Quality indicators for the processing of health products: A mixed-methods study.

OBJECTIVE: to analyze the use of quality assessment indicators and their implementation to improve quality in the processing of health products. METHOD: a mixed-methods study with a multiple case approach using Structure, Process and Results indicators and elaboration of a plan using Appreciative Inquiry, carried out in four central sterile supply departments from hospital units. RESULTS: the indicators for the Cleaning stage presented 47.8% compliance for Structure and 59.0% for Process: in addition 71.8% of the products were clean. In the Preparation operational stage, 50.0% of the Results indicators were in compliance for Structure and 66.7% for Process. In the Sterilization, Storage and Distribution stage, 43.5% compliance was obtained for Structure, 55.7% for Process and 78.6% for Packaging conservation. Appreciative planning proposed improvements to the physical structure, review of processes and protocols, promotion and appreciation of the work done and strengthening of teaching about processing and service management, highlighting the protagonism of the group and of the leaders. CONCLUSION: using indicators was positive in materializing reality; however, it was verified that the improvements proposed are related to people. The affirmative and constructive view of Appreciative Inquiry presented itself as a path to changes and quality improvements.

Reutilización de barrera de tela de algodón estéril en la práctica clínica: estudio observacional longitudinal / Reusing sterile cotton fabric barriers in the clinical practice: an observational and longitudinal study / Reuso de barreira estéril de tecido de algodão na prática clínica: estudo longitudinal observacional

Objetivo: analizar las características de barrera física y biológica de los campos de algodón utilizados como sistema de barrera estéril después de ser sometidos a múltiples usos y procesos en la práctica clínica. Método: estudio observacional longitudinal de seguimiento y evaluación de tela 100% algodón, utilizada como sistema de barrera estéril en un hospital de mediano porte. Se recolectaron muestras antes del uso (después de tres lavados) y después de tres, seis, nueve, 12 y 15 meses de uso y se evaluaron el número, grosor e integridad de los hilos, peso, absorción de agua y penetración húmeda de microorganismos. Resultados: después de 85 lavados, no cambió el número de hilos, aumentó el número de fibras deshilachadas y el volumen de agua absorbida. La prueba microbiológica mediante la metodología estándar alemana obtuvo un resultado negativo y la de penetración húmeda de microorganismos no mostró cambios significativos con el tiempo, a pesar de que una fracción de células microbianas pasó a través de las muestras de doble capa. Conclusión: las propiedades físicas de la tela 100% algodón utilizada como sistema de barrera estéril cambiaron con el uso/procesamiento; sin embargo, no interfirieron significativamente con los resultados obtenidos en las pruebas realizadas a la barrera microbiológica hasta los 85 lavados.

Objective: to analyze the physical and biological barrier characteristics of cotton fields used as a sterile barrier system after multiple use and processing cycles in the clinical practice. Method: an observational and longitudinal study to monitor and evaluate 100% cotton fabric used as a sterile barrier system in a medium-sized hospital. Samples were collected before use (after three washes) and at three, six, nine, 12 and 15 months of use and evaluated for the number, thickness and integrity of threads, weight, water absorption and wet penetration by microorganisms. Results: after 85 washes, the number of threads remained unchanged, and the shredded fibers and the water volume absorbed were increased. The microbiological test using the German standard methodology obtained a negative result and wet penetration by microorganisms did not show significant changes over time, although a percentage of the microbial cells passed through the double-layer samples. Conclusion: the physical properties of 100% cotton used as a sterile barrier system changed with use/processing cycles; however, these alterations did not significantly interfere with the results obtained by the tests performed on the microbiological barrier up to 85 washes.

Objetivo: analisar as características de barreira física e biológica de campos de algodão, que são utilizados como sistema de barreira estéril, após múltiplos usos e processamentos na prática clínica. Método: estudo longitudinal observacional de acompanhamento e de avaliação de tecido 100% algodão que foi utilizado como sistema de barreira estéril em um hospital de médio porte. Amostras foram coletadas antes do uso (após três lavagens) e com três, seis, nove, 12 e 15 meses de uso e avaliadas quanto ao número, à espessura e à integridade dos fios, peso, absorção de água e penetração úmida de micro-organismos. Resultados: após 85 lavagens, o número de fios permaneceu inalterado, porém aumentaram-se as fibras desfiadas e o volume de água absorvido. O teste microbiológico utilizando metodologia padrão alemão obteve resultado negativo; já o de penetração de úmida de micro-organismos não apresentou mudanças significativas ao longo do tempo, embora uma fração das células microbianas tenham passado pelas amostras de dupla camada. Conclusão: as propriedades físicas do tecido 100% algodão, utilizado como sistema de barreira estéril, alteraram com usos/processamentos; entretanto essas não interferiram significativamente nos resultados obtidos pelos testes realizados na barreira microbiológica até 85 lavagens.

Serological and vaccine evaluation for hepatitis B among Community Health Workers / Avaliação sorológica e vacinal para hepatite B entre Agentes Comunitários de Saúde / Evaluación serológica y vacuna para la hepatitis B entre Agentes Comunitarios de Salud

Abstract Objective: to identify the vaccination and serological status against hepatitis B among community health workers; to vaccinate against hepatitis B virus and to evaluate the immune response of susceptible workers. Method: phase I, cross-sectional and descriptive study, among community health workers in a capital city of the Midwest region, through a self-administered questionnaire, checking of vaccination cards, and blood collection for testing of serological markers for hepatitis B. Phase II, cohort study carried out in vaccinated non-immune workers identified in phase I. They received one dose of vaccine (challenge dose) and serological testing. Results: a total of 109 workers participated in the study. Most had vaccination record (97; 89.0%) and vaccination completeness (75; 77.3%), while the isolated anti-HBs (Antibodies against hepatitis B virus) marker was detected in 78 (71.6%) workers. The prevalence of hepatitis B virus exposure was 8.2%. Of the ten non-immune vaccinated workers, after challenge dose, one remained susceptible. Conclusion: although most workers are vaccinated and show immunological response to hepatitis B, susceptibility after challenge dose was identified. Therefore, it is necessary to have a surveillance program of the vaccination situation and serological status for this virus, to promote these workers' safety.

Resumo Objetivo: identificar a situação vacinal e sorológica contra hepatite B entre agentes comunitários de saúde; vacinar contra o vírus da hepatite B e avaliar a resposta imunológica dos agentes susceptíveis. Método: fase I, estudo transversal e descritivo, entre agentes comunitários de saúde de uma capital da região Centro-oeste, por meio de questionário autoaplicável, conferência do cartão vacinal e coleta de sangue para testagem dos marcadores sorológicos para hepatite B. Fase II, estudo de coorte realizado em trabalhadores vacinados não imunes e identificados na fase I. Estes receberam uma dose da vacina (dose desafio) e teste sorológico. Resultados: participaram do estudo 109 agentes. A maioria tinha registro de vacinação (97; 89,0%) e completude vacinal (75; 77,3%), já o marcador anti-HBs (anticorpos contra o vírus da hepatite B) isolado foi detectado em 78 (71,6%) agentes. A prevalência de exposição ao vírus da hepatite B foi de 8,2%. Dos dez agentes vacinados não imunes, após a dose desafio, um permaneceu susceptível. Conclusão: apesar da maioria dos trabalhadores estarem vacinados e apresentarem resposta imunológica para hepatite B, a suscetibilidade após a dose desafio foi identificada. Portanto, é necessário que haja um programa de vigilância da situação vacinal e estado sorológico para este vírus, para promover a segurança destes trabalhadores.

Resumen Objetivo: identificar la situación de la vacunación y serología contra la hepatitis B entre agentes comunitarios de la salud, vacunar contra el virus de la hepatitis B y evaluar la respuesta inmunológica de los agentes susceptibles. Método: fase I, estudio transversal y descriptivo, entre agentes comunitarios de la salud de una capital de la región centro oeste, por medio de cuestionario autoadministrado, verificación del carné de vacunación y extracción de sangre para comprobar los marcadores serológicos para la hepatitis B. Fase II, estudio de cohorte realizado en trabajadores vacunados no inmunes e identificados en la Fase I; estos recibieron una dosis de la vacuna (dosis de desafío) y realizaron el test serológico. Resultados: participaron del estudio 109 agentes. La mayoría tenía registro de vacunación (97; 89,0%) y de cobertura de vacunación (75; 77,3%); el marcador anti-HBs (Anticuerpos contra el virus de la hepatitis B) aislado fue detectado en 78 (71,6%) de los agentes. La prevalencia de exposición al virus de la hepatitis B fue de 8,2%. De los diez agentes vacunados no inmunes, después de la dosis desafío, uno permaneció susceptible. Conclusión: a pesar de que la mayoría de los trabajadores estaban vacunados y presentaron respuesta inmunológica para la hepatitis B, la susceptibilidad, después de la dosis desafío, fue identificada. Por tanto, es necesario que exista un programa de vigilancia de la situación de vacunación y estado serológico para este virus, para promover la seguridad de estos trabajadores.

Reusing sterile cotton fabric barriers in the clinical practice: an observational and longitudinal study. / Reutilización de barrera de tela de algodón estéril en la práctica clínica: estudio observacional longitudinal.

OBJECTIVE: to analyze the physical and biological barrier characteristics of cotton fields used as a sterile barrier system after multiple use and processing cycles in the clinical practice. METHOD: an observational and longitudinal study to monitor and evaluate 100% cotton fabric used as a sterile barrier system in a medium-sized hospital. Samples were collected before use (after three washes) and at three, six, nine, 12 and 15 months of use and evaluated for the number, thickness and integrity of threads, weight, water absorption and wet penetration by microorganisms. RESULTS: after 85 washes, the number of threads remained unchanged, and the shredded fibers and the water volume absorbed were increased. The microbiological test using the German standard methodology obtained a negative result and wet penetration by microorganisms did not show significant changes over time, although a percentage of the microbial cells passed through the double-layer samples. CONCLUSION: the physical properties of 100% cotton used as a sterile barrier system changed with use/processing cycles; however, these alterations did not significantly interfere with the results obtained by the tests performed on the microbiological barrier up to 85 washes. (1) Clinical use and processing exert an impact on the sterile fabric barrier system. (2) There was weight loss, reduction in size and increase in water absorption volume. (3) The longer the use, the more loose fibers. (4) Penetration by microorganisms did not increase over the 15 months of the study. (5) The physical changes of the fabric did not interfere with the fabric barrier efficiency.

Adenosine triphosphate (ATP) sampling algorithm for monitoring the cleanliness of surgical instruments.

BACKGROUND: Timely detection of cleaning failure is critical for quality assurance within Sterilising Service Units (SSUs). Rapid Adenosine Triphosphate (ATP) testing provides a real time and quantitative indication of cellular contaminants, when used to measure surface or device cleanliness. The aim of this study was to investigate the use of an ATP algorithm and to whether it could be used as a routine quality assurance step, to monitor surgical instruments cleanliness in SSUs prior to sterilisation. METHODS: Cleanliness monitoring using rapid ATP testing was undertaken in the SSUs of four hospitals located in the western (Amazonia) region of Brazil. ATP testing was conducted (Clean Trace, 3M) on 163 surgical instruments, following manual cleaning. A sampling algorithm using a duplicate swab approach was applied to indicate surgical instruments as (i) very clean, (ii) clean, (iii) equivocal or (iv) fail, based around a 'clean' cut-off of 250 Relative Light Units (RLU) and a 'very clean' <100 RLU. RESULTS: The four cleanliness categories were significantly differentiated (P≤0.001). The worst performing locations (hospitals A & C) had failure rates of 39.2% and 32.4%, respectively, and were distinctly different from hospitals B & D (P≤0.001). The best performing hospitals (B & D) had failure rates of 7.7% and 2.8%, respectively. CONCLUSION: The ATP testing algorithm provides a simple to use method within SSUs. The measurements are in real time, quantitative and useful for risk-based quality assurance monitoring, and the tool can be used for staff training. The four-tiered approach to the grading of surgical instrument cleanliness provides a nuanced approach for continuous quality improvement within SSU than does a simple pass/fail methodology.

Significant increased bacterial contamination with endoscope overnight and weekend storage times.

BACKGROUND AND AIM: Forced-air drying (FAD) cabinets are recommended for storage of reprocessed endoscopes, but financial constraints prevent their universal application. The study aimed to determine bacterial contamination in flexible gastroscopes (FG) channels after storage, in a cabinet with filtered air and UV lights, but without FAD. METHODS: Eight FG in clinical use in an endoscopy service of a large Brazilian hospital were sampled: immediately "Time zero" (N = 50), 12 h "Time 1" (N = 25), and 60 h "Time 2" (N = 25) after reprocessing. Following a flush-brush-flush of channels, 40-mL sterile water and 3 cm of the brush were collected. Each sample was divided, filtered onto two 0.22-µm membranes, and incubated in media without or with disinfectant neutralizer. Automated method was used for identification and antibiotic resistance test of isolated bacteria. RESULTS: Bacterial contamination in times "1" and "2" was 5.9 and 16.1 times greater than that of "Time zero," respectively. Number of positive cultures in media with and without neutralizer was similar at times "1" and "2," while media with neutralizer produced more positive cultures at "Time zero." Most bacteria isolated at "Time 2" were Gram-negative rods (52.3%) and showed resistance to one or more antibiotics (65%). CONCLUSION: Bacterial contamination was detected on reprocessed FG stored in non-FAD cabinets overnight (12 h) and increased with longer storage time (60 h). The contamination source is likely to be bacteria in biofilm which multiply in the absence of FAD. Evidence-based criteria should be available for storage time according to the cabinet available.

Biofilm on and structural damage of rotary cutting instruments after 5 cycles of clinical use and processing.

BACKGROUND: Rotary cutting instruments (RCIs) are sterilized routinely. The authors aimed to analyze the structural integrity, presence of dirt, and microbial contamination of RCIs used in clinical practice after processing. METHODS: Eighty-four RCIs (42 carbide burs, 42 diamond burs) were divided into baseline, control, and test groups. The RCIs were evaluated by means of scanning electron microscopy and microbiological analysis. Evaluation criteria included presence of structural damage, dirt, biofilm, and isolated cells and their phenotypic profile. RESULTS: The carbide burs from all groups and diamond burs from the test groups had structural damage. Dirt was observed in the baseline and test groups. Three bacterial species were isolated from 4 RCIs (9.52%). An isolated cell was observed from 1 carbide bur. Biofilm was observed on 3 RCIs (7.14%). CONCLUSIONS: RCIs should not be subjected to multiple uses; after the first clinical use they accumulate structural damage and dirt that hampers the cleaning step, causing failure in the sterilization process. PRACTICAL IMPLICATIONS: The presence of microorganisms and structural damage on the RCIs confirmed that they are not amenable to processing, a fact that characterizes them as a single-use health care product.

Serological and vaccine evaluation for hepatitis B among Community Health Workers.

OBJECTIVE: to identify the vaccination and serological status against hepatitis B among community health workers; to vaccinate against hepatitis B virus and to evaluate the immune response of susceptible workers. METHOD: phase I, cross-sectional and descriptive study, among community health workers in a capital city of the Midwest region, through a self-administered questionnaire, checking of vaccination cards, and blood collection for testing of serological markers for hepatitis B. Phase II, cohort study carried out in vaccinated non-immune workers identified in phase I. They received one dose of vaccine (challenge dose) and serological testing. RESULTS: a total of 109 workers participated in the study. Most had vaccination record (97; 89.0%) and vaccination completeness (75; 77.3%), while the isolated anti-HBs (Antibodies against hepatitis B virus) marker was detected in 78 (71.6%) workers. The prevalence of hepatitis B virus exposure was 8.2%. Of the ten non-immune vaccinated workers, after challenge dose, one remained susceptible. CONCLUSION: although most workers are vaccinated and show immunological response to hepatitis B, susceptibility after challenge dose was identified. Therefore, it is necessary to have a surveillance program of the vaccination situation and serological status for this virus, to promote these workers' safety.

Changes in the properties of pure cotton surgical gowns and drapes with clinical use and reprocessing.

The impact of repeated in-hospital reprocessing on 100% cotton fabric continues to be debated. We analyzed the properties of surgical gowns and drapes over 15 months of clinical use. The amount of linting fibers and the water absorption rate increased significantly, but microbial and blood penetration was preserved.

Fatores associados à percepção do risco biológico e aos acidentes com material biológico em Agentes Comunitários de Saúde / Factors associated with the perception of biological risk and accidents with biological material in community health workers / Factores asociados a la percepción del riesgo biológico y de los accidentes con material biológico en los agentes comunitarios de salud

Objetivos: identificar fatores associados à acidentes com material biológico e à percepção do risco biológico entre Agentes Comunitários de Saúde (ACS). Métodos: estudo transversal analítico realizado com ACS, mediante aplicação de questionário e consulta de registros no cartão de vacinas. Regressão múltipla de Poisson com variância robusta foi realizada para analisar os fatores associados aos acidentes com material biológico e à percepção do risco biológico. Resultados: dos 207 participantes, 50,24% (IC 95% = 43,4 - 56,9) apresentou autorrelato de acidentes com material biológico, tendo como fatores associados possuir formação de nível superior [RP ajustada = 2,2 (IC 95% = 1,0 - 4,7)], ter outro vínculo empregatício [RP ajustada = 1,5 (IC 95% = 1,0 - 2,3)] e conhecimento quanto às vacinas necessárias ao ACS [RP ajustada = 0,7 (0,5 - 0,9)]. Constatou-se que 74,39% dos ACS tinham percepção de algum risco biológico, mesmo de forma limitada. Entre as variáveis investigadas, na análise ajustada, nenhuma mostrou associação com a percepção de risco biológico pelos ACS. Conclusão: a prevalência de acidentes com material biológico em ACS é elevada, sendo fatores associados possuir formação de nível superior, ter outro vínculo empregatício e apresentar conhecimento quanto as vacinas necessárias para a atividade laboral. Há limitada percepção de risco pela maioria dos ACS. Não foram encontrados fatores associados à esta variável.

Objectives: to identify factors associated with accidents involving biological material and the perception of biological risk among community health workers (CHWs). Methods: an analytical cross-sectional study was carried out with CHWs using a questionnaire and consultation of vaccination card records. Poisson multiple regression with robust variance was conducted to analyze the factors associated with accidents involving biological material and perception of biological risk. Results: of the 207 participants, 50.24% (95% CI = 43.4 - 56.9) self-reported accidents with biological material, and the associated factors were having a university degree [adjusted PR = 2.2 (95% CI = 1.0 - 4.7)], having another job [adjusted PR = 1.5 (95% CI = 1.0 - 2.3)] and knowledge of the vaccines needed by CHWs [adjusted PR = 0.7 (0.5 - 0.9)]. It was found that 74.39% of CHWs were aware of some biological risk, even to a limited extent. Among the variables investigated, in the adjusted analysis, none showed an association with the perception of biological risk by CHWs. Conclusion: the prevalence of accidents involving biological material among CHWs is high, and the associated factors are having a university degree, having another job, and having knowledge of the vaccines required for the job. Most CHWs have a limited perception of the risk. No factors were associated with this variable.

Objetivos: identificar los factores asociados a los accidentes con material biológico y la percepción del riesgo biológico entre agentes comunitarios de salud (ACS). Métodos: estudio transversal analítico realizado con los ACS mediante cuestionario y consulta de los registros de las cartillas de vacunación. Se realizó una regresión múltiple de Poisson con varianza robusta para analizar los factores asociados a los accidentes con material biológico y la percepción del riesgo biológico. Resultados: de los 207 participantes, el 50,24% (IC 95% = 43,4 - 56,9) declararon haber sufrido accidentes con material biológico, y los factores asociados fueron tener un título universitario [PR ajustado = 2,2 (IC 95% = 1,0 - 4,7)], tener otro trabajo [PR ajustado = 1,5 (IC 95% = 1,0 - 2,3)] y conocer las vacunas que necesitan los ACS [PR ajustado = 0,7 (0,5 - 0,9)]. Se observó que el 74,39% de los ACS conocían algún riesgo biológico, aunque fuera de forma limitada. De las variables investigadas en el análisis ajustado, ninguna mostró una asociación con la percepción del riesgo biológico por parte de los ACS. Conclusión: la prevalencia de accidentes con material biológico entre los ACS es alta, y los factores asociados son tener un título universitario, tener otro trabajo y tener conocimientos sobre las vacunas necesarias para el trabajo. La mayoría de los ACS tienen una percepción limitada del riesgo. No se encontraron factores asociados a esta variable.

Biofilme em parafusos ortopédicos prontos para uso adquiridos por meio de sistema de consiganação/comodato / Biopelícula en tornillos ortopédicos listos para uso adquiridos por medio del sistema de consignación/comodato / Biofilm on patient-ready orthopaedic screws acquired through the loaner system

Resumo Objetivo Avaliar a integridade da superfície e as condições microbiológicas de parafusos prontos para uso em bandejas ortopédicas após múltiplos processamentos. Métodos Após o processamento completo, as bandejas utilizadas em cirurgias de pequenos fragmentos, fornecidas por meio de sistema de consignação/comodato em um hospital brasileiro, foram selecionadas aleatoriamente durante quatro meses. Os parafusos mais utilizados (números 14, 16 e 18 - Grupo 1) e menos utilizados (números 10 e 38 - Grupo 2), portanto, os mais e menos expostos a agentes biológicos, químicos e físicos, foram aleatoriamente removidos e submetidos a inspeção visual (n=126), seguido de cultura bacteriana (n=6 parafusos/bandeja, 9 bandejas), teste de proteínas (n=6 parafusos/bandeja, 9 bandejas) e Microscopia Eletrônica de Varredura (MEV) (n=2 parafusos/bandeja, 9 bandejas). As culturas positivas foram submetidas a métodos automatizados de identificação bacteriana e suscetibilidade antimicrobiana. Resultados Foram detectadas ranhuras em 8,7% dos parafusos, predominantemente no Grupo 2 (8/11). Proteína residual foi detectada em 96,3%, e não houve diferença estatisticamente significativa na quantidade de proteína entre os grupos (P=0,07). Crescimento bacteriano foi identificado em 3/54 parafusos. Danos na superfície e presença de sujidade foram visualizados em todos os parafusos submetidos a MEV. Formação de biofilmes extensos foi detectada em oito parafusos, três do Grupo 1 e cinco do Grupo 2. Conclusão Recuperação de bactérias viáveis, acúmulo de biofilme e danos na superfície foram detectados nos parafusos prontos para uso. Os parafusos costumam permanecer nas bandejas cirúrgicas e serem submetidos a múltiplos processamento, sendo expostos a contaminação e danos repetidas vezes. Esses achados apontam para a necessidade de discutir e repensar a forma como esses implantes de uso único são atualmente disponibilizados para cirurgias.

Resumen Objetivo Evaluar la integridad de la superficie y las condiciones microbiológicas de tornillos listos para uso en bandejas ortopédicas después de múltiples procesamientos. Métodos Después del procesamiento completo, fueron seleccionadas aleatoriamente durante cuatro meses las bandejas utilizadas en cirugías de pequeños fragmentos, proporcionadas mediante el sistema de consignación/comodato en un hospital brasileño. Los tornillos más utilizados (números 14, 16 y 18 - Grupo 1) y menos utilizados (números 10 y 38 - Grupo 2), por lo tanto, los más y menos expuestos a agentes biológicos, químicos y físicos, fueron quitados aleatoriamente y sometidos a inspección visual (n=126), seguido de cultivo bacteriano (n=6 tornillos/bandeja, 9 bandejas), prueba de proteínas (n=6 tornillos/bandeja, 9 bandejas) y microscopía electrónica de barrido (MEB) (n=2 tornillos/bandeja, 9 bandejas). Los cultivos positivos fueron sometidos a métodos automatizados de identificación bacteriana y susceptibilidad antimicrobiana. Resultados Se detectaron ranuras en el 8,7 % de los tornillos, predominantemente en el Grupo 2 (8/11). Se detectó proteína residual en el 96,3 % y no se encontró diferencia estadísticamente significativa en la cantidad de proteína entre los grupos (P=0,07). En 3/54 tornillos se identificó crecimiento bacteriano. Se visualizaron daños en la superficie y presencia de suciedad en todos los tornillos sometidos a MEB. En ocho tornillos se detectó la formación de biopelículas, tres del Grupo 1 y cinco del Grupo 2. Conclusión Se detectó recuperación de bacterias viables, acumulación de biopelícula y daños en la superficie en los tornillos listos para uso. Los tornillos suelen permanecer en las bandejas quirúrgicas y son sometidos a múltiples procesamientos, donde están expuestos a contaminación y daños repetidas veces. Estos descubrimientos señalan la necesidad de discutir y repensar la forma como estos implantes de uso único se ponen a disposición para cirugía actualmente.

Abstract Objective Assess the surface integrity and microbiological conditions of patient-ready screws in orthopaedic trays that had been multiply reprocessed. Methods After full reprocessing, clinical trays used for small fragment surgery provided through a loaner system to a Brazilian hospital were randomly selected during four months. The most (numbers 14, 16 and 18 - Group 1) and least (numbers 10 and 38 - Group 2) frequently implanted screws, therefore, the ones estimated to be the most and least exposed to biological, chemical and physical agents, were randomly removed and subjected to visual inspection (n=126), followed by bacterial culture (n=6 screws/tray, 9 trays), protein test (n=6 screws/tray, 9 trays) and Scanning Electron Microscopy (SEM) (n=2 screws/tray, 9 trays). Positive cultures were subjected to automated bacterial identification and antimicrobial susceptibility tests. Results Grooves were detected on 8.7% screws, predominantly in Group 2 (8/11). Residual protein was detected on 96,3%, and there was no statistically significant difference in the amount of protein between the groups (P=0.07). Bacterial growth was identified in 3/54 screws. Surface damage and soil were visualized on all screws subjected to SEM. Extensive biofilms were detected on eight screws, three from Group 1 and five from Group 2. Conclusion Recovery of bacteria, biofilm accumulation and surface damage were detected on patient-ready screws. Screws frequently remain in surgical trays for multiple reprocessing; thus they are repeatedly exposed to contamination and damage. These findings point to the need to discuss and review the way these single-use implants are currently made available for surgeries.

The monitoring system of surgical textile in health services.

OBJECTIVES: to report the implementation of a monitoring system of the operative field, surgical gown, and utilized fields as sterile barrier system of products for health, manufactured from cotton fabrics. METHODS: technological innovation report of a monitoring system of the use and processing of surgical textiles in a medium-size hospital. RESULTS: steps: planning, confection, exchange of the surgical textiles, monitoring, and 12 months of supervision. The new pieces were silkscreened with a black indelible marker. FINAL CONSIDERATIONS: the implemented system is practical, low cost, and easily manageable for the team, it favored the work process management, contributing to the quality and security of the textile used in health care, and being able to be implemented in other health services.

Perfuração de luvas cirúrgicas: limpeza de produtos para saúde versus procedimentos cirúrgicos / Surgical glove perforation: cleaning of medical devices versus surgical procedures / Perforación de guantes quirúrgicos: limpieza de productos sanitarios versus procedimientos quirúrgicos

Objetivo: Comparar os índices de perfuração de luvas cirúrgicas utilizadas em cirurgias gerais e na limpeza manual de produtos para a saúde. Método: Estudo desenvolvido num hospital de ensino de grande porte em Goiânia, Goiás. Foram comparados os índices de perfuração de luvas cirúrgicas obtidos por meio de teste de vazamento em dois grupos de luvas: (I) as utilizadas durante a limpeza manual de produtos para a saúde e (II) as utilizadas em cirurgias gerais. Resultados: A frequência de perfuração foi superior nas luvas utilizadas para a limpeza de produtos para saúde (46,1%) do que naquelas empregadas em cirurgias gerais (12,5%) (p = 0,047), e o tempo de uso interferiu no aumento do risco de perfuração em ambos os grupos. Não houve diferença nas perfurações das mãos direita e esquerda nem no uso de luvas simples e sobrepostas. Conclusão: O índice de perfuração de luvas cirúrgicas durante a limpeza manual revela maior risco ao trabalhador que realiza essa atividade e reforça a contraindicação desse tipo de luva para tal finalidade.

Objective: To compare the surgical glove perforation rates in general surgeries and in the manual cleaning of medical devices. Method: This study was developed in a large teaching hospital in Goiânia, Goiás, Brazil. We compared the surgical glove perforation rates obtained from the leak test performed in two groups of gloves: (I) those used during manual cleaning of medical devices and (ii) those used in general surgeries. Results: The frequency of perforation was higher in the gloves used for cleaning medical devices (46.1%) than in those used for general surgeries (12.5%) (p=0.047), and the duration of use was associated with increased risk of perforation in both groups. No difference was found regarding perforations in the right and left hands or in the use of single or double gloving. Conclusion: The surgical glove perforation rate during manual cleaning reveals a higher risk to the worker who performs this activity and reinforces the contraindication of this type of glove for this purpose.

Objetivo: Comparar las tasas de perforación de los guantes quirúrgicos utilizados en cirugías generales y en la limpieza manual de productos sanitarios. Método: Estudio desarrollado en un gran hospital de enseñanza en Goiânia, Goiás. Se compararon las tasas de perforación de guantes quirúrgicos, obtenidas mediante prueba de fugas, en dos grupos: (I) utilizados durante la limpieza manual de productos sanitarios y (II) utilizados en cirugía general. Resultados: La frecuencia de perforación fue mayor en los guantes utilizados para limpieza de productos sanitarios (46,1%) que en los utilizados para cirugía general (12,5%) (p = 0,047) y el tiempo de uso interfirió en el aumento del riesgo de perforación en ambos grupos. No hubo diferencia en las perforaciones de la mano derecha e izquierda y el uso de guantes simples y superpuestos. Conclusión: La tasa de perforación de los guantes quirúrgicos durante la limpieza manual revela el mayor riesgo para el trabajador que realiza esta actividad y refuerza la contraindicación de este tipo de guantes para este fin.

Biofilme em smartphones de profissionais da saúde: padrão de uso e de descontaminação do aparelho / Biofilm on smartphones of healthcare professionals: pattern of device use and decontamination

Objetivo: avaliar a presença de biofilme nas películas de smartphones de profissionais da saúde, investigar o padrão de uso e de descontaminação dos smartphones no ambiente de assistência à saúde em um hospital de médio porte. Métodos: estudo analítico e transversal, realizado com profissionais de saúde que possuíam smartphone. Foram realizadas entrevistas estruturadas e a presença de biofilme nas películas de vidro dos smartphones foi avaliada pela microscopia eletrônica de varredura. Resultados: todas as amostras de películas foram positivas para presença de biofilme, mesmo após descontaminação com álcool a 70%. Dos participantes, 96,4% utilizavam smartphone no ambiente de trabalho, a maioria utilizava o aparelho para fins pessoais e descontaminavam com álcool a 70% com frequência irregular. Conclusões: o smartphone pode servir como fômite, visto que biofilmes foram detectados na superfície das películas. Esses achados apontam para a necessidade de políticas de controle de infecção relacionadas ao uso dos smartphones.

Objective: to evaluate the presence of biofilm on the protective glass films of smartphones of health professionals, to investigate the pattern of use and decontamination of smartphones in the health care environment of a medium-sized hospital. Methods: analytical and cross-sectional study, carried out with health professionals with smartphones. Structured interviews were carried out and the presence of biofilm on the protective glass films of smartphones was evaluated by scanning electron microscopy. Results: all film samples were positive for the presence of biofilm, even after decontamination with alcohol 70%. 96.4% of the participants used a smartphone in the work environment, most used the device for personal purposes and decontaminated it with alcohol 70% with irregular frequency. Conclusion(s): the smartphones can serve as a fomite, considering that biofilms were detected on the surface of the films. These findings point to the need for infection control policies related to the use of smartphones.

Reprocessing of loaned surgical instruments/implants in Australia and Brazil: A survey of those at the coalface.

BACKGROUND: Acquisition of surgical instruments (SI) and implants by loaner system is a worldwide practice. Although quality of device reprocessing has been reported to be lower in low and middle-income countries compared with higher income countries, few investigations have been conducted on the management and reprocessing of loaned devices. Thus, in this study we evaluate the practices of management and reprocessing of loaner SI and non-sterile implants (NSI) in a high (Australia) and a middle-income (Brazil) country. METHODS: Cross-sectional surveys (hardcopy or online form) was self-administered by sterilising service unit's personnel of Brazilian and Australian hospitals. Only those units that sourced orthopaedic surgical instruments and non-sterile loaned implants from independent companies were eligible. RESULTS: A total of 65 questionnaires from Australia and 168 from Brazil were analysed. Quality indicators regarding structure and work process for the management and reprocessing of loaned SI and NSI was of a higher standard in Australia than in Brazil. However, failures were detected in both countries, for instance delivery delays and improper point-of-use pre-cleaning practices. CONCLUSION: There are key challenges inherent of the multifaceted reusable medical devices loaner system in both countries, such as communication failures, implementation of non-recommended practices, reprocessing of NSI, and other related to structure and process quality indicators, that must be faced. Initial and ongoing education and training should be provided and should embrace the themes of technical proficiency, effective communication and teamwork, and should include all personnel involved in this process, even loaner company staff.

Biofilm accumulation in new flexible gastroscope channels in clinical use.

OBJECTIVE: Assess the accumulation of protein and biofilm on the inner surfaces of new flexible gastroscope (FG) channels after 30 and 60 days of patient use and full reprocessing. DESIGN: Clinical use study of biofilm accumulation in FG channels. SETTING: Endoscopy service of a public hospital. METHODS: First, we tested an FG in clinical use before the implementation of a revised reprocessing protocol (phase 1 baseline; n = 1). After replacement of the channels by new ones and the implementation of the protocol, 3 FGs were tested after 30 days of clinical use (phase 2; n = 3) and 3 FGs were tested after 60 days of clinical use (phase 3; n = 3), and the same FGs were tested in phase 2 and 3. Their biopsy, air, water, and air/water junction channels were removed and subjected to protein testing (n = 21), bacteriological culture (n = 21), and scanning electron microscopy (SEM) (n = 28). Air-water junction channels fragments were subjected to SEM only. RESULTS: For the FGs, the average number of uses and reprocessing cycles was 60 times. Extensive biofilm was detected in air, water, and air-water junction channels (n = 18 of 28). All channels (28 of 28) showed residual matter, and structural damage was identified in most of them (20 of 28). Residual protein was detected in the air and water channels of all FG evaluated (phases 1-3), except for 1 air channel from phase 2. Bacteria were recovered from 8 of 21 channels, most air or water channels. CONCLUSIONS: The short time before damage and biofilm accumulation in the channels was evident and suggests that improving the endoscope design is necessary. Better reprocessing methods and channel maintenance are needed.

The monitoring system of surgical textile in health services / Sistema de monitoreo de tejidos quirúrgicos en servicios sanitarios / Sistema de monitoramento de têxteis cirúrgicos em serviços de saúde

ABSTRACT Objectives: to report the implementation of a monitoring system of the operative field, surgical gown, and utilized fields as sterile barrier system of products for health, manufactured from cotton fabrics. Methods: technological innovation report of a monitoring system of the use and processing of surgical textiles in a medium-size hospital. Results: steps: planning, confection, exchange of the surgical textiles, monitoring, and 12 months of supervision. The new pieces were silkscreened with a black indelible marker. Final Considerations: the implemented system is practical, low cost, and easily manageable for the team, it favored the work process management, contributing to the quality and security of the textile used in health care, and being able to be implemented in other health services.

RESUMEN Objetivos: informar sobre la aplicación de un sistema de monitoreo de campos operatorios, delantales y campos quirúrgicos utilizados como sistema de barrera estéril para productos sanitarios fabricados con tejidos de algodón Métodos: se trata de un informe de innovación tecnológica de un sistema de monitoreo de uso y procesamiento de tejidos quirúrgicos de un hospital de porte medio. Resultados: etapas realizadas: planificación, confección, cambio de los tejidos quirúrgicos, control y seguimiento durante 12 meses. Las nuevas prendas fueron serigrafiadas con un marco de control, en el que después de cada ciclo de lavado se pintaba, con un rotulador negro indeleble, un espacio del marco. Consideraciones Finales: el sistema implantado demostró ser práctico, de bajo costo y de fácil ejecución, además de facilitar la gestión del proceso de trabajo y contribuir con la calidad y la seguridad del uso de textiles en el cuidado de la salud, con la posibilidad de reproducirse en otros servicios sanitarios.

RESUMO Objetivos: relatar a implementação de um sistema de monitoramento de campos operatórios, aventais cirúrgicos e campos utilizados como sistema de barreira estéril de produtos para a saúde confeccionados de tecidos de algodão. Métodos: relato de inovação tecnológica de um sistema de monitoramento do uso e processamento de têxteis cirúrgicos em um hospital de médio porte. Resultados: etapas percorridas: planejamento, confecção, troca dos têxteis cirúrgicos, monitoramento e acompanhamento por 12 meses. As novas peças foram serigrafadas com um quadro para o controle, no qual após cada ciclo de lavagem um espaço do quadro era pintado com um marcador indelével preto. Considerações Finais: o sistema implantado mostrou-se prático, de baixo custo e de fácil execução pela equipe, além de favorecer a gestão do processo de trabalho, contribuindo para a qualidade e segurança do uso dos têxteis na assistência à saúde, podendo ser reproduzido em outros serviços de saúde.

Transformation of a surgical clinic for covid-19 patients: experience report / Transformación de una clínica quirúrgica para la atención de pacientes con covid 19: reporte de experiencia / Transformação de uma clínica cirúrgica para atendimento a pacientes com covid 19: relato de experiência

ABSTRACT Objective: to report the transformation process of a surgical inpatient unit into a coronavirus patient care unit and the impact on the health of nursing professionals and users of this service, in the opinion of nurses who experienced the process. Method: this is an experience report of nurses of a surgical inpatient unit of a Federal Teaching Hospital in the Midwest region of Brazil. The experience was presented in three thematic axes: 1) Internal restructuring of the surgical hospitalization unit; 2) Training, personnel management and distribution of resources; 3) Impacts on worker health. Results: the surgical clinic started to have an exclusive team and flow of single care. Pre-surgical patients were discharged from the hospital with no prospect of returning to the planned treatment. Surgical wards were adapted to isolation wards, and equipment facilities for ventilatory care were optimized. The lack of adequate Personal Protective Equipment and work overload were identified as situations that increase the risk of infection in health professionals. Conclusion: the study demonstrated unhealthy conditions that favor the physical exhaustion and mental suffering of nursing professionals. New research in occupational health planning which supports the work of health service managers in future pandemic scenarios in Brazil is suggested.

RESUMEN Objetivo: relatar el proceso de transformación de una unidad de hospitalización quirúrgica en una unidad de atención al paciente con coronavirus y el impacto en la salud de los profesionales de enfermería y usuarios de este servicio, en la opinión de los enfermeros que vivieron el proceso. Método: se trata de un relato de experiencia de enfermeros de una unidad de hospitalización quirúrgica de un Hospital Federal de Enseñanza de la región Centro-Oeste de Brasil. La experiencia fue presentada en tres ejes temáticos: 1) Reestructuración interna de la unidad de hospitalización quirúrgica; 2) Capacitación, manejo de personal y distribución de recursos; 3) Impactos en la salud de los trabajadores. Resultados: la clínica quirúrgica pasó a tener un equipo exclusivo y un flujo de atención único. Los pacientes prequirúrgicos fueron dados de alta del hospital sin perspectivas de volver al tratamiento planificado. Se adaptaron los pabellones quirúrgicos a pabellones de aislamiento y se optimizaron las instalaciones de equipos para el cuidado ventilatorio. La falta de Equipos de Protección Individual adecuados y la sobrecarga de trabajo fueron identificadas como situaciones que aumentan el riesgo de infección para los profesionales de la salud. Conclusión: el estudio demostró condiciones insalubres que favorecen el desgaste físico y el sufrimiento psíquico de los profesionales de enfermería. Se sugiere nueva investigación en planificación de salud ocupacional que apoye el trabajo de los gestores de servicios de salud en futuros escenarios de pandemia en Brasil.

RESUMO Objetivo: relatar o processo de transformação de uma unidade de internação cirúrgica em unidade de atendimento a pacientes infectados pelo novo coronavírus e o impacto na saúde dos profissionais de enfermagem e usuários desse serviço, na opinião de enfermeiros que vivenciaram o processo. Método: trata-se de um relato de experiência de enfermeiros de uma unidade de internação cirúrgica de um Hospital Escola Federal da região Centro-Oeste do Brasil. A experiência foi apresentada em três eixos temáticos: 1) Reestruturação interna da unidade de internação cirúrgica; 2) Capacitação, gerenciamento de pessoal e distribuição de recursos; 3) Impactos na saúde dos trabalhadores. Resultados: a clínica cirúrgica passou a contar com equipe exclusiva e fluxo de atendimento único. Pacientes pré-cirúrgicos receberam alta hospitalar sem perspectiva de retorno ao tratamento previsto. Enfermarias cirúrgicas foram adaptadas para enfermarias de isolamento, e instalações de equipamentos para a assistência ventilatória foram otimizadas. A falta de Equipamentos de Proteção Individual adequados e a sobrecarga de trabalho foram apontados como situações que aumentam o risco de infecção para os profissionais da saúde. Conclusão: o estudo retratou condições insalubres que favorecem o esgotamento físico e o sofrimento mental de profissionais da enfermagem. Sugerem-se novas pesquisas no âmbito do planejamento da saúde ocupacional que possam subsidiar o trabalho de gestores de serviços de saúde em futuros cenários de pandemia no Brasil.

Hand hygiene by the nursing team in home care: a cross-sectional study.

OBJECTIVE: to identify whether nursing professionals carry out hand hygiene, how they do it, and what resources are available for this practice during home visits. METHOD: cross-sectional study conducted in a public Home Care service. The World Health Organization instrument was used to observe the hand hygiene technique, the time of performance, and the product used. RESULTS: a total of 940 hand hygiene opportunities taking place in 231 home visits were observed. Overall adherence was 14.4%, with the practice of hand hygiene being higher after contact with the patient (53.7%). Before aseptic procedures, after risk/exposure to body fluids, after contact with the patient's environment, and before contact with the patient, adherence was 0.4%. Regarding the quality of the technique, in none of the 135 practices the recommended steps were followed. As for the structure available in the households, 35 (15.2%) had accessible sinks and none had liquid soap and alcohol-based formulation. CONCLUSION: adherence to hand hygiene by nursing professionals in home care was low, the technique was not performed, and households did not have resources for the practice.

Biossegurança para a assistência transoperatória a pacientes suspeitos ou confirmados da COVID-19: relato de experiência / Biosafety in intraoperative care for suspected or confirmed COVID-19 patients: experience report

Objetivo: relatar a experiência do planejamento e implementação de medidas de biossegurança para a assistência transoperatória a pacientes suspeitos ou confirmados da COVID-19. Método: relato de experiência desenvolvido no centro cirúrgico de um hospital de ensino, entre março e maio de 2020. Foi composto por quatro etapas - Formação do grupo de trabalho para planejamento do Procedimento Operacional Padrão (POP); Elaboração do POP; Implementação do POP e Avaliação. Resultados: as medidas implementadas foram a suspensão parcial de cirurgias eletivas, realocação de profissionais do grupo de risco, aquisição de equipamento de proteção individual; fortalecimento do sistema de comunicação entre equipes; controle de pessoas e do ambiente cirúrgico; cuidados com superfícies, equipamentos e produtos para saúde utilizados na cirurgia e capacitação da equipe. Conclusão: a implementação do POP, embora desafiadora, foi essencial para a continuidade da assistência cirúrgica mais segura no contexto pandêmico para os pacientes, trabalhadores de saúde e instituição.

Objective: to report the experience of planning and implementing biosafety measures for intraoperative care for suspected or confirmed COVID-19 patients. Method: experience report developed in the operating room of a teaching hospital, between March and May 2020. The report consisted of four stages - Formation of the working group for planning the Standard Operating Procedure (SOP); Preparation of the SOP; Implementation and Evaluation of the SOP. Results: the measures implemented were the partial suspension of elective surgeries, relocation of professionals in the risk group, acquisition of personal protective equipment; strengthening of the communication system between teams; control of people and the surgical environment; care with surfaces, equipment and health products used in surgery and team training. Conclusion: the implementation of the SOP, although challenging, was essential for the continuity of safer surgical care in the pandemic context for patients, health workers and the institution.