Maria Isabel Pedreira de Freitas

Laryngoscope blades and handles as sources of cross-infection: an integrative review.

The lack of standardization of efficient procedures to clean and disinfect laryngoscope blades and handles, which may be important sources of infection during their clinical use, has been reported previously, revealing contamination with blood, body fluids and micro-organisms. This paper aimed to evaluate the evidence available in the literature regarding the risk of laryngoscope blades and handles as a source of patient contamination. An integrative review of the literature was performed using databases such as Medline, LILACS, SciELO, Cochrane Library, BDENF and PubMed, and keywords in Medical Subject Headings (MeSH). The sample comprised 20 articles published between 1994 and 2012. The studies demonstrated risk of cross-infection and no consensus in current guidelines regarding cleaning and disinfection of this equipment. It was concluded that there are important gaps to be filled and urgent investigations required in order to facilitate standardization of efficient procedures to clean and disinfect laryngoscope blades and handles, and in turn to reduce the potential risk to which the patient and/or health team is exposed.

Comportamentos em saúde de uma população portadora do HIV/Aids

Estudio descriptivo exploratorio, con abordaje cuantitativo y corte transversal, cuyo objetivo fue identificar comportamientos de una poblacion de ancianos, portadora de HIV/Aids, y analizar asociacion con genero. Se utilizo un instrumento probado y convalidado en relacion al contenido. Las variables fueran analizadas con testes de Qui-cuadrado y de Fisher. Ciento nueve pacientes fueron entrevistados. Los resultados revelaron una poblacion sexualmente activa (57,8%); heterosexuales (85,5%); y con companero fijo (66,1%). Relataron dificultad para uso del preservativo (22,2% de los hombres) por el compromiso con la ereccion; 97,2 % relataron no usar drogas para estimulacion sexual; 90,8% afirman no haber usado proteccion en las relaciones antes de saber que estaban infectados. Concluimos que se trata de una poblacion de personas sexualmente activas, que paso a usar proteccion, en las relaciones sexuales, despues de saber que estaban infectados.This is a descriptive exploratory research, with quantitative approach and transversal cut. The purpose was to identify behaviors in aged population HIV/Aids infected and also to analyze association with sex. Regarding the content, a tested and validated instrument was used. The variables were analyzed with qui-square and Fisher test. A hundred and nine individuals were interviewed. The results revealed them as sexually active (57,8%), heterosexual (85,5%), with fix partner (66,1%). They reported difficulty in using condoms (22,2% of men) due to erection issues; 97,2% referred not using drugs for sexual stimulation; 90, 8% of them reported not having used protection in sexual relations before being aware of the infection. It was concluded that the population were sexually active, and that they started using protection, in their sexual relations, after awareness of the infection.

Reprocessamento de artigos críticos em unidades básicas de saúde: perfil do operador e ações envolvidas

Estudo descritivo-exploratorio que teve como objetivo conhecer o perfil e acoes do operador do reprocessamento de artigos criticos nas unidades basicas de saude de um municipio do Estado de Sao Paulo. Das 34 unidades basicas de saude, verificou-se que 32,4% destes operadores receberam treinamentos admissionais e 8,8% ha menos de um ano. Eles exerciam funcoes concomitantes ao reprocessamento como: imunizacao (11,7%), curativos (26,4%) e coletas de exames (23,5%). Esses resultados podem influenciar negativamente na qualidade do processo, limitando o controle de infeccao nos locais estudados.Descriptve-exploratory study that aimed to outline the profile and the actions of workers who conduct the reprocessing of critical devices at primary health care units in a city in the State of São Paulo. Thirty-four primary health care units were surveyed. Individuals responsible for reprocessing are nursing assistants (88.2%), that conducted concomitantly activities related to immunization (11.7%), dressing (26.4%) collection of samples for exams (23.5%); 32.4% had received training at the beginning of their reprocessing activities, and 8,82% at least one year before. The lack of dully skilled individuals may influence the quality of the process and constitute a limiting factor for the control of cross infection.

Methods to determine the internal length of nasogastric feeding tubes: An integrative review

OBJECTIVES Improper placement of nasogastric tube used for feeding may lead to serious complications, including death of the patient. There are several different methods used to determine the appropriate length of nasogastric tube for optimal placement in adults. This integrative review of the literature was designed to identify the most accurate method to determine the internal length of nasogastric feeding tube in adults. DESIGN An integrative review of the research literature (1979-2015) using the population-intervention-comparison-outcomes strategy. DATA SOURCES The literature search included the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Joanna Briggs, PubMed (MEDLINE), SCOPUS, and Web of Science electronic databases. REVIEW METHODS Two researchers evaluated the literature to determine if an article met inclusion and exclusion criteria. The quality of the evidence was assessed using the Johns Hopkins Strength of the Evidence critical appraisal tool. RESULTS Twenty studies, published between 1979 and 2014, met inclusion criteria. Of these, nine articles were expert opinion, seven were original research, three were review articles, and one was a guideline. Despite seven original research papers being found, only five reports were about the methods to determine the internal length of nasogastric feeding tube in adults. The literature suggests that four different methods for measuring the tube length are likely to result in proper placement of the tip of the tube in the stomach and all side ports inside it: [nose-to-ear-to-xiphisternum - 50]cm/2+50cm]; [gender-weight and nose-umbilicus-flat]; [xiphisternum-to-ear-to-nose+10cm]; [earlobe to xiphisternum to umbilicus - tip of the nose to earlobe]. Four studies found nose-to-ear-to-xiphisternum was most likely to result in a tube that is positioned incorrectly, either ending in the esophagus, in the stomach but too close to the esophagus, or too far into the stomach or duodenum. CONCLUSIONS The nose-to-ear-to-xiphisternum and Hanson method should no longer be taught in nursing programs or used in practice by the nurse. The [gender-weight and nose-umbilicus-flat] method has been shown to be safer.

Health Behavior in a population with HIV/Aids

Estudio descriptivo exploratorio, con abordaje cuantitativo y corte transversal, cuyo objetivo fue identificar comportamientos de una poblacion de ancianos, portadora de HIV/Aids, y analizar asociacion con genero. Se utilizo un instrumento probado y convalidado en relacion al contenido. Las variables fueran analizadas con testes de Qui-cuadrado y de Fisher. Ciento nueve pacientes fueron entrevistados. Los resultados revelaron una poblacion sexualmente activa (57,8%); heterosexuales (85,5%); y con companero fijo (66,1%). Relataron dificultad para uso del preservativo (22,2% de los hombres) por el compromiso con la ereccion; 97,2 % relataron no usar drogas para estimulacion sexual; 90,8% afirman no haber usado proteccion en las relaciones antes de saber que estaban infectados. Concluimos que se trata de una poblacion de personas sexualmente activas, que paso a usar proteccion, en las relaciones sexuales, despues de saber que estaban infectados.This is a descriptive exploratory research, with quantitative approach and transversal cut. The purpose was to identify behaviors in aged population HIV/Aids infected and also to analyze association with sex. Regarding the content, a tested and validated instrument was used. The variables were analyzed with qui-square and Fisher test. A hundred and nine individuals were interviewed. The results revealed them as sexually active (57,8%), heterosexual (85,5%), with fix partner (66,1%). They reported difficulty in using condoms (22,2% of men) due to erection issues; 97,2% referred not using drugs for sexual stimulation; 90, 8% of them reported not having used protection in sexual relations before being aware of the infection. It was concluded that the population were sexually active, and that they started using protection, in their sexual relations, after awareness of the infection.

Validação do conteúdo de instrumento para caracterizar pessoas maiores de 50 anos portadoras do Vírus da Imunodeficiência Humana/Síndrome da Imunodeficiência Adquirida

OBJETIVO: Presentar el desarrollo y la validacion de un instrumento para la caracterizacion de personas, con 50 anos o mas, portadoras del Virus de la Inmunodeficiencia Humana/Sindrome de la Inmunodeficiencia Adquirida. METODOS: El contenido del instrumento, elaborado con base en la literatura consultada y experiencia profesional de los investigadores, fue validado por siete peritos. La validacion fue realizada en dos momentos de evaluacion, utilizandose el coeficiente de concordancia de Kendall para evaluar en el primer momento la concordancia entre los jueces en cuanto a pertinencia, claridad y alcance del contenido y, en segundo, la pertinencia y alcance. El test de Cochran fue utilizado para evaluar la concordancia en relacion a la claridad, en la segunda evaluacion. RESULTADOS: Se observo discordancia entre los peritos en la primera evaluacion y despues de la reformulacion del instrumento, se obtuvo concordancia en la segunda evaluacion. CONCLUSION: El instrumento para la caracterizacion de esapoblacion fue validado en relacion al contenido, siendo aplicado por los investigadores encontrandose disponible para su utilizacion.Objective: To present the development and validation of an instrument for characterizing people, aged 50 or over, who are carriers of the Human Immunodeficiency Virus / Acquired Immunodeficiency Syndrome. Methods: The content of the instrument, which was developed based on consulted literature and the professional experience of the researchers, was validated by seven experts. The validation was performed in two stages of evaluation, using the Kendall coefficient of concordance to evaluate, the first time, concordance among experts with regard to relevance, clarity, and completeness of content, and secondly, the adequacy and comprehensiveness. The Cochran test was used to evaluate the concordance regarding clarity, in the second evaluation. Results: There was disagreement among the experts in the first evaluation, and after reformulation of the instrument, concordance was obtained in the second evaluation. Conclusion: The instrument for characterizing this population was validated against the content being used by researchers, and is now made available for use.

Can manual hyperinflation maneuvers cause aspiration of oropharyngeal secretions in patients under mechanical ventilation

BACKGROUND AND OBJECTIVES To evaluate whether manual hyperinflation maneuvers can cause aspiration of oropharyngeal secretions in patients under mechanical ventilation. METHODS Adult patients under mechanical ventilation in whom a dye was injected in the oropharyngeal cavity and had their tracheal secretion aspirated after 30 minutes (min) participated in this study. In the event of dye slid, the patient was eliminated. The other patients were divided in Control Group: patients in whom tracheal secretions were aspirated after 30, 60, 120, and 180 min, and Experimental Group: after 30 min, manual hyperventilation maneuvers were performed and secretions were aspirated on the established intervals. RESULTS Forty-three patients were enrolled in this study. In 13, dye slippage was observed after 30 min, before allocating them into two groups. In the remaining 29 patients, 226 secretion samples were collected. In only two samples the presence of dye in the secretion was observed after manual hyperinflation maneuvers in the experimental group. CONCLUSION Manual hyperinflation maneuvers did not cause aspiration of oropharyngeal secretions in patients under mechanical ventilation.

Processo de enfermagem na saúde mental: revisão integrativa da literatura.

Objective: to identify evidences from the literature on the application of nursing process in care developed by the nurse in mental health. Method: integrative literature review between 1990 and 2013, in the PubMed, Scopus, CINAHL and LILCACS bases. Descriptors: nursing processes, mental health, nursing care. Results: 19 papers were identified. Limited and partial usage of the nursing process in care established by a therapeutic relationship that respects the patients individuality. We observe care proposals systematized for patients that present pathological aspects in the limits between the physical and psychical, which might be a response to the influence of the practice based on evidences. Conclusion: it was found an antagonistic movement between care based on the relationship and located in the standardization of diagnoses that respond to physical malaise. A lack of evidence was verified for the usage of the nursing process in mental health, and we point at the necessity for the creation of new possibilities for dialogue between relational and biological perspectives.

Validação de checklist cirúrgico para prevenção de infecção de sítio cirúrgico

Objective: To design and validate a surgical checklist to improve patient safety and prevent surgical site infection. Methods: This quantitative study was carried out to validate an instrument created and used for surgical safety. Seven experts validated the instrument. For agreement among experts, was used Kendall’s concordance coefficient; if their opinions differed significantly, the Cochran’s test was adopted. An instrument is validated when concordance among experts is achieved and its clarity is significant. Results: In the first assessment of the instrument, Kendall’s concordance coefficients were 0.230 in terms of pertinence and 0.390 for clarity. These results cauded a reformulation in the checklist. After reformulation, an absolute concordance was achieved for pertinence and no significant difference was seen in terms of clarity. After instrument validation, was created an information system to input data collected. Conclusion: The instrument was validated. It can help improve patient safety and prevent surgical site infection. Descritores Enfermagem de centro cirurgico; Enfermagem perioperatoria; Servico hospitalar de enfermagem; Infeccao de ferida operatoria; Seguranca do paciente

Estudo de caso como estratégia de ensino do processo de enfermagem e do uso de linguagem padronizada

O ensino de Enfermagem ainda esta fortemente vinculado ao modelo biomedico, embora tenham ocorrido esforcos em busca de uma perspectiva de Enfermagem neste contexto. Este trabalho tem como objetivo relatar experiencia de ensino, na qual se utilizou o estudo de caso para discutir Processo de Enfermagem, assistencia e uso de linguagem padronizada. Tal experiencia foi vivenciada junto a 35 alunos que cursavam o quinto semestre do curso de Graduacao em Enfermagem de uma universidade publica de Sao Paulo. Esta estrategia de ensino teve limitacoes e desafios no que se refere a participacao ativa dos alunos, porem se mostrou mais instigante para estes que aulas expositivas ao coloca-los na posicao de sujeitos do processo de ensino-aprendizagem e corresponsaveis por sua formacao.