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Antimicrob Resist Infect Control ; 10(1): 6, 2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33407882


BACKGROUND/OBJECTIVE: After wearing powdered gloves, healthcare workers (HCW) are supposed to wash their hands instead of using alcohol-based hand-rub (ABHR). Washing hands takes longer than using ABHR, and the use of powdered gloves may be an obstacle to hand-hygiene compliance. This study aimed to evaluate the impact of replacing powdered gloves with powder-free gloves on hand-hygiene compliance among HCW of an intensive care unit (ICU). METHODS: A quasi-experimental study was conducted in a general ICU of a tertiary care university hospital in Brazil. From June 1st to July 15th, 2017, all HCW were provided with powdered latex gloves only for all clinical procedures. From July 15th to August 31st, 2017, HCW were provided with nitrile powder-free gloves only. Hand-hygiene compliance was assessed through direct observation, and evaluated according to the World Health Organization Hand Hygiene guidelines. We calculated that a sample size of 544 hand hygiene opportunities needed to be observed per period. Data analysis were performed using the STATA SE® version 14, and we compared the individual's percentage of compliance using the t test for paired data before and after the intervention. RESULTS: Overall, 40 HCW were assessed before and after the introduction of nitrile powder-free gloves, with 1114 and 1139 observations of hand hygiene opportunities, respectively. The proportion of compliance with hand hygiene was 55% (95% confidence interval [CI] 51-59%) using powdered latex gloves and 60% (95% CI 57-63%) using powder-free gloves. The difference in proportions between the two types of gloves was 5.1% (95% CI 2.5-7.6%, p < 0.001). CONCLUSION: Our data indicate that replacing powdered gloves with powder-free gloves positively influenced hand-hygiene compliance by HCW in an ICU setting.

Medicine (Baltimore) ; 99(28): e20757, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664069


The search for early clinical risk factors in the intensive care setting may improve the outcome of critically ill patients. The objective of this retrospective study is to identify and quantify early predictors for patients who would require tracheostomy. Five hundred and forty four septic patients were divided in 2 groups: non-tracheostomized (NT) (n = 484) and tracheostomized (T) (n = 60). The patients consisted of 241 males (49.8%) in NT and 27 (45%) in T group, respectively (P = .4971). The median and interquartile range difference of age of NT group was of 72 years [59-82] and T of 75 [55.0-83.5] (P = .4687). The SAPS 3 for the group NTxT was 70 [55-85] and 85.5 [77-91] (P = .0001), the SOFA of 9 [6-13] and 12 [10-14] (P = .0002). The comparison of logistic regression analysis for predictors of non-tracheostomy and tracheostomy groups showed an adjusted odds ratio (OR) for SAPS 3 range between 74 and 87 of 18.14 (95%CI = 3.36-97.84) and between 88 and 116 of 27.77 (95%CI = 4.43-174.24) (P < .05). For SOFA, the adjusted OR between 10 and 13 was 12.23 (95%CI = 2.46-60.81) and between 14 and 20 was 8.45 (95%CI = 1.58-45.29) (P < .05). The need for blood transfusions and dialysis presented an OR of 2.74 (95%CI = 1.23-6.08) and 3.33 (95%CI = 1.43-7.73) (P < .05), respectively. Our data shows that SAPS 3 ≥ 74, SOFA ≥ 11, blood transfusions and the need for dialysis were independently associated and could be considered major predictors for tracheostomy requirements in septic patients.

Sepse , Traqueostomia/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estado Terminal , Árvores de Decisões , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco
Rev Bras Enferm ; 73(3): e20180748, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32294709


OBJECTIVES: to analyze lawsuits brought by beneficiaries of health insurance operators. METHODS: this was a cross-sectional descriptive study carried out in a large-capacity private health insurance operator using data collected by the company from 2012 to 2015. RESULTS: ninety-six lawsuits were brought by 86 beneficiaries regarding medical procedures (38.5%), treatments (26.1%), examinations (14.6%), medications (9.4%), home care (6.2%), and other types of hospitalization (5.2%). The procedures with the highest number of lawsuits were percutaneous rhizotomy; chemotherapy; treatment-related positron-emission tomography scans; and for medications relative to antineoplastic and Hepatitis C treatment. CONCLUSIONS: the lawsuits were filed because of the operators' refusal to comply with items not established in contracts or not regulated and authorized by the Brazilian National Regulatory Agency for Private Health Insurance and Plans, refusals considered unfounded.

Rev. bras. enferm ; 73(3): e20180748, 2020. tab, graf
Artigo em Inglês | LILACS-Express | LILACS, BDENF - Enfermagem | ID: biblio-1092571


ABSTRACT Objectives: to analyze lawsuits brought by beneficiaries of health insurance operators. Methods: this was a cross-sectional descriptive study carried out in a large-capacity private health insurance operator using data collected by the company from 2012 to 2015. Results: ninety-six lawsuits were brought by 86 beneficiaries regarding medical procedures (38.5%), treatments (26.1%), examinations (14.6%), medications (9.4%), home care (6.2%), and other types of hospitalization (5.2%). The procedures with the highest number of lawsuits were percutaneous rhizotomy; chemotherapy; treatment-related positron-emission tomography scans; and for medications relative to antineoplastic and Hepatitis C treatment. Conclusions: the lawsuits were filed because of the operators' refusal to comply with items not established in contracts or not regulated and authorized by the Brazilian National Regulatory Agency for Private Health Insurance and Plans, refusals considered unfounded.

RESUMEN Objetivos: analizar las acciones judiciales iniciadas por beneficiarios de planes de salud de prepago. Métodos: estudio descriptivo, transversal, desarrollado en importante operadora de planes de salud de prepago, utilizando datos recopilados por la empresa entre 2015 y 2015. Resultados: fueron impulsadas 96 acciones judiciales por parte de 86 beneficiarios, referentes a procedimientos médicos (38,5%), tratamientos (26,1%), estudios (14,6%), medicación (9,4%), Home Care (6,2%) y 5,2% por otros tipos de internación. La mayoría de acciones por procedimientos correspondió a rizotomía percutánea; en tratamientos, a quimioterapia; en estudios, a tomografía por emisión de positrones; en medicamentos, a antineoplásicos y para tratar la hepatitis C. Conclusiones: motivaron las acciones judiciales interpuestas la negativa de la operadora de planes de salud a cubrir prestaciones no incluidas en el alcance del plan contratado por el beneficiario, así como asuntos no reglados y autorizados por la Agencia Nacional de Salud Complementaria, considerándose, en consecuencia, improcedentes.

RESUMO Objetivos: analisar as ações judiciais demandadas por beneficiários de uma operadora de plano de saúde. Métodos: estudo descritivo de corte transversal desenvolvido em uma operadora de plano privado de saúde de grande porte, utilizando dados compilados pela empresa no período de 2012 a 2015. Resultados: foram movidas 96 ações judiciais por 86 beneficiários, referentes a procedimentos médicos (38,5%), tratamentos (26,1%), exames (14,6%), medicamentos (9,4%), Home Care (6,2%) e 5,2% a outros tipos de internações. O maior número de ações dentre os procedimentos foi rizotomia percutânea; para tratamentos, a quimioterapia; exames solicitados de tomografia por emissão de pósitrons; para medicamentos, os antineoplásicos e para tratamento de Hepatite C. Conclusões: a razão para as demandas judiciais impetradas foi a negativa da operadora em atender os itens não pertencentes ao escopo do que foi contratado pelo beneficiário ou itens não regulamentados e autorizados pela Agência Nacional de Saúde Suplementar, portanto sendo consideradas improcedentes.

Rev Esc Enferm USP ; 53: e03498, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31800801


OBJECTIVE: To evaluate the level of satisfaction of inpatients in a teaching hospital regarding the quality of the hospital service by comparing term and non-term times. METHOD: Cross-sectional study carried out in three inpatient units with users from 18 to 80 years old who stayed in the hospital for at least 72 hours. An instrument for sociodemographic characterization and the SERVQUAL scale were applied to measure the level of satisfaction. Data collection occurred in two periods: term and non-term times. RESULTS: Three hundred and five users of the service of both genders, with an average age of 46.2 years, were interviewed. Concerning the dimensions that make up the SERVQUAL scale, empathy was mentioned as the one with which the users attended to during term time expressed the greatest dissatisfaction (p=0.01). Regarding the service dimension, the level of satisfaction of the users was higher during term time (p=0.01). Tangibles, reliability, and assurance did not show differences when comparing the two examined periods. CONCLUSION: The users identified higher empathy and better service during term time, but similar perceptions were not reported for assurance and reliability.

Hospitais de Ensino , Satisfação do Paciente , Estudantes de Medicina , Estudantes de Enfermagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
Front Public Health ; 7: 240, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31555629


Hospital-associated infections (HAIs) are a leading cause of morbidity and mortality in intensive care units (ICUs) and neonatal intensive care units (NICUs). Organisms causing these infections are often present on surfaces around the patient. Given that microbiota may vary across different ICUs, the HAI-related microbial signatures within these units remain underexplored. In this study, we use deep-sequencing analyses to explore and compare the structure of bacterial communities at inanimate surfaces of the ICU and NICU wards of The Medical School Clinics Hospital (Brazil). The data revealed that NICU presents higher biodiversity than ICU and surfaces closest to the patient showed a peculiar microbiota, distinguishing one unit from the other. Several facultative anaerobes or obligate anaerobes HAI-related genera were classified as biomarkers for the NICU, whereas Pseudomonas was the main biomarker for ICU. Correlation analyses revealed a distinct pattern of microbe-microbe interactions for each unit, including bacteria able to form multi-genera biofilms. Furthermore, we evaluated the effect of concurrent cleaning over the ICU bacterial community. The results showed that, although some bacterial populations decreased after cleaning, various HAI-related genera were quite stable following sanitization, suggesting being well-adapted to the ICU environment. Overall, these results enabled identification of discrete ICU and NICU reservoirs of potentially pathogenic bacteria and provided evidence for the presence of a set of biomarkers genera that distinguish these units. Moreover, the study exposed the inconsistencies of the routine cleaning to minimize HAI-related genera contamination.

Artigo em Inglês | MEDLINE | ID: mdl-31285821


Background: The World Health Organization (WHO) ethanol-based handrub (EBHR) formulation contains 1.45% glycerol as an emollient to protect healthcare workers' (HCWs) skin against dryness and dermatitis. However, glycerol seems to negatively affect the antimicrobial efficacy of alcohols. In addition, the minimal concentration of glycerol required to protect hands remain unknown. We aim to evaluate the tolerance of HCWs to the WHO EBHR formulation using different concentrations of glycerol in a tropical climate healthcare setting. Methods: We conducted a cluster-randomized, double-blind, crossover study among 40 HCWs from an intensive care unit of a tertiary-care hospital in Brazil, from June 1st to September 30, 2017. We tested the WHO EBHR original formulation containing 1.45% glycerol against three other concentrations (0, 0.5, and 0.75%). HCWs used one formulation at a time for seven working days during their routine practice and then had their hands evaluated by an external observer using the WHO scale for visual inspection. Participants also used a WHO self-evaluation tool to rate their own skin condition. We used a generalized estimating equations of the logit type to compare differences between the tolerability to different formulations. Results: According to the independent observation, participants had 2.4 times (95%CI: 1.12-5.15) more chance of having a skin condition considered good when they used the 0.5% compared to the 1.45% glycerol formulation. For the self-evaluation scale, participants were likely to have a worst evaluation (OR: 0.23, 95%CI: 0.11-0.49) when they used the preparation without glycerol compared to the WHO standard formulation (1.45%), and there were no differences between the other formulations used. Conclusion: In a tropical climate setting, the WHO-modified EBHR formulation containing 0.5% glycerol led to better ratings of skin tolerance than the original formulation, and, therefore, may offer the best balance between skin tolerance and antimicrobial efficacy.

Medicine (Baltimore) ; 98(26): e16204, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31261567


Several prognostic indices have been employed to predict the outcome of surgical critically ill patients. Among them, acute physiology and chronic health evaluation (APACHE) II, sequential organ failure assessment (SOFA) and simplified acute physiology score (SAPS 3) are widely used. It seems that biological markers such as C-reactive protein (CRP), albumin, and blood lactate levels correlate with the degree of inflammation during the immediate postoperative phase and could be used as independent predictors. The objective of this study is to compare the different predictive values of prognostic indices and biological markers in the outcome of 847 surgical patients admitted to the intensive care unit (ICU) in the postoperative phase.The patients were divided into survivors (n = 765, 57.4% males, age 61, interquartile range 51-71) and nonsurvivors (n = 82, 57.3% males, age 70, interquartile range 58-79). APACHE II, APACHE II death probability (DP), SOFA, SAPS 3, SAPS 3 DP, CRP, albumin, and lactate were recorded on ICU admission (first 24 hours). The area under the ROC curve (AUROC) and 95% confidence interval (95% CI) were used to measure the index accuracy to predict mortality.The AUROC and 95% CI for APACHE II, APACHE II DP, SOFA, SAPS 3, SAPS 3 DP, CRP/albumin ratio, CRP, albumin, and lactate were 0.850 (0.824-0.873), 0.855 (0.829-0.878), 0.791 (0.762-0.818), 0.840 (0.813-0.864), 0.840 (0.813-0.864), 0.731 (0.700-0.761), 0.708 (0.676-0.739), 0.697 (0.665-0.728), and 0.601 (0.567-0.634), respectively. The ICU and overall in-hospital mortality were 6.6 and 9.7%, respectively. The APACHE II, APACHE II DP, SAPS 3, SAPS 3 DP, and SOFA scores showed a better performance than CRP/albumin ratio, CRP, albumin, or lactate to predict in-hospital mortality of surgical critically ill patients.Even though all indices were able to discriminate septic from nonseptic patients, only APACHE II, APACHE II DP, SOFA and to a lesser extent SAPS 3, SAPS 3 DP, and blood lactate levels could predict in the first 24-hour ICU admission surgical patients who have survived sepsis.

Cuidados Críticos , Estado Terminal/mortalidade , Estado Terminal/terapia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/mortalidade , APACHE , Idoso , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Cuidados Críticos/métodos , Feminino , Mortalidade Hospitalar , Humanos , Ácido Láctico/sangue , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Complicações Pós-Operatórias/terapia , Período Pós-Operatório , Curva ROC , Estudos Retrospectivos , Sepse/diagnóstico , Sepse/mortalidade , Sepse/terapia , Albumina Sérica/metabolismo , Escala Psicológica Aguda Simplificada
Am J Crit Care ; 28(2): 136-141, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30824518


BACKGROUND: Septic shock is one of the main causes of mortality in intensive care units worldwide. Nutritional support can affect the survival of patients with sepsis. OBJECTIVE: To evaluate whether resting energy expenditure, respiratory quotient, and oxygen consumption and carbon dioxide production (measured by indirect calorimetry) differ between critically ill patients with vs without sepsis. METHODS: A total of 205 patients receiving mechanical ventilation were evaluated consecutively within the first 48 hours of admission. Demographic and clinical data were collected, including age, body mass index, oxygen consumption, carbon dioxide production, respiratory quotient, and resting energy expenditure, with the clinical data measured or estimated via indirect calorimetry. RESULTS: Of the 205 patients, 114 (56%) had no sepsis and 91 (44%) had sepsis. The median values of the studied variables in the no sepsis and sepsis groups, respectively, were as follows: age, 53 vs 58 years (P = .07); body mass index, 25 vs 26 (P = .14); Acute Physiology and Chronic Health Evaluation II score, 24 vs 25 (P = .04); death risk, 47% vs 63% (P = .04); oxygen consumption, 211 vs 202 mL/min (P = .72); and resting energy expenditure, 1434 vs 1430 kcal/d (P = .73). Analysis of receiver operating characteristic curves showed no significant differences between patients with and without sepsis for any of the indirect calorimetry variables. CONCLUSION: In clinical practice, patients with sepsis do not seem to require an increased energy supply. Additional studies are needed to confirm this conclusion.

Estado Terminal/terapia , Metabolismo Energético/fisiologia , Consumo de Oxigênio/fisiologia , Sepse/dietoterapia , Sepse/fisiopatologia , APACHE , Fatores Etários , Índice de Massa Corporal , Calorimetria Indireta , Estado Terminal/enfermagem , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Apoio Nutricional , Descanso , Sepse/enfermagem , Fatores Sexuais , Fatores Socioeconômicos
Medicine (Baltimore) ; 98(8): e14417, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30813142


BACKGROUND: Removing an indwelling urinary catheter as soon as possible is the cornerstone of catheter-associated urinary tract infections (CAUTI) prevention. However, implementing this measure may be challenging in clinical settings. To evaluate the impact of implementing a healthcare workers (HCWs) educational program and a daily checklist for indwelling urinary catheter indications among critical patients on the incidence of CAUTI. METHODS: This was a quasi-experimental study performed in a general intensive care unit of a tertiary-care hospital over a 12 years period, from January 1, 2005 to December 31, 2016. Rates of urinary catheter use and incidence density of CAUTI were monthly evaluated following the Centers for Disease Control and Prevention (CDC) criteria throughout the study period. Phase I (2005-2006) was the pre-intervention period. In phase II (2007-2010), HCWs routine training on CAUTI prevention was performed twice-a-year. In phase III (2011-2014), we implemented a daily checklist for indwelling urinary catheter indications, in addition to the biannual training. In phase IV, (2015-2016) the biannual training was replaced by training only newly hired HCWs and the daily checklist was maintained. RESULTS: The mean rate of urinary catheter utilization decreased from phase I to phase IV (73.1%, 74.1%, 54.9%, and 45.6%, respectively). Similarly, the incidence density of CAUTI decreased from phase I to phase IV (14.9, 7.3, 3.8, and 1.1 per 1000 catheter-days, respectively). CONCLUSIONS: HCWs education and daily evaluation of indwelling urinary catheter indications were highly effective in reducing the rates of catheter utilization as well as the incidence density of CAUTI.

Infecções Relacionadas a Cateter/prevenção & controle , Pessoal de Saúde/educação , Controle de Infecções/métodos , Cateteres Urinários/efeitos adversos , Infecções Urinárias/prevenção & controle , Brasil , Infecções Relacionadas a Cateter/epidemiologia , Lista de Checagem/métodos , Estado Terminal/terapia , Humanos , Incidência , Unidades de Terapia Intensiva/normas , Ensaios Clínicos Controlados não Aleatórios como Assunto , Avaliação de Programas e Projetos de Saúde/métodos , Cateterismo Urinário/efeitos adversos , Cateteres Urinários/estatística & dados numéricos , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia
Cogitare enferm ; 24: e62411, 2019. tab
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1055938


RESUMO Objetivo: avaliar a qualidade da assistência de enfermagem de uma instituição hospitalar por meio de indicadores de qualidade. Método: estudo observacional, transversal, prospectivo, realizado nas Unidades de Clínica Médica e Cirúrgica de um hospital filantrópico em Minas Gerais, durante quatorze dias consecutivos em 2017, utilizando o instrumento de Registro de Busca Ativa, desenvolvido e validado por Vituri. Resultado: foram avaliados 185 pacientes adultos, totalizando 650 observações. O panorama dos indicadores de ambas as clínicas demonstrou que, dos 14 indicadores, sete (50%) foram classificados como "insuficientes" em ambas as clínicas. Conclusão: processos avaliativos sistemáticos possibilitam conhecer o desempenho técnico e relacional dos profissionais bem como os conhecimentos e habilidades para as práticas assistenciais. A adoção de indicadores assistenciais pode auxiliar o processo de gestão e gerenciamento do serviço de enfermagem.

RESUMEN: Objetivo: Evaluar la calidad de la atención de enfermería en una institución hospitalaria mediante indicadores de calidad. Método: Estudio observacional, transversal, prospectivo, realizado en los Servicios de Clínica Médica y Quirúrgica de un hospital filantrópico de Minas Gerais, durante catorce días consecutivos en 2017, utilizando el instrumento de Registro de Búsqueda Activa, desarrollado y validado por Vituri. Resultados: Fueron evaluados 185 pacientes adultos, totalizándose 650 observaciones. El panorama de los indicadores en ambos servicios demostró que, de los 14 indicadores, 7 (50%) fueron clasificados como "insuficientes" en los dos servicios observados. Conclusión: Los procesos de evaluación sistemáticos permiten conocer el desempeño técnico y relacional de los profesionales, y los conocimientos y habilidades para las prácticas de atención. La adopción de indicadores de atención puede colaborar en el proceso de gestión y gerenciamiento del servicio de enfermería.

ABSTRACT Objective: To evaluate the quality of nursing care in a hospital using quality indicators. Method: observational, prospective, cross-sectional study conducted at the Inpatient Medical and Surgical Units of a philanthropic hospital in Minas Gerais, Brazil for 14 consecutive days in 2017, using the Active Search Registration instrument, developed and validated by Vituri. Result: 185 adult patients were evaluated, totaling 650 observations. The overview of the indicators of both units showed that, of the 14 indicators, seven (50%) were classified as "insufficient" in both places. Conclusion: systematic evaluation processes make it possible to identify the technical and relational performance of the professionals as well as their knowledge and skills for the care practices. The adoption of care indicators can help the management process of the nursing service.

Humanos , Garantia da Qualidade dos Cuidados de Saúde , Avaliação em Saúde , Avaliação em Enfermagem , Indicadores de Qualidade em Assistência à Saúde , Cuidados de Enfermagem
BMC Infect Dis ; 18(1): 547, 2018 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-30390634


BACKGROUND: The Leuconostoc mesenteroides are members of the Streptococcae family and currently has been recognized as potential pathogens. This case describes a bacteremia caused by L. mesenteroides in an immunocompetent patient affected by Chagas disease. CASE PRESENTATION: A 67-year-old female patient with chagasic megaesophagus and megacolon was submitted to a Heller myotomy for achalasia in 2000 and endoscopic dilatation in 2015. Patient was admitted to the Nutrology Ward in May 2016 with protein-calorie malnutrition associated with achalasia and receiving enteral nutrition. In July 2016, the patient underwent a Serra-Doria surgery. In the third postoperative day she presented an important abdominal distension. She was submitted to a new surgical intervention, and then a terminal ileum perforation was detected, leading the surgeon to perform an enterectomy with side-to-side anastomosis. The next day after the surgery (4th postoperative day) the patient presented a decreased level of consciousness (Glasgow coma scale = 8), hypotension and hypoxemia. In two samples of blood cultures there was growth of Leuconostoc mesenteroides. Susceptibility pattern was evaluated by the diffusion disk method. The microorganism was susceptible to penicillin, ampicillin, chloramphenicol, erythromycin, and fluoroquinolones, but resistant to rifampin, tetracycline, vancomycin and teicoplanin. CONCLUSION: We concluded that infections caused by L. mesenteroides is serious and should be considered not only in settings of immunosuppression and prolonged antimicrobial use, but also in immunocompetent patients undergoing surgeries involving the gastrointestinal tract.

Doença de Chagas/diagnóstico , Infecções por Bactérias Gram-Positivas/diagnóstico , Leuconostoc mesenteroides/isolamento & purificação , Idoso , Antibacterianos/farmacologia , Doença de Chagas/complicações , Testes de Sensibilidade a Antimicrobianos por Disco-Difusão , Feminino , Infecções por Bactérias Gram-Positivas/complicações , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Hospedeiro Imunocomprometido , Leuconostoc mesenteroides/efeitos dos fármacos , Choque Séptico/diagnóstico , Choque Séptico/etiologia
J Clin Med Res ; 10(12): 898-903, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30425762


Background: The aim of this study was to identify factors associated with pressure injury (PI) occurrence in critically ill patients. This was a retrospective cohort study conducted at a mixed intensive care unit (ICU). Methods: Univariate analysis and logistic regression were used to identify which variables are associated with PI. Results: Twenty-one (15%) of 142 patients developed PI. The median and the range of the variables in the groups without and with PI were as follows: Braden scale risk score, 13 (8 - 20) and 10 (8 - 14) points, respectively; Acute Physiology and Chronic Health Evaluation II (APACHE II) death risk, 39% (2 - 97%) and 75% (26 - 96%), respectively; and length of stay in the ICU, 4 (2 - 36) and 16 (5 - 29) days, respectively. The socio-demographic variables included in the logistic regression were age (P = 0.09), Braden scale risk score (P = 0.0003), APACHE II death risk (P < 0.0001), length of stay in the ICU (P < 0.0001) and reason for ICU admission (P = 0.09). Only APACHE II death risk and length of stay in the ICU presented significant differences; the odds ratios were 1.05 and 1.25, respectively, and the 95% confidence intervals were 1.01 - 1.09 and 1.12 - 1.39, respectively. Conclusion: APACHE II death risk and length of stay in the ICU are probably associated with PI occurrence in the study population.

Medicine (Baltimore) ; 97(41): e12769, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30313090


Guidelines for patients with subarachnoid hemorrhage (SAH) management and several grading systems or prognostic indices have been used not only to improve the quality of care but to predict also the outcome of these patients. Among them, the gold standards Fisher radiological grading scale, Hunt-Hess and the World Federation of Neurological Surgeons (WFNS) are the most employed. The objective of this study is to compare the predictive values of simplified acute physiology score (SAPS) 3, sequential organ failure assessment (SOFA), and Glasgow Coma Scale (GCS) in the outcome of patients with aneurysmal SAH.Fifty-one SAH patients (33% males and 67% females; mean age of 54.1 ±â€Š10.3 years) admitted to the intensive care units (ICU) in the post-operative phase were retrospectively studied. The patients were divided into survivors (n=37) and nonsurvivors (n = 14). SAPS 3, Fischer scale, WFNS, SOFA, and GCS were recorded on ICU admission (day 1 - D1), and 72-hours (day 3 - D3) SOFA, and GCS. The capability of each index SAPS 3, SOFA, and GCS (D1 and D3) to predict mortality was analyzed by receiver operating characteristic (ROC) curves. The area under the ROC curve (AUC) and the respective confidence interval (CI) were used to measure the index accuracy. The level of significance was set at P < .05.The mean SAPS 3, SOFA, and GCS on D1 were 13.5 ±â€Š12.7, 3.1 ±â€Š2.4, and 13.7 ±â€Š2.8 for survivors and 32.5 ±â€Š28.0, 5.6 ±â€Š4.9, and 13.5 ±â€Š1.9 for nonsurvivors, respectively. The AUC and 95% CI for SAPS 3, SOFA, and GCS on D1 were 0.735 (0.592-0.848), 0.623 (0.476-0.754), 0.565 (0.419-0.703), respectively. The AUC and 95% CI for SOFA and GCS on D3 were 0.768 (0.629-0.875) and 0.708 (0.563-0.826), respectively. The overall mortality was 37.8%.Even though SAPS 3 and Fischer scale predicted mortality better on admission (D1), both indices SOFA and GCS performed similarly to predict outcome in SAH patients on D3.

Escala de Coma de Glasgow , Escores de Disfunção Orgânica , Escala Psicológica Aguda Simplificada , Hemorragia Subaracnóidea/mortalidade , Adulto , Área Sob a Curva , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Curva ROC , Estudos Retrospectivos
Int Dent J ; 68(6): 420-427, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29777534


OBJECTIVE: To evaluate the effectiveness of dental treatment in improving oral health in critical patients. METHODS: This randomised clinical trial was conducted in a general intensive care unit (ICU) at a tertiary care public facility from 1 January 2011 to 8 August 2013. Data from 254 adult patients staying in the ICU for 48 hours or more were analysed. The experimental group (n = 127) had access to dental treatment provided by a dentist four to five times a week, in addition to routine oral hygiene, whereas the control group (n = 127) had access only to routine oral hygiene, including topical application of chlorhexidine, provided by the ICU nursing staff. The baseline oral health status of the enrolled patients was poor and included edentulism, caries, gingivitis, periodontitis and residual roots. Dental treatment consisted of toothbrushing, tongue scraping, removal of calculus, scaling and root planing, caries restoration and tooth extraction. RESULTS: The Oral Hygiene Index Simplified (OHI-S) and Gingival Index (GI) scores decreased in the experimental group but did not change significantly in the control group during the ICU stay. Dental treatment prevented most of the episodes of respiratory tract infections, as previously reported. No severe adverse events from the dental treatment were observed. CONCLUSION: From an interprofessional perspective, our results support the idea of including dentists in the ICU team to improve oral health in critical patients and effectively prevent respiratory tract infections, in addition to the improvement achievable by applying chlorhexidine alone.

Assistência Odontológica , Equipe Hospitalar de Odontologia , Unidades de Terapia Intensiva , Saúde Bucal , Equipe de Assistência ao Paciente , Adulto , Brasil , Assistência Odontológica/métodos , Feminino , Mão de Obra em Saúde , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem no Hospital , Higiene Bucal , Infecções Respiratórias/prevenção & controle
Texto & contexto enferm ; 27(4): e0390017, 2018. tab, graf
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-979416


RESUMO Objetivo: verificar se a carga de trabalho de enfermagem é em preditor de mortalidade em Unidade de Terapia Intensiva. Método: estudo documental, retrospectivo, corte transversal, desenvolvido na Unidade de Terapia Intensiva de um hospital universitário terciário. Utilizou-se a curva Receiver Operator Characteristic Curve composta pelo Nursing Activities Score e índice de gravidade APACHE e regressão logística para análise da predição de mortalidade. Resultados: compuseram a amostra 324 pacientes, sendo 214 (66%) sobreviventes. A média Nursing Activities Score das primeiras 24 horas de internação foi de 79,3 pontos, variando de 34,8 a 134,2 pontos e o APACHE II mediano foi 24,5 (2-42). Na análise da curva Receiver Operator Characteristic Curve o Nursing Activities Score evidenciou uma área sobre a curva de 0,626; IC 0,570 a 0,678 e o APACHE II de 0,721 com intervalo de confiança IC 95% de 0,669 a 0,769. Conclusão: a carga de trabalho de enfermagem não foi um preditor de mortalidade em Unidade de Terapia Intensiva, pois os pacientes que demandam a maior carga de trabalho de enfermagem não necessariamente são aqueles que evoluem para óbito.

RESUMEN Objetivo: verificar si la carga de trabajo de enfermería aferida por el Nursing Activity Score como predictor de mortalidad en Unidad de Terapia Intensiva. Método: estudio documental, retrospectivo, corte transversal, desarrollado en la Unidad de Terapia Intensiva de un hospital universitario terciario. Se utilizó la curva Receiver Operator Characteristic Curve compuesta por el Nursing Activity Score y índice de gravedad APACHE y regresión logística para análisis de la predicción de mortalidad. Resultados: compusieron la muestra 324 pacientes, siendo 214 (66%) sobrevivientes. El promedio Nursing Activities Score de las primeras 24 horas de internación fue de 79,3 puntos, variando de 34,8 a 134,2 puntos y el APACHE II mediano fue de 24,5 (2-42). En el análisis de la curva Receiver Operator Characteristic Curve o Nursing Activities Score evidenció un área sobre la curva de 0,626; IC 0,570 a 0,678 y el APACHE II de 0,721 con intervalo de confianza IC 95% de 0,669 a 0,769. Conclusión: la carga de trabajo de enfermería no fue un predictor de mortalidad en Unidad de Terapia Intensiva, pues los pacientes que demandan la mayor carga de trabajo de enfermería no necesariamente son aquellos que evolucionan a muerte

ABSTRACT Objective: to verify if the nursing workload is a predictor of mortality at an Intensive Care Unit. Method: cross-sectional and retrospective documentary study, developed at the Intensive Care Unit of a tertiary university hospital. The Receiver Operator Characteristic Curve was used, consisting of the Nursing Activities Score and the APACHE severity score, using logistic regression to analyze the prediction of mortality. Results: the sample included 324 patients, 214 (66%) of whom survived. The mean Nursing Activities Score during the first 24 hours of hospitalization was 79.3 points, ranging from 34.8 to 134.2 points, and the median APACHE II was 24.5 (2-42). In the analysis of the Receiver Operator Characteristic Curve, the Nursing Activities Score evidenced an area under the curve corresponding to 0.626; CI between 0.570 and 0.678 and an APACHE II score of 0.721, with a 95% confidence interval from 0.669 to 0.769. Conclusion: the nursing workload did not serve as a mortality predictor at the Intensive Care Unit, as the patients who demand the main nursing workload are not necessarily the patients who evolve to death.

Humanos , Índice de Gravidade de Doença , Mortalidade , Carga de Trabalho , Unidades de Terapia Intensiva , Recursos Humanos de Enfermagem
Rev Rene (Online) ; 19: e32478, jan. - dez. 2018.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-979715


Objetivo: estimar a prevalência de Staphylococcus aureus resistente à oxacilina isolado na saliva e em secreção nasal dos profissionais de enfermagem. Métodos: estudo transversal realizado em unidades especializadas de um hospital universitário. No total, 600 amostras de saliva e secreções nasais foram obtidas de profissionais de enfermagem. Resultados: dos 100 participantes, identificou-se o crescimento de Staphylococcus aureus em 43,0% dos profissionais, 7,0% eram resistentes à oxacilina. Desses Staphylococcus aureus resistentes à oxacilina, 100,0% foram carreadores nasais; dois profissionais foram carreadores nasais e na saliva. Todos os profissionais colonizados por Staphylococcus aureus resistente à oxacilina tiveram indicação para realizar o protocolo de descolonização vigente na instituição do estudo, seis aceitaram seguir o protocolo e apenas dois apresentaram culturas negativas para Staphylococcus aureus após a descolonização. Conclusão: os resultados demonstraram a colonização do profissional de enfermagem por Staphylococcus aureus, sendo a cavidade nasal apontada como um importante sítio de colonização. (AU)

Staphylococcus aureus , Resistência a Meticilina , Enfermagem
PLoS One ; 12(11): e0188241, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29190742


OBJECTIVES: To correlate the average number of nursing care hours dedicated to Intensive Care Unit (ICU) patients with nursing care indicators. METHOD: Transverse, descriptive study conducted between 2011 and 2013. Data were obtained from the electronic records system and from the nursing staff daily schedule. Generalized Linear Models were used for analysis. RESULTS: A total of 1,717 patients were included in the study. The average NAS (Nursing Activities Score) value was 54.87. The average ratio between the number of nursing care hours provided to the patient and the number of nursing care hours required by the patient (hours ratio) was 0.87. Analysis of the correlation between nursing care indicators and the hours ratio showed that the indicators phlebitis and ventilator-associated pneumonia significantly correlated with hours ratio; that is, the higher the hours ratio, the lower the incidence of phlebitis and ventilator-associated pneumonia. CONCLUSION: The number of nursing care hours directly impacts patient outcomes, which makes adjustment of nurse staffing levels essential.

Cuidados Críticos , Cuidados de Enfermagem , Resultado do Tratamento , Humanos
Rev. enferm. UFPE on line ; 11(supl.12): 5305-5311, dez.2017. ilus, tab
Artigo em Português | BDENF - Enfermagem | ID: biblio-1032360


Objetivo: analisar comparativamente a carga de trabalho de Enfermagem em duas unidades de terapiaintensiva. Método: estudo quantitativo, de coorte transversal, descritivo, realizado em duas UTI de umhospital universitário. A amostra foi aleatória constituindo-se de 100 pacientes. A análise foi realizada pormeio da regressão multivariada, cuja variável dependente foi carga de trabalho de Enfermagem,permanecendo, no modelo final, as variáveis independentes com significância estatística menor que 0,05.Resultados: a maioria dos pacientes foi do sexo masculino (60%), com média de idade de 52,3 anos. A cargade trabalho de Enfermagem nas UTI apresentou a média do escore NAS total do conjunto de pacientes de75,65 e escore APACHE II de 25,5. Conclusão: o tempo de permanência, o sexo e a faixa etária nãoapresentaram associação significativa com a carga de trabalho de Enfermagem, porém, esta se associou aoescore de gravidade (APACHE II) e à condição de saída do paciente (alta/óbito).

Masculino , Feminino , Humanos , Carga de Trabalho , Enfermagem , Recursos Humanos de Enfermagem no Hospital/provisão & distribução , Unidades de Terapia Intensiva , Epidemiologia Descritiva , Estudos Transversais