Vanessa de Brito Poveda

Análise dos fatores de risco relacionados à incidência de infecção do sítio cirúrgico em gastrocirurgias

La infeccion hospitalaria es considerada un problema grave, creciendo tanto en incidencia como en complejidad, generando diversos tipos de implicaciones sociales y economicas. La presente investigacion tuvo como objetivo identificar la incidencia de infeccion del sitio quirurgico en pacientes sometidos a cirugias electivas, en la especialidad de Gastroenterologia, realizadas en un hospital publico del interior del estado de Sao Paulo. Los datos fueron recoleccionados por medio de un estudio retrospectivo de los archivos medicos, en el periodo entre enero y diciembre de 1999. En 134 casos estudiados, detectamos la ocurrencia de infeccion del sitio quirurgico en 18 situaciones (13.4%), ocurriendo 9 casos (50%) del tipo considerado infeccion incisional superficial, 8 (44.4%) infeccion incisional profunda y 1 (5.5%) infeccion de organo/espacio. Con relacion a los factores de riesgo presentes en los casos de ISC detectados, los que alcanzaron percentaje mayor or igual a 50% fueron: edad acima de 50 anos, presencia de neoplasias, duracion de la cirugia mayor que dos horas y tricotomia inadecuada.Nosocomial infection is regarded as a serious problem whose incidence and complexity has been increasing, thus generating various types of social and economic implications. This investigation aimed at assessing the incidence of surgical site infection and risk factors in patients submitted to elective surgeries in the specialty of gastroenterology performed in a public hospital in the interior of São Paulo State. Data were collected by means of a retrospective study of medical records from January to December 1999. Of the 134 cases under study, the occurrence of surgery site infection was detected in 18 situations (13.4%). Nine cases (50%) were considered to be superficial incisional infections, 8 (44.4%) were deep incisional infections and 1 (5.5%) was an organ/space infection. With respect to the risk factors, the ones with percentage higher or equal to 50% were: age above 50 years, the presence of neoplasia, surgeries that last more than two hours and inadequate trichotomy.

Factors associated to the development of hypothermia in the intraoperative period

This study aimed to assess factors associated to body temperature changes intraoperatively in patients undergoing elective surgery. A prospective study including 70 patients was carried out in a charity hospital. A data collection instrument was developed and its face and content validity was established. The variables measured were operating room temperature and humidity and patient body temperature at different times. In the multivariate linear regression, the variables type of anesthesia, duration of anesthesia, body mass index, and operating room temperature were directly associated to mean body temperature. Nurses are responsible for planning and implementing effective interventions that can contribute to minimize costs and most importantly reduce hypothermia complications.This study aimed to assess factors associated to body temperature changes intraoperatively in patients undergoing elective surgery. A prospective study including 70 patients was carried out in a charity hospital. A data collection instrument was developed and its face and content validity was established. The variables measured were operating room temperature and humidity and patient body temperature at different times. In the multivariate linear regression, the variables type of anesthesia, duration of anesthesia, body mass index, and operating room temperature were directly associated to mean body temperature. Nurses are responsible for planning and implementing effective interventions that can contribute to minimize costs and most importantly reduce hypothermia complications.

Construção e avaliação de software educacional sobre cateterismo urinário de demora

Tratando-se de uma era na qual a informacao constitui abertura concernente aos beneficios que dela advem, o campo da informatica em enfermagem ganha seu momento. Este estudo teve como objetivo construir um software educativo para o ensino-aprendizado da tecnica de cateterismo urinario de demora e comparar a apreensao do conhecimento sobre a tecnica de cateterismo urinario de demora antes e apos a aplicacao de um software educativo. Pesquisa descritiva de abordagem quantitativa tendo como fundamentacao pedagogica na construcao do software as teorias de Piaget e Vygotsky. Posteriormente, avaliou-se o processo ensino-aprendizagem atraves de um questionario composto por 10 questoes de multipla escolha, anterior a utilizacao do software, e o mesmo teste apos o manuseio do software, resolvidos por 60 alunos participantes. Os dados obtidos demonstraram significativa contribuicao do software apos a aplicacao do mesmo, sendo bastante util no processo ensino-aprendizagem.

Active cutaneous warming systems to prevent intraoperative hypothermia: a systematic review

O estudo teve como objetivo analisar as evidencias disponiveis na literatura sobre a efetividade dos diferentes metodos ativos de aquecimento cutâneo, para a prevencao de hipotermia no periodo intraoperatorio. Para tal, a revisao sistematica foi empregada como metodo de revisao. A busca por estudos primarios foi realizada nas bases de dados CINAHL, EMBASE, Cochrane Register of Controlled Trials e MEDLINE. A amostra da revisao foi composta por 23 ensaios clinicos randomizados controlados. Na literatura, ha evidencias que indicam que o sistema de circulacao de agua aquecida e o metodo mais efetivo a manutencao da temperatura corporal. Os resultados evidenciados podem subsidiar a tomada de decisao do enfermeiro na implementacao de medidas efetivas para a manutencao da temperatura corporal. Recomenda-se, entretanto, que a escolha do sistema em cada servico de saude seja tambem baseada na analise custo/beneficio, devido aos custos relativos a aquisicao dos sistemas investigados.This study analyzed the evidence available in the literature concerning the effectiveness of different active cutaneous warming systems to prevent intraoperative hypothermia. This is a systematic review with primary studies found in the following databases: CINAHL, EMBASE, Cochrane Register of Controlled Trials and Medline. The sample comprised 23 randomized controlled trials. There is evidence in the literature indicating that the circulating water garment system is the most effective in maintaining patient body temperature. These results can support nurses in the decision-making process concerning the implementation of effective measures to maintain normothermia, though the decision of health services concerning which system to choose should also take into account its cost-benefit status given the cost related to the acquisition of such systems.

Fatores de risco de infecção da ferida operatória em neurocirurgia

Objective To analyze risk factors for surgery site infection in neurosurgery. Methods A prospective cross-sectional study conducted in a tertiary hospital analyzing 85 elective and clean neurosurgeries with an outcome of infection within 30 days after surgery. Results Surgical site infection occurred in 9.4% (n=8) of cases. Bivariate analysis revealed that the following risk factors were associated with the presence of infection: total length of hospital stay, Body Mass Index, surgical size and blood transfusion. After running binary logistic regression adjustments, only the total length of hospital stay was significantly related to the presence of infection. Conclusion The occurrence of surgical site infection in neurosurgery in the studied institution was higher than recommended by the scientific literature. The results show that outpatient follow up of patients who undergo surgery after hospital discharge may reduce the underreporting of infection cases.

Carga de trabalho de enfermagem: preditor de infecção relacionada à assistência à saúde na terapia intensiva?

Objective To analyze the influence of nursing workload on the occurrence of healthcare associated infection (HAI) in patients in the intensive care unit (ICU), according to type of treatment. Method Retrospective cohort study developed in nine ICUs in São Paulo, Brazil, from September to December 2012. Nursing workload was measured by the Nursing Activities Score (NAS). The Students t and Fishers exact tests and logistic regressions were used in the analyses. Results The sample was composed of 835 patients (54.3±17.3 years; 57.5% male), of which 12.5% acquired HAI in the ICU. The NAS of the patients admitted for clinical treatment was 71.3±10.9, and for surgery 71.6±9.2. Length of stay in ICU and severity were predictive factors for occurrence of HAI in patients admitted to the unit for clinical or surgical treatment, and male sex only for surgical patients. When considering the admissions independent of type of treatment, in addition to the variables mentioned above, index of comorbidities also remained in the regression model. The NAS was not a predictive factor of HAI. Conclusion Nursing workload did not influence occurrence of HAI in the patients included in this study.Objetivo Analizar la influencia de la carga de trabajo de enfermeria en caso de infeccion hospitalaria (IH) en pacientes en la Unidad de Cuidados Intensivos (UCI) segundo tipo de tratamiento. Metodo Estudio retrospectivo de cohorte realizado en nueve unidades de cuidados intensivos, en Sao Paulo, Brasil, de septiembre a diciembre de 2012. La carga de trabajo de enfermeria se midio por lo Nursing Activities Score (NAS). Las pruebas t de Student, test exacto de Fisher y regresiones logisticas fueron utilizados. Resultados La muestra fue de 835 pacientes (54,3±17,3 anos; 57,5% hombres), entre los cuales el 12,5% adquirio IH. El NAS de pacientes admitidos a tratamiento clinico fue de 71,3±10,9 y quirurgico, 71,6±9,2. La duracion de la estancia en la unidad y la gravedad fueron factores predictivos de la ocurrencia de IH en pacientes ingresados en la UCI para el tratamiento medico o quirurgico y los hombres solo para los pacientes quirurgicos. Al considerar las admisiones independientes del tipo de tratamiento, indice de comorbilidad tambien se mantuvo en el modelo de regresion. El NAS no fue predictivo de IH. Conclusion La carga de trabajo de enfermeria ejerce ninguna influencia sobre la ocurrencia de IH en los pacientes analizados.Objetivo Analisar a influencia da carga de trabalho de enfermagem na ocorrencia de infeccao relacionada a assistencia a saude (IRAS) em pacientes na Unidade de Terapia Intensiva (UTI), segundo o tipo de tratamento. Metodo Estudo de coorte retrospectivo desenvolvido em nove UTI em Sao Paulo, Brasil, de setembro a dezembro de 2012. A carga de trabalho de enfermagem foi mensurada pelo Nursing Activities Score (NAS). Os testes T-Student, Exato de Fisher e regressoes logisticas foram utilizados nas analises. Resultados A casuistica foi composta por 835 pacientes (54,3±17,3 anos; 57,5% do sexo masculino), dentre os quais 12,5% adquiriram IRAS na UTI. O NAS dos pacientes admitidos para tratamento clinico foi de 71,3±10,9 e para cirurgico, 71,6±9,2. O tempo de permanencia na unidade e a gravidade foram fatores preditivos para ocorrencia de IRAS em pacientes admitidos nas UTI para tratamento clinico ou cirurgico e o sexo masculino apenas para pacientes cirurgicos. Ao considerar as admissoes independentes do tipo de tratamento, alem das variaveis citadas, o indice de comorbidades tambem permaneceu no modelo de regressao. O NAS nao foi fator preditivo de IRAS. Conclusao A carga de trabalho de enfermagem nao exerceu influencia na ocorrencia de IRAS nos pacientes deste estudo.

Predisposing factors for surgical site infection in case of gastrectomy

This research aimed to identify the predisposing factors for surgical site infection related to the surgical procedure in patients submitted to a potentially contaminated elective gastrectomy, as a part of Gastric surgery, in the period between 1998 and 2002, at a public hospital in the interior of Sao Paulo, Brazil. Therefore, a retrospective study was carried out by means of a medical record information survey, using the following non-parametric tests for statistical data analysis: Mann-Whitney (quantitative variables) and contingency coefficient (qualitative variables). Out of the 181 cases that were examined, the occurrence of surgical site infection was detected in 17 situations (9.4%), 23.6% of which were categorized as superficial incisional infection, 52.9% as deep incisional infection and 23.6% as organ/space infection. Statistically significant differences between the groups with and without infection were found for the following variables: post-operative hospitalization period, total hospitalization period, surgery time, time to dwelling vesical catheter removal.ABSTRACT : This research aimed to identify the predisposingfactors for surgical site infection related to the surgical procedurein patients submitted to a potentially contaminated electivegastrectomy, as a part of Gastric surgery, in the period between1998 and 2002, at a public hospital in the interior of Sao Paulo,Brazil. Therefore, a retrospective study was carried out by meansof a medical record information survey, using the following non-parametric tests for statistical data analysis: Mann-Whitney(quantitative variables) and contingency coefficient (qualitativevariables). Out of the 181 cases that were examined, theoccurrence of surgical site infection was detected in 17 situations(9.4%), 23.6% of which were categorized as superficial incisionalinfection, 52.9% as deep incisional infection and 23.6% as organ/space infection. Statistically significant differences between thegroups with and without infection were found for the followingvariables: post-operative hospitalization period, total hospitalizationperiod, surgery time, time to dwelling vesical catheter removal.

Autoestima dos cuidadores de doentes oncológicos com capacidade funcional reduzida

Objetivo: Avaliar a autoestima de cuidadores de doentes oncologicos com capacidade funcional reduzida. Metodos: Trata-se de estudo do tipo transversal, realizado em um hospital publico, de grande porte, especializado em oncologia. Utilizou-se uma amostra por conveniencia composta por 90 cuidadores principais de doentes com câncer com capacidade funcional (Karnofsky) entre 20 e 50. Foram coletados dados sociodemograficos, sobre os encargos envolvidos no cuidar e a autoestima foi avaliada pela Escala para Medida do Sentimento de Autoestima de Dela Coleta. Os dados foram analisados pelo teste de Mann-Whitney e de Kurskall-Wallis, com nivel de significância de 5%. Resultados: A maioria dos cuidadores eram mulheres, com companheiros, com baixa renda mensal, mantinham relacoes familiares com o doente e apresentavam media autoestima. A autoestima foi associada de forma estatisticamente significante apenas com a renda familiar (p = 0,002). Conclusao: A autoestima dos cuidadores de pacientes oncologicos e influenciada pelas condicoes de vida, especialmente as financeiras.Objective: To evaluate the caregivers’ self-esteem of cancer patients with reduced functional capacity. Methods: This is a cross sectional study, conducted in a large oncology public hospital. We used a convenience sample consisted of 90 primary caregivers of cancer patients with functional capacity (Karnofsky) between 20 and 50. We collected data about demographic characteristics, the responsibility involved in the care and self-esteem was assessed by the Scale to Measure the Feeling of Self-Esteem of Dela Coleta. Data were analyzed using the Mann-Whitney test and Kruskal-Wallis test, with 5% significance level. Results: The majority of caregivers was women, with a partner, low income and maintained family relationships with the patient and had an average self-esteem. Self-esteem was significantly associated to family income (p = 0.002). Conclusion: The self-esteem of caregivers of cancer patients is influenced by the conditions of life, especially financial.

Contaminação microbiana de punhos de jalecos durante a assistência à saúde

The study aimed to evaluate the bacterial contamination in lab coats worn by nursing students, before and after being worn in health care practices. A quantitative and descriptive study was carried out, in which the students’ coats were collected, washed and ironed in a standardized way and wore for four hours in assistance activities. Subsequently, samples from the cuffs were collected with sterile cotton swabs in order to be incubated in order to analyze microbial growth through morphological analysis by Gram’s Method and antibiogram. There was bacterial growth of Staphylococcus aureus and Staphylococcus epidermidis in 50% of the collected samples and Staphylococcus aureus, found in patients with wounds in outpatient care, showed resistance to antibiotics such as Vancomycin, Chloramphenicol and Sulfonamides. The data demonstrated that the lab coats wore during assistance activities, even in short periods,

Hipotermia no período intra-operatório: é possível evitá-la?

The objective of this study was to identify what measures are taken to prevent hypothermia in the intraoperative period. This is a non-experimental, descriptive-exploratory prospective study. To do this, a data collection instrument was developed, which was submitted to appearance and content validations. The sample consisted of 70 patients. The measure that was most commonly used in the operation room was the passive skin heating, such as using cotton sheets (11.4%) and bandaging the patients lower limbs (14.3%). There was only one occurrence of active skin heating (1.4%). Results show there is a need to implement effective interventions to prevent hypothermia, and nurses play an important role in this context, as patient safety and avoiding complications due to the surgical anesthetic procedure are nursing care goals.El estudio objetivo identificar las medidas adoptadas para prevencion de hipotermia en periodo intraoperatorio. Estudio delineado como no experimental, descriptivo-exploratorio, prospectivo. Se elaboro instrumento de recoleccion de datos, sometido a validacion aparente y de contenido. Muestra constituida por 70 pacientes. La medida mas empleada en quirofano fue el metodo pasivo de calentamiento cutaneo, como uso de sabana de algodon (11,4%) y fajado de miembros inferiores (14,3%). La utilizacion de un metodo activo de calentamiento cutaneo sucedio apenas una vez (1,4%). Los resultados evidenciados demostraron la necesidad de implementacion de intervenciones eficaces para la prevencion de la hipotermia. El enfermero tiene importante papel en este contexto, toda vez que la seguridad del paciente y la reduccion de complicaciones derivadas del proceso anestesico quirurgico son metas del cuidado de enfermeria.