Bruna Engelman

Risk factors for health care–associated infection in hospitalized adults: Systematic review and meta-analysis

HighlightsHealth care–associated infections (HAIs) have become a global public health problem.Approximately 20%‐30% of HAIs are preventable through hospital control programs.This review synthesizes and updates the evidence about risk factors for HAIs in adults.Identifying risk factors for HAIs may improve patient safety. Background: Health care–associated infections (HAIs) are a public health problem that increase health care costs. This article aimed to systematically review the literature and meta‐analyze studies investigating risk factors (RFs) independently associated with HAIs in hospitalized adults. Methods: Electronic databases (MEDLINE, Embase, and LILACS) were searched to identify studies from 2009‐2016. Pooled risk ratios (RRs) or odds ratios (ORs) or mean differences (MDs) and 95% confidence intervals (CIs) were calculated and compared across the groups. This review followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses statement. Results: Of 867 studies, 65 met the criteria for review, and the data of 18 were summarized in the meta‐analysis. The major RFs independently associated with HAIs were diabetes mellitus (RR, 1.76; 95% CI, 1.27‐2.44), immunosuppression (RR, 1.24; 95% CI, 1.04‐1.47), body temperature (MD, 0.62; 95% CI, 0.41‐0.83), surgery time in minutes (MD, 34.53; 95% CI, 22.17‐46.89), reoperation (RR, 7.94; 95% CI, 5.49‐11.48), cephalosporin exposure (RR, 1.77; 95% CI, 1.30‐2.42), days of exposure to central venous catheter (MD, 5.20; 95% CI, 4.91‐5.48), intensive care unit (ICU) admission (RR, 3.76; 95% CI, 1.79‐7.92), ICU stay in days (MD, 21.30; 95% CI, 19.81‐22.79), and mechanical ventilation (OR, 12.95; 95% CI, 6.28‐26.73). Conclusions: Identifying RFs that contribute to develop HAIs may support the implementation of strategies for their prevention, therefore maximizing patient safety.

Clinical Indicators for Evaluation of Outcomes of Impaired Tissue Integrity in Orthopedic Patients: Consensus Study

PURPOSE To select outcomes from the Nursing Outcomes Classification (NOC) to evaluate impaired tissue integrity in patients undergoing orthopedic surgeries, and develop conceptual and operational definitions for their indicators. METHODS A consensus study involving 10 nurses from clinical practice. A 100% consensus was established in the outcomes selection. FINDINGS Wound Healing: Primary intention (1102) with two indicators: (110214) Scar formation, and (110201) Skin approximation were selected. Four indicators were grouped to evaluate inflammatory signs together with foul wound odor and six for drainage. CONCLUSIONS These indicators direct the outcomes evaluation for wound healing. IMPLICATIONS FOR NURSING PRACTICE Support to the definition the priority interventions in nursing process documentation.

CICATRIZAÇÃO DA FERIDA OPERATÓRIA AVALIADA ATRAVÉS DA NURSING OUTCOMES CLASSIFICATION

1 Enfermeira, Doutora em Educação. Professora Associada. Escola de Enfermagem da UFRGS. Porto Alegre, Rio Grande do Sul, Brasil. e-mail: miriam.abreu2@gmail.com 2 Enfermeira, Doutoranda. Programa de Pós-Graduação em Enfermagem da Universidade Federal do Rio Grande do Sul -UFRGS-. Porto Alegre, Rio Grande do Sul, Brasil. 3 Enfermeiro, Doutor em Epidemiologia. Pesquisador, Programa de Enfermagem, Universidade de Santander UDES, Bucaramanga, Colômbia, Pesquisador de Pós-doutorado. Faculdade de Medicina da Universidade Federal do Rio Grande do Sul -UFRGS-. Porto Alegre, Rio Grande do Sul, Brasil. 4 Enfermeira, Doutoranda. Programa de Pós-Graduação em Enfermagem da Universidade Federal do Rio Grande do Sul -UFRGS-. Porto Alegre, Rio Grande do Sul, Brasil. 5 Enfermeiro, Doutor em Enfermagem. Enfermeiro do Hospital Pronto Socorro de Canoas e Professor do Curso Técnico em Enfermagem – UNIPACS. Porto Alegre, Rio Grande do Sul, Brasil. 6 Enfermeira, Doutoranda. Programa de Pós-Graduação em Enfermagem da Universidade Federal do Rio Grande do Sul -UFRGS-. Porto Alegre, Rio Grande do Sul, Brasil. 7 Acadêmica. Escola de Enfermagem da Universidade Federal do Rio Grande do Sul -UFRGS-. Porto Alegre, Rio Grande do Sul, Brasil. 8 Enfermeira, Mestranda. Programa de Pós-Graduação em Enfermagem da Universidade Federal do Rio Grande do Sul -UFRGS-. Porto Alegre, Rio Grande do Sul, Brasil. 9 Enfermeira. Escola de Enfermagem da Universidade Federal do Rio Grande do Sul -UFRGS-. Porto Alegre, Rio Grande do Sul, Brasil. 10 Enfermeira, Doutora em Ciências. Professora Associada. Escola de Enfermagem da UFRGS. Porto Alegre, Rio Grande do Sul, Brasil.