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1.
Medicine (Baltimore) ; 98(37): e17092, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517832

RESUMO

BACKGROUND: Low back pain (LBP) is a major health problem around the world. Two previous meta-analyses showed that the spa therapy has a positive effect on reducing pain among patients with LBP based on studies published before 2006 and studies published between 2006 and 2013. In recent years, more studies reported the effect of spa therapy on treating chronic low back pain (CLBP). Our study aimed to update the meta-analysis of randomized controlled trials (RCTs) about the effect of spa therapy on treating CLBP and to examine the effect of spa therapy based on different interventions. METHODS: PubMed, Embase, Web of Science, and Cochrane Library were searched until May 2018 to identify RCTs about spa therapy among patients with CLBP. Summary effect estimates were calculated by using a random-effects model. The quality of each eligible study was evaluated by Jadad checklist. RESULTS: Twelve studies met the inclusion criteria for the systematic review and were included in meta-analysis. There was a significant decrease in pain based on visual analogue scale (VAS) (mean difference [MD] 16.07, 95% confidence interval [CI] [9.57, 22.57], P < .00001, I = 88%, n = 966), and lumbar spine function in Oswestry disability index (ODI) (MD 7.12, 95% CI [3.77, 10.47], P < .00001, I = 87%, n = 468) comparing spa therapy group to control group. Methodological assessment for included studies showed that the study's quality is associated with lacking blinding. CONCLUSION: This updated meta-analysis confirmed that spa therapy can benefit pain reliving and improve lumbar spine function among patients with CLBP. Physiotherapy of subgroup analysis indicated that it can improve lumbar spine function. However, these conclusions should be treated with caution due to limited studies. More high-quality RCTs with double-blind design, larger sample size, and longer follow-up should be employed to improve the validity of study results.


Assuntos
Banhos/normas , Dor Lombar/terapia , Banhos/métodos , Dor Crônica/terapia , Humanos , Medição da Dor/métodos
2.
Dermatitis ; 30(3): 191-197, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31094942

RESUMO

Bathing additives are regularly used for a range of inflammatory dermatoses that affect a large body surface area. Emerging evidence demonstrates that certain bathing additives have anti-inflammatory, skin barrier repair, antimicrobial, and antioxidative properties, all pertinent to atopic dermatitis. This review summarizes the mechanism and effects of Dead Sea salt, hard water, commercial baby cleansers, oatmeal, rice, and natural oils as bathing additives for the treatment of atopic dermatitis. The use of these compounds seems to augment the benefit of traditional treatments while also reducing the need for and side effects of prescription modalities. Bathing additives are useful adjuvant treatments for atopic dermatitis. Benefits of these compounds are derived from anti-inflammatory, antimicrobial, antioxidative, and skin barrier repair properties.


Assuntos
Banhos/métodos , Dermatite Atópica/terapia , Higiene da Pele/métodos , Administração Cutânea , Dermatite Atópica/tratamento farmacológico , Fármacos Dermatológicos/uso terapêutico , Eczema/tratamento farmacológico , Emolientes/administração & dosagem , Humanos
3.
Lancet ; 393(10177): 1205-1215, 2019 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-30850112

RESUMO

BACKGROUND: Universal skin and nasal decolonisation reduces multidrug-resistant pathogens and bloodstream infections in intensive care units. The effect of universal decolonisation on pathogens and infections in non-critical-care units is unknown. The aim of the ABATE Infection trial was to evaluate the use of chlorhexidine bathing in non-critical-care units, with an intervention similar to one that was found to reduce multidrug-resistant organisms and bacteraemia in intensive care units. METHODS: The ABATE Infection (active bathing to eliminate infection) trial was a cluster-randomised trial of 53 hospitals comparing routine bathing to decolonisation with universal chlorhexidine and targeted nasal mupirocin in non-critical-care units. The trial was done in hospitals affiliated with HCA Healthcare and consisted of a 12-month baseline period from March 1, 2013, to Feb 28, 2014, a 2-month phase-in period from April 1, 2014, to May 31, 2014, and a 21-month intervention period from June 1, 2014, to Feb 29, 2016. Hospitals were randomised and their participating non-critical-care units assigned to either routine care or daily chlorhexidine bathing for all patients plus mupirocin for known methicillin-resistant Staphylococcus aureus (MRSA) carriers. The primary outcome was MRSA or vancomycin-resistant enterococcus clinical cultures attributed to participating units, measured in the unadjusted, intention-to-treat population as the HR for the intervention period versus the baseline period in the decolonisation group versus the HR in the routine care group. Proportional hazards models assessed differences in outcome reductions across groups, accounting for clustering within hospitals. This trial is registered with ClinicalTrials.gov, number NCT02063867. FINDINGS: There were 189 081 patients in the baseline period and 339 902 patients (156 889 patients in the routine care group and 183 013 patients in the decolonisation group) in the intervention period across 194 non-critical-care units in 53 hospitals. For the primary outcome of unit-attributable MRSA-positive or VRE-positive clinical cultures (figure 2), the HR for the intervention period versus the baseline period was 0·79 (0·73-0·87) in the decolonisation group versus 0·87 (95% CI 0·79-0·95) in the routine care group. No difference was seen in the relative HRs (p=0·17). There were 25 (<1%) adverse events, all involving chlorhexidine, among 183 013 patients in units assigned to chlorhexidine, and none were reported for mupirocin. INTERPRETATION: Decolonisation with universal chlorhexidine bathing and targeted mupirocin for MRSA carriers did not significantly reduce multidrug-resistant organisms in non-critical-care patients. FUNDING: National Institutes of Health.


Assuntos
Bacteriemia/prevenção & controle , Banhos/métodos , Clorexidina/administração & dosagem , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Administração Intranasal , Idoso , Anti-Infecciosos Locais/administração & dosagem , Portador Sadio/sangue , Portador Sadio/epidemiologia , Feminino , Humanos , Controle de Infecções , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Mupirocina/administração & dosagem , Infecções Estafilocócicas/prevenção & controle , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/patogenicidade
4.
Rio de Janeiro; s.n; 20190000. 72 p. ilus, tab.
Tese em Português | LILACS, BDENF - Enfermagem | ID: biblio-1026652

RESUMO

Introdução: As doenças cardiovasculares são uma das principais causas de mortalidade no mundo. A forma aguda desta situação é denominada Síndrome Coronariana Aguda (SCA) que pode ser classificada como: angina instável e infarto agudo do miocárdio. Após o diagnóstico médico definido como SCA, o paciente necessita de internação em uma Unidade Coronariana. Neste ambiente é oferecida uma assistência guiada por protocolos clínicos e diretrizes de forma a contribuir na sua recuperação, minimizar o risco de complicações e prevenir os danos. Entre os protocolos que envolvem esse cuidado destaca-se o banho, que pode ser classificado como no leito ou de aspersão. Para a tomada de decisão do do enfermeiro quanto a indicação ao banho do paciente coronariopata são necessárias informações clinicas, e da hemodinâmica atual do paciente. Pontua-se como problema "A ausência de sistematização para tomada de decisão quanto a escolha banho do paciente coronariopata em uma Unidade Coronariana". Objetivo: Elaborar um algoritmo no formato de aplicativo móvel para auxiliar a tomada de decisão do enfermeiro quanto ao banho do paciente coronariopata em uma Unidade Coronariana. Método: Trata-se de estudo exploratório, metodológico e abordagem quantitativa para a elaboração de um algoritmo no formato de aplicativo móvel. O estudo foi realizado em duas etapas: 1ªetapa: elaborou-se um intrumento a partir de uma revisão de literatura abordando as temáticas reabilitação cardíaca e banho. Este instrumento foi submetido a validação de seus critérios por enfermeiros. A abordagem dos dados, foi realizada por estatística descritriva como cálculo do Coeficiente de Alfa de Cronbach. 2ªetapa: Elaboração do algoritmo baseado nos achados do instrumento aplicado, em formato de aplicativo móvel para auxiliar na tomada de decisão quanto ao banho do paciente coronariopata na UTI. Resultados: Avaliaram o instrumento um total de 29 enfermeiros, em um período de 03 meses. Dentre estes 26 (89%) eram do sexo feminino, com idade na faixa de 23 à 58 anos e todos os enfermeiros possuíam algum tipo de pós-graduação em seu currículo. Foram 22 critérios submetidos à validação por 29 especialistas, totalizando 638 avaliações. Dentre estes, 63% (401) foi classificada como Concordância. O valor encontrado para o coeficiente α foi de aproximadamente 0,9536. Foram 19 itens validados, através do coeficiente α, e 19 itens sugeridos e utilizados pelos especialistas. Após categorização, foram selecionados 19 itens, organizados em formato de algoritmo, com respostas dicotômicas (sim ou não) o que sugere a cada final de fluxo o tipo do banho (não banho, banho no leito ou banho de aspersão) indicado ao paciente, devido suas condições clínicas. Conclusão: O aplicativo móvel, produto desta pesquisa, foi elaborado por um colaborador que o utilizou a interface de desenvolvimento Android Studio® com a linguagem Java® a partir do algoritmo estruturado baseado nos achados do julgamento prévio dos especialistas para auxiliar na tomada de decisão quanto ao banho do paciente em uma Unidade Coronariana, para sua disponibilização para download, sugere-se a validação através de um estudo piloto, para garantir a segurança ao paciente


Introduction: Cardiovascular diseases are one of the leading causes of mortality in the world. The acute form of this condition is called Acute Coronary Syndrome (ACS), which can be classified as unstable angina and acute myocardial infarction. After the medical diagnosis defined as SCA, the patient needs hospitalization in a Coronary Unit. In this environment, it is offered assistance guided by clinical protocols and guidelines in order to contribute to its recovery, to minimize the risk of complications and to prevent damages. Among the protocols that involve this care is the bath, which can be classified as bedding or spraying. The clinician's clinical information and the patient's current hemodynamics are necessary for the decision-making of the nurse regarding the indication to the coronary patient's bath. The problem "The absence of systematization for decision making regarding the choice of bath of the coronariopata patient in a Coronary Unit" is a problem. Objective: To elaborate an algorithm in the format of a mobile application to aid the decision making of the nurse regarding the bath of the coronariopata patient in a Coronary Unit. Method: This is an exploratory, methodological and quantitative approach to the elaboration of an algorithm in the mobile application format. The study was carried out in two stages: 1st stage: an instrument was elaborated from a literature review addressing the themes of cardiac and bath rehabilitation. This instrument was submitted to validation of its criteria by nurses. The data approach was carried out by a statistic described as the calculation of Cronbach's Alpha Coefficient. 2nd stage: Elaboration of the algorithm based on the findings of the applied instrument, in a mobile application format to aid in decision making regarding the coronary patient's ICU bath. Results: A total of 29 nurses were evaluated in a period of 03 months. Of these, 26 (89%) were female, ranging in age from 23 to 58 years old and all nurses had some type of postgraduate degree in their curriculum. There were 22 criteria submitted to validation by 29 specialists, totaling 638 evaluations. Of these, 63% (401) was classified as Concordance. The value found for the coefficient α was approximately 0.9536. There were 19 items validated through the α coefficient and 19 items suggested and used by the specialists. After categorization, we selected 19 items, organized in an algorithm format, with dichotomic responses (yes or no), which suggests to each end of the flow the type of bath (not bath, bath in the bed or bath of sprinkling) due to its clinical conditions. Conclusion: The mobile application, the product of this research, was developed by a developer who used the Android Studio® development interface with the Java® language from a structured algorithm based on the findings of the expert's prior judgment to assist in decision making to the patient's bath in a Coronary Unit, for its availability for download, validation is suggested through a pilot study, to guarantee patient safety


Assuntos
Humanos , Banhos/métodos , Doença das Coronárias/enfermagem , Enfermagem de Cuidados Críticos , Aplicativos Móveis
5.
J Clin Nurs ; 28(11-12): 2235-2244, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30786096

RESUMO

AIMS AND OBJECTIVES: To gain an in-depth understanding of patients' preferences regarding two bed bath methods: soap and water and disposable wet wipes. BACKGROUND: Bed baths allow hospitalised, bedridden patients to stay clean and fresh. They serve a number of purposes: health promotion, social propriety and pure pleasure. Traditionally, soap and water have been used for personal hygiene, but in recent years soap and water have increasingly been replaced by the use of disposable wet wipes. DESIGN: A qualitative study with a hermeneutical-phenomenological approach was chosen to explore and understand patients' experiences of bed bath methods. METHODS: Semi-structured, individual, in-depth interviews with 16 bedridden patients from three wards were conducted. The software program nvivo was used to structure the transcribed interviews and assist in the initial data analysis. The data were analysed and interpreted within a phenomenological-hermeneutical framework. COREQ guidelines were used in the preparation of this paper (See Supporting information Appendix S1). RESULTS: Four overall themes were identified: "Creating a sense of cleanliness," "Preferences and concerns in different situations," "Cleanliness of hands and face" and "Clinical decision-making about bed bath method." CONCLUSIONS: Overall, patients' bed bath preference was for soap and water, but disposable wet wipes were considered a convenient alternative and preferred in certain circumstances, for example, when a patient had pain or diarrhoea. Shared decision-making regarding bed bath method is recommended. Hands and face had specific requirements. RELEVANCE TO CLINICAL PRACTICE: Nursing staff should be aware that bedridden patients have varying preferences, and it is important to incorporate the patients' preferences in the development of standards, health policies and clinical guidelines for bed bath practices.


Assuntos
Banhos/métodos , Preferência do Paciente , Adulto , Banhos/enfermagem , Tomada de Decisões , Feminino , Humanos , Masculino , Pesquisa Qualitativa , Sabões , Água
6.
J Pak Med Assoc ; 69(2): 261-263, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30804597

RESUMO

A 61 year male, admitted in Combined Military Hospital Rawlpindi on 12th March 2017, operated for diverticulitis became colonized with Staphylococcus haemolyticus. Patient suffered repeated septic episodes caused by the same organism during his stay in hospital. The strain was identified as methicillin resistant Staphylococcus haemolyticus (MRSH) also resistant to Linezolid by analytical profile index for Staphylococcus (API Staph) and VITEK 2 Gram positive cocci panel. The isolate was cultured from blood cultures, Central Venous Catheter (CVC) tip and skin swabs. Patient was successfully treated with injectable vancomycin and skin decolonization was acheived with chlorhexidine bath after which no episode of MRSH infection occurred. Patient had an uneventful recovery and was discharged on 21st June. His follow up visit showed clinical improvement.


Assuntos
Infecções Relacionadas a Cateter , Clorexidina/administração & dosagem , Infecção Hospitalar , Resistência a Meticilina , Sepse , Infecções Estafilocócicas , Staphylococcus haemolyticus , Vancomicina/administração & dosagem , Antibacterianos/administração & dosagem , Banhos/métodos , Infecções Relacionadas a Cateter/microbiologia , Infecções Relacionadas a Cateter/fisiopatologia , Infecções Relacionadas a Cateter/terapia , Infecção Hospitalar/microbiologia , Infecção Hospitalar/fisiopatologia , Infecção Hospitalar/terapia , Humanos , Injeções , Linezolida/farmacologia , Masculino , Pessoa de Meia-Idade , Prevenção Secundária , Sepse/microbiologia , Sepse/fisiopatologia , Sepse/terapia , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/fisiopatologia , Infecções Estafilocócicas/terapia , Staphylococcus haemolyticus/efeitos dos fármacos , Staphylococcus haemolyticus/isolamento & purificação
7.
Biomed Res Int ; 2019: 7535140, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30800676

RESUMO

Background: The effect of thermal stress on the physiological parameters of young overweight and sedentary men who sporadically use the sauna remains insufficiently investigated. Aim: The aim of the study was to determine the effect of sauna bathing on the physiological parameters of young overweight, physically inactive men and to test the correlations between physiological parameters versus anthropometric features and body composition parameters. Materials and Methods: Forty-five overweight and sedentary men aged 20.76±2.4 y were exposed to four sauna sessions of 10 minutes each (temperature: 90-91°C; relative humidity: 14-16 %) with four 5-minute cool-down breaks. Body composition was determined before sauna, and body mass and blood pressure were measured before and after sauna. Physiological parameters were monitored during four 10-minute sauna sessions. Results: A significant (p<0.0001) increase in all analyzed physiological parameters was observed during four successive 10-minute sauna sessions. Heart rate, energy expenditure, blood pressure, and body mass loss were most strongly correlated with anthropometric parameters (body mass, body mass index, and body surface area) and body composition parameters (percent body fat, body fat mass, and visceral fat level). The 60-minute treatment resulted in a significant reduction in body mass (0.65 kg). Conclusions: Repeated use of Finnish sauna induces significant changes in the physiological parameters of young sedentary overweight men, and these changes are intensified during successive treatments. Deleterious cardiovascular adaptations were most prevalent in men characterized by the highest degree of obesity and the largest body size.


Assuntos
Composição Corporal/fisiologia , Sobrepeso/fisiopatologia , Adulto , Antropometria/métodos , Banhos/métodos , Pressão Sanguínea/fisiologia , Índice de Massa Corporal , Temperatura Corporal/fisiologia , Frequência Cardíaca/fisiologia , Humanos , Masculino , Atividade Motora/fisiologia , Obesidade/fisiopatologia , Banho a Vapor/métodos , Temperatura Ambiente , Adulto Jovem
8.
Nurs Womens Health ; 23(1): 31-37, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30593766

RESUMO

OBJECTIVE: To develop an evidence-based practice project to evaluate the effect of delaying a newborn's first bath on exclusive breastfeeding rates at discharge. DESIGN: A pre- and post-implementation evaluation of the effect of delaying the first bath on exclusive breastfeeding rates at discharge. SETTING: A postpartum unit in a southern California community hospital. PARTICIPANTS: Breastfeeding dyads of women and newborns (>37 weeks gestational age) who were admitted to the postpartum unit. INTERVENTION/MEASUREMENTS: Postpartum nurses involved in the unit practice council, in collaboration with unit leadership, changed the newborn's first bath practice through development of a bathing guideline, nurse education, and mother education. Measurements of the practice change included time of the first bath and exclusive breastfeeding rates at discharge. RESULTS: We observed an increased time for the newborn's first bath from 6.88 hours to 13.71 hours (p ≤ .001). The number of times women chose not to bathe their newborns while in the hospital also increased by approximately seven times, from 0.16% to 1.1%. The rate of exclusive breastfeeding at discharge did not change significantly after implementation (p ≥ .05), regardless of when the first bath was given. CONCLUSION: Delaying a newborn's first bath was not associated with an increase in exclusive breastfeeding rates. More research is needed to determine the effect of bath times.


Assuntos
Banhos/normas , Aleitamento Materno/métodos , Tempo para o Tratamento , Adulto , Banhos/métodos , Banhos/estatística & dados numéricos , Aleitamento Materno/estatística & dados numéricos , California , Distribuição de Qui-Quadrado , Prática Clínica Baseada em Evidências/métodos , Prática Clínica Baseada em Evidências/estatística & dados numéricos , Feminino , Humanos , Recém-Nascido , Fatores de Tempo
9.
J Hosp Infect ; 101(3): 264-271, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30408504

RESUMO

BACKGROUND: Vancomycin-resistant Enterococcus faecium (VRE) is emerging in German intensive care units (ICUs). On a 32-bed surgical ICU at a university hospital, increasing numbers of nosocomial cases occurred despite enforcement of hand hygiene and environmental disinfection. AIM: To introduce universal octenidine-based bathing in order to reduce the burden of VRE. METHODS: Between January 2012 and March 2014, patients were screened for VRE on admission and twice weekly. Active surveillance was undertaken for VRE infections and colonizations, and for bloodstream infections (BSI) with any pathogen. Intervention in this before-after study comprised of standardized octenidine-based bathing. Distinct subgroups of VRE colonizations or infections were defined and used for statistical analysis of frequency, prevalence and incidence density. FINDINGS: In the pre-intervention period (January 2012 to April 2013), the admission prevalence of VRE was 4/100 patients and the mean incidence density of nosocomial cases was 7.55/1000 patient-days (PD). Pulsed-field gel electrophoresis analysis revealed prevalence of three vanA and two vanB clusters. In the post-intervention period (August 2013 to March 2014), the admission prevalence of VRE was 2.41/100 patients and the mean incidence density of nosocomial cases was 2.61/1000 PD [P = 0.001 (pre- vs post-intervention)]. Thirteen nosocomial VRE infections were identified in the pre-intervention period, compared with one nosocomial VRE infection in the post-intervention period. Incidence densities of BSI pre- and post-intervention were 2.98 and 2.06/1000 PD (P = 0.15), respectively. CONCLUSION: The epidemiology of emerging VRE appeared as a complex mix of admitted cases and transmissions in small clusters, challenging infection control measures. The implementation of universal octenidine-based bathing combined with a standardized washing regime led to a significant reduction in nosocomial VRE.


Assuntos
Anti-Infecciosos Locais/administração & dosagem , Banhos/métodos , Transmissão de Doença Infecciosa/prevenção & controle , Unidades de Terapia Intensiva , Piridinas/administração & dosagem , Sepse/prevenção & controle , Enterococos Resistentes à Vancomicina/isolamento & purificação , Infecção Hospitalar/microbiologia , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/transmissão , Desinfecção/métodos , Enterococcus faecium/isolamento & purificação , Alemanha , Infecções por Bactérias Gram-Positivas/microbiologia , Infecções por Bactérias Gram-Positivas/prevenção & controle , Infecções por Bactérias Gram-Positivas/transmissão , Hospitais Universitários , Humanos , Prevalência , Sepse/microbiologia , Sepse/transmissão
10.
Animal ; 13(6): 1319-1325, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30392490

RESUMO

Footbaths represent a potentially useful strategy for the prevention of claw infectious diseases by treating a large number of animals concomitantly. Nevertheless, under field conditions, footbath solutions are exposed to increasing number of animal passages and therefore, to different volume losses and concentrations of manure contamination which could alter their presumed bactericidal activity. Across increasing number of cow passages, the organic matter (OM) concentration, the microbial load (ML) and the residual volumes were assessed in six commercial farms. The results indicate that the OM concentration and ML increased linearly with the number of passages of animals, and with the number of defecations in the footbath. The OM concentrations and the ML were not impacted by the farm's feet hygiene status (clean, fair and dirty), suggesting that probably the increasing number of cow passages and defecations influenced more the contamination of footbaths than the hygiene of the feet. In all the farms the volumes decreased drastically after 200 cow passages (50%). The OM concentrations after 150 and 200 cow passages did not exceed the regulatory concentrations in which disinfectant products should demonstrate to still be effective (20 g/l), and coincide with the often advised renewal rates. The findings of this study suggested that beyond the footbath contamination by OM, the renewal rates must be mainly adapted according to the remaining volume to guarantee that the entire foot is covered and therefore assure the topical action of the solution. This study highlights the importance of footbath designs for the successful implementation of these strategies in practice.


Assuntos
Banhos/veterinária , Indústria de Laticínios/métodos , Higiene , Animais , Banhos/métodos , Bovinos , Feminino , França
11.
Clin Microbiol Infect ; 25(6): 705-710, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30267930

RESUMO

OBJECTIVES: To investigate whether daily bathing with a soap-like solution of 4% chlorhexidine (CHG) followed by water rinsing (CHGwr) would decrease the incidence of hospital-acquired infections (HAI) in intensive care settings. METHODS: Randomized, controlled trial; infectious diseases specialists were blinded to the intervention status. All patients admitted to the Intensive Care Unit (ICU) and to the Post-operative Cardiosurgical Intensive Care Unit (PC-ICU) of the University Hospital of Perugia were enrolled and randomized to the intervention arm (daily bathing with 4% CHGwr) or to the control arm (daily bathing with standard soap). The incidence rate of acquisition of HAI was compared between the two arms as primary outcome. We also evaluated the incidence of bloodstream infections (BSI), central-line-associated BSI (CLABSI), ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infections (CAUTI), and 4% CHGwr safety. RESULTS: In all, 449 individuals were enrolled, 226 in treatment arm and 223 in control arm. Thirty-four individuals of the 226 (15%) and 57 (25.6%) suffered from at least an HAI in the intervention and control arms, respectively (p 0.008); 23.2 and 40.9 infections/1000 patient-days were detected in the intervention arm and control arm, respectively (p 0.037). The incidence of all bloodstream infections (BSI plus CABSI) was significantly reduced in the intervention arm (9.2 versus 22.6 infections/1000 patient-days, p 0.027); no differences were observed in the mortality between the two arms. CONCLUSIONS: Daily bathing with 4% CHGwr significantly reduced HAI incidence in intensive care settings. CLINICALTRIAL. GOV REGISTRATION: NCT03639363.


Assuntos
Anti-Infecciosos Locais/administração & dosagem , Banhos/métodos , Clorexidina/análogos & derivados , Cuidados Críticos/métodos , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Desinfecção/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Clorexidina/administração & dosagem , Feminino , Hospitais Universitários , Humanos , Incidência , Unidades de Terapia Intensiva , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
12.
J Nurs Care Qual ; 34(2): 133-138, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29975217

RESUMO

BACKGROUND: Evidence supports daily bathing using chlorhexidine gluconate (CHG) cloths to decrease preventable hospital-acquired central line-associated bloodstream infections (CLABSIs). However, implementation of this practice is inconsistent. Using multifaceted strategies to promote implementation is supported in the literature, yet there is a gap in knowing which strategies are most successful. PURPOSE: Using the Grol and Wensing Model of Implementation as a guide, the purpose of this study was to determine whether using tailored, multifaceted strategies would improve implementation of daily CHG bathing and decrease CLABSIs in a large neuro ICU. METHODS: An observational pre-/postdesign was used. RESULTS: Following implementation, infection rates decreased (P = .031). Statistically significant improvements were also seen across all process measures: bathing documentation, nursing knowledge, and perceived importance of CHG bathing. CONCLUSIONS: This study assists in closing the research-practice gap by using tailored, multifaceted implementation strategies to increase use of evidence-based nursing care for infection prevention practices.


Assuntos
Banhos/métodos , Prática Clínica Baseada em Evidências , Ciência da Implementação , Unidades de Terapia Intensiva , Anti-Infecciosos Locais/administração & dosagem , Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Venoso Central/efeitos adversos , Clorexidina/administração & dosagem , Clorexidina/análogos & derivados , Enfermagem de Cuidados Críticos , Infecção Hospitalar/prevenção & controle , Humanos , Neurologia
13.
Photodermatol Photoimmunol Photomed ; 35(1): 31-39, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30120835

RESUMO

BACKGROUND: Far-infrared (FIR) is well known with various therapeutic benefits. Recently, we have developed a novel FIR bathing system called the Enseki sandbath. In this regard, we focused on physical nature of ceramic to radiate FIR rays when heated adequately. METHODS: A bathtub was filled with ceramic beads and was equipped with computerized system which enabled to supply hot water over the ceramic beads and to drain out when beads were sufficiently heated. This system was used like sandbathing. Healthy volunteers were laid in bathtubs, covered in heated ceramic beads and were bathed for 15 minutes. Microbiological analysis was done in samples obtained from the skin surface, ceramic beads, or drained water. Furthermore, various physiological parameters were monitored, including blood pressure, heart rates, oral temperature, body weight, and blood viscosity. Blood samples were simultaneously collected and subjected to biochemical analysis, including blood glucose, HbA1c, uric acid, lactate, fatty acid, and others. RESULTS: All data showed no physiological overload for tested individuals, and any biochemical analysis did not present abnormal score. Bacteriological culture grew no pathogens. Results of questionnaires demonstrated that 90% of the participants answered the comfort and wished to further repeat the bathing. LIMITATIONS: This is a nonrandomized prospective case study. CONCLUSION: We concluded that the Enseki method is a safe and well-tolerated FIR bathing procedure for regeneration and relaxation.


Assuntos
Banhos/instrumentação , Banhos/métodos , Raios Infravermelhos , Segurança , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
14.
Am J Infect Control ; 47(1): 23-26, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30172611

RESUMO

BACKGROUND: Patient bathing basins are a potential source of health care-acquired infections. This descriptive study was designed to describe current patient bathing procedures and the cleaning and storage of disposable bath basins after use. METHODS: After instrument validation, a 20-item questionnaire designed by the researchers was delivered electronically to infection prevention professionals working in acute care facilities in the United States. Descriptive statistics including frequencies and percentages were used to analyze the data. RESULTS: A total of 344 participants completed the survey. Of those responding, most were employed in facilities with ≤300 beds and accredited by the Joint Commission. Many of the facility staff assisting patients with bathing were nursing aides. Participants reported varying bathing procedures in their facilities. CONCLUSIONS: A collaborative approach is needed to ensure standard and efficient procedures that focus on quality, safety, and patient satisfaction. A mechanism to continually evaluate patient bathing practices should also be developed to address evolving changes in the health care system.


Assuntos
Banhos/métodos , Transmissão de Doença Infecciosa/prevenção & controle , Serviços Médicos de Emergência/métodos , Controle de Infecções/métodos , Humanos , Inquéritos e Questionários , Estados Unidos
15.
Am J Infect Control ; 47(1): 18-22, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30174255

RESUMO

BACKGROUND: Many studies investigating daily chlorhexidine gluconate (CHG) bathing as an infection control intervention to decrease health care-associated infections have focused on reduction of infection and colonization; few studies have assessed CHG bathing compliance, work system factors, facilitators, and barriers to implementation. METHODS: This is a combination retrospective/prospective pilot study conducted at a large academic teaching hospital that implemented daily CHG bathing across all inpatient units. CHG compliance and patient refusal were calculated on the basis of documentation in the electronic medical record. We used the health belief model to guide semistructured interviews with patients about knowledge and barriers related to CHG bathing. RESULTS: Of the 31 patients interviewed, 74% reported using CHG soap during their stay. Average compliance documented in the electronic medical record was 78% with a range of 57%-91% among all hospital units. Sixteen percent of patients declined CHG bathing, and refusal ranged from 3%-29% among all units. Major themes about CHG bathing from patient interviews include low perceived susceptibility to infection, high degree of trust in medical professionals, low knowledge of benefits of CHG, and low perceived self-efficacy in preventing HAIs. CONCLUSIONS: Educating patients about CHG bathing appears to be a critical factor in decreasing patient refusal of CHG bathing.


Assuntos
Banhos/métodos , Banhos/psicologia , Clorexidina/administração & dosagem , Desinfetantes/administração & dosagem , Desinfecção/métodos , Conhecimentos, Atitudes e Prática em Saúde , Adesão à Medicação/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Saúde , Hospitais de Ensino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Estudos Retrospectivos
16.
Medicine (Baltimore) ; 97(51): e12345, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30572422

RESUMO

We developed a bathroom safety management information system to decrease adverse nursing events, and observed the application of the self-developed safety management information system in neonatal bathroom.A total of 3482 newborns receiving neonatal bath and rooming in between May 2015 and May 2017, were enrolled in this study. Of the 3482 newborns, 1727 that did not use the safety management information system from May 1, 2015 to May 31, 2016, were considered as control group; and other 1755 that used the safety management information system from June 1, 2016 to May 31, 2017 were entered in observation group. The accident rate of adverse nursing events, the duration to check wristbands, response time of urgency call, quantitative data recording for nursing procedures, and pregnant women's and their families' satisfaction degree were compared between the 2 groups.The management information system possesses 4 functions including personal identification, nursing operation quantification, monitoring alarm and music function, and guidance on specialized knowledge and skills. The accident rate of adverse nursing events was significantly lower in the observation than in the control group (P < .05). The duration to check wristbands and the response time of urgency call were all significantly shorter in the observation group than in the control group (all P < .05). Quantitative data recording was significantly better in the observation than in the control group (P < .05). Satisfaction degree was significantly higher in the observation group (96.47%) than in the control group (89.69%) (P < .05). The wireless transmission information was exact and safe, and the system was sensitive and reliable.The system not only is clinically practical but also can enhance the safety of newborns and improve pregnant women's and their families' satisfaction degree.


Assuntos
Banhos , Recém-Nascido , Sistemas de Informação Administrativa , Segurança do Paciente , Toaletes , Banhos/métodos , Família , Feminino , Humanos , Monitorização Fisiológica/métodos , Enfermagem Neonatal/educação , Enfermagem Neonatal/métodos , Satisfação do Paciente , Gravidez
17.
Adv Neonatal Care ; 18(6): E3-E12, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30507829

RESUMO

BACKGROUND: Newborn infants are susceptible to hypothermia during bathing due to environmental conditions. PURPOSE: This study examined the effects of 2 common newborn bathing methods used in Turkey, underrunning water bathing (URWB) and immersion tub bathing (ITB), on infant heart rate (HR), oxygen saturation, and body temperature. METHODS: In this randomized controlled study, 44 newborns were allocated to the ITB group and 36 newborns to the URWB group. Body temperature, HR, and oxygen saturation values of the newborns were compared between groups every hour during 4 hours before the bath to evaluate infants' vital sign stability. All measurements were compared at 10, 20, 40, and 60 minutes after the bath too. RESULTS: No statistically significant differences were found in vital signs performed prior to bathing as compared with after bathing; however, changes in oxygen saturation at 20 minutes after the bath were significantly higher in the ITB group (P < .05). CONCLUSION: Although both bathing methods decreased overall infant body temperature, ITB positively affected newborn oxygen saturation and HR to a greater degree compared with URWB. IMPLICATIONS FOR PRACTICE: ITB facilitated maintenance of oxygen saturation and HR during the bath and should be preferred for newborn infants to feel more relaxed. IMPLICATIONS FOR RESEARCH: These findings indicate a need for additional studies with larger sample sizes to further evaluate the effect of different bathing methods on newborn comfort.


Assuntos
Banhos/métodos , Temperatura Corporal , Frequência Cardíaca , Oxigênio/metabolismo , Feminino , Humanos , Recém-Nascido , Masculino , Enfermagem Neonatal , Oximetria , Turquia , Sinais Vitais
18.
J Orthop Surg Res ; 13(1): 287, 2018 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-30428905

RESUMO

BACKGROUND: Acute calcific periarthritis of the hand is a relatively uncommon painful condition involving juxta-articular deposits of amorphous calcium hydroxyapatite. Although conservative treatments have been generally considered effective, there is little evidence regarding how long they could remain effective. METHODS: We retrospectively reviewed ten patients who were diagnosed with acute calcific periarthritis of the hand from January 2015 to June 2018. We recommended the use of warm baths, nonsteroidal anti-inflammatory drugs (NSAIDs), and limited activity as initial treatments. If the pain persisted despite at least 3 months of conservative treatment, we explained surgical treatment options. If the pain improved, we recommended gradual range-of-motion exercises with the continuation of daily NSAIDs use. The visual analogue scale (VAS) score for pain at each subsequent visit (3, 6, and 9 months) was compared with that of the previous visit to investigate whether the pain had decreased during each time interval. Simple radiographs taken at each visit were compared with those taken at the previous visit to determine whether any significant changes in the amount of calcification had occurred during each time interval. RESULTS: All 10 patients with 17 affected joints continued conservative treatments for an average of 11.1 months. The average VAS score for pain at the initial visit was 7, while that at 3, 6, and 9 months was 4.3, 3.3, and 2.9, respectively. There was a significant reduction in the VAS score at 3 and 6 months, but not at 9 months (P values = 0.004, 0.008, and 0.598, respectively). The simple radiographs also showed a significant reduction in the amount of calcification at 3 and 6 months, but not at 9 months (P values = 0.020, 0.034, and 0.083, respectively). CONCLUSIONS: Patients with acute calcific periarthritis of the hand exhibited residual pain and calcification for a relatively prolonged period. Those who continued conservative treatment, including NSAIDs, showed pain relief and reduced calcification for up to 6 months. These results suggest that conservative treatment could be tried for at least 6 months before considering the surgical treatment of calcific periarthritis of the hand.


Assuntos
Calcinose/diagnóstico por imagem , Calcinose/terapia , Tratamento Conservador/métodos , Mãos/diagnóstico por imagem , Periartrite/diagnóstico por imagem , Periartrite/terapia , Doença Aguda , Adulto , Anti-Inflamatórios não Esteroides/uso terapêutico , Banhos/métodos , Feminino , Temperatura Alta/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Estudos Retrospectivos , Resultado do Tratamento
19.
Health Technol Assess ; 22(57): 1-116, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30362939

RESUMO

BACKGROUND: Childhood eczema is very common. Treatment often includes emollient bath additives, despite there being little evidence of their effectiveness. OBJECTIVES: To determine the clinical effectiveness and cost-effectiveness of emollient bath additives in the management of childhood eczema. DESIGN: Pragmatic, randomised, open-label, multicentre superiority trial with two parallel groups. SETTING: Ninety-six general practices in Wales, the west of England and southern England. Invitation by personal letter or opportunistically. PARTICIPANTS: Children aged between 12 months and 12 years fulfilling the UK Diagnostic Criteria for Atopic Eczema. Children with inactive or very mild eczema (a score of ≤ 5 on the Nottingham Eczema Severity Scale) were excluded, as were children who bathed less than once per week or whose parents/carers were not prepared to accept randomisation. INTERVENTIONS: The intervention group were prescribed bath additives by their usual clinical team and were asked to use them regularly for 12 months. The control group were asked to use no bath additives for 12 months. Both groups continued standard eczema management, including regular leave-on emollients and topical corticosteroids (TCSs) when required. MAIN OUTCOME MEASURES: The primary outcome was eczema control measured by Patient Oriented Eczema Measure [POEM, 0 (clear) to 28 (severe)] weekly for 16 weeks. The secondary outcomes were eczema severity over 1 year (4-weekly POEM), number of eczema exacerbations, disease-specific quality of life (QoL) (Dermatitis Family Impact Questionnaire), generic QoL (Child Health Utility-9 Dimensions) and type and quantity of topical steroid/calcineurin inhibitors prescribed. Children were randomised (1 : 1) using online software to either bath additives plus standard eczema care or standard eczema care alone, stratified by recruiting centre, and there was open-label blinding. RESULTS: From December 2014 to May 2016, 482 children were randomised: 51% were female, 84% were white and the mean age was 5 years (n = 264 in the intervention group, n = 218 in the control group). Reported adherence to randomised treatment allocation was > 92% in both groups, with 76.7% of participants completing at least 12 (80%) of the first 16 weekly questionnaires for the primary outcome. Baseline POEM score was 9.5 [standard deviation (SD) 5.7] in the bath additives group and 10.1 (SD 5.8) in the no bath additives group. Average POEM score over the first 16 weeks was 7.5 (SD 6.0) in the bath additives group and 8.4 (SD 6.0) in the no bath additives group, with no statistically significant difference between the groups. After controlling for baseline severity and confounders (ethnicity, TCS use, soap substitute use) and allowing for clustering of participants within centres and responses within participants over time, POEM scores in the no bath additive group were 0.41 points higher than in the bath additive group (95% confidence interval -0.27 to 1.10), which is well below the published minimal clinically important difference of 3 points. There was no difference between groups in secondary outcomes or in adverse effects such as redness, stinging or slipping. LIMITATIONS: Simple randomisation resulted in an imbalance in baseline group size, although baseline characteristics were well balanced between groups. CONCLUSION: This trial found no evidence of clinical benefit of including emollient bath additives in the standard management of childhood eczema. FUTURE WORK: Further research is required on optimal regimens of leave-on emollients and the use of emollients as soap substitutes. TRIAL REGISTRATION: Current Controlled Trials ISRCTN84102309. FUNDING: This project was funded by the NIHR Health Technology Assessment Programme and will be published in full in Health Technology Assessment; Vol. 22, No. 57. See the NIHR Journals Library website for further project information.


Assuntos
Banhos/métodos , Eczema/tratamento farmacológico , Emolientes/economia , Emolientes/uso terapêutico , Corticosteroides/administração & dosagem , Inibidores de Calcineurina/administração & dosagem , Criança , Pré-Escolar , Análise Custo-Benefício , Emolientes/administração & dosagem , Emolientes/efeitos adversos , Feminino , Gastos em Saúde/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Humanos , Lactente , Masculino , Adesão à Medicação , Qualidade de Vida , Índice de Gravidade de Doença , Reino Unido
20.
Trials ; 19(1): 582, 2018 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-30355360

RESUMO

BACKGROUND: Patient-reported outcomes measures in clinical trials ensure that evaluations of effectiveness focus on outcomes that are important to patients. In relapsing-remitting conditions, such as eczema, repeated measurements may allow a more accurate reflection of disease burden and treatment effect than less frequent measurements. We asked parents/carers of children with eczema taking part in a trial of bath emollients to complete weekly questionnaires for 16 weeks. METHODS: The objective of this study was to determine the acceptability and practicality of collecting weekly measures of eczema severity online for 16 weeks in children aged 1 to 11 years as part of the BATHE study. BATHE randomised patients to bath emollients plus standard eczema care or standard eczema care only. The primary outcome was eczema severity, measured by the seven-item Patient-Oriented Eczema Measure (POEM) repeated weekly for 16 weeks. Acceptability was explored through qualitative interviews with 10 participants. Interviews were audio-recorded, transcribed and analysed thematically. Practicality was assessed by exploring the completeness of the data and keeping a log of any problems. RESULTS: Four hundred and eighty-two participants were recruited to the trial and 429 opted to complete measures online (89.0%). Data were collected online for 83% of time points over the 16-week period and there was no association between socio-demographic characteristics and data completeness. Two hundred and six (48%) completed their weekly data every week for 16 weeks and 341 (79%) completed it at least 80% of the time. The mean number of weeks completed was 13.3 out of 16 (SD 4.2). Interviewees said that they understood the rationale behind weekly collection and some welcomed this as it helped them realise how their child's eczema changed weekly. Whilst some interviewees spoke of weekly questionnaires as onerous, others said that they found them quick and easy. Reminders were welcomed. Parents/carers seemed happy to receive telephone reminders and it was sometimes useful for eliciting problems relating to obtaining trial medication or password problems for online data collection. CONCLUSIONS: Amongst this population, high levels of data completeness suggests that weekly completion of the online questionnaire appears to be acceptable and feasible over a 16-week period. TRIAL REGISTRATION: ISRCTN84102309 . Registered on 9 December 2013.


Assuntos
Banhos/métodos , Coleta de Dados , Eczema/terapia , Emolientes/administração & dosagem , Medidas de Resultados Relatados pelo Paciente , Atenção Primária à Saúde , Banhos/efeitos adversos , Cuidadores/psicologia , Criança , Pré-Escolar , Eczema/diagnóstico , Emolientes/efeitos adversos , Estudos de Viabilidade , Feminino , Humanos , Lactente , Masculino , Pais/psicologia , Recidiva , Fatores de Tempo , Resultado do Tratamento , Reino Unido
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