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

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

Infection control and patient safety measures addressed in nursing pedagogical projects.

OBJECTIVE: To characterize teaching about patient safety and standard precautionary measures for infection prevention and control in undergraduate nursing courses. METHOD: A descriptive documentary analysis study carried out in undergraduate courses, with a concept equal to or greater than three in the National Student Performance Exam and in the Preliminary Course Concept, located in the state of Goiás, Brazil. RESULTS: Six education institutions participated, with the majority being private with curricular structure by discipline. Six pedagogical projects and 273 subject plans were analyzed. The most discussed topics for patient safety development were human factors related to communication, interpersonal relationships, and principles and techniques. Thirty-nine (39) disciplines contemplated teaching infection prevention and control measures, and the most approached topics were personal protective equipment and hand hygiene. CONCLUSION: Teaching about patient safety presented strong gaps in the six evaluated courses. There is fragility in teaching infection prevention and control measures. The data indicate the need to review the Course Pedagogical Projects in order to incorporate necessary educational demands for training professionals so that they develop safe and quality care.

[Intervening factors in attention flow of professionals injured by biological material]. / Fatores intervenientes no fluxo de atendimento ao profissional acidentado com material biológico.

OBJECTIVE: To describe the barriers and facilitator factors to follow the attention flow of professionals injured by biological material in the worker perspective. METHOD: Qualitative descriptive study with data collected through individual interviews with 18 injured workers, assisted in reference public units in the city of Goiânia. The content analysis was carried out with assistance of the ATLAS.ti 6.2 software, under the work organization and subjective perspectives. RESULTS: From the interviews regarding the barriers and facilitator factors emerged the categories: organizational structure, Support from close people, and Knowledge influence. CONCLUSION: The organized services have enabled more qualified consultations and the workers follow-up, which caused a satisfaction feeling in relation to the working environment.

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

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

Factors associated with Community Health Agents' knowledge about tuberculosis.

OBJECTIVE: To analyze the factors associated with the knowledge of Community Health Agents (ACS) about tuberculosis. METHODS: A cross-sectional study was conducted with 110 ACS. A questionnaire was used to assess knowledge about pulmonary tuberculosis (component 1) and the work functions of ACS in the National Tuberculosis Control Program (component 2). The level of knowledge, according to the scores converted into a scale of 0 to 100, was classified as: 0-50% (low), 51-75% (medium), and over 75% (high). Multiple regression was used in the analysis of associated factors. RESULTS: The global score (average of the scores of components 1 and 2) median knowledge was 68.6%. Overall knowledge about tuberculosis was positively associated with the length of professional experience, having received training on tuberculosis, and access to the tuberculosis guide/handbook. CONCLUSIONS: Investments in training and capacity-building strategies for ACS will contribute to increasing these professionals' knowledge, resulting in greater success in tuberculosis control.

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

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

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

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

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

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

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

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

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

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

The monitoring system of surgical textile in health services.

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

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

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

Biofilm accumulation in new flexible gastroscope channels in clinical use.

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

[Monitoring the physical processes of sterilization in hospitals in the state of Goiás]. / O monitoramento de processos físicos de esterilização em hospitais do interior do estado de Goiás.

The objective of this descriptive study was to identify the physical, chemical and biological controls of the sterilization process by saturated steam in Pasteur autoclaves at Material and Sterilization Centers (MSC). The data was obtained by interviewing the worker responsible for the MSC of the largest hospital in every city in the interior of Goiás that had population of at least 20,000, in the period from August 2005 to June 2006. A total 44 municipalities participated. The analysis was performed using SPSS software. In 31 (94.0%) hospitals there were no nurses exclusive to the MSC, the workers responsible for the center were nursing aides and technicians. Most did not perform any physical, chemical and biological control of the sterilization process, and, in one case only these controls were performed simultaneously. Failing to monitor the sterilization cycles, and thus not ensuring the quality of the processes, is a risk to the population being assisted.

[Driving and hindering forces for team work in a Material and Sterilization Center of a teaching hospital]. / Forças impulsoras e restritivas para trabalho em equipe em um Centro de Material e Esterilização de hospital escola.

The objective of this descriptive, cross-sectional study was to analyze the driving and hindering forces for team work at a Material and Sterilization Center (MSC) of a teaching hospital, through an approximation of Kurt Lewin's Field Theory,in Goiânia, Goiás. Participants were 35 professionals, who answered a self-administered questionnaire based on the referred theory, which establishes that group situations are permeated by forces that have a positive or negative influence on the individuals' movements, and concern the subjects' involvement (I), the groups interaction (Other) and the working environment (Evnironment). The data were submitted to content analysis, and distributed in the predefined dimensions. Results consolidated 1990 registers, with most (59.3%) being categorized as driving forces, mostly in the I dimension. It was observed there was balance between forces in the Other and Environment dimensions. Outlining the force field permitted an objective, concrete view of the strengths and weaknesses of the studied team, and the possibilities to promote changes.

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.

Post-vaccination anti-HBs testing among healthcare workers: More economical than post-exposure management for Hepatitis B.

OBJECTIVE: to compare the direct cost, from the perspective of the Unified Health System, of assessing the post-vaccination serological status with post-exposure management for hepatitis B among health care workers exposed to biological material. METHOD: cross-sectional study and cost-related, based on accident data recorded in the System of Information on Disease Notification between 2006 and 2016, where three post-exposure and one pre-exposure management scenarios were evaluated: A) accidents among vaccinated workers with positive and negative serological status tests for hepatitis B, exposed to known and unknown source-person; B) handling unvaccinated workers exposed to a known and unknown source-person; C) managing vaccinated workers and unknown serological status for hepatitis B and D) cost of the pre-exposure post-vaccination test. Accidents were assessed and the direct cost was calculated using the decision tree model. RESULTS: scenarios where workers did not have protective titles after vaccination or were unaware of the serological status and were exposed to a positive or unknown source-person for hepatitis B. CONCLUSION: the direct cost of hepatitis B prophylaxis, including confirmation of serological status after vaccination would be more economical for the health system.

Skills for generalist and specialist nurses working in the prevention and control of infections in Brazil. / Competências para enfermeiros generalistas e especialistas atuarem na prevenção e controle de infecções no Brasil.

OBJECTIVE: to define the competencies for the prevention and control of healthcare-related infections that should be developed by the generalist nurse and the specialist nurse in infection control in Brazil. METHOD: the Delphi technique, developed in four rounds, was used. Thirty-one nurses and eight physicians participated in the study, with expertise in infection prevention and control. Data were collected using open-ended questionnaires, whose answers were treated using the content analysis technique. Structured instruments were used to evaluate the importance of each competency using a Likert scale. Data were analyzed and presented in a descriptive way, use of median and coefficient of variation. RESULTS: the competences were organized in 4 core, 14 generic and 17 specific, with name and description of each competency. CONCLUSION: the definition of competencies for the prevention and control of healthcare-related infections is the first step to begin the rethinking of the teaching and learning process in the initial training of nurses. The data found in the present study may help to restructure education and support permanent education programs in health.

Work accidents with biological material: factors associated with abandoning clinical and laboratory follow-up. / Acidente de trabalho com material biológico: fatores associados ao abandono do acompanhamento clínico-laboratorial.

OBJECTIVE: To analyze the epidemiology of abandoning clinical and laboratory follow-up among health workers who suffered accidents with biological material. METHOD: Cohort study based on reported work accidents with biological material in Goiânia/Goiás. Data were analyzed in Stata with descriptive and analytical statistics. RESULTS: 2,104 exposures of the 8,596 reported accidents were analyzed, most of them involving females with completed high school education and belonging to the nursing staff. The accidents predominantly occurred by percutaneous injury involving a needle with lumen during medication administration or vascular access. Follow-up abandonment rate was 41.5%. Predictive factors for discontinuing clinical and laboratory follow-up were age, occupation, use of personal protective equipment (gowns), the object involved in the accident, situation in the labor market, circumstance of exposure and recommended prophylactic conduct. CONCLUSION: Given the high abandonment rate found, it is suggested to implement strategies to ensure follow-up and reduce risks to health workers.

Factors associated with Community Health Agents' knowledge about tuberculosis / Factores asociados al conocimiento sobre tuberculosis de los Agentes Comunitarios de Salud / Fatores associados ao conhecimento sobre tuberculose de Agentes Comunitários de Saúde

ABSTRACT Objective: To analyze the factors associated with the knowledge of Community Health Agents (ACS) about tuberculosis. Methods: A cross-sectional study was conducted with 110 ACS. A questionnaire was used to assess knowledge about pulmonary tuberculosis (component 1) and the work functions of ACS in the National Tuberculosis Control Program (component 2). The level of knowledge, according to the scores converted into a scale of 0 to 100, was classified as: 0-50% (low), 51-75% (medium), and over 75% (high). Multiple regression was used in the analysis of associated factors. Results: The global score (average of the scores of components 1 and 2) median knowledge was 68.6%. Overall knowledge about tuberculosis was positively associated with the length of professional experience, having received training on tuberculosis, and access to the tuberculosis guide/handbook. Conclusions: Investments in training and capacity-building strategies for ACS will contribute to increasing these professionals' knowledge, resulting in greater success in tuberculosis control.

RESUMEN Objetivo: Analizar los factores asociados al conocimiento de los Agentes Comunitarios de Salud (ACS) sobre la tuberculosis. Métodos: Se realizó un estudio transversal con 110 ACS. Se utilizó un cuestionario para evaluar el conocimiento sobre la tuberculosis pulmonar (componente 1) y las funciones laborales de los ACS en el Programa Nacional de Control de la Tuberculosis (componente 2). El nivel de conocimiento, según las puntuaciones convertidas en una escala de 0 a 100, se clasificó como: 0-50% (bajo), 51-75% (medio) y más del 75% (alto). La regresión múltiple se utilizó en el análisis de factores asociados. Resultados: La puntuación global (media de las puntuaciones de los componentes 1 y 2) del conocimiento mediano fue del 68,6%. El conocimiento general sobre la tuberculosis estuvo positivamente asociado con la duración de la experiencia profesional, haber recibido capacitación sobre tuberculosis y el acceso a la guía/manual de tuberculosis. Conclusiones: Las inversiones en formación y estrategias de capacitación para los ACS contribuirán a aumentar el conocimiento de estos profesionales, lo que resultará en un mayor éxito en el control de la tuberculosis.

RESUMO Objetivo: Analisar os fatores associados ao conhecimento dos Agentes Comunitários de Saúde (ACS) sobre tuberculose. Métodos: Estudo transversal realizado com 110 ACS. Utilizou-se um questionário para avaliar o conhecimento sobre tuberculose pulmonar (componente 1) e as funções laborais dos ACS no Programa Nacional de Controle de Tuberculose (componente 2). O nível de conhecimento, de acordo com os escores transformados em uma escala de 0 a 100, foi classificado como: 0-50% (baixo), 51-75% (mediano) e mais de 75% (alto). A regressão múltipla foi empregada na análise dos fatores associados. Resultados: A pontuação global (média dos escores dos componentes 1 e 2) mediana do conhecimento foi de 68,6%. O conhecimento global sobre tuberculose mostrou-se positivamente associado ao tempo de atuação profissional, à recepção de capacitação sobre tuberculose e ao acesso ao guia/cartilha de tuberculose. Conclusões: Investimentos na formação e nas estratégias de capacitação dos ACS contribuirão para o aumento do conhecimento desses profissionais, resultando em maior sucesso no controle da tuberculose.