Tecnologias para manutenção do Cateter Central de Inserção Periférica em neonatos: revisão integrativa / Tecnologías para el mantenimiento del Catéter Central de Inserción Periférica en neonatos: revisión integrativa / Technologies for maintenance of Peripherally Inserted Central Catheter in neonates: an integrative review

Objetivo: analisar a literatura científica acerca das tecnologias e cuidados para posicionamento e reposicionamento do cateter central de inserção periférica (PICC) em neonatos. Método: revisão integrativa, com busca realizada em fevereiro de 2022 em quatro bases de dados. Resultados: incluíram-se 32 estudos que abordam uso de tecnologias para verificação da localização do PICC, procedimentos para seu posicionamento e manobras para reposicionamento. Para posicionamento adequado deve-se atentar para seleção do vaso, mensuração correta do dispositivo e manutenção do bem-estar do recém-nascido. Frente ao mal posicionamento sugere-se a movimentação do membro, flush, tração do cateter, e conduta expectante. A verificação da localização da ponta é rotineira, por meio de radiografia, ultrassonografia ou eletrocardiograma. Conclusão: recomenda-se a adoção de tecnologias não invasivas para o posicionamento e reposicionamento do PICC em neonatos. As evidências apontam para competência profissional na tomada de decisão para o cuidado seguro e de qualidade, e prevenção de eventos adversos.

Objective: to analyze the scientific literature on technologies and care for positioning and repositioning of the peripherally inserted central catheter (PICC) in neonates. Method: integrative review, with search conducted in February 2022 in four databases. Results: 32 studies were included that address the use of technologies to verify the location of the PICC, procedures for its positioning and maneuvers for repositioning. For proper positioning should pay attention to the selection of the vessel, correct measurement of the device and maintenance of the well-being of the newborn. In the face of poor positioning, it is suggested limb movement, flush, catheter traction, and expectant management. The verification of the tip location is routine, by radiography, ultrasonography or electrocardiogram. Conclusion: the adoption of non-invasive technologies for the positioning and repositioning of PICC in neonates is recommended. The evidence points to professional competence in decision making for safe and quality care and prevention of adverse events.

Objetivo: analizar la literatura científica acerca de las tecnologías y cuidados para posicionamiento y reposicionamiento del catéter central de inserción periférica (PICC) en neonatos. Método: revisión integrativa, con búsqueda realizada en febrero de 2022 en cuatro bases de datos. Resultados: se incluyeron 32 estudios que abordan el uso de tecnologías para verificar la localización del PICC, procedimientos para su posicionamiento y maniobras para reposicionamiento. Para un posicionamiento adecuado se debe prestar atención a la selección del recipiente, la medición correcta del dispositivo y el mantenimiento del bienestar del recién nacido. Frente al mal posicionamiento se sugiere el movimiento de la extremidad, color, tracción del catéter, y conducta expectante. La verificación de la localización de la punta es rutinaria, por medio de radiografía, ultrasonido o electrocardiograma. Conclusión: se recomienda la adopción de tecnologías no invasivas para el posicionamiento y reposicionamiento del PICC en neonatos. La evidencia apunta a la competencia profesional en la toma de decisiones para el cuidado seguro y de calidad, y la prevención de eventos adversos.

The health facility as a risk factor for multidrug-resistant gram-negative bacteria in critically ill patients with COVID-19.

BACKGROUND: The relationship between Multidrug Resistant-Gram Negative Bacteria (MDR-GNB) infection and colonization in critically ill COVID-19 patients has been observed, however, it is still poorly understood. This study evaluated the risk factors for acquiring MDR-GNB in patients with severe COVID-19 in Intensive Care Units (ICU). METHODS: This is a nested case-control study in a cohort of 400 adult patients (≥ 18 years old) with COVID-19, hospitalized in the ICU of 4 hospitals in the city of Curitiba, Brazil. Cases were critical COVID-19 patients with one or more MDR GNB from any surveillance and/or clinical cultures were taken during their ICU stay. Controls were patients from the same units with negative cultures for MDR-GNB. Bivariate and multivariate analyses were done. RESULTS: Sixty-seven cases and 143 controls were included. Independent risk factors for MDR bacteria were: male gender (OR = 2.6; 95% CI 1.28‒5.33; p = 0.008); the hospital of admission (OR = 3.24; 95% CI 1.39‒7.57; p = 0.006); mechanical ventilation (OR = 25.7; 95% CI 7.26‒91; p < 0.0001); and desaturation on admission (OR = 2.6; 95% CI 1.27‒5.74; p = 0.009). CONCLUSIONS: Male gender, desaturation, mechanical ventilation, and the hospital of admission were the independent factors associated with MDR-GNB in patients in the ICU with COVID-19. The only modifiable factor was the hospital of admission, where a newly opened hospital posed a higher risk. Therefore, coordinated actions toward a better quality of care for critically ill COVID-19 patients are essential.

The health facility as a risk factor for multidrug-resistant gram-negative bacteria in critically ill patients with COVID-19

Abstract Background The relationship between Multidrug Resistant-Gram Negative Bacteria (MDR-GNB) infection and colonization in critically ill COVID-19 patients has been observed, however, it is still poorly understood. This study evaluated the risk factors for acquiring MDR-GNB in patients with severe COVID-19 in Intensive Care Units (ICU). Methods This is a nested case-control study in a cohort of 400 adult patients (≥ 18 years old) with COVID-19, hospitalized in the ICU of 4 hospitals in the city of Curitiba, Brazil. Cases were critical COVID-19 patients with one or more MDR GNB from any surveillance and/or clinical cultures were taken during their ICU stay. Controls were patients from the same units with negative cultures for MDR-GNB. Bivariate and multivariate analyses were done. Results Sixty-seven cases and 143 controls were included. Independent risk factors for MDR bacteria were: male gender (OR = 2.6; 95% CI 1.28‒5.33; p = 0.008); the hospital of admission (OR = 3.24; 95% CI 1.39‒7.57; p = 0.006); mechanical ventilation (OR = 25.7; 95% CI 7.26‒91; p < 0.0001); and desaturation on admission (OR = 2.6; 95% CI 1.27‒5.74; p = 0.009). Conclusions Male gender, desaturation, mechanical ventilation, and the hospital of admission were the independent factors associated with MDR-GNB in patients in the ICU with COVID-19. The only modifiable factor was the hospital of admission, where a newly opened hospital posed a higher risk. Therefore, coordinated actions toward a better quality of care for critically ill COVID-19 patients are essential.

Safe surgery: validation of pre and postoperative checklists.

Objective: to develop, evaluate and validate a surgical safety checklist for patients in the pre and postoperative periods in surgical hospitalization units. Method: methodological research carried out in a large public teaching hospital in the South of Brazil, with application of the principles of the Safe Surgery Saves Lives Programme of the World Health Organization. The checklist was applied to 16 nurses of 8 surgical units and submitted for validation by a group of eight experts using the Delphi method online. Results: the instrument was validated and it was achieved a mean score ≥1, level of agreement ≥75% and Cronbach's alpha >0.90. The final version included 97 safety indicators organized into six categories: identification, preoperative, immediate postoperative, immediate postoperative, other surgical complications, and hospital discharge. Conclusion: the Surgical Safety Checklist in the Pre and Postoperative periods is another strategy to promote patient safety, as it allows the monitoring of predictive signs and symptoms of surgical complications and the early detection of adverse events.

Safe surgery: validation of pre and postoperative checklists / Cirurgia segura: validação de checklist pré e pós-operatório / Cirugía segura: validación de checklist pre y postoperatorio

ABSTRACT Objective: to develop, evaluate and validate a surgical safety checklist for patients in the pre and postoperative periods in surgical hospitalization units. Method: methodological research carried out in a large public teaching hospital in the South of Brazil, with application of the principles of the Safe Surgery Saves Lives Programme of the World Health Organization. The checklist was applied to 16 nurses of 8 surgical units and submitted for validation by a group of eight experts using the Delphi method online. Results: the instrument was validated and it was achieved a mean score ≥1, level of agreement ≥75% and Cronbach's alpha >0.90. The final version included 97 safety indicators organized into six categories: identification, preoperative, immediate postoperative, immediate postoperative, other surgical complications, and hospital discharge. Conclusion: the Surgical Safety Checklist in the Pre and Postoperative periods is another strategy to promote patient safety, as it allows the monitoring of predictive signs and symptoms of surgical complications and the early detection of adverse events.

RESUMO Objetivo: elaborar, avaliar e validar um checklist de segurança cirúrgica para os períodos pré e pós-operatório de unidades de internação cirúrgica. Método: pesquisa metodológica, realizada em hospital de ensino público de grande porte do Sul do Brasil, com aplicação dos fundamentos do Programa Cirurgias Seguras Salvam Vidas da Organização Mundial da Saúde. O checklist foi aplicado a 16 enfermeiros de oito unidades cirúrgicas, e submetido à validação por meio da técnica Delphi on-line com oito especialistas. Resultados: o instrumento foi validado, obtendo-se ranking médio ≥1, grau de concordância ≥75% e Alfa de Cronbach >0,90. A versão final contemplou 97 indicadores de segurança organizados em seis categorias: identificação, pré-operatório, pós-operatório imediato, pós-operatório mediato, outras complicações cirúrgicas, e alta hospitalar. Conclusão: o Checklist de Segurança Cirúrgica Pré e Pós-Operatório é mais uma estratégia na promoção da segurança do paciente, pois possibilita monitorar sinais e sintomas preditivos de complicações cirúrgicas e detecção precoce de eventos adversos.

RESUMEN Objetivo: desarrollar, evaluar y validar un checklist de seguridad quirúrgica para los períodos pre y postoperatorio de unidades de hospitalización quirúrgica.. Método: investigación metodológica llevada a cabo en un amplio hospital público de enseñanza del Sur de Brasil, con aplicación de los principios del Programa de Cirugía Segura Salva Vidas de la Organización Mundial de la Salud. El checklist se aplicó a 16 enfermeros de 8 unidades quirúrgicas y fue sometida a validación por ocho expertos utilizando el método Delphi en línea. Resultados: el instrumento fue validado y se logró una puntuación media ≥1, grado de acuerdo ≥75% y alfa de Cronbach >0.90. La versión final incluyó 97 indicadores de seguridad organizados en seis categorías: identificación, preoperatorio, postoperatorio inmediato, postoperatorio inmediato, otras complicaciones quirúrgicas y alta hospitalaria. Conclusión: el Checklist de Seguridad Quirúrgica en el Período Pre y Postoperatorio es otra estrategia más para promover la seguridad del paciente, ya que permite monitorear los signos y síntomas predictivos de las complicaciones quirúrgicas y la detección temprana de eventos adversos.

Fatores de risco para a ocorrência de bactérias multirresistentes em pacientes críticos / Risk factors for the occurrence of multi-resistant bacteria in critically ill patients

Resumo: A ocorrência bactérias resistentes aos antimicrobianos representa grave e crescente problema de saúde pública mundial. Investigar os fatores de risco associados a esse evento contribui para o conhecimento e subsidia o planejamento de medidas de prevenção e controle, culminando em redução na mortalidade e economia de recursos financeiros. Este estudo teve por objetivo investigar a ocorrência de bactérias multirresistentes em pacientes hospitalizados na unidade de terapia intensiva geral para adultos de hospital de ensino. Pesquisa observacional, transversal e prospectiva observou preceitos éticos e legais e utilizou como fonte de dados o prontuário dos pacientes admitidos na unidade entre 31 de março a 31 de julho de 2016,com idade 18 anos e tempo de internação 24 horas. Foram excluídos da pesquisa aqueles que permaneceram na unidade após 31 de agosto de 2016. Os dados do prontuário foram transferidos para ficha física e posteriormente para planilha do Microsoft Excel. Os fatores de risco para bactérias multirresistentes entre os grupos de desfecho positivo e desfecho negativo (adquirir e não adquirir bactéria multirresistentes na unidade, respectivamente) foram comparados e analisados por meio de estatística descritiva e analítica, com análise univariada (t de Student para amostras independentes e Mann-Whitney para variáveis de tempo) e análise multivariada (regressão logística). Valores de p 0,05 foram considerados significativos. No período de estudo foram admitidos 239 pacientes,185 incluídos na pesquisa e 44 (23,8%) tiveram desfecho positivo, predominantemente colonização. Admissão clínica, comprometimento imunológico, tempo de hospitalização, uso de antibióticos e admissão em leito previamente ocupado por paciente colonizado/infectado por bactéria multirresistente foram fatores de risco independentes para desfecho positivo. Uso e tempo de exposição a dispositivo invasivo, e internação em leito próximo a paciente colonizado/infectado foram fatores de risco para desfecho positivo na análise multivariada. Com base no mapeamento da ocorrência dos casos infere-se que a transmissão cruzada contribuiu para adquirir bactéria multirresistentes na unidade, fator esse dependente de confirmação por análise molecular dos isolados, indisponível nesta pesquisa. Como medida imediata para o controle de fatores de risco modificáveis, recomendam-se ações para a sanitização do ambiente e rigor na permanência, restrita ao mínimo necessário, de dispositivos invasivos, visando à segurança do paciente crítico.

Abstract: Antimicrobial resistance occurrence represents a serious and growing threat for global public health. Study the risk factors associated with this event contributes to the knowledge and supports the adoption of prevention and control measures, resulting in mortality reduction and cost saving. This study aimed to investigate the occurrence of multidrug resistant bacteria in hospitalized patients in the general intensive care unit for adult teaching hospital. Observational, cross-sectional and prospective research, observed ethical and legal precepts and used as a data source the medical records of patients admitted to the unit between March 31 and July 31, 2016, with age 18 years and length of hospital stay 24 hours. The participants who remained in the unit after August 31, 2016 were excluded from the survey. Data from the medical record were compiled and transferred to Microsoft Excel worksheets. The risk factors for multidrug resistant bacteria between the groups of positive outcome and negative outcome (acquisition and non-acquisition of multidrug resistant bacteria in the unit, respectively) were compared and analyzed using descriptive and analytical statistics, with univariate analysis (Student's test for independent samples and Mann-Whitney for time relative variables) and multivariate analysis(logistic regression). P values?0.05 were considered statistically significant. During the study period, 239 patients were admitted, 185 included in the study and 44 (23.8%) had a positive outcome, most of them colonization. Clinical admission, immunological compromise, hospitalization time, use of antibiotics and admission to bed prior occupied by carriers of multidrug resistant bacteria were independent risk factors for positive outcome. Use and time of exposure to invasive devices, and bed placement in close to colonized / infected patients were risk factors for a positive outcome in the multivariate analysis. Based on the mapping of the occurrence of cases, it was inferred that cross-transmission contributed to acquire multidrug resistant bacteria in the unit, a factor that depends on confirmation by molecular analysis of the isolates, unavailable in this study. As an immediate measure for the control of modifiable risk factors, actions are recommended for the sanitization of the environment and rigor in the stay, restricted to the minimum necessary, of invasive devices, aiming at the safety of critical patients.