Camila Quartim de Moraes Bruna

Indicadores de avaliação do processamento de artigos odonto-médico-hospitalares: elaboração e validação

Methodological study to elaborate and validate measures of evaluation in health contributing to an evaluation system of practices related to the control and prevention of hospital infection. It was elaborated eight dental-medical-hospital supply reprocessing conformity indicators. Indicators are described using items of the structure, process and outcomes that permitted the elaboration of conformity indicators related to the best practices (gold pattern). It was performed the content validity of the attributes of applicability and representativeness by a consensus expert judgment process using a psychometric scale. All the indicators showed to have content validity. Expert judgments, including comments and suggestions, evidenced the importance of perform validity of the evaluation processes, independently of the existence of golden pattern criteria and/or relevancies to the nursing practice.Estudio de desenvolvimiento metodologico para la elaboracion y validacion de medidas de evaluacion en salud, con la finalidad de contribuir con los sistemas de evaluacion de practicas para el control y prevencion de las infecciones hospitalarias, por la elaboracion y validacion de ocho indicadores de evaluacion del procesamiento de instrumentos odonto-medico-hospitalarios. A partir de la fundamentacion teorico cientifico, tales indicadores contemplan evaluaciones de estructura, proceso y resultado asi como permiten la elaboracion de indices de conformidad con relacion a las mejores practicas esperadas (padron-oro). La evaluacion se refirio a la validez del contenido, por la tecnica de consenso de especialistas para el juzgamiento de representatividad y aplicabilidad. Todos los indicadores fueron aprobados. Los juzgamientos efectuados, incluyendo comentarios y sugestiones, demostraron la importancia de realizar la validacion de procesos de evaluacion, independiente da existencia de criterios padron-oro y/o a la relevancia de su repercusion en la practica asistencial.* Extracted from project “Indicadores de Avaliação de Práticas de Controle de Infecção Hospitalar”, School of Nursing at University of São Paulo, 2006. 1 Full Professor of Medical-Surgery Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. kugrazia@usp 2 Associate Professor of Medical-Surgery Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. rlacerda@usp.br 3 Doctorate Professor of Medical-Surgery Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. rturrini@usp.br 4 Student. PostGraduation Program PROESA at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. caquartim@yahoo.com.br 5 Student. Post-Graduation Program PROESA at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. cris_pr_silva@hotmail.com 6 Student. Post-Graduation Program PROESA at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. cristianeschmmitt@yahoo.com.br 7 Student. Post-Graduation Program PROESA at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. gioaraujo@yahoo.com.br 8 Student. Post-Graduation Program PROESA at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. lilian.torres@superig.com.br O R IG IN A L A R IC LE

Effectiveness of disinfection with alcohol 70% (w/v) of contaminated surfaces not previously cleaned

OBJETIVO: avaliar a eficacia desinfetante do alcool 70% (p/v) sob friccao, sem limpeza previa, nas superficies de trabalho, como procedimento de desinfeccao concorrente em Servicos de Saude. METODO: foi desenvolvido estudo experimental laboratorial, randomizado e unicegado. As amostras foram constituidas de superficies esmaltadas, intencionalmente contaminadas com microrganismos Serratia marcescens ATCC 14756 106 Unidades Formadoras de Colonias/mL, acrescidos de 10% de saliva humana, e submetidas ao procedimento de desinfeccao sem limpeza previa. Os resultados foram comparados a desinfeccao precedida da limpeza. RESULTADOS: houve reducao de seis logaritmos da populacao microbiana inicial, igualmente nos grupos com e sem limpeza previa (p=0,440) e uma carga microbiana residual ≤ 102 Unidades Formadoras de Colonias. CONCLUSAO: a pesquisa demonstrou a aceitabilidade da pratica avaliada, trazendo importante resposta para a area da saude, especialmente a enfermagem, que mais executa os procedimentos de limpeza/desinfeccao concorrentes dessas superficies de trabalho.OBJECTIVE To evaluate the disinfectant effectiveness of alcohol 70% (w/v) using friction, without previous cleaning, on work surfaces, as a concurrent disinfecting procedure in Health Services. METHOD An experimental, randomized and single-blinded laboratory study was undertaken. The samples were enamelled surfaces, intentionally contaminated with Serratia marcescens microorganisms ATCC 14756 106 CFU/mL with 10% of human saliva added, and were submitted to the procedure of disinfection WITHOUT previous cleaning. The results were compared to disinfection preceded by cleaning. RESULTS There was a reduction of six logarithms of the initial microbial population, equal in the groups WITH and WITHOUT previous cleaning (p=0.440) and a residual microbial load ≤ 102 CFU. CONCLUSION The research demonstrated the acceptability of the practice evaluated, bringing an important response to the area of health, in particular to Nursing, which most undertakes procedures of concurrent cleaning /disinfecting of these work surfaces.

Indicators for evaluation of processing dental-medical-hospital supplies: elaboration and validation

Methodological study to elaborate and validate measures of evaluation in health contributing to an evaluation system of practices related to the control and prevention of hospital infection. It was elaborated eight dental-medical-hospital supply reprocessing conformity indicators. Indicators are described using items of the structure, process and outcomes that permitted the elaboration of conformity indicators related to the best practices (gold pattern). It was performed the content validity of the attributes of applicability and representativeness by a consensus expert judgment process using a psychometric scale. All the indicators showed to have content validity. Expert judgments, including comments and suggestions, evidenced the importance of perform validity of the evaluation processes, independently of the existence of golden pattern criteria and/or relevancies to the nursing practice.Estudio de desenvolvimiento metodologico para la elaboracion y validacion de medidas de evaluacion en salud, con la finalidad de contribuir con los sistemas de evaluacion de practicas para el control y prevencion de las infecciones hospitalarias, por la elaboracion y validacion de ocho indicadores de evaluacion del procesamiento de instrumentos odonto-medico-hospitalarios. A partir de la fundamentacion teorico cientifico, tales indicadores contemplan evaluaciones de estructura, proceso y resultado asi como permiten la elaboracion de indices de conformidad con relacion a las mejores practicas esperadas (padron-oro). La evaluacion se refirio a la validez del contenido, por la tecnica de consenso de especialistas para el juzgamiento de representatividad y aplicabilidad. Todos los indicadores fueron aprobados. Los juzgamientos efectuados, incluyendo comentarios y sugestiones, demostraron la importancia de realizar la validacion de procesos de evaluacion, independiente da existencia de criterios padron-oro y/o a la relevancia de su repercusion en la practica asistencial.* Extracted from project “Indicadores de Avaliação de Práticas de Controle de Infecção Hospitalar”, School of Nursing at University of São Paulo, 2006. 1 Full Professor of Medical-Surgery Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. kugrazia@usp 2 Associate Professor of Medical-Surgery Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. rlacerda@usp.br 3 Doctorate Professor of Medical-Surgery Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. rturrini@usp.br 4 Student. PostGraduation Program PROESA at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. caquartim@yahoo.com.br 5 Student. Post-Graduation Program PROESA at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. cris_pr_silva@hotmail.com 6 Student. Post-Graduation Program PROESA at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. cristianeschmmitt@yahoo.com.br 7 Student. Post-Graduation Program PROESA at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. gioaraujo@yahoo.com.br 8 Student. Post-Graduation Program PROESA at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. lilian.torres@superig.com.br O R IG IN A L A R IC LE

The practice of disinfection of high-speed handpieces with 70% w/v alcohol: An evaluation.

HighlightsThe high speed handpiece (HSH) are potencial sources of microbial dissemination.The lack of previous cleaning compromise the bactericide action of alcohol.The cleaning and sterilization of the HSH is required by reducing the chance of cross‐infection in dentistry. &NA; A high‐speed handpiece is used in several dental procedures and the official recommendation for safe decontamination consists of rinsing with water, washing with detergent, mechanical friction, and sterilization; however, many professionals only apply 70% w/v alcohol without also cleaning the tool between patients. We performed an analysis of high‐speed handpieces reprocessed only with 70% w/v alcohol and found that the methods used in clinical practice are not safe.

Comparison of hand hygiene antimicrobial efficacy: Melaleuca alternifolia essential oil versus triclosan

OBJETIVOS: este estudio objetivo evaluar la eficacia de la higienizacion de las manos realizada con dos formulas diferentes de jabones: aceite esencial de Melaleuca alternifolia al 0,3% versus triclosan al 0,5%, y compararlas con dos higienizaciones de referencia: procedimiento de la metodologia oficial (soft soap) versus procedimiento de la version draft (soft soap + propan-2-ol). METODO: utilizando la metodologia europea EN 1499, fueron determinados factores de reduccion logaritmica del numero de unidades formadoras de colonia de Escherichia coli K12 antes y despues de la higiene de las manos de 15 sujetos voluntarios y comparados por el test de Wilcoxon de una sola cola. RESULTADOS: Tomando como referencia el soft soap, no hubo diferencia entre el desempeno del jabon con Melaleuca alternifolia al 0,3% o jabon conteniendo triclosan al 0,5%. El soft soap + propan-2-ol se demostro mas eficaz en relacion a los demas procedimientos de higienizacion de las manos. CONCLUSION: estudios que verifiquen la eficacia terapeutica de aceite esencial en la higienizacion de las manos pueden mejorar la adhesion a esa practica.OBJECTIVE this study aimed to evaluate the efficacy of hand hygiene performed with two different soap formulations: 0.3% Melaleuca alternifolia essential oil versus 0.5% triclosan, and to compare them with two reference hygiene procedures: the official methodology procedure (soft soap) versus the draft version of the procedure (soft soap + propan-2-ol). METHOD using the European EN 1499 method, logarithmic reduction factors were determined for the number of colony forming units of Escherichia coli K12 before and after hand hygiene of 15 volunteer subjects, and compared using the one-tailed Wilcoxon test. RESULTS referring to the soft soap, there was no difference between the performance of soap with 0.3% M. alternifolia and soap containing 0.5% triclosan. The soft soap + propan-2-ol proved to be more effective than the other hand hygiene procedures. CONCLUSION studies to verify the therapeutic efficacy of essential oil in hand hygiene can improve adherence to this practice.

Eficácia da desinfecção com álcool 70% (p/v) de superfícies contaminadas sem limpeza prévia

OBJETIVO: avaliar a eficacia desinfetante do alcool 70% (p/v) sob friccao, sem limpeza previa, nas superficies de trabalho, como procedimento de desinfeccao concorrente em Servicos de Saude. METODO: foi desenvolvido estudo experimental laboratorial, randomizado e unicegado. As amostras foram constituidas de superficies esmaltadas, intencionalmente contaminadas com microrganismos Serratia marcescens ATCC 14756 106 Unidades Formadoras de Colonias/mL, acrescidos de 10% de saliva humana, e submetidas ao procedimento de desinfeccao sem limpeza previa. Os resultados foram comparados a desinfeccao precedida da limpeza. RESULTADOS: houve reducao de seis logaritmos da populacao microbiana inicial, igualmente nos grupos com e sem limpeza previa (p=0,440) e uma carga microbiana residual ≤ 102 Unidades Formadoras de Colonias. CONCLUSAO: a pesquisa demonstrou a aceitabilidade da pratica avaliada, trazendo importante resposta para a area da saude, especialmente a enfermagem, que mais executa os procedimentos de limpeza/desinfeccao concorrentes dessas superficies de trabalho.OBJECTIVE To evaluate the disinfectant effectiveness of alcohol 70% (w/v) using friction, without previous cleaning, on work surfaces, as a concurrent disinfecting procedure in Health Services. METHOD An experimental, randomized and single-blinded laboratory study was undertaken. The samples were enamelled surfaces, intentionally contaminated with Serratia marcescens microorganisms ATCC 14756 106 CFU/mL with 10% of human saliva added, and were submitted to the procedure of disinfection WITHOUT previous cleaning. The results were compared to disinfection preceded by cleaning. RESULTS There was a reduction of six logarithms of the initial microbial population, equal in the groups WITH and WITHOUT previous cleaning (p=0.440) and a residual microbial load ≤ 102 CFU. CONCLUSION The research demonstrated the acceptability of the practice evaluated, bringing an important response to the area of health, in particular to Nursing, which most undertakes procedures of concurrent cleaning /disinfecting of these work surfaces.

Manual and Automated Cleaning Are Equally Effective for the Removal of Organic Contaminants From Laparoscopic Instruments

OBJECTIVE To compare the effectiveness of manual and automated methods for cleaning laparoscopic instruments. DESIGN Experimental laboratory study. METHODS We evaluated 4 methods of cleaning laparoscopic instruments: (1) manual-only cleaning and rinsing with potable tap water; (2) manual cleaning and rinsing with potable tap water, followed by ultrasonic cleaning without rinsing; (3) manual cleaning and rinsing with potable tap water followed by ultrasonic cleaning and rinsing with potable tap water; and (4) manual cleaning and rinsing with potable tap water, followed by ultrasonic cleaning and rinsing: first with potable tap water and then with sterile distilled water. Organic residues of protein, hemoglobin, and carbohydrates were evaluated using spectrophotometry. RESULTS The various cleaning methods tested did not result in statistically significant differences (P>.05) in the levels of investigated organic residues. CONCLUSIONS All cleaning and rinsing methods tested were found to be effective in reducing the levels of organic residues on laparoscopic instruments. Thus, there is no advantage gained by supplementing manual-only cleaning with automated ultrasonic cleaning, nor was there a difference between rinsing with potable tap versus sterile distilled water. Infect Control Hosp Epidemiol 2018;39:58-63.

Processamento de cabos de laringoscópio: revisão integrativa

Objective: This is an integrative review study of the scientific literature based on the following guiding question: “What kind of processing is required for the safety reuse of the laryngoscope handle?” Method: An integrative review was performed using the following portals and databases: Pubmed, Embase, Scopus, Web of Science, and CINAHL. Results: Seven experimental studies were found and the results showed the uncertainty of the classification of the laryngoscope handle in relation to the risk of causing infection, proven by the diversity of reprocessing methods identified. Conclusion: We concluded that the laryngoscope handles cannot be considered independent of the blades and, therefore, they are semicritical materials. Considering the microbial and the organic load identified in this review, the recommended minimal processing is cleaning, followed by the high-level disinfection. A small inventory and the lack of access to technologies for reprocessing are not acceptable reasons for improvised recommendations, thus avoiding the certification and the spread of the bad practices.

The impact of the use of different types of gloves and bare hands for preparation of clean surgical instruments

Objetivos: determinar se existe diferencas na seguranca do preparo de instrumentais cirurgicos relacionada ao uso de distintos tipos de luvas e das maos nuas no preparo, e avaliar a carga microbiologica destes preparados sem luvas. Metodo: experimento laboratorial com abordagem pragmatica, onde amostras foram manipuladas com diferentes tipos de luvas e com as maos nuas, elaborado teste de citotoxicidade por meio da difusao em agar. Outras Amostras sofreram analise microbiologica apos serem manipuladas sem luvas. Resultados: nenhuma das amostras apresentou efeito citotoxico. Todas as culturas microbiologicas apresentaram crescimento de microrganismos, embora nenhum microrganismo tenha sido recuperado apos a autoclavacao. Conclusao: nao houve diferencas nas respostas citotoxicas relacionadas ao uso de diferentes tipos de luvas e das maos nuas na manipulacao do instrumental cirurgico limpo que sinalizasse risco de iatrogenia. Ressalta-se que o uso de luvas implica em aumento dos custos do processo e da geracao de residuos, alem do potencial risco alergenico ao latex.ABSTRACT Objectives: to determine if there are differences on the safety of the preparation of clean surgical instruments using different types of gloves and bare hands and evaluate the microbiological load of these preparations without gloves. Method: laboratory procedure with a pragmatic approach, in which the samples were handled with different types of gloves and bare hands. In addition, cytotoxicity assays were carried out by means of the agar diffusion method. Further samples were subjected to microbiological analysis after being handled without gloves. Results: none of the samples showed cytotoxic effect. All microbiological cultures showed growth of microorganisms, but no microorganism has been recovered after autoclaving. Conclusion: there were no differences in the cytotoxic responses regarding the use of different types of gloves and bare hands in the handling of clean surgical instruments, which could entail iatrogenic risk. It is noteworthy that the use of gloves involves increase in the costs of process and waste generation, and the potential allergenic risk to latex.

Comparación de la eficacia antimicrobiana en la higienización de las manos: aceite esencial de Melaleuca alternifolia versus triclosan

OBJETIVOS: este estudio objetivo evaluar la eficacia de la higienizacion de las manos realizada con dos formulas diferentes de jabones: aceite esencial de Melaleuca alternifolia al 0,3% versus triclosan al 0,5%, y compararlas con dos higienizaciones de referencia: procedimiento de la metodologia oficial (soft soap) versus procedimiento de la version draft (soft soap + propan-2-ol). METODO: utilizando la metodologia europea EN 1499, fueron determinados factores de reduccion logaritmica del numero de unidades formadoras de colonia de Escherichia coli K12 antes y despues de la higiene de las manos de 15 sujetos voluntarios y comparados por el test de Wilcoxon de una sola cola. RESULTADOS: Tomando como referencia el soft soap, no hubo diferencia entre el desempeno del jabon con Melaleuca alternifolia al 0,3% o jabon conteniendo triclosan al 0,5%. El soft soap + propan-2-ol se demostro mas eficaz en relacion a los demas procedimientos de higienizacion de las manos. CONCLUSION: estudios que verifiquen la eficacia terapeutica de aceite esencial en la higienizacion de las manos pueden mejorar la adhesion a esa practica.OBJECTIVE this study aimed to evaluate the efficacy of hand hygiene performed with two different soap formulations: 0.3% Melaleuca alternifolia essential oil versus 0.5% triclosan, and to compare them with two reference hygiene procedures: the official methodology procedure (soft soap) versus the draft version of the procedure (soft soap + propan-2-ol). METHOD using the European EN 1499 method, logarithmic reduction factors were determined for the number of colony forming units of Escherichia coli K12 before and after hand hygiene of 15 volunteer subjects, and compared using the one-tailed Wilcoxon test. RESULTS referring to the soft soap, there was no difference between the performance of soap with 0.3% M. alternifolia and soap containing 0.5% triclosan. The soft soap + propan-2-ol proved to be more effective than the other hand hygiene procedures. CONCLUSION studies to verify the therapeutic efficacy of essential oil in hand hygiene can improve adherence to this practice.