Kazuko Uchikawa Graziano

Eficácia da esterilização de canetas de bisturi elétrico de uso único reprocessadas

No Brasil, a caneta de bisturi eletrico de uso unico (CBEUU) e um dos artigos mais comumente reutilizados. O presente estudo avaliou a eficacia da esterilizacao de CBEUUs reprocessadas, utilizando dois metodos de limpeza (manual ou automatizado), seguidos de um dos seguintes metodos de esterilizacao: plasma de peroxido de hidrogenio (PPH), oxido de etileno (OE) ou vapor de baixa temperatura de formaldeido (VBTF). Foram analisadas 360 CBEUUs apos sua primeira utilizacao. A probabilidade de falha de esterilizacao foi estimada considerando o numero de resultados positivos de cultura dos dispositivos estudados. A probabilidade geral de falha de esterilizacao das CBEUUs foi de 0,26. A menor probabilidade de falha foi obtida com o VBTF (0,01), seguida do OE (0,21) e do PPH (0,56). A limpeza automatizada obteve melhores resultados quando comparada a limpeza manual. O presente estudo demonstrou que a probabilidade de esterilizacao das CBEUUs reprocessadas e altamente dependente dos metodos de limpeza ou esterilizacao aplicados.In Brazil, single use diathermy pencils (SUDP) are among the most common reused devices. This study assesses the sterilization efficacy of reprocessing SUDP using two cleansing methods (manual or automated), followed by one of three of the low-temperature sterilization methods: Hydrogen Peroxide Plasma (HPP), Ethylene Oxide (ETO) or Low-Temperature Steam Formaldehyde (LTSF). The sample was composed of 360 SUDP after their first use. The probability of sterilization failure was estimated considering the number of positive microbiological results obtained by cultures of the studied devices. The overall sterilization failure probability for SUDP was 0.26. The sterilization method, which presented the lowest failure probability was the LTSF (0.01), followed by ETO (0.21) and HPP (0.56). Automated cleansing obtained a better result than manual cleansing. This trial demonstrated that the probability of sterilization in reprocessed SUDP is highly dependent on both the type of cleansing and the sterilization method applied.

Analysis of the microbial load in instruments used in orthopedic surgeries

BACKGROUND Because of advances in technology, the number of orthopedic surgeries, mainly hip and knee replacement surgeries, has increased, with a total of 150,000 prosthetic surgeries estimated per year in the United States and 400,000 worldwide. METHODS We used an exploratory cross-sectional study, with a quantitative approach to determine the microbial load in instruments used in orthopedic surgeries, quantifying and identifying the microbial growth genus and species, according to the surgical potential of contamination that characterizes the challenge faced by the Material and Sterilization Center at the Institute of Orthopedics and Traumatology of Hospital das Clinicas of the School of Medicine of the University of Sao Paulo, Brazil.The orthopedic surgical instruments were immersed, after their use, in sterilized distilled water, sonicated in an ultrasonic washer, and posteriorly agitated. Subsequently, the wash was filtrated through a 0.45-mum membrane and incubated in aerobic and anaerobic mediums and in medium for fungi and yeasts. RESULTS In clean surgeries, 47% of the instruments were contaminated; in contaminated surgeries, 70%; and, in infected surgeries, 80%. Regardless of the contamination potential of the surgeries, the highest quantitative incidence of microorganism recovery was located in the 1 to 100 colony-forming unit range, and 13 samples presented a microbial growth potential >300 colony-forming units. Regardless of the contamination potential of the surgeries, there was a convergence in the incidence of negative-coagulase Staphylococcus growth (28%, clean surgeries; 32%, contaminated surgeries; and 29%, infected surgeries) and Staphylococcus aureus (28%, contaminated surgeries; and 43%, infected surgeries). CONCLUSION Most of the microorganisms recovered from the analyzed instruments (78%) were vegetative bacteria that presented their death curve at around 80 degrees C, characterizing a low challenge considering the processes of cleaning and sterilization currently employed by the Material and Sterilization Center. Fewer microorganisms were recovered from instruments used in clean surgeries in comparison with those used in contaminated and infected surgeries.

Critérios para avaliação das dificuldades na limpeza de artigos de uso único

Neste estudo foram elaborados criterios para avaliacao das dificuldades na limpeza de artigos de uso unico (AUU), que embasem a decisao de investir na validacao de protocolos de reuso. Trata-se de uma pesquisa metodologica, realizada no Hospital Universitario da Universidade de Sao Paulo e teve como objetivos: identificar os AUU utilizados na Instituicao com indicacao para o reprocessamento, propor um instrumento de avaliacao do grau de risco dos AUU para a limpeza, classificar os AUU por meio de nove criterios estabelecidos no instrumento e avaliar a sua aplicabilidade. Foram identificados e classificados trinta e dois AUU, atribuindo-se para cada criterio uma cor alusiva aos sinais de trânsito, de acordo com o risco, para auxiliar na tomada de decisao quanto ao reuso. Conclui-se que os criterios propostos permitiram estabelecer um diagnostico do grau de risco relacionado a limpeza dos AUU analisados e as consequentes implicacoes na seguranca do processo de esterilizacao.In this study, we elaborated criteria to evaluate difficulties in cleaning single-use articles (SVA), which will be used for decision making about investments in the validation of reuse protocols. This methodological research was carried out at a University Hospital and aimed to: identify SVA used and reused at the institution; propose an instrument to measure risk levels of SVA for cleaning; classify SVA using 9 criteria established in the proposed instrument and evaluate its applicability. We identified 32 SVA, whose risks were classified using the colors used in traffic lights, with a view to supporting decision making about reuse. The proposed criteria make it possible to diagnose the risk of cleaning the SVA under analysis, as well as their implications for the safety of the sterilization process.

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

Evidence-based practices published in Brazil: identification and analysis of their types and methodological approches

Revisao integrativa de estudos brasileiros sobre praticas baseadas em evidencias (PBE) em saude, publicados em periodicos ISI/JCR, nos ultimos 10 anos. O objetivo foi identificar as especialidades que mais realizaram estes estudos, seus enfoques e abordagens metodologicas. A partir de criterios de inclusao, foram selecionados 144 trabalhos. Os resultados indicam que a maior quantidade de estudos feitos em PBE foram sobre infância e adolescencia, infectologia, psiquiatria/saude mental e cirurgia. Os enfoques predominantes foram prevencao, tratamento/reabilitacao, diagnostico e avaliacao. As metodologias mais empregadas foram revisao sistematica sem ou com metanalise, revisao de protocolos ou sintese de estudos de evidencias ja disponiveis, e revisao integrativa. Constata-se forte expansao multiprofissional da PBE no Brasil, contribuindo para a busca de praticas mais criteriosas pela reuniao, reconhecimento e analise critica dos conhecimentos produzidos. O estudo contribui tambem para a propria analise dos modos de fazer pesquisa e novas possibilidades de investigacao.This is an integrative review of Brazilian studies on evidence-based practices (EBP) in health, published in ISI/JCR journals in the last 10 years. The aim was to identify the specialty areas that most accomplished these studies, their foci and methodological approaches. Based on inclusion criteria, 144 studies were selected. The results indicate that most EBP studies addressed childhood and adolescence, infectious diseases, psychiatrics/mental health and surgery. The predominant foci were prevention, treatment/rehabilitation, diagnosis and assessment. The most used methods were systematic review with or without meta-analysis, protocol review or synthesis of available evidence studies, and integrative review. A strong multiprofessional expansion of EBP is found in Brazil, contributing to the search for more selective practices by collecting, recognizing and critically analyzing the produced knowledge. The study also contributes to the analysis itself of ways to do research and new research possibilities.

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.

Evaluation of single-use reprocessed laparoscopic instrument sterilization

This experimental, comparative, laboratory study evaluated the effectiveness of the sterilization of single-use laparoscopic instruments--SULIs (grasper, dissector, scissors, Veress needle and electrosurgical probe system), after contamination-challenge with bacterial spores and sheep blood, and compared the results of the sterilization tests with those of the equivalent reusable instruments. The cleaning methods used were; ultrasonic washer with pulsatile water jet and enzymatic detergent, manual cleaning, cleaning with pressurized water and rinsing. The SULIs were sterilized with ethylene oxide and the reusable instruments in an autoclave. Sterility tests showed 100% negative results for recovery of contaminate microorganisms in both groups. It was concluded that, regarding the sterilization, that it is possible to reprocess SULIs.

Práticas baseadas em evidências publicadas no Brasil: identificação e análise de suas vertentes e abordagens metodológicas

Revisao integrativa de estudos brasileiros sobre praticas baseadas em evidencias (PBE) em saude, publicados em periodicos ISI/JCR, nos ultimos 10 anos. O objetivo foi identificar as especialidades que mais realizaram estes estudos, seus enfoques e abordagens metodologicas. A partir de criterios de inclusao, foram selecionados 144 trabalhos. Os resultados indicam que a maior quantidade de estudos feitos em PBE foram sobre infância e adolescencia, infectologia, psiquiatria/saude mental e cirurgia. Os enfoques predominantes foram prevencao, tratamento/reabilitacao, diagnostico e avaliacao. As metodologias mais empregadas foram revisao sistematica sem ou com metanalise, revisao de protocolos ou sintese de estudos de evidencias ja disponiveis, e revisao integrativa. Constata-se forte expansao multiprofissional da PBE no Brasil, contribuindo para a busca de praticas mais criteriosas pela reuniao, reconhecimento e analise critica dos conhecimentos produzidos. O estudo contribui tambem para a propria analise dos modos de fazer pesquisa e novas possibilidades de investigacao.This is an integrative review of Brazilian studies on evidence-based practices (EBP) in health, published in ISI/JCR journals in the last 10 years. The aim was to identify the specialty areas that most accomplished these studies, their foci and methodological approaches. Based on inclusion criteria, 144 studies were selected. The results indicate that most EBP studies addressed childhood and adolescence, infectious diseases, psychiatrics/mental health and surgery. The predominant foci were prevention, treatment/rehabilitation, diagnosis and assessment. The most used methods were systematic review with or without meta-analysis, protocol review or synthesis of available evidence studies, and integrative review. A strong multiprofessional expansion of EBP is found in Brazil, contributing to the search for more selective practices by collecting, recognizing and critically analyzing the produced knowledge. The study also contributes to the analysis itself of ways to do research and new research possibilities.

Reuse of cardiac catheters: a review

Hemodynamic catheters are widely reused mainly in developing countries where the cost of new devices is very high. Scientific publications point to an absence of validated cleaning and sterilization processes and there is a consensus that reusing these devices causes physical, chemical and funcional damage. So what is the evidence related to the use of this kind of catheter? The objective of this study is to identify the scientific evidence related to the effects of reprocessing. A search for publications in English, Portuguese and Spanish was performed in Medline/ Pubmed and LILACS using Medical Subject Headings (MeSH) terms and free terms without stipulating restraints on time. In total 21 papers were analized. It was found that there is commonly damage to the surface polymers as identified by eletronic microscopy. Failure in the cleaning and sterilization process was identified by the presence of debris and microrganisms at the end of the procedure. The results of this study are very important when choosing to reuse hemodynamic catheters.Hemodynamic catheters are widely reused mainly in developing countries where the cost of new devices is very high. Scientific publications point to an absence of validated cleaning and sterilization processes and there is a consensus that reusing these devices causes physical, chemical and funcional damage. So what is the evidence related to the use of this kind of catheter? The objective of this study is to identify the scientific evidence related to the effects of reprocessing. A search for publications in English, Portuguese and Spanish was performed in Medline/ Pubmed and LILACS using Medical Subject Headings (MeSH) terms and free terms without stipulating restraints on time. In total 21 papers were analized. It was found that there is commonly damage to the surface polymers as identified by eletronic microscopy. Failure in the cleaning and sterilization process was identified by the presence of debris and microrganisms at the end of the procedure. The results of this study are very important when choosing to reuse hemodynamic catheters.

Evidência de eficácia de cobertura de sapatos e sapatos privativos no controle e prevenção de infecção do sítio cirúrgico: revisão sistemática de literatura

O estudo refere-se a propes e sapatos privativos, realizado em 2003, e teve como objetivo a busca de evidencia cientifica sobre sua relacao direta no controle de contaminacao e/ou infeccao do ar ambiente e do sitio cirurgico por microrganismos oriundos do piso. A metodologia utilizada foi a revisao sistematica de pesquisas basicas, desde 1950 ate 2003, por meio de busca em fontes eletronicas, bibliografias de estudos relevantes e anais de eventos cientificos. Do total de publicacoes encontradas, somente 10 constituiram pesquisas basicas, as quais foram analisadas quanto ao escopo, tipo de investigacao, metodologia, resultados, conclusoes e comentarios dos analisadores. A analise foi auxiliada por dois pesquisadores, ambos com experiencia na tematica e um em metodologia de pesquisa. Observou-se, nesta analise, diversidade e problemas dos metodos de investigacao utilizados, sendo que apenas 4 pesquisas obtiveram dispersao de microrganismos do piso para o ar ambiente, porem nao significativa, e nenhuma relacionada diretamente com contaminacao e/ou infeccao do sitio cirurgico. Obteve-se evidencias sobre: 1) a capacidade de barreira e de transferencia de microrganismos no piso de uma area para outra depende do tipo de cobertura de sapatos; 2) contaminacao ocupacional durante remocao e colocacao de propes. Como conclusao, nao ha evidencia de que propes e sapatos privativos evitem a contaminacao do ambiente e da ferida cirurgica, e a decisao pela continuidade do seu uso precisa ser tecnica e administrativamente controlada.The study is about shoe cover and private shoe usage and aimed to find scientific evidence on their direct relation in the control of surgical site contamination and/or infection transmitted by floor microorganisms. A systematic review of basic research on shoe covers and private shoes usage was carried out, covering the period from 1950 to 2003, by means of a search in electronic sources, bibliographies of relevant studies and proceedings of scientific events. The analysis was supported by two researchers, both of whom were experienced in this theme and one of them in research methodology. The research methods revealed a diverse range and various problems. Only 4 studies obtained a dispersion of floor microorganisms to the air environment, although not significant, and none of them was directly related to surgical site contamination and/or infection. Results do not suggest direct evidence on their efficacy but there is evidence, nonetheless, that barrier and microorganisms transfer from one specific area to another depend on the type of shoe cover, with lower transfer rates when private shoes and shoe covers are employed. Occupational contamination risk during shoe cover attire and removal is also evident and the decision about continuity of their usage needs to be technically and administratively controlled.