Denise de Andrade

Oral hygiene with chlorhexidine in preventing pneumonia associated with mechanical ventilation

Ventilator-associated pneumonia (VAP) is a common infection in intensive care units (ICUs), and oral antiseptic is used as a preventive measure. We reviewed meta-analyses and randomized clinical trials indexed in the Medical Literature Analysis and Retrieval System and Cumulative Index to Nursing and Allied Health Literature databases regarding the topical use of chlorhexidine in the prevention of VAP. Eight publications were analyzed. In seven (87.5%) chlorhexidine diminished the colonization of the oropharynx, and in four (50%) there was a reduction of VAP. Chlorhexidine seems to reduce colonization, thus reducing the incidence of VAP.

Avaliação prospectiva da ocorrência de infecção em pacientes críticos de unidade de terapia intensiva

BACKGROUND AND OBJECTIVES: Care in the intensive care unit (ICU) is constantly challenged by infections related to invasive procedures, which result in increased morbidity and mortality, hospitalization term and costs. This study aimed to prospectively evaluate critical patients according to age, clinical conditions, hospitalization term, occurrence of hospital infection, topography of hospital infection, occurrence of microbial multi-resistance or not, use of invasive procedures and antimicrobial agents. METHODS: This is a prospective, observational, clinical research, carried out at an ICU between February and July 2006. The research subjects were critical patients hospitalized for more than 24 hours at the ICU, followed from admission until discharge, transference or death. RESULTS: The study group consisted of 71 patients with a mean age of 53.5 ± 18.75 years. Forty-seven of these patients (66.2%) acquired hospital infection. Twenty-nine infections (37.6%) occurred in the blood stream, 20 (26%) respiratory and 13 (16.9%) urinary. The most frequent multi-resistant strains were: 14 (10.85%) Pseudomonas aeruginosa, 4 (3.1%) coagulase-negative Staphylococcus sp and 4 (3.1%) Staphylococcus aureus. The most used antimicrobial agents were carbapenem (22.4%), glycopeptides (21.6%) and cephalosporin (21.6%). Twenty-nine (40.8%) of these patients died. CONCLUSIONS: Hospital infection is aggravated if associated to the increased resistance of the microorganisms to the antibiotics.

Ocorrência de bactérias multiresistentes em um centro de Terapia Intensiva de Hospital brasileiro de emergências

BACKGROUND AND OBJECTIVES: Nosocomial infection represents a challenge in clinical practice involving hospitalized patients, as they considerably extend the hospitalization period and morbidity and mortality rates and, at the same time, increase hospital costs. Given their clinical conditions, which require invasive procedures and antimicrobial treatment, hospitalized patients, especially at the Intensive Care Unit, are particularly susceptible to hospital infection. This study aimed to evaluate the occurrence of multiresistant bacteria in patients hospitalized at the Intensive Care Unit of a Brazilian emergency hospital. METHODS: Our retrospective study was approved by the Ethics Committee and considered the period between October 2003 and September 2004. A database was developed through variable coding and double entry, and Statistical Package for Social Sciences (SPSS) software, version 10.0, was used for statistical analysis. RESULTS: Multiresistant bacteria were identified in 68 patients, 47 (69.1%) of whom were men, with 55 years as the mean age. All patients were submitted to endotracheal intubation and central venipuncture. The most frequent bacteria were coagulase-negative Staphylococcus sp. (36.4%), followed by Staphylococcus aureus (19%). Cephalosporin was the most frequently used (21.4%) antimicrobial agent. CONCLUSIONS: Knowledge on infection occurrence provokes reflections on multiresistance, directs educative actions and favors interventions to prevent and control problem situations.

La familia y los factores de riesgo relacionados con el consumo de alcohol y tabaco en los niños y adolescentes (Guayaquil-Ecuador)

The present investigation had as objective identifying in a family the possible factors of risk related to the use of alcohol and tobacco in the children and adolescents. It is important to emphasize that study of this nature within a social and culture perspective expresses the attempt to include/understand the factors of risk for the use of tobacco and to drink alcoholic the environmental influences in the familiar surroundings views to prevent futures cases with dependency. For the study used a sample of one hundred families, to that applied to an instrument pre to them established with the people in charge of the respective families. As result were obtained 51% of the schooling level are low, 54% has inferior wage to the basic one, 61% to drink alcoholic. To emphasize that unquestionable the reduction of the casuistry of alcoholism and/or tabaquismo to influence significantly in the quality of the individuals life.A presente investigacao teve como objetivo identificar no ambiente familiar os possiveis fatores de risco associados ao alcoolismo e tabagismo em criancas e adolescentes. E importante enfatizar que estudo desta natureza dentro de uma perspectiva socio-cultural expressa a tentativa de entender os fatores do risco para o uso do tabaco e de bebidas alcoolicas, bem como as influencias ambientais de maneira a impedir futuras dependencias. Utilizou-se uma amostra de cem familias e aplicou-se um instrumento preestabelecido. Como resultado obteve que 51% dos pais possuem nivel educacional baixo, 54% tem o salario inferior ao basico, 61% fazem uso de bebidas alcoolicas. Vale enfatizar que inquestionavelmente a reducao do casuistica do alcoolismo e/ou tabagismo influenciam significativamente na qualidade da vida dos individuos.

Curativo do paciente queimado: uma revisão de literatura

O objetivo deste estudo foi descrever, mediante revisao de literatura, os agentes topicos e tipos de cobertura que tem sido recomendados no tratamento de queimaduras e discutir as implicacoes do uso desses produtos. O estudo foi desenvolvido mediante levantamento bibliografico dos ultimos 12 anos, nas bases de dados Lilacs, Medline e Dedalus. As publicacoes encontradas foram organizadas como de pesquisa e de revisao e, posteriormente, categorizadas de acordo com a tematica: agentes topicos e substitutos temporarios de pele. Foram discutidos os possiveis efeitos colaterais, indicacoes e recomendacoes quanto a manipulacao.This study aimed at describing, by means of a literature review, the topical agents and bandage types which have been recommended in the treatment of burns and their implications in nursing care. This study was conducted by collected bibliographic data concerning the last 12 years from Lilacs, Medline and Dedalus databases. The articles found were organized as research and review articles and later categorized according to the theme: topical agents and temporarily skin dressing. We discussed the possible effects as well as the indications and recommendations as to the manipulation of the agents and bandage types which have been recommended in the treatment of burns.This study aimed at describing, by means of a literature review, the topical agents and bandage types which have been recommended in the treatment of burns and their implications in nursing care. This study was conducted by collected bibliographic data concerning the last 12 years from Lilacs, Medline and Dedalus databases. The articles found were organized as research and review articles and later categorized according to the theme: topical agents and temporarily skin dressing. We discussed the possible effects as well as the indications and recommendations as to the manipulation of the agents and bandage types which have been recommended in the treatment of burns.

Condition of cleanliness of surfaces close to patients in an intensive care unit

La limpieza de las superficies es reconocidamente una medida de control de la diseminacion de microorganismos en el ambiente hospitalario. Este estudio prospectivo, realizado en una unidad de terapia intensiva, durante 14 dias, tuvo como objetivo describir las condiciones de limpieza/desinfeccion de cuatro superficies proximas al paciente. Cien evaluaciones de las superficies fueron realizadas despues del proceso de limpieza. Se utilizaron tres metodos para evaluar la limpieza: inspeccion visual, adenosin trifosfato (ATP) bioluminiscencia y presencia de Staphylococcus aureus/MSRA. Respectivamente, 20%, 80% y 16% de las evaluaciones por los metodos: visual, ATP y presencia de Staphylococcus aureus/MSRA, fueron consideradas reprobadas. Hubo diferencias estadisticamente significativas (p<0.05) entre las tasas de reprobacion de la limpieza utilizando los metodos ATP, comparado al visual y al microbiologico. La inspeccion visual no se mostro una medida confiable para evaluar la limpieza de las superficies. Los resultados demostraron que la actual rutina de limpieza precisa ser modificada.La limpieza de las superficies es reconocidamente una medida de control de la diseminacion de microorganismos en el ambiente hospitalario. Este estudio prospectivo, realizado en una unidad de terapia intensiva, durante 14 dias, tuvo como objetivo describir las condiciones de limpieza/desinfeccion de cuatro superficies proximas al paciente. Cien evaluaciones de las superficies fueron realizadas despues del proceso de limpieza. Se utilizaron tres metodos para evaluar la limpieza: inspeccion visual, adenosin trifosfato (ATP) bioluminiscencia y presencia de Staphylococcus aureus/MSRA. Respectivamente, 20%, 80% y 16% de las evaluaciones por los metodos: visual, ATP y presencia de Staphylococcus aureus/MSRA, fueron consideradas reprobadas. Hubo diferencias estadisticamente significativas (p<0.05) entre las tasas de reprobacion de la limpieza utilizando los metodos ATP, comparado al visual y al microbiologico. La inspeccion visual no se mostro una medida confiable para evaluar la limpieza de las superficies. Los resultados demostraron que la actual rutina de limpieza precisa ser modificada.

A AUTO-ESTIMA EM ADOLESCENTES COM E SEM FISSURAS DE LÁBIO E/OU DE PALATO

Self-image is an important determinant of self-esteem among men and women, which makes us reflect about the process of rehabilitation of people with facial malformations. In order to measure self-esteem, the Janis and Field Scale was used. The sample consisted of 608 adolescents aged 17 to 20 years including males and females. Two hundred and thirty-five had a cleft lip and/or palate and 373 did not. The analysis of the self-esteem levels obtained enabled to conclude that the adolescents with a cleft lip and/or palate behave differently from those without it, that is, they present lower self-esteem scores.O auto-conceito e um determinante importante da auto-estima, entre homens e mulheres, isto nos fez refletir sobre o processo de reabilitacao das pessoas portadoras de malformacao. Utilizamos para mensurar o nivel de auto-estima a escala de Janis e Field. Entrevistou-se 608 adolescentes sendo 235 com e 373 sem fissuras de labio e/ou de palato, entre idades de 17 a 20 anos e de ambos o sexos. Analisando os niveis de auto-estima concluimos que o grupo de adolescentes com fissuras se comporta de forma diferente do grupo sem fissura, ou seja, os portadores de fissuras exibem menores escores de auto-estima.Self-image is an important determinant of self-esteem among men and women, which makes us reflect about the process of rehabilitation of people with facial malformations. In order to measure self-esteem, the Janis and Field Scale was used. The sample consisted of 608 adolescents aged 17 to 20 years including males and females. Two hundred and thirty-five had a cleft lip and/or palate and 373 did not. The analysis of the self-esteem levels obtained enabled to conclude that the adolescents with a cleft lip and/or palate behave differently from those without it, that is, they present lower self-esteem scores.

Endotracheal tube biofilm and ventilator‐associated pneumonia with mechanical ventilation

Objective: To analyze biofilm on internal and external surfaces of endotracheal tubes after their use in critical care patients, and to produce evidence of association between use of the tube, presence of biofilm, and the occurrence of pneumonia. Methods: This was a clinical study performed at the Intensive Care Unit of an emergency hospital in the interior of São Paulo state, Brazil. Data collection involved 30 endotracheal tubes used on adult patients for a period of ≥48 h of mechanical ventilation for scanning electron microscopy. Results: Analysis of the biofilm on the 30 tubes by scanning electron microscopy showed various abiotic and biotic structures, predominately on the internal surface, such as: fibrin network, erythrocytes, leukocytes, cocci, bacilli, and molds, among others. The intubation period of the endotracheal tube for ≥8 days represented one of the risk factors for ventilator‐associated pneumonia (RR 7.41, P < 0.001). Conclusions: The presence of the endotracheal tube permits microbial colonization, overall contributing to the development of biofilm and the occurrence of pneumonia. Microsc. Res. Tech. 77:305–312, 2014.

La escuela básica en la prevención del consumo de alcohol y tabaco: retrato de una realidad

The use of alcohol and drugs is a social issue that constitutes serious problem for the health, with personal, family and social consequences. The present study is exploratory-descriptive nature and its objective was to evaluate the primary school as a predicting factor in the prevention of the consumption of the school and tobacco in students. Interviews to students and professors were made by a pre-established guide, the results demonstrate that the 66.6% age is of 10 to 11 years. Exposed to factors of risks associated to scholastic problems, low self- esteem and familiar problems. Research shows that 15.6% have experienced alcohol and the 13.4% tobacco. The professors say that the children do not consume alcohol, tobacco or drugs, they say the children have conduct problems.The use of alcohol and drugs is a social issue that constitutes serious problem for the health, with personal, family and social consequences. The present study is exploratory-descriptive nature and its objective was to evaluate the primary school as a predicting factor in the prevention of the consumption of the school and tobacco in students. Interviews to students and professors were made by a pre-established guide, the results demonstrate that the 66,6% age is of 10 to 11 years. Exposed to factors of risks associated to scholastic problems, low self- esteem and familiar problems. Research shows that 15,6% have experienced alcohol and the 13,4% tobacco. The professors say that the children do not consume alcohol, tobacco or drugs, they say the children have conduct problems.

Pseudomonas aeruginosa multiresistente em unidade de cuidados intensivos: desafios que procedem?

Objectives: To evaluate the occurrence of multi-resistant Pseudomonas Aeruginosa infection among patients from an Intensive Care Unit. Methods: This retrospective study was conducted in an Emergency Hospital. Data were collected from October 2003 to September 2004. Results: Sixty-eight patients were infected with multi-resistant bacteria. Ten of these patients (14.7%) were infected with Pseudomonas Aeruginosa. Among these with Pseudomonas Aeruginosa, 8 patients were male and they had a mean age of 57 years and a mean of hospitalization of 43.7 days. Strains of Pseudomonas Aeruginosa were isolated in blood (n =8), in urine (n = 5), in venous catheter port (n = 2), and in cerebrospinal fluid (n =1). Seven of these strains were sensitive to Polymyxin B and 3 strains were sensitive to Imipenem. Conclusions: Since patients’ microbiological profile is specific to a unit or institution, it should be assessed periodically and addressed with