Oleci Pereira Frota

Surface cleaning effectiveness in a walk-in emergency care unit: Influence of a multifaceted intervention

BACKGROUND Cleaning of surfaces is essential in reducing environmental bioburdens and health care-associated infection in emergency units. However, there are few or no studies investigating cleaning surfaces in these scenarios. Our goal was to determine the influence of a multifaceted intervention on the effectiveness of routine cleaning of surfaces in a walk-in emergency care unit. METHODS This prospective, before-and-after interventional study was conducted in 4 phases: phase I (situational diagnosis), phase II (implementation of interventions-feedback on results, standardization of cleaning procedures, and training of nursing staff), phase III (determination of the immediate influence of interventions), and phase IV (determination of the late influence of interventions). The surfaces were sampled before and after cleaning by visual inspection, adenosine triphosphate bioluminescence assay, and microbiologic culture. RESULTS We sampled 240 surfaces from 4 rooms. When evaluated by visual inspection and adenosine triphosphate bioluminescence, there was a progressive reduction of surfaces found to be inadequate in phases I-IV (P < .001), as well as in culture phases I-III. However, phase IV showed higher percentages of failure by culture than phase I (P = .004). CONCLUSIONS The interventions improved the effectiveness of cleaning. However, this effect was not maintained after 2 months.

Quality of nursing care in intensive care unit at a university hospital

Este estudo transversal objetivou analisar a qualidade da assistencia de enfermagem numa unidade de terapia intensiva geral para adultos de um hospital escola. Os dados foram coletados de 23 clientes com permanencia na unidade ≥ 72 horas, de junho a novembro de 2012, por meio de um Roteiro de Auditoria Operacional e a qualidade dos cuidados foi classificada segundo o indice de positividade (IP) da seguinte forma: IP = 100%: cuidado desejavel; de 90-99%: adequado; de 80-89%: seguro; de 70-79%: limitrofe; e < 70%: cuidado sofrivel. Assim, a qualidade da assistencia prestada foi sofrivel, pois a media global foi 61,71%. Ademais, o melhor IP foi atribuido ao item “utilizacao de equipamentos” (100%) e o pior ao item “atividades fisicas” (17,39%). Este estudo estabeleceu o diagnostico situacional das praticas de enfermagem no cenario estudado, etapa fundamental para o planejamento de estrategias e acoes que visem a melhoria da qualidade da assistencia prestada.This cross-sectional study aimed to identify and analyze the quality of nursing care in an adult general intensive care unit (ICU) at a university hospital. Data were collected from 23 clients with ICU length of stay > or = 72 hours, from June to November 2012, through an Operational Audit Script and quality of care classified according to the index of positivity (IP) as follows: IP = 100%. desirable care; 90-99%: appropriate care; 80-89%: safe care; 70-79%: limitrophe care, and > 70%: tolerable care. Thus, the quality of care provided was rated as tolerable, as the global average was 61.71%. Furthermore, it was found that the best IP was assigned to the item equipment use (100%) and the worst to the item physical activities (17.39%). This study established the diagnosis of the status of nursing practices in the studied environment, which is a critical step in planning strategies and actions aimed at improving the quality of care provided.

Collection of tracheal aspirate: safety and microbiological concordance between two techniques

Objetivo: Avaliar a seguranca da execucao das tecnicas tradicional e protegida de colheita de aspirado traqueal e identificar a concordância qualitativa e quantitativa dos resultados de culturas microbiologicas entre as tecnicas. Metodo: Pesquisa clinica, prospectiva, comparativa, simples-cega. A amostra foi constituida de 54 pacientes com idade ≥18 anos, submetidos a ventilacao mecânica invasiva por periodo ≥48 horas e com suspeita de Pneumonia Associada a Ventilacao Mecânica. As duas tecnicas foram implementadas no mesmo paciente, uma imediatamente seguida da outra, sendo a ordem de execucao aleatoria, segundo randomizacao por software especializado. Resultados: Nao ocorreram eventos significativos de queda da saturacao de oxigenio, instabilidade hemodinâmica e hemorragias traqueobronquicas (p<0,05) e, embora tenham ocorrido divergencias em algumas cepas, houve concordância qualitativa e quantitativa entre as tecnicas (p<0,001). Conclusao: A utilizacao da tecnica protegida nao proporciona vantagem em detrimento da tradicional e a execucao de ambas as tecnicas foi segura para o paciente.OBJECTIVE To evaluate the safety of the performance of the traditional and protected collection techniques of tracheal aspirate and to identify qualitative and quantitative agreement of the results of microbiological cultures between the techniques. METHOD Clinical, prospective, comparative, single-blind research. The sample was composed of 54 patients of >18 years of age, undergoing invasive mechanical ventilation for a period of ≥ 48 hours and with suspected Ventilator Associated Pneumonia. The two techniques were implemented in the same patient, one immediately after the other, with an order of random execution, according to randomization by specialized software. RESULTS No significant events occurred oxygen desaturation, hemodynamic instability or tracheobronchial hemorrhage (p<0.05) and, although there were differences in some strains, there was qualitative and quantitative agreement between the techniques (p<0.001). CONCLUSION Utilization of the protected technique provided no advantage over the traditional and execution of both techniques was safe for the patient.

Colheita de aspirado traqueal: segurança e concordância microbiológica entre duas técnicas

Objetivo: Avaliar a seguranca da execucao das tecnicas tradicional e protegida de colheita de aspirado traqueal e identificar a concordância qualitativa e quantitativa dos resultados de culturas microbiologicas entre as tecnicas. Metodo: Pesquisa clinica, prospectiva, comparativa, simples-cega. A amostra foi constituida de 54 pacientes com idade ≥18 anos, submetidos a ventilacao mecânica invasiva por periodo ≥48 horas e com suspeita de Pneumonia Associada a Ventilacao Mecânica. As duas tecnicas foram implementadas no mesmo paciente, uma imediatamente seguida da outra, sendo a ordem de execucao aleatoria, segundo randomizacao por software especializado. Resultados: Nao ocorreram eventos significativos de queda da saturacao de oxigenio, instabilidade hemodinâmica e hemorragias traqueobronquicas (p<0,05) e, embora tenham ocorrido divergencias em algumas cepas, houve concordância qualitativa e quantitativa entre as tecnicas (p<0,001). Conclusao: A utilizacao da tecnica protegida nao proporciona vantagem em detrimento da tradicional e a execucao de ambas as tecnicas foi segura para o paciente.OBJECTIVE To evaluate the safety of the performance of the traditional and protected collection techniques of tracheal aspirate and to identify qualitative and quantitative agreement of the results of microbiological cultures between the techniques. METHOD Clinical, prospective, comparative, single-blind research. The sample was composed of 54 patients of >18 years of age, undergoing invasive mechanical ventilation for a period of ≥ 48 hours and with suspected Ventilator Associated Pneumonia. The two techniques were implemented in the same patient, one immediately after the other, with an order of random execution, according to randomization by specialized software. RESULTS No significant events occurred oxygen desaturation, hemodynamic instability or tracheobronchial hemorrhage (p<0.05) and, although there were differences in some strains, there was qualitative and quantitative agreement between the techniques (p<0.001). CONCLUSION Utilization of the protected technique provided no advantage over the traditional and execution of both techniques was safe for the patient.

Open system endotracheal suctioning: practices of intensive care nursing professionals

The purpose of this study was to investigate the practices of nursing professionals working in intensive care units regarding open system endotracheal suctioning (ETS). This quantitative study of 25 subjects was conducted in the State of Mato Grosso do Sul (MS), Brazil. Data was collected from April to September 2011 using a checklist monitoring tool composed of 23 items related to the technique. Data was subjected to descriptive statistical analysis. The mean global adherence rate was 51.33%. Poor adherence to 16 items was observed, these being risk factors for the occurrence of adverse effects, particularly occupational accidents, hypoxemia, infection, and hemodynamic instability. Dissatisfactory performance of ETS was found among the professionals investigated, warranting interventions capable of promoting behavioral changes through continuing education aimed at improving the quality of care.Objetivo: Investigar las practicas de los profesionales de enfermeria de cuidados intensivos cuanto a la aspiracion endotraqueal (AET) por sistema abierto. Metodos: Se trata de una investigacion con enfoque cuantitativo, realizada con 25 sujetos en un Hospital Universitario en el estado de Mato Grosso do Sul, Brasil. Los datos fueron recolectados entre abril y septiembre de 2011 con instrumento de monitoreo tipo checklist, con 23 items de la tecnica, analizados mediante estadistica descriptiva. Resultados: El promedio de adhesion global fue del 51,33%. Se ha verificado poca adhesion para 16 items, los cuales son factores de riesgo para la ocurrencia de efectos adversos, en particular los accidentes laborales, las hipoxemias, las infecciones y la inestabilidad hemodinamica. Conclusion: Los profesionales no cumplen satisfactoriamente con la AET, siendo necesario intervenciones para promover cambios de comportamiento a traves de educacion continua dirigida a la mejora de la calidad de la atencion.

Aspiração endotraqueal por sistema aberto: práticas de profissionais de enfermagem em terapia intensiva

The purpose of this study was to investigate the practices of nursing professionals working in intensive care units regarding open system endotracheal suctioning (ETS). This quantitative study of 25 subjects was conducted in the State of Mato Grosso do Sul (MS), Brazil. Data was collected from April to September 2011 using a checklist monitoring tool composed of 23 items related to the technique. Data was subjected to descriptive statistical analysis. The mean global adherence rate was 51.33%. Poor adherence to 16 items was observed, these being risk factors for the occurrence of adverse effects, particularly occupational accidents, hypoxemia, infection, and hemodynamic instability. Dissatisfactory performance of ETS was found among the professionals investigated, warranting interventions capable of promoting behavioral changes through continuing education aimed at improving the quality of care.Objetivo: Investigar las practicas de los profesionales de enfermeria de cuidados intensivos cuanto a la aspiracion endotraqueal (AET) por sistema abierto. Metodos: Se trata de una investigacion con enfoque cuantitativo, realizada con 25 sujetos en un Hospital Universitario en el estado de Mato Grosso do Sul, Brasil. Los datos fueron recolectados entre abril y septiembre de 2011 con instrumento de monitoreo tipo checklist, con 23 items de la tecnica, analizados mediante estadistica descriptiva. Resultados: El promedio de adhesion global fue del 51,33%. Se ha verificado poca adhesion para 16 items, los cuales son factores de riesgo para la ocurrencia de efectos adversos, en particular los accidentes laborales, las hipoxemias, las infecciones y la inestabilidad hemodinamica. Conclusion: Los profesionales no cumplen satisfactoriamente con la AET, siendo necesario intervenciones para promover cambios de comportamiento a traves de educacion continua dirigida a la mejora de la calidad de la atencion.

Knowledge about endotracheal suctioning on the part of intensive care nursing professionals: a descriptive study

Objetivo: Avaliar o conhecimento dos profissionais de enfermagem de Unidade de Terapia Intensiva (UTI) acerca da aspiracao endotraqueal (AET) por sistema aberto. Metodo: Estudo exploratorio, descritivo, de abordagem quantitativa, realizado em julho de 2011 em duas UTIs de um hospital universitario de grande porte de Mato Grosso do Sul. Os dados foram coletados por meio de um questionario. A amostra constituiu-se de 27 profissionais, dos quais 51,9% eram do sexo masculino. Resultados: De maneira global, o conhecimento dos profissionais foi qualificado como regular (73,2% de acertos); contudo, foi considerado como pobre em cinco itens, alem de apresentar-se de maneira distinta entre as categorias profissionais. Discussao: Considerando que conhecimento incorreto predispoe comportamentos inadequados, infere-se que a pratica desses sujeitos pode comprometer a seguranca dos pacientes. Conclusao: Os estudados apresentaram deficits de conhecimento em alguns aspectos da AET, fato que merece investimentos no âmbito do ensino e da assistencia de enfermagem.

Effectiveness of Surface Cleaning and Disinfection in a Brazilian Healthcare Facility

Background: Failures in the processes of cleaning and disinfecting health service surfaces may result in the spread and transfer of pathogens that are often associated with healthcare-related infections and outbreaks. Aims: To assess the effectiveness of environmental surface cleaning and disinfection in a hospital clinic. Method: The study was conducted in a nursing ward with 45 beds. A total of 80 samples from five high-touch surfaces were evaluated before and after cleaning and disinfection, using the following methods: visual inspection, adenosine triphosphate bioluminescence assay, aerobic colony count, Staphylococcus aureus colony count, and evaluation of resistance to methicillin. The data analysis used nonparametric comparative and correlative tests to observe any differences in the pre- and post- cleaning and disinfection results for the surfaces assessed. Results: Effective cleaning and disinfection had a significant effect on only two surfaces when measured for the presence of adenosine triphosphate, the inner bathroom door handle (p=0.007) and the toilet bowl (p=0.01). When evaluated for Staphylococcus aureus colony count, the toilet flush handle also demonstrated a significant effect (p=0.04). Conclusion: The effectiveness of cleaning and disinfection of the surfaces tested was not satisfactory. An educational intervention is recommended for the cleaning and disinfection staff and the nursing team at the healthcare facility. Relevance to Clinical Practice: The data in the study revealed that daily hospital cleaning and disinfection in the sampled sites are not sufficient in medical and surgical wards. Hospital cleanliness must be reevaluated from the point of view of materials, such as an adequate supply of clean cloths, in addition to establishing more precise cleanliness protocols and accurate monitoring systems.

Efficiency of cleaning and disinfection of surfaces: correlation between assessment methods

OBJECTIVE to assess the correlation among the ATP-bioluminescence assay, visual inspection and microbiological culture in monitoring the efficiency of cleaning and disinfection (C&D) of high-touch clinical surfaces (HTCS) in a walk-in emergency care unit. METHOD a prospective and comparative study was carried out from March to June 2015, in which five HTCS were sampled before and after C&D by means of the three methods. The HTCS were considered dirty when dust, waste, humidity and stains were detected in visual inspection; when ≥2.5 colony forming units per cm2 were found in culture; when ≥5 relative light units per cm2 were found at the ATP-bioluminescence assay. RESULTS 720 analyses were performed, 240 per method. The overall rates of clean surfaces per visual inspection, culture and ATP-bioluminescence assay were 8.3%, 20.8% and 44.2% before C&D, and 92.5%, 50% and 84.2% after C&D, respectively (p<0.001). There were only occasional statistically significant relationships between methods. CONCLUSION the methods did not present a good correlation, neither quantitative nor qualitatively.

Recolección de aspirado traqueal: seguridad y concordancia microbiológica entre dos técnicas

Objetivo: Avaliar a seguranca da execucao das tecnicas tradicional e protegida de colheita de aspirado traqueal e identificar a concordância qualitativa e quantitativa dos resultados de culturas microbiologicas entre as tecnicas. Metodo: Pesquisa clinica, prospectiva, comparativa, simples-cega. A amostra foi constituida de 54 pacientes com idade ≥18 anos, submetidos a ventilacao mecânica invasiva por periodo ≥48 horas e com suspeita de Pneumonia Associada a Ventilacao Mecânica. As duas tecnicas foram implementadas no mesmo paciente, uma imediatamente seguida da outra, sendo a ordem de execucao aleatoria, segundo randomizacao por software especializado. Resultados: Nao ocorreram eventos significativos de queda da saturacao de oxigenio, instabilidade hemodinâmica e hemorragias traqueobronquicas (p<0,05) e, embora tenham ocorrido divergencias em algumas cepas, houve concordância qualitativa e quantitativa entre as tecnicas (p<0,001). Conclusao: A utilizacao da tecnica protegida nao proporciona vantagem em detrimento da tradicional e a execucao de ambas as tecnicas foi segura para o paciente.OBJECTIVE To evaluate the safety of the performance of the traditional and protected collection techniques of tracheal aspirate and to identify qualitative and quantitative agreement of the results of microbiological cultures between the techniques. METHOD Clinical, prospective, comparative, single-blind research. The sample was composed of 54 patients of >18 years of age, undergoing invasive mechanical ventilation for a period of ≥ 48 hours and with suspected Ventilator Associated Pneumonia. The two techniques were implemented in the same patient, one immediately after the other, with an order of random execution, according to randomization by specialized software. RESULTS No significant events occurred oxygen desaturation, hemodynamic instability or tracheobronchial hemorrhage (p<0.05) and, although there were differences in some strains, there was qualitative and quantitative agreement between the techniques (p<0.001). CONCLUSION Utilization of the protected technique provided no advantage over the traditional and execution of both techniques was safe for the patient.