Lilian Machado Torres

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

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

[Sterilization with ozone in health care: an integrative literature review].

The objective of this integrative literature review was to find evidence to support using ozone as a sterilizing agent for health products. The search was performed on the following bases: MEDLINE, SCOPUS, COCHRANE, COMPENDEX, INSPEC and ENGINEERING RESEARCH DATABASE; using ozone and sterilization as descriptors. Five articles were found between 1990 and 2008, which tested ozone as a sterilizer. All studies used the same type of investigation (experimental laboratory study) and achieved sterilization with ozone, but with different scopes and products, besides using different methodological procedures. Considering the ever-growing technology for new products, with the vast range of forms and materials, the findings point at ozone sterilization as a promising method, but still in an initial phase of investigation. Further experimental studies are needed to provide broader evidence regarding the possibilities and limitations of ozone sterilization.The objective of this integrative literature review was to find evidence to support using ozone as a sterilizing agent for health products. The search was performed on the following bases: MEDLINE, SCOPUS, COCHRANE, COMPENDEX, INSPEC and ENGINEERING RESEARCH DATABASE; using ozone and sterilization as descriptors. Five articles were found between 1990 and 2008, which tested ozone as a sterilizer. All studies used the same type of investigation (experimental laboratory study) and achieved sterilization with ozone, but with different scopes and products, besides using different methodological procedures. Considering the ever-growing technology for new products, with the vast range of forms and materials, the findings point at ozone sterilization as a promising method, but still in an initial phase of investigation. Further experimental studies are needed to provide broader evidence regarding the possibilities and limitations of ozone sterilization.

Micro-organismos da subclasse Coccidia: resistência e implicações para o processamento de materiais de assistência à saúde

This theoretical study proposes a reflection on the intrinsic resistance of the subclass Coccidia, particularly the genus Cryptosporidium, considered to be potential pathogens for immunocompromised patients, and the implications for nursing practice. Currently, the international and national guidelines support the chemical disinfection of digestive system endoscopes after their cleansing as a safe and effective procedure. However, studies show that microorganisms of the subclass Coccidia, namely Cryptosporidium, responsible for enteric infection, are more resistant than mycobacteria and are not inactivated by high-level disinfectants, except for hydrogen peroxide 6% and 7.5%, which are not currently available in Brazil. We conclude that the legislation should include this agent among test microorganisms for approving high-level disinfectants. Health authorities should make efforts to ensure that healthcare institutions have access to effective disinfectants against Cryptosporidium.This theoretical study proposes a reflection on the intrinsic resistance of the subclass Coccidia, particularly the genus Cryptosporidium, considered to be potential pathogens for immunocompromised patients, and the implications for nursing practice. Currently, the international and national guidelines support the chemical disinfection of digestive system endoscopes after their cleansing as a safe and effective procedure. However, studies show that microorganisms of the subclass Coccidia, namely Cryptosporidium, responsible for enteric infection, are more resistant than mycobacteria and are not inactivated by high-level disinfectants, except for hydrogen peroxide 6% and 7.5%, which are not currently available in Brazil. We conclude that the legislation should include this agent among test microorganisms for approving high-level disinfectants. Health authorities should make efforts to ensure that healthcare institutions have access to effective disinfectants against Cryptosporidium.

Ozônio na esterilização de produtos para assistência à saúde: revisão integrativa da literatura

The objective of this integrative literature review was to find evidence to support using ozone as a sterilizing agent for health products. The search was performed on the following bases: MEDLINE, SCOPUS, COCHRANE, COMPENDEX, INSPEC and ENGINEERING RESEARCH DATABASE; using ozone and sterilization as descriptors. Five articles were found between 1990 and 2008, which tested ozone as a sterilizer. All studies used the same type of investigation (experimental laboratory study) and achieved sterilization with ozone, but with different scopes and products, besides using different methodological procedures. Considering the ever-growing technology for new products, with the vast range of forms and materials, the findings point at ozone sterilization as a promising method, but still in an initial phase of investigation. Further experimental studies are needed to provide broader evidence regarding the possibilities and limitations of ozone sterilization.The objective of this integrative literature review was to find evidence to support using ozone as a sterilizing agent for health products. The search was performed on the following bases: MEDLINE, SCOPUS, COCHRANE, COMPENDEX, INSPEC and ENGINEERING RESEARCH DATABASE; using ozone and sterilization as descriptors. Five articles were found between 1990 and 2008, which tested ozone as a sterilizer. All studies used the same type of investigation (experimental laboratory study) and achieved sterilization with ozone, but with different scopes and products, besides using different methodological procedures. Considering the ever-growing technology for new products, with the vast range of forms and materials, the findings point at ozone sterilization as a promising method, but still in an initial phase of investigation. Further experimental studies are needed to provide broader evidence regarding the possibilities and limitations of ozone sterilization.

Readmission from orthopedic surgical site infections: an integrative review

OBJECTIVE Characterizing readmissions from orthopedic surgical site infections. METHOD An integrative review of literature in the LILACS, IBECS, MEDLINE, Cochrane, SciELO and PUBMED databases, using the descriptors Patient readmission, Wound infection, Cross infection, Orthopedic procedures, Orthopedics. RESULTS 78 studies were identified and 10 publications were selected. Surgical site infections are the most common cause of unplanned orthopedic readmissions, representing long periods of hospitalization, new surgical procedures and high costs, and greater possibility of subsequent hospitalizations. Most significant predictors have indicated average length of hospitalization, need for intensive care, emergency status at admission, risk of death, age > 65 years, males and higher body mass index. CONCLUSION Readmission rates have increasingly become measures of quality and concerns about costs. New studies could involve issues related to indirect costs, specifically social and psychological costs.OBJETIVO Caracterizar los reingresos por infeccion del sitio quirurgico ortopedico. METODO Revision integradora de la literatura, en las bases de datos LILACS, IBECS, MEDLINE, Cochrane, SciELO y PUBMED, por medio de los descriptores Reingreso del paciente, Infeccion de la herida operatoria, Infeccion hospitalaria, Procedimientos ortopedicos, Ortopedia. RESULTADOS Fueron identificados 78 estudios y seleccionadas 10 publicaciones. La infeccion del sitio quirurgico es la causa mas frecuente entre los reingresos ortopedicos no planificados, que representan largas estancias hospitalarias, nuevas intervenciones quirurgicas y costos elevados, ademas de mayor posibilidad de ingresos subsiguientes. Los factores predictivos mas significativos senalaron tiempo de estancia media, necesidad de cuidados intensivos, status de urgencia en el ingreso, riesgo de muerte, edad >; 65 anos, sexo masculino y mayor indice de masa corporea. CONCLUSION Las tasas de reingreso se hacen cada vez mas medidas de cualidad y preocupacion con relacion a los costos. Nuevos estudios podrian involucrar cuestiones relacionadas con costos indirectos, especialmente los sociales y psicologicos.

Factors associated with health risk behaviors among Brazilian adolescents: an integrative review

OBJECTIVE Identifying knowledge about factors associated with health risk behaviors among Brazilian adolescents. METHOD An integrative review of the literature conducted in the Cochrane, IBECS, LILACS, MEDLINE and SciELO databases in relation to risk behaviors recommended by the Centers for Disease Control and Prevention. RESULTS Thirty-seven (37) studies were analyzed, with a predominance of risky sexual behavior, tobacco use and violent behavior. Advancing age favored unprotected sex, alcohol and tobacco use. Family and friends influence was related to smoking and alcoholism. Males were more involved in situations of violence and the female gender was associated with physical inactivity. Belonging to a lower economic class was related to unprotected sex, physical inactivity, unhealthy dietary behaviors and violence. Studying in private school was related to unhealthy dietary behavior. CONCLUSION Risk behaviors were related to social, economic and family factors and they tend to agglomerate.

Factores asociados con los comportamientos de riesgo sanitario entre adolescentes brasileños: una revisión integrativa

OBJECTIVE Identifying knowledge about factors associated with health risk behaviors among Brazilian adolescents. METHOD An integrative review of the literature conducted in the Cochrane, IBECS, LILACS, MEDLINE and SciELO databases in relation to risk behaviors recommended by the Centers for Disease Control and Prevention. RESULTS Thirty-seven (37) studies were analyzed, with a predominance of risky sexual behavior, tobacco use and violent behavior. Advancing age favored unprotected sex, alcohol and tobacco use. Family and friends influence was related to smoking and alcoholism. Males were more involved in situations of violence and the female gender was associated with physical inactivity. Belonging to a lower economic class was related to unprotected sex, physical inactivity, unhealthy dietary behaviors and violence. Studying in private school was related to unhealthy dietary behavior. CONCLUSION Risk behaviors were related to social, economic and family factors and they tend to agglomerate.

Fatores associados aos comportamentos de risco à saúde entre adolescentes brasileiros: uma revisão integrativa

OBJECTIVE Identifying knowledge about factors associated with health risk behaviors among Brazilian adolescents. METHOD An integrative review of the literature conducted in the Cochrane, IBECS, LILACS, MEDLINE and SciELO databases in relation to risk behaviors recommended by the Centers for Disease Control and Prevention. RESULTS Thirty-seven (37) studies were analyzed, with a predominance of risky sexual behavior, tobacco use and violent behavior. Advancing age favored unprotected sex, alcohol and tobacco use. Family and friends influence was related to smoking and alcoholism. Males were more involved in situations of violence and the female gender was associated with physical inactivity. Belonging to a lower economic class was related to unprotected sex, physical inactivity, unhealthy dietary behaviors and violence. Studying in private school was related to unhealthy dietary behavior. CONCLUSION Risk behaviors were related to social, economic and family factors and they tend to agglomerate.

Reingreso por infección del sitio quirúrgico ortopédico: una revisión integradora

OBJECTIVE Characterizing readmissions from orthopedic surgical site infections. METHOD An integrative review of literature in the LILACS, IBECS, MEDLINE, Cochrane, SciELO and PUBMED databases, using the descriptors Patient readmission, Wound infection, Cross infection, Orthopedic procedures, Orthopedics. RESULTS 78 studies were identified and 10 publications were selected. Surgical site infections are the most common cause of unplanned orthopedic readmissions, representing long periods of hospitalization, new surgical procedures and high costs, and greater possibility of subsequent hospitalizations. Most significant predictors have indicated average length of hospitalization, need for intensive care, emergency status at admission, risk of death, age > 65 years, males and higher body mass index. CONCLUSION Readmission rates have increasingly become measures of quality and concerns about costs. New studies could involve issues related to indirect costs, specifically social and psychological costs.OBJETIVO Caracterizar los reingresos por infeccion del sitio quirurgico ortopedico. METODO Revision integradora de la literatura, en las bases de datos LILACS, IBECS, MEDLINE, Cochrane, SciELO y PUBMED, por medio de los descriptores Reingreso del paciente, Infeccion de la herida operatoria, Infeccion hospitalaria, Procedimientos ortopedicos, Ortopedia. RESULTADOS Fueron identificados 78 estudios y seleccionadas 10 publicaciones. La infeccion del sitio quirurgico es la causa mas frecuente entre los reingresos ortopedicos no planificados, que representan largas estancias hospitalarias, nuevas intervenciones quirurgicas y costos elevados, ademas de mayor posibilidad de ingresos subsiguientes. Los factores predictivos mas significativos senalaron tiempo de estancia media, necesidad de cuidados intensivos, status de urgencia en el ingreso, riesgo de muerte, edad >; 65 anos, sexo masculino y mayor indice de masa corporea. CONCLUSION Las tasas de reingreso se hacen cada vez mas medidas de cualidad y preocupacion con relacion a los costos. Nuevos estudios podrian involucrar cuestiones relacionadas con costos indirectos, especialmente los sociales y psicologicos.