respiratory distress syndrome. Conclusion: The characterization of the clinical profile contributed to the understanding of the pathophysiology of the disease and discussion with similar studies.

Objetivo: describir el perfil clínico, principales cambios analíticos y hemodinámicos de pacientes con Covid-19 ingresados en la unidad de cuidados intensivos de un hospital universitario de la región de Campos Gerais - Paraná. Método: Estudio de cohorte retrospectivo. La muestra consistió en registros médicos de pacientes ingresados en la unidad de cuidados intensivos cuyo resultado de la prueba de reacción en cadena de la polimerasa fue positivo para Covid-19. Se analizó el cuadro clínico durante 10 días desde el ingreso a la unidad. La recogida de datos se obtuvo mediante el acceso a la historia clínica electrónica. El estudio fue aprobado por el Comité de Ética en Investigación. Resultados: Predominó el sexo masculino de 48 a 57 años. Destaca el uso de ventilación mecánica, con una relación PaO2 FiO2 inferior a 200, padeciendo síndrome de distrés respiratorio agudo. Conclusión: La caracterización del perfil clínico contribuyó al conocimiento de la fisiopatología de la enfermedad y la discusión con estudios similares

A Retrospective Cohort Study of Risk Factors for Surgical Site Infection Following Lung Transplant.

BACKGROUND: Surgical site infections (SSIs) are among the leading health care-associated infections as well as a major problem in the postoperative period of lung transplant recipients. Little is known about the risk factors in this specific population. The objective of this study was to identify the incidence, risk factors, and outcomes of SSI following lung transplant. METHODS: Digital medical records of adult recipients subjected to lung transplant from July 2011 and June 2016 in a large Brazilian referral teaching public center were analyzed in this retrospective cohort follow-up. RESULTS: Among the 121 recipients analyzed, 19 (15.7%) had SSI; of these, 11 (57.8%) had superficial incisional infections, 1 (5.2%) had a deep incisional infection, and 7 (36.8%) had organ/space infection. Recipient-related risk factors for SSI were high body mass index (P = .041), prolonged surgery time (P = .043), and prolonged duration of chest drain placement (P = .009). At the multiple logistic regression was found that each hour elapsed in the surgical time increased the odds of SSI by around 2 times (odds ratio 2.34; 95% CI, 1.46-4.53; P = .002). Donor-related risk factors included smoking status (P = .05) and positive bronchoalveolar lavage (P < .001). Having an SSI was associated with an increased length of stay in intensive care units (P = .003), reoperation (P = .014), and a higher 1-year mortality rate (P = .02). CONCLUSIONS: The identified incidence rate was higher to that observed in the previous studies. The risk factors duration of chest tube placement and donor smoking status are different from those reported in the scientific literature.

Perioperative intensive glycemic control for liver transplant recipients to prevent surgical site infection: A systematic review and meta-analysis.

BACKGROUND: Surgical Site Infections (SSIs) are common among liver transplant recipients and result in adverse patient outcomes. Standard glycemic control is effective in reducing SSIs. Some studies suggest intensive glycemic control reduces the risk of SSI further. METHODS: For this systematic review, were searched for studies comparing perioperative intensive and standard glycemic control in liver transplant recipients. Clinical trials registries and reference lists of included studies were also searched. No date or language restrictions were applied. Randomized controlled trials (RCTs) were assessed using Cochrane risk of bias tool and GRADE method. Cohort studies were assessed using the Newcastle-Ottawa Scale. RESULTS: Two RCTs and three cohort studies met the inclusion criteria. Low-quality evidence from the two RCTs in a meta-analysis with 264 recipients found it was uncertain whether the risk of SSI was reduced by having intensive glycemic control (Risk Ratio [RR] 1.52, 95% CI 0.66-3.51). However, there was an increased risk of hypoglycemia among recipients having intensive glycemic control (RR 2.34, 95% CI 1.40-3.92) n = 264. Meta-analyses found it uncertain whether secondary outcomes, allograft rejection and death, were reduced among recipients having intensive glycemic control; (RR 0.85, 95% CI 0.48-1.50) and (RR 0.92, 95% CI 0.44-1.95), respectively. The two cohort studies were poor quality and presented conflicting outcomes on the effects of intensive blood glucose control on SSI. CONCLUSION: There is insufficient evidence to recommend the use of intensive glycemic control among liver transplant recipients to reduce SSIs.

Perioperative body temperature maintenance and occurrence of surgical site infection: A systematic review with meta-analysis.

BACKGROUND: Current guidelines recommend perioperative warming as one of the strategies to prevent surgical site infection, although there are gaps in the knowledge produced on this issue. AIM: Assess the efficacy of active warming methods to maintain perioperative patients' body temperature and its effect on the occurrence of surgical site infection. METHODS: A systematic review with meta-analysis was carried out. PubMed, CINAHL, LiLACS, CENTRAL, and EMBASE databases were searched. FINDINGS: Of the 956 publications identified, 9 studies were selected for quantitative synthesis and 6 for the meta-analysis. The forced-air warming system was investigated in 8 studies. The generated evidence indicated that the use of an active warming method could maintain higher average body temperature as well as could decrease the surgical site infection incidence. Exposure of the patient to temperatures below 36°C in the perioperative period increased the chances of developing this type of infection. The meta-analysis indicated that the association between perioperative active warming methods compared with others to reduce the chances of developing surgical site infection remains unclear (odds ratio = e-3.59 = 2.718-0.59 = 0.552, 95% confidence interval (odds ratio) = (0.269-1.135), P = 0.106 I2 = 54.34%). CONCLUSIONS: The employment of an active warming method is effective to maintain higher averages of body temperature. However, more randomized clinical trials are needed to assess the efficacy of that intervention to prevent surgical site infection.

Efeitos do controle glicêmico intensivo pós-operatório sobre a incidência de infecção do sítio cirúrgico entre receptores de transplante de fígado: um ensaio clínico controlado randomizado / Effects of intensive blood glucose control on surgical site infection for liver transplant recipients: A Randomized Controlled Trial

Introdução: As evidências disponíveis na literatura científica a respeito dos efeitos do controle glicêmico intensivo como estratégia para prevenção de infecção do sítio cirúrgico (ISC) entre receptores de transplante de fígado são limitadas. Objetivo: Avaliar os efeitos de um protocolo intensivo de controle glicêmico pós-operatório, comparativamente a um protocolo institucional padrão, sobre a incidência de ISC entre receptores de transplante de fígado. Método: Ensaio clínico controlado randomizado, paralelo, composto por dois grupos, a saber: receptores de transplante de fígado submetidos ao controle glicêmico intensivo (CGI) (80-130 mg/dL) ou controle glicêmico padrão (CGP) (130-180 mg/dL), até o início da ingestão de alimentos pela via oral ou por cateter nasoentérico. O desfecho primário, ISC, foi avaliado até o 30o dia do pós-operatório. A avaliação foi realizada por um Comitê de Adjudicação cegado, adotando a definição estabelecida pelo Centers for Disease Control and Prevention. A análise dos dados foi realizada por intenção de tratar. As associações foram verificadas utilizando-se os testes Qui-quadrado de Pearson ou Exato de Fisher. As comparações entre médias ou medianas foram feitas por meio dos testes t de Student ou de Mann-Whitney, a depender do atendimento aos pressupostos de normalidade segundo o teste de Kolmogorov-Smirnov. A comparação de médias de glicemia entre os grupos ao longo do tempo foi obtida por meio da Análise de Variâncias (ANOVA) com medidas repetidas. O nível de significância adotado foi de 5%. O número de registro do estudo no ClinicalTrials.gov é NCT03474666. Resultados: Dos 41 receptores de transplante de fígado inscritos para participação no estudo, 20 foram randomicamente alocados no grupo CGI e 21 no grupo CGP. As incidências de ISC foram semelhantes entre os grupos (CGI 3/20 e CGP 5/21) (RR 0,78; IC 95% 0,21-2,88; P=0,695). A média de glicemia, no período inicial de 24 horas após o transplante, foi significativamente inferior no grupo CGI comparativamente ao CGP (145,0 ± 20,7 mg/dL vs. 230,2 ± 51,5 mg/dL; P=0,001). Episódios de hipoglicemia severa não foram observados nos grupos de estudo. Hiperglicemia e hiperglicemia severa foram significativamente menos frequentes no grupo CGI (RR 0,70; IC 95% 0,52-0,93; P=0,009 e RR 0,07; IC 95% 0,01-0,48; P<0,001, respectivamente). O tempo de ventilação mecânica foi semelhante entre os grupos (CGI 19,6 ± 14,7 horas vs. 16,2 ± 11,3 horas; P=0,884). Tendência de menor tempo de internação em UTI foi observada no CGI (8,0 [4,0-13,5 dias]) em comparação ao CGP (11,0 [7,0-15,0 dias]) (P=0,097). O tempo de estadia hospitalar pós-operatória foi significativamente mais breve, em aproximadamente seis dias, no CGI em comparação ao CGP (13,1 ± 5,5 dias vs. 19,3 ± 12,1 dias; P= 0,043). A ocorrência de óbito em até 90 dias após o transplante foi semelhante entre os grupos (CGI 20% vs. 14,3%; P= 0,697). Receptores acometidos por ISC incisional profunda ou órgão/cavidade apresentaram risco superior de óbito comparativamente àqueles que não desenvolveram (RR 4,95; IC 95% 1,54-15,86; P=0,007). Conclusão: Os resultados deste estudo não apontaram redução na incidência de ISC por meio do emprego de um protocolo intensivo de controle glicêmico. Contudo, verificou-se que os receptores alocados no grupo CGI apresentaram médias glicêmicas inferiores, menor incidência de hiperglicemia e hiperglicemia severa, e menor tempo de internação pós-operatória. Considerando que esse estudo foi conduzido em um único centro transplantador de um país em desenvolvimento, sugere-se a realização de estudos multicêntricos a fim de que sejam confirmados os resultados.

Background: The evidence supporting intensive blood glucose control to prevent surgical site infections (SSIs) among liver transplant recipients is insufficient. Aim: To assess the effects of postoperative intensive blood glucose control protocol (IBGC) against standard blood glucose control (SBGC) on the incidence of SSI among adult liver transplant recipients. Methods: This is a parallel-design, randomized controlled trial, comparing two blood glucose control protocol beginning at the time of the post-operative admission of the recipient to the Intensive Care Unit. All recipients who consented to take part in this trial were randomly assigned to either group, IBGC (blood glucose targeted on 80-130 mg/dL) or SBGC (130-180 mg/dL). The primary outcome, SSI was assessed at 30 days by a blind adjudication panel. This trial was approved by the relevant ethics committee before the study initiation and enrolment. Analysis was based on intention-to-treat information. Categorical variables were analysed by Pearson's chi-squared test or Fisher's exact test, as appropriate. Normality was tested using the Kolmogorov-Smirnov test. Continuous variables were analysed by the Student t test for normally distributed data and the Mann-Whitney test for all other data. The comparison between glycaemic levels was calculated using analysis of variance of repeated measures (ANOVA). To keep the level of global significance the Bonferroni correction was used. Statistical significance was set at P= 0.05. The ClinicalTrials.gov identifier is NCT03474666. Results: Of the 41 liver transplant recipients enrolled onto the trial, 20 were randomly allocated to the IBGC group and 21 to the SBGC group. There were no significant differences in SSIs among recipients allocated to either group (RR 0,78, 95% CI 0.21-2.88; P=0.695). Mean blood glucose levels were significantly lower in the IBCG group in the 24-hour period after surgery (145.0 ± 20.7 mg/dL and 230.2 ± 51.6 mg/dL; P=0.001). While there were fewer episodes of hypoglycaemia in the IBGC group, this did not reach statistical significance. There were no episodes of severe hypoglycaemia in either group. Hyperglycaemia and severe hyperglycaemia were significantly more frequent in the SBGC group (RR 0.70, 95% CI 0.52-0.93; P=0.009 and RR 0.07; 95% CI 0.01-0.48; P< 0.001, respectively). The length of mechanic ventilation was similar between the two groups (IBGC 19.6 ± 14.7 h vs 16.2 ± 11.3 h; P=0.884). A tendency of shorter length of ICU stay was detected on the IBGC (8.0 [4.0-13.5 days]) comparatively to the SBGC (11.0 [7.0-15.0 days]) (P=0.097). Length of hospital stay was significantly shorter for recipients in the IBGC group (13.1 ± 5.5 vs 19.3 ± 12.1 days; P=0.043). The occurrence of death was similar between recipients allocated to the IBGC and SBGC (20.0% vs. 14.3%; P=0.697). The risk of death was higher among recipients who developed deep incisional or organ/space SSI comparatively to those who did not (RR 4.95; CI 95% 1.54- 15.86; P=0.007). Conclusion: Although this small trial did not find intensive blood glucose control reduced SSI, it was associated with lower blood glucose levels, fewer episodes of hyperglycaemia and severe hyperglycaemia, and shorter length of hospital stay. Also, this trial was carried out in a single transplant centre in a middle-income country. It would be interesting to see if the results were supported by a multicentre trial.

Knowledge of responsible technical nurses on management skills: a qualitative study.

OBJECTIVE: To identify the knowledge of responsible technical nurses in relation to the general and management skills required to perform this function. METHOD: Qualitative case study with 14 nurses. The semi-structured interviews were recorded and the data analyzed through the thematic content analysis. RESULTS: Two categories stood out: Main Responsibilities for the Position of Technical Manager: Leadership, Interpersonal Relationship and Systemic view; and Developing Skills: Dissociation between Theory and Practice. FINAL CONSIDERATIONS: The fact that only three skills have been recognized as necessary for the exercise of the function of technical leader and the perception of the interviewees about the dissociation between theory and practice during graduation should be explored by the teaching and health institutions, because to exercise this nurses must develop the technical-scientific, socio-educational and ethical-political skills to be able to lead the organization to positive results..

A Retrospective Cohort Study of Risk Factors for Surgical Site Infection Following Liver Transplantation.

BACKGROUND: Surgical site infection is an important complication in the postoperative period among liver transplant recipients. However, little is known about the risk factors in this patient group. Therefore, the objective of this study was to analyze the incidence and risk factors for surgical site infections among adult liver transplant recipients. METHODS: Medical records of adult liver transplant recipients from January 1, 2009, to December 31, 2015, were analyzed in this retrospective cohort study. RESULTS: We enrolled 156 recipients' medical records. Forty-two (26.9%) cases of surgical site infections were identified. The main isolated microorganisms were methicillin-resistant Staphylococcus species, extended spectrum ß-lactamase-producing Klebsiella species, carbapenem-resistant Pseudomonas aeruginosa, carbapenem-resistant Acinetobacter baumannii, and vancomycin-susceptible Enterococcus faecalis. We found that long operative times (≥487 minutes) and differences in body mass index between donor and recipient (≥1.3 kg/m2) increased the risk for surgical site infections by approximately 5 times (odds ratio [OR], 5.5; 95% confidence interval [CI], 2.5-11.8), and capillary glycemia ≥175 mg/dL in the first 96 postoperative hours increased the risk by approximately 3 times (OR, 2.97; 95% CI, 1.43-6.17). CONCLUSIONS: There was a high incidence of surgical site infections among the studied population and that some risk factors identified differ from those reported in the scientific literature.

Knowledge of responsible technical nurses on management skills: a qualitative study / Conocimiento de enfermeros responsables técnicos sobre competencias gerenciales: Un estudio cualitativo / Conhecimento de enfermeiros responsáveis técnicos sobre competências gerenciais: um estudo qualitativo

ABSTRACT Objective: To identify the knowledge of responsible technical nurses in relation to the general and management skills required to perform this function. Method: Qualitative case study with 14 nurses. The semi-structured interviews were recorded and the data analyzed through the thematic content analysis. Results: Two categories stood out: Main Responsibilities for the Position of Technical Manager: Leadership, Interpersonal Relationship and Systemic view; and Developing Skills: Dissociation between Theory and Practice. Final considerations: The fact that only three skills have been recognized as necessary for the exercise of the function of technical leader and the perception of the interviewees about the dissociation between theory and practice during graduation should be explored by the teaching and health institutions, because to exercise this nurses must develop the technical-scientific, socio-educational and ethical-political skills to be able to lead the organization to positive results..

RESUMEN Objetivo: Identificar el conocimiento de enfermeros responsables técnicos con relación a las competencias generales y gerenciales necesarias para ejercer esta función. Método: Estudio de caso cualitativo realizado con 14 enfermeros. Las entrevistas semiestructuradas fueron grabadas y los datos analizados por medio del análisis temático de contenido. Resultados: Dos categorías se destacaron: Principales competencias para ejercer el cargo de responsable técnico: Liderazgo, relación interpersonal y visión sistémica; y Desarrollando las competencias: Disociación entre teoría y práctica. Consideraciones finales: El hecho de que sólo tres competencias hayan sido reconocidas como necesarias para el ejercicio de la función de responsable técnico y la percepción de los entrevistados sobre la disociación entre teoría y práctica durante la graduación, deben ser explotadas por las instituciones de enseñanza y salud, pues para ejercer ese papel el enfermero debe desarrollar las competencias técnico-científicas, socioeducativas y ético-políticas, para poder conducir a la organización a resultados positivos.

RESUMO Objetivo: Identificar o conhecimento de enfermeiros responsáveis técnicos com relação às competências gerais e gerenciais necessárias para exercer esta função. Método: Estudo de caso qualitativo realizado com 14 enfermeiros. As entrevistas semiestruturadas foram gravadas e os dados analisados por meio da análise temática de conteúdo. Resultados: Duas categorias destacaram-se: Principais competências para se exercer o cargo de responsável técnico: liderança, relacionamento interpessoal e visão sistêmica e Desenvolvendo as competências: dissociação entre teoria e prática. Considerações finais: O fato de apenas três competências terem sido reconhecidas como necessárias para o exercício da função de responsável técnico e a percepção dos entrevistados sobre a dissociação entre teoria e prática, durante a graduação, devem ser exploradas pelas instituições de ensino e saúde, pois para exercer esse cargo, o enfermeiro deve desenvolver as competências técnico-científica, socioeducativa e ético-política, para poder conduzir à organização a resultados positivos.

Escalas de avaliação de risco para queda: revisão integrativa da literatura / Escalas de evaluación de riesgo de caídas: revisión integrativa de la literatura / Fall risk evaluation scales: an integrative literature review

Objetivo caracterizar e qualificar escalas de avaliação de risco de quedas validadas para emprego entre pacientes adultos hospitalizados. Método revisão integrativa da literatura que incluiu investigações desenvolvidas entre pacientes hospitalizados com idade igual ou superior a 18 anos, consultadas as bases de dados LILACS, PubMed, CINAHL e Embase. Resultados localizaram-se 319 artigos, dos quais 9 foram incluídos nesta revisão. A maioria das escalas foi criada entre os anos de 1989 e 1999, para avaliação de riscos entre adultos e idosos. Os domínios mobilidade (88,8%), história de queda (88,8%), estado mental (66,6%), incontinência (77,7%), uso de medicamentos (66,6%) e déficit sensorial (55,5%) foram mais frequentemente empregados. Quatro escalas (44,4%) apresentaram resultados de testes para avaliação de propriedades psicométricas. Conclusão as escalas encontradas na literatura científica não apresentaram consenso entre os domínios para predição de quedas e a maioria não foi submetida à avaliação das propriedades psicométricas recomendadas.

Objetivo caracterizar y calificar escalas de evaluación de riesgo de caídas validadas para su aplicación en pacientes adultos hospitalizados. Método Revisión integrativa de la literatura que incluyó estudios desarrollados entre pacientes hospitalizados con edad igual o mayor a 18 años, consultadas en las bases LILACS, PubMed, CINAHL y Embase. Resultados Se obtuvieron 319 artículos, 9 de los cuales fueron incluidos en la revisión. La mayoría de las escalas fueron creadas entre 1989 y 1999, para evaluación de riesgos entre adultos y ancianos. Los dominios movilidad (88,8%), historial de caídas (88,8%), estado mental (66,6%), incontinencia (77,7%), uso de medicamentos (66,6%) y déficit sensorial (55,5%) fueron los más habitualmente empleados. Cuatro escalas (44,4%) presentaron resultados de tests para evaluación de propiedades psicométricas. Conclusión Las escalas encontradas en la literatura científica no expresaron consenso entre los dominios para la predicción de caídas. La mayoría no fue sometida a evaluación de propiedades psicométricas recomendadas.

Objective to characterize and qualify fall risk evaluation scales validated for application in hospitalized adult patients. Method an integrative literature review that included investigations developed with hospitalized patients 18 years old or older after consulting the LILACS, PubMed, CINAHL, and Embase databases. Results 319 papers were found, among which nine were included in the present review. Most scales were developed between 1989 and 1999 and oriented to assess fall risk in adults and elderly people. The domains mobility (88.8%), fall history (88.8%), mental state (66.6%), incontinence (77.7%), use of medications (66.6%), and sensory deficit (55.5%) were used most often. Four scales (44.4%) showed test results for the evaluation of psychometric properties. Conclusion the scales found in the scientific literature did not present a consensus on the domains for fall prediction and most were not submitted to evaluation of the recommended psychometric properties.

Nurse work environment: comparison between private and public hospitals.

OBJECTIVE: To compare the characteristics of the work environment that enable the professional practice of nurses in private and public organizations. METHODS: A quantitative, exploratory, cross-section study, carried out in four health organizations - one public and three private, with 188 registered nurses. Participants answered the Brazilian version of the Nursing Work Index - Revised, which aims to evaluate the presence of characteristics that favor the development of nursing activities through 15 items distributed into three subscales: autonomy, control over the practice setting and relationships with physicians. The measurement scale used is Likert, and lower scores represent better evaluation of the environment, i.e. , more favorable characteristics are present to assist the development of nursing activities. RESULTS: The means of the responses of participants of private hospitals were smaller in all subscales of the instrument, as compared to those from public hospitals. CONCLUSION: The environment of private hospitals showed more favorable characteristics to the professional practice of registered nurses than the public hospital environment.

Risk factors for development of surgical site infections among liver transplantation recipients: An integrative literature review.

BACKGROUND: Surgical site infection (SSI) is an important complication in the postoperative period of recipients of liver transplantation. The purpose of this integrative literature review is to summarize the knowledge available about the risk factors contributing to the development SSI among adults undergoing liver transplantation. METHODS: We reviewed the Medical Literature Analysis and Retrieval System Online/PubMed, the Cumulative Index to Nursing and Allied Health Literature, the Latin American and Caribbean Health Sciences Literature, Scopus, and Web of Science databases. RESULTS: Two hundred sixteen articles were identified and the final sample of 9 articles was analyzed in full length. The SSI rate found in the investigations ranged between 9.6% and 35.5%. Risk factors for SSI were grouped into categories related to the preoperative period, such as Model for End-Stage Renal Disease score > 35 and ventilated support on day of transplant; to the intraoperative period activity, such as transfusion of packed red blood cells, extended surgical time, hyperglycemia >200 mg/dL, use of vasopressor drugs, and ascites flow >1 L; and to the donor/recipient relationship, such as age differences >10 years, ratio of donor liver mass to recipient body mass < 0.01. Additionally, centers that annually perform <50 transplants appear to have higher rates of SSI. CONCLUSIONS: Few studies have addressed the subject of SSI in relation to liver transplantation in the scientific literature. Risk factors for SSI in patients who underwent liver transplantation vary between institutions.

Nurse work environment: comparison between private and public hospitals / Ambiente de trabalho do enfermeiro: comparação entre hospitais privados e público

ABSTRACT Objective To compare the characteristics of the work environment that enable the professional practice of nurses in private and public organizations. Methods A quantitative, exploratory, cross-section study, carried out in four health organizations - one public and three private, with 188 registered nurses. Participants answered the Brazilian version of the Nursing Work Index − Revised, which aims to evaluate the presence of characteristics that favor the development of nursing activities through 15 items distributed into three subscales: autonomy, control over the practice setting and relationships with physicians. The measurement scale used is Likert, and lower scores represent better evaluation of the environment, i.e. , more favorable characteristics are present to assist the development of nursing activities. Results The means of the responses of participants of private hospitals were smaller in all subscales of the instrument, as compared to those from public hospitals. Conclusion The environment of private hospitals showed more favorable characteristics to the professional practice of registered nurses than the public hospital environment.

RESUMO Objetivo Comparar as características do ambiente de trabalho que favorecem a prática profissional do enfermeiro em instituições privadas e pública. Métodos Estudo quantitativo, exploratório, transversal, realizado em quatro instituições de saúde, sendo uma pública e três privadas, com 188 enfermeiros. Os participantes responderam a versão brasileira do Nursing Work Index − Revised , que tem por objetivo avaliar a presença de características que favorecem o desenvolvimento das atividades do enfermeiro por meio de 15 itens distribuídos em três subescalas: autonomia, controle sobre o ambiente de trabalho e relações entre médicos. A escala de medida utilizada é do tipo Likert e menores pontuações representam melhor avaliação do ambiente, ou seja, mais características favoráveis estão presentes para auxiliar o desenvolvimento das atividades da enfermagem. Resultados As médias das respostas dos participantes dos hospitais privados foram menores em todas as subescalas do instrumento, quando comparadas às do hospital público. Conclusão Os ambientes dos hospitais privados demonstraram possuir mais características favoráveis à prática profissional do enfermeiro do que o ambiente do hospital público.

An Integrative Review of Postoperative Accelerated Recovery Protocols.

We undertook an integrative literature review of articles pertaining to perioperative nursing care provided to patients using postoperative accelerated recovery protocols. To select the articles, we searched the MEDLINE, PubMed, Cumulative Index to Nursing and Allied Health Literature, and LiteraturaLatino-Americana e do Caribe em Ciências da Saúde databases. We identified 329 studies, 13 of which met our inclusion criteria and described perioperative nursing care activities. Nursing activities noted in these articles were hypothermia prevention and maintenance of normothermia, restriction of IV fluids, assessment of vital signs, management of symptoms and pain, support of early ambulation, care for tubes and drains, oral administration of carbohydrate-rich foods, assessment of ability to tolerate diet, and encouragement to resume activities of daily living. There was a lack of research on this topic by nursing professionals; additional research by nursing professionals is needed regarding nurses' roles in providing this care.

Adherence to immunosuppressive therapy following liver transplantation: an integrative review.

OBJECTIVE: to investigate the evidence available in the literature on non-adherence to immunosuppressive therapy among patients undergoing liver transplantation. METHOD: integrative literature review, including research whose sample consisted of patients aged over 18 years undergoing liver transplantation. It excluded those containing patients undergoing multiple organ transplants. For the selection of articles, Medline / Pubmed, CINAHL, LILACS, Scopus and Embase were searched. The search period corresponded to the initial date of indexation of different bases, up to the deadline of February 10, 2015, using controlled and uncontrolled descriptors: liver transplantation, hepatic transplantation, liver orthotopic transplantation, medication adherence, medication non-adherence, medication compliance and patient compliance. RESULTS: were located 191 investigations, 10 of which met the objectives of the study and were grouped into four categories, namely: educational process and non-adherence; non-adherence related to the number of daily doses of immunosuppressive medications; detection methods for non-adherence and side effects of therapy. CONCLUSION: there were risk factors related to the health service, such as control and reduction of the number of doses; related to the individual, such as being male, divorced, alcohol or other substances user, exposed to low social support and being mentally ill.

Adherence to immunosuppressive therapy following liver transplantation: an integrative review / Adesão à terapêutica imunossupressora após o transplante de fígado: revisão integrativa / La adherencia a la terapia inmunosupresora tras un trasplante de hígado: una revisión integradora

ABSTRACT Objective: to investigate the evidence available in the literature on non-adherence to immunosuppressive therapy among patients undergoing liver transplantation. Method: integrative literature review, including research whose sample consisted of patients aged over 18 years undergoing liver transplantation. It excluded those containing patients undergoing multiple organ transplants. For the selection of articles, Medline / Pubmed, CINAHL, LILACS, Scopus and Embase were searched. The search period corresponded to the initial date of indexation of different bases, up to the deadline of February 10, 2015, using controlled and uncontrolled descriptors: liver transplantation, hepatic transplantation, liver orthotopic transplantation, medication adherence, medication non-adherence, medication compliance and patient compliance. Results: were located 191 investigations, 10 of which met the objectives of the study and were grouped into four categories, namely: educational process and non-adherence; non-adherence related to the number of daily doses of immunosuppressive medications; detection methods for non-adherence and side effects of therapy. Conclusion: there were risk factors related to the health service, such as control and reduction of the number of doses; related to the individual, such as being male, divorced, alcohol or other substances user, exposed to low social support and being mentally ill.

RESUMO Objetivo: investigar as evidências disponíveis na literatura sobre a não adesão à terapêutica imunossupressora entre pacientes submetidos ao transplante de fígado. Método: revisão integrativa da literatura, que incluiu investigações cuja amostra era composta por pacientes com idade igual ou superior a 18 anos, submetidos a transplante de fígado. Excluíram-se as que continham pacientes submetidos a transplantes de múltiplos órgãos. Para a seleção dos artigos foram consultadas as bases Medline/Pubmed, CINAHL, LILACS, Scopus e Embase. O período de busca determinado correspondeu à data inicial de indexação das diferentes bases, até a data limite de 10 de fevereiro de 2015, empregando-se os descritores controlados e não controlados: liver transplantation, hepatic transplantation, liver orthotopic transplantation, medication adherence, medication non-adherence, medication compliance e patient compliance. Resultados: foram localizadas 191 investigações, das quais 10 atenderam aos objetivos do estudo e foram agrupadas em quatro categorias, a saber: processo educativo e ocorrência de não adesão; não adesão relacionada ao número de doses diárias dos medicamentos imunossupressores; métodos de detecção da não adesão e efeitos colaterais da terapêutica. Conclusão: verificou-se a existência de fatores de risco relacionados ao serviço de saúde, como controle e redução do número de doses; relacionados ao indivíduo, como ser do sexo masculino, divorciado, usuário de álcool ou outras substâncias, expostos a menor suporte social e portadores de transtorno mental.

RESUMEN Objetivo: investigar la evidencia disponible en la literatura sobre la falta de adherencia a la terapia inmunosupresora en los pacientes sometidos a trasplante hepático. Método: revisión integradora de la literatura, que incluye investigaciones cuya muestra estaba constituida por pacientes mayores de 18 años sometidos a trasplante hepático. Se excluyeron aquellos que tenían pacientes sometidos a trasplantes de varios órganos. Para la selección de los artículos fueron consultadas las bases Medline / Pubmed, CINAHL, LILACS, Scopus y Embase. El período de búsqueda determinado correspondió a la fecha inicial de indexación de las diferentes bases, con fecha límite de 10 de febrero de 2015, usándose descriptores controlados y no controlados: liver transplantation, hepatic transplantation, liver orthotopic transplantation, medication adherence, medication non-adherence, medication compliance e patient compliance. Resultados: se localizaron 191 investigaciones, de los cuales 10 cumplieron con los objetivos del estudio y se agruparon en cuatro categorías, a saber: proceso educativo y ocurrencia de no adhesión; falta de adhesión relacionada con el número de dosis diarias de medicamentos inmunosupresores; métodos de detección de la falta de adhesión y los efectos secundarios de la terapia. Conclusión: se verificaron factores de riesgo relacionados con el servicio de salud, tales como el control y la reducción del número de dosis; inherentes a la persona, como ser hombre, divorciado, usuario de alcohol u otras sustancias, expuestos a un menor apoyo social y portadores de enfermedades mentales.

Perfil do trabalho e acidentes na atividade ocupacional de motociclistas profissionais / Profile of labor and accidents in the occupational activity of motorcyclist workers

Objetivo: caracterizar o perfil dos motociclistas profissionais, as condições de trabalho, bem como a ocorrência de acidentes e adoecimentos laborais. Método: estudo descritivo, de abordagem quantitativa, realizado em uma cidade mineira, com 131 motociclistas profissionais. Na coleta de dados, utilizou-se um questionário e os dados foram analisados no software SPSS. A pesquisa teve aprovado o projeto pelo Comitê de Ética em Pesquisa, CAAE nº 0026.0.213.000-09. Resultados: 95,4% eram homens, 55,7% tinham de 21 a 30 anos, 45% com ensino médio completo, 57,3% já sofreram acidente de trabalho e somente 1,5% utilizavam todos os equipamentos de proteção individual. Conclusão: o trabalho dos motoboys é realizado de forma precária e repleto de riscos, suas condições de trabalho favorecem o adoecimento. Sugerem-se mudanças na legislação e na fiscalização no sentido de reduzir a informalidade, bem como melhorar a proteção social e sanitária desta classe trabalhadora.(AU)

Objective: to characterize the profile of motorcyclist workers, the working conditions and the occurrence of occupational accidents and illnesses. Method: a descriptive study with quantitative approach, performed in a town of Minas Gerais state, with 131 motorcyclist workers. During data collection, we used a questionnaire and the data were analyzed using SPSS software. The research had its project approved by the Research Ethics Committee, CAAE No. 0026.0.213.000-09. Results: 95.4% were men, 55.7% were between 21 and 30 years old, 45% had completed high school, 57.3% had already suffered accidents at work and only 1.5% used all personal protective equipment. Conclusion: the work of professional motorcyclists is performed in a precarious and risky manner, their working conditions favor the illness. Changes are suggested in legislation and monitoring in order to reduce informality and improve the social and health protection of this working class.(AU)

Objetivo: caracterizar el perfil de los motociclistas profesionales, las condiciones de trabajo, así como la ocurrencia de accidentes y enfermedades laborales. Método: estudio descriptivo, de abordaje cuantitativo, realizado en una ciudad minera, con 131 motociclistas profesionales. La recolección de datos utilizó cuestionario y los datos analizados en el software SPSS. La investigación aprobó el proyecto por el Comité de Ética en Investigación, CAAE 0026.0.213.000-09. Resultados: 95,4% eran hombres, 55,7% tenían de 21 a 30 años, 45% con secundaria completa, 57,3 ya sufrieron accidentes de trabajo y solamente 1,5% utilizaban todos los equipamientos de protección individual. Conclusión: el trabajo de los motoboys es realizado de forma precaria y repleto de riesgos, sus condiciones de trabajo favorecen las enfermedades. Se sugieren cambios en la legislación y en la legislación y en la fiscalización con el sentido de reducir la informalidad, así como mejorar la protección social y sanitaria de ésta clase trabajadora.(AU)