[Clinical treatment adherence of health care workers and students exposed to potentially infectious biological material]. / Seguimento clínico de profissionais e estudantes da área da saúde expostos a material biológico potencialmente contaminado.

OBJECTIVE: To assess adherence to clinical appointments by health care workers (HCW) and students who suffered accidents with potentially infectious biological material. METHOD: A retrospective cross-sectional study that assessed clinical records of accidents involving biological material between 2005 and 2010 in a specialized unit. RESULTS: A total of 461 individuals exposed to biological material were treated, of which 389 (84.4%) were HCWs and 72 (15.6%) students. Of the 461 exposed individuals, 307 (66.6%) attended a follow-up appointment. Individuals who had suffered an accident with a known source patient were 29 times more likely to show up to their scheduled follow-up appointments (OR: 29.98; CI95%: 16.09-55.83). CONCLUSION: The predictor in both univariate and multivariate analyses for adherence to clinical follow-up appointment was having a known source patient with nonreactive serology for the human immunodeficiency virus and/or hepatitis B and C.

Under-reporting of accidents involving biological material by nursing professionals at a Brazilian emergency hospital.

BACKGROUND: Pathogens can be transmitted to health professionals after contact with biological material. The exact number of infections deriving from these events is still unknown, due to the lack of systematic surveillance data and under-reporting. METHODS: A cross-sectional study was carried out, involving 451 nursing professionals from a Brazilian tertiary emergency hospital between April and July 2009. Through an active search, cases of under-reporting of occupational accidents with biological material by the nursing team were identified by means of individual interviews. The Institutional Review Board approved the research project. RESULTS: Over half of the professionals (237) had been victims of one or more accidents (425 in total) involving biological material, and 23.76% of the accidents had not been officially reported using an occupational accident report. Among the underreported accidents, 53.47% were percutaneous and 67.33% were bloodborne. The main reason for nonreporting was that the accident had been considered low risk. CONCLUSIONS: The under-reporting rate (23.76%) was low in comparison with other studies, but most cases of exposure were high risk.

[Care and specialized clinical follow-up of nursing professionals who have been victims of accidents with biological material]. / Atendimento e seguimento clínico especializado de profissionais de enfermagem acidentados com material biológico.

This cross-sectional study aimed to evaluate the conduct of nursing professionals who had been victims of accidents with biological material in a teaching hospital in the interior of the state of São Paulo, Brazil, regarding their care and specialized clinical follow-up. The study population consisted of 1,215 nursing professionals, who were interviewed individually between 2010 and 2011. Of the 1,215 nursing professionals interviewed, 636 (52.3%) reported having experienced accidents with biological material; of this population, 182 (28.6%) didn't sought specialized care. The most frequent reason reported for not seeking care was believing that it was a low-risk accident. The reasons professionals do not seek care and do not complete treatment and the clinical follow-up can contribute to strategies to increase professionals' adherence to prophylaxis measures after occupational exposure to biological material.

[Adherence to standard precautions of nurses working in intensive care at a university hospital]. / Adesão às precauções-padrão por profissionais de enfermagem que atuam em terapia intensiva em um hospital universitário.

This study evaluated individual factors relating to work and the organization, related to adherence to standard precautions for nurses working in intensive care. It was a cross-sectional study conducted in a large hospital with 178 professionals. For data collection, Likert-type psychometric scales were used. In the Adherence Scale to Standard Precautions we obtained a score of 4.45 (SD=0.27), classified as intermediate. There was a correlation when compared with the individual risk factors of the Scale of the Risk Personality (r =- 0.169, p=0.024) and the factors related to working with the barriers of the Scale for following standard precautions(r =- 0.359, p=0.000). Adherence to standard precautions among the nursing professionals was intermediate. Individual factors and factors related to work influenced the adherence to standard precautions.

[Aids and tuberculosis: coinfection from the perspective of the quality of life of patients]. / Aids e tuberculose: a coinfecção vista pela perspectiva da qualidade de vida dos indivíduos.

Tuberculosis (TB) and HIV coinfection adversely affects the lives of individuals in both the biological and psychosocial aspects. Aiming to describe the quality of life of individuals with HIV/TB coinfection, this descriptive cross-sectional study was conducted in Ribeirão Preto-SP. Participants were HIV-seropositive individuals with and without TB, using the WHOQOL HIV BREF. 115 individuals who were HIV-positive participated: 57 were coinfected and 58 were not; most were male heterosexuals, predominantly aged 40-49 years. Of those coinfected, most had lower education and income. In assessing the quality of life the coinfected individuals showed lower results in all areas, with significant differences in the Physical, Psychological, Level of Independence and Social Relations areas. TB and HIV / AIDS are stigmatized diseases, and overlap of the two may have severe consequences on the physical and psychosocial health of the individual.

[Assessment of tuberculosis treatment accessibility for patients co-infected or not with the human immunodeficiency virus]. / Avaliação do acesso ao tratamento de tuberculose por coinfectados ou não pelo vírus da imunodeficiência humana.

This study aimed to evaluate accessibility to treatment for people with TB co-infected or not with HIV. This cross-sectional study addressed issues regarding accessibility to treatment in a city in the interior of São Paulo state, Brazil. The instrument Primary Care Assessment Tool was utilized with 95 people. To evaluate access to treatment, Student's t test was used. The mean scores of variables were analyzed separately and compared between two groups (people with TB co-infected with HIV and people with TB not co-infected with HIV ). Mean scores showed that HIV co-infected people presented greater difficulties in gaining access than those not co-infected. Professionals visited co-infected people more often when compared to those not co-infected; the co-infected people almost never accessed treatment for their disease in the Health Unit nearest their home. There is, therefore, the need for greater integration and communication between the programs for treatment of Tuberculosis and STD/AIDS.

Comparing surgeons' skin tolerance and acceptability to alcohol-based surgical hand preparation vs traditional surgical scrub: A matched quasi-experimental study.

BACKGROUND: We aimed to compare the tolerance and acceptability of alcohol-based surgical hand preparation versus handscrubbing with antimicrobial soap and water by surgeons. METHODS: Matched quasi-experimental trial in an academic quaternary care hospital in Ribeirão Preto, Brazil, from April 1 to October, 31, 2017. Participants were cardiac and orthopedics surgeons from the study facility. In the first study phase, they performed handscrubbing with either 2% chlorhexidine (CHG) or 10% iodopovidone (PVP-I) and, in the second phase, they performed handrubbing with alcohol-based handrub (ABHR). Surgeons' skin tolerance and acceptability were evaluated using WHO-validated tools. Data were analyzed using the MacNemar's test within STATA. RESULTS: A total of 33 surgeons participated to the "per protocol" population; the majority were male (94%); mean age of 35 years (SD, 8.5). On product tolerance, there was a minimal variation in redness, scaliness, fissures, and visual evaluation of the skin when handrubbing with ABHR was compared to handscrubbing with either PVP-I or CHX. Regarding acceptability, participants rated better handrubbing with ABHR than handscrubbing with PVP-I when assessing product smell (66.6% vs 0%, p=0.002), color (73.3% vs 0%, p=0.001), product texture (60% vs 0%, p=0.004), skin dryness (60% vs 0%, p=0.004), ease of application (66.6% vs 0%, p=0.002) and overall satisfaction (66.6% vs 6.7% p=0.011). Participants rated similarly handrubbing with ABHR and handscrubbing with CHX, except for product texture, where handrubbing rated better (71,4% vs. 0%, p=0.002). Handrubbing with ABHR was preferred by 73.3%. CONCLUSION: Although handrubbing and handscrubbing were equally well tolerated by surgeons, alcohol-based surgical hand preparation fell into the personal preference for most of them. TRIAL REGISTRATION: Brazilian Clinical Trials Registry (ReBEC), RBR-8ym9yj.

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.

Impact of replacing powdered gloves with powder-free gloves on hand-hygiene compliance among healthcare workers of an intensive care unit: a quasi-experimental study.

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.

Methicillin resistant Staphylococcus aureus: knowledge and factors related to the nursing teams adherence to preventive measures.

This study evaluated the knowledge of a nursing team from a public hospital in the state of São Paulo, Brazil concerning preventive measures recommended in the care delivered to patients colonized with Methicillin Resistant Staphylococcus Aureus (MRSA) and, through the Health Beliefs Model, identified the factors influencing adherence or non-adherence to preventive measures. A total of 318 professionals from different units participated in the study. According to the analysis, the nursing teams knowledge and perception of MRSA susceptibility was limited, which indicates the need for actions to improve the understanding of preventive measures employed in the care delivered to patients colonized or infected by this microorganism.

Nursing diagnoses of patients in the preoperative period of esophageal surgery.

This study aimed to identify and analyze the nursing diagnoses of patients in the preoperative period of esophageal surgeries. Data were collected by means of an instrument, based on Horta's Conceptual Model. The study group consisted of 20 patients hospitalized at the Ribeirão Preto Medical School Hospital das Clínicas, who would undergo esophageal surgery. The patients were submitted to an interview and a physical examination. The nursing diagnoses identified at frequencies of more than 50% were: impaired swallowing (100%); risk for infection (100%); knowledge deficit about disease and perioperative period (95%), and chronic pain (75%). These diagnoses were analyzed in view of the related factors, defining characteristics or risk factors, according to the type of diagnosis and the responses to the esophageal disease.

Long-term prevention of catheter-associated urinary tract infections among critically ill patients through the implementation of an educational program and a daily checklist for maintenance of indwelling urinary catheters: A quasi-experimental study.

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.

Percutaneous injuries correlates in the nursing team of a Brazilian tertiary-care university hospital.

The study aims to identify percutaneous injuries correlates in the nursing team from a Brazilian tertiary-care hospital. A case-control study was conducted from January 2003 to July 2004, including 200 cases and 200 controls. Cases and controls were paired by gender, professional category, and work section. To evaluate the relationship between potential risk/protective factors and the outcome, odds ratios were estimated, using multivariate logistic regression methods. The results shown six predictors of percutaneous injuries: "recapping needles" (OR 9.48; CI(95%): 5.29-16.96); "hours worked per week > 50 hours" (OR 2.47; CI(95%): 1.07-5.67); "years in nursing practice < 5 years" (OR 6.70; CI(95%): 2.42-18.53); "work shift in night" (OR 2.77; CI(95%): 1.35-5.70); "low self evaluation of risk" (OR 10.19; CI(95%): 3.67-28.32) and "previous percutaneous injuries" (OR 3.14; CI(95%): 1.80-5.48). The results support the recommendation of applying effective strategies to prevent percutaneous injuries in the nursing team working on tertiary-care institutions.

Accidents with biological material and immunization against hepatitis B among students from the health area.

Undergraduate students from the health area often handle piercing-cutting instruments in their academic activities, which exposes them to the risk of contracting infections. This study aimed to analyze accidents with biological material among these students. Out of 170 accidents registered, 83 (48.8%) occurred with Dentistry students, 69 (40.6%) with Medical students, 11 (6.5%) with Nursing students and in 06 (3.5%) of the cases there was no such information in the files. Most accidents, 106 (62.4%), occurred with students from private schools and 55 (32.3%) with those from public schools. Percutaneous accidents occurred in 133 (78.2%) exposures and there was immediate search for specialized health care in only 38 (21.3%) accidents. In 127 (74.7%) accidents, the immunization schedule against hepatitis B was complete. Therefore, schools need to offer courses and specific class subjects regarding biosafety measures, including aspects related to immunization, especially the vaccine against hepatitis B.

New guidelines for cardiopulmonary resuscitation.

Cardiopulmonary arrest (CPA) poses a severe threat to life; cardiopulmonary resuscitation (CPR) represents a challenge for research and assessment by nurses and their team. This study presents the most recent international recommendations for care in case of cardiopulmonary heart arrest, based on the 2005 Guidelines by the American Heart Association (AHA). These CPR guidelines are based on a large-scale review process, organized by the International Liaison Committee on Resuscitation (ILCOR). High-quality basic and advanced CPR maneuvers can save lives.

Relations between nursing data collection, diagnoses and prescriptions for adult patients at an intensive care unit.

This descriptive, retrospective study aimed to analyze the relation between nursing data collection, diagnoses and prescriptions for 26 adult patients who were hospitalized at the intense care unit of a large teaching hospital for at least 24 hours. Through the analysis of medical records, 135 diagnoses and 421 nursing prescriptions were established, and 24 different diagnosis categories and 20 different items for prescriptions were identified. The most frequent diagnosis risk was that for infection, present in the medical records of 22 (84.60%) patients, with 175 prescriptions (42%) related to this diagnosis. The data the nurses collected were sufficient to establish the nursing diagnoses, and the majority of prescriptions (87.9%) were related to the diagnoses.

[Nurses in leading positions and measures to prevent occupational exposure: facilities and barriers]. / Enfermeiros com cargos de chefia e medidas preventivas a exposição ocupacional: facilidades e barreiras.

This descriptive study aimed to assess the facilities and barriers that nurses in leading positions endure with respect to the nursing team's compliance to measures for preventing occupational exposure involving biological materials, based on Rosenstock's Health Belief Model. The study was carried out with 87 nurses of a university hospital in Sao Paulo, Brazil, in the year of 2006. Data were collected through a semistructured form with open and closed questions and analyzed through Content Analysis. Individual protection equipment was mentioned as the greatest form for preventing accidents, but lack of compliance to usage and incorrect use were indicated as barriers to accident prevention and as the main reasons for their occurrence. It is important for these nurses to be prepared to develop individualized and motivating strategies focused on compliance to the use of individual protection equipment in their work sectors.

Family crisis in the context of bone marrow transplantation: an integrative review.

This study presents an integrative literature review about the crisis experienced by relatives of bone marrow transplant (BMT) patients. The sample consisted of 25 publications, one of which came from Lilacs and 24 from Medline. The results evidenced that there were no experimental studies and that interventions are aimed at psychological and social aspects. In terms of aspects of family crisis indicated in the articles, all publications discussed the characteristic of the event (diagnosis of the disease and BMT) and the perceived threat; 52% of the articles mention the resources offered as being relevant and 20% mention that past crisis experiences influence the current crisis. Understanding the elements of family crisis and identifying appropriate interventions help nurses in care delivery to BMT patients.

Risco de mediastinite no pós-operatório de cirurgia de revascularização do miocárdio / Risk of mediastinitis in the postoperative period of myocardial revascularization surgery / Riesgo de mediastinitis en el postoperatorio de cirugía de revascularización miocárdica

Objetivo: classificar os pacientes segundo o risco de desenvolvimento de mediastinite no pós-operatório de cirurgia de revascularização do miocárdio. Método: estudo observacional, transversal, realizado na Unidade de Terapia Intensiva Pós-Operatória de um hospital universitário no interior paulista. Amostra consecutiva e não probabilística foi constituída por pacientes adultos, submetidos à revascularização do miocárdio. A coleta de dados foi realizada na alta da Terapia Intensiva, utilizando o Escore de Risco Multivariável para Mediastinite. Para a obtenção do escore foram realizadas análises estatística descritivas. Resultados: participaram do estudo 50 pacientes, 68% do sexo masculino, com média de idade de 62,7 anos. Nenhum paciente foi reoperado ou apresentava doença pulmonar obstrutiva crônica; 26,0% eram obesos; 12,0% apresentaram angina instável e 4,0% foram politransfundidos no pós-operatório. Segundo o escore, 58,0% apresentaram baixo e 42,0% médio risco de desenvolvimento de mediastinite. Conclusão: a maior parte dos pacientes apresentava baixo risco de desenvolvimento de mediastinite

Objective: to classify patients according to the risk of developing mediastinitis in the postoperative period of myocardial revascularization surgery. Method: observational, cross-sectional study, carried out in the Post-Operative Intensive Care Unit of a university hospital in the interior of São Paulo. Consecutive and non-probabilistic sample consisted of adult patients who underwent myocardial revascularization. Data collection was performed at discharge from the Intensive Care, using the Multivariable Risk Score for Mediastinitis. To obtain the score, descriptive statistical analyzes were performed. Results: the50 patients participated in the study, 68% were male, with a mean age of 62.7 years. No patient was reoperated or had chronic obstructive pulmonary disease; 26.0% were obese; 12.0% had unstable angina and 4.0% were transfused in the postoperative period. According to the score, 58.0% had a low and 42.0% medium risk of developing mediastinitis. Conclusion: most patients were at low risk of developing mediastinitis

Objetivo: clasificar a los pacientes según el riesgo de desarrollar mediastinitis en el postoperatorio de cirugía de revascularización miocárdica. Método: estudio observacional, transversal, realizado en la Unidad de Cuidados Intensivos Posoperatorios de un hospital universitario del interior de São Paulo. La muestra consecutiva y no probabilística estuvo constituida por pacientes adultos sometidos a revascularización miocárdica. La recolección de datos se realizó al alta de la Unidad de Cuidados Intensivos, utilizando el Multivariable Risk Score para Mediastinitis. Para obtener la puntuación se realizaron análisis estadísticos descriptivos. Resultados: participaron en el estudio 50 pacientes, el 68% eran varones, con una edad media de 62,7 años. Ningún paciente fue reintervenido ni presentó enfermedad pulmonar obstructiva crónica; El 26,0% eran obesos; El 12,0% presentó angina inestable y el 4,0% recibió transfusión en el postoperatorio. Según el puntaje, el 58.0% tenía un riesgo bajo y el 42.0% medio de desarrollar mediastinitis. Conclusión: la mayoría de los pacientes tenían un riesgo bajo de desarrollar mediastinitis

Accidents with potentially hazardous biological material among workers in hospital supporting services.

Descriptive study was carried out to characterize the occupational accidents involving potentially contaminated material among workers of hospital supporting services. The study reviewed records of workers involved in these accidents and attended at a specialized outpatient clinic of a large tertiary care hospital between January 1997 and October 2001. A total of 2814 workers from different professional categories were attended during this period. Of these, 147 (5.2%) belonged to the hospital supporting services and were the victims of 156 accidents, auxiliary cleaning personnel (80.2%), and over a third of the workers had not received any dose of hepatitis B vaccine (35.4%). Most accidents were due to sharp injuries (96.8%) caused by inadequately discarded hollow needles. Chemoprophylaxis for HIV was not indicated in only 23.1% of cases. We conclude that these workers are also exposed to the possibility of acquiring blood-borne pathogens and that periodical education programs are needed.