Vårdrelaterade infektioner är ett globalt problem och god handhygien är det främsta verktyget i kampen mot vårdrelaterade infektioner. Följsamhet till handhygien är globalt sett låg. Sjuksköterskans händer är den främsta källan för att sprida smitta därför är sjuksköterskans beteende vad gäller handhygien viktig. Sjuksköterskans avsikt att utföra handhygien kan förklaras av den inre dimensionen som enligt Theory of planned behaviour är attityder, subjektiva normer och upplevd beteendekontroll. Syfte: Litteraturöversiktens syfte var att beskriva vilka attityder, subjektiva normer och upplevda beteendekontroller som påverkar sjuksköterskans följsamhet av riktlinjer för handhygien. Metod: Denna studie har genomförts som en litteraturöversikt och baserades på fjorton artiklar av kvantitativ- och kvalitativ metod som har sökts ur databaserna PubMed, CINAHL och Web of Science. Resultat: Studiens resultat visade att det utifrån perspektivet av Theory of planned behaviour finns attityder, subjektiva normer och upplevda beteendekontroller som påverkar sjuksköterskans följsamhet till riktlinjer för handhygien. Sjuksköterskan upplevde att personligt skydd var en framträdande attityd som motiverade till handhygien. Under subjektiv norm så framträdde patienten, kollegor och förebilder som motiverande faktorer till att utföra handhygien och att känslan av att det är enkelt att utföra handhygien var den mest framträdande faktorn under upplevd beteendekontroll. Sammanfattning: Följsamhet till riktlinjer för handhygien är låg trots nationella insatser och kampanjer för att öka följsamheten. Resultatet visade att sjuksköterskans följsamhet till riktlinjer för handhygien främst påverkades av personligt skydd, patienten, kollegor, förebilder och känslan av att det är enkelt att utföra handhygien. Litteraturöversiktens resultat kan användas för att öka kunskapen om området och utveckla nya strategier för att öka sjuksköterskans följsamhet till riktlinjer för handhygien. / Background: Healthcare-associated infections are a global problem and good handhygiene is the main tool in the fight against healthcare- associated infections. Adherence to hand hygiene is globally low. The nurse’s hands are the main source of spreading infection, and because of that the nurse’s behavior towards hand hygiene is important. The nurse’s intention to perform hand hygiene can be explained by the internal dimension, who are, according to the Theory of planned behaviour, attitudes, subjective norms and perceived behavioural control. Aim: The aim of this literature review was to describe the attitudes, subjective norms and perceived behavioural controls that affect nurses’ adherence to guidelines for hand hygiene. Method: This study was conducted as a literature review and based on fourteen articles of quantitative and qualitative method from the databases PubMed, CINAHL and Web of Science. Results: The results of the literature review demonstrate that, from the perspective of the Theory of planned behaviour, there were attitudes, subjective norms and perceived behavioural controls that affected nurses’ adherence to guidelines for hand hygiene. Nurses felt that personal protection was an important attitude that motivated to hand hygiene. In subjective norm the patient, colleagues and role models emerged as motivating factors to perform hand hygiene and the feeling that it is easy to perform hand hygiene was the most prominent factor under perceived behavioural control. Summary: Adherence to guidelines for hand hygiene is low in spite of national efforts and campaigns to increase adherence. The results showed that nurses’ adherence to guidelines for hand hygiene was mainly influenced by personal protection, the patient, peers, role models and the feeling that it is easy to perform hand hygiene. The results of this literature review can be used to increase the knowledge in this area and develop new strategies to increase nurses’ adherence to guidelines for hand hygiene.

Cette étude visait à documenter les perceptions et les croyances sur l’hygiène des mains chez des infirmières de deux hôpitaux de la République démocratique du Congo (RDC). Le modèle PRECEDE-PROCEED a guidé les travaux et permis de centrer l’analyse sur les facteurs prédisposants et les facteurs facilitants, éléments favorisant l’adoption des comportements de santé. Le devis utilisé est de type descriptif corrélationnel. Un échantillon de convenance incluant 74 infirmières recrutées dans les deux hôpitaux a été assemblé. Les données ont été recueillies au moyen d’un questionnaire auto-administré composé de 34 questions, tirées d’outils repérés dans la recension des écrits. Les questions portaient sur les connaissances, les perceptions au regard de l’hygiène des mains et l’accès aux infrastructures facilitant l’adoption de ce comportement. La collecte des données s’est déroulée à Kinshasa, capitale de la RDC. Les résultats révèlent d’importantes lacunes dans les connaissances. Les perceptions relatives aux normes sociales sont ressorties comme davantage favorables. Les résultats révèlent également des lacunes en ce qui a trait aux facteurs facilitants, notamment dans l’utilisation de la friction hydro-alcoolique. Par ailleurs, les infirmières les plus instruites et les plus expérimentées étaient plus nombreuses à percevoir l'importance de la pratique d’hygiène des mains. La discussion aborde quelques pistes en termes d’actions à entreprendre pour améliorer les comportements d’hygiène chez les infirmières dans les pays en développement telle la RDC. / This study aimed to document perceptions and beliefs about hand hygiene among nurses from two hospitals in the Democratic Republic of Congo (DRC). The PRECEDE-PROCEED model guided the work and helped focus the analysis on predisposing factors and facilitating factors which could favor the adoption of health behaviors. The estimate used is of a correlational descriptive kind. A convenience sample including 74 nurses recruited from the two hospitals was used. Data were collected through a self-administered questionnaire composed of 34 questions, drawn from tools identified in the literature. The questions focused on knowledge and perceptions with regard to hand hygiene, as well as access to infrastructure facilitating the adoption of this behavior. Data collection took place in Kinshasa, the capital of the DRC. The results reveal significant gaps in knowledge. Perceptions related to social norms stood out as more favorable. The results also reveal gaps in awareness of facilitating factors, including the use of alcohol-based handrubs. It was also noted that the more educated and experienced nurses were more likely to perceive the importance of hand hygiene practices. The discussion proposes some possible actions to improve hygiene behavior among nurses in developing countries such as the DRC.

The aim of this thesis is summarising the issue of hospital related infections on intensive care units in district hospitals. This issue is greatly underestimated. The background section discusses the different types of healthcare acquired infection, where they are most commonly found and the most common types. They use statistical data to confirm these points. Within this section risk factors and preventive measures are also discussed. The researchers use a questionnaire to assess the intensive care units staff's knowledge of the procedures to prevent a healthcare acquired infection. The data is expressed using tables and graphs to aid clarity. The results of research reveal, that the staff all downgrade the prevalence and prevention of hospital acquired infections. Key words: Healthcare acquired infections / Nosocomial disease Prevention of hospital related diseases Hand hygiene Intensive care

Objetivo: Reduzir a transmissão de Enterobactérias resistentes a carbapenêmicos (ERC) em uma unidade de terapia intensiva com intervenções baseadas em simulações por um modelo matemático desenvolvido. Desenho: Ensaio antes e depois com um período basal de 44 semanas e um período de intervenção de 24 semanas. Métodos: O estudo foi conduzido em uma Unidade de Terapia Intensiva Médica (UTI) de um hospital de ensino terciário. Desenvolvemos um modelo de transmissão de ERC em uma UTI e medimos todos os parâmetros necessários para a entrada do modelo. Foram estabelecidas metas de adesão à higienização das mãos e às precauções de contato com base nas simulações e conduziu-se uma intervenção focada em atingir essas métricas como metas, com auditoria semanal da unidade e reuniões com a equipe para dar feedback sobre o desempenho. Resultados: As metas para a adesão à higienização das mãos e às precauções de contato foram alcançadas na terceira semana do período de intervenção. Durante o período basal, o R0 calculado foi de 11, a prevalência mediana de pacientes colonizados por ERC na unidade foi de 33% e ultrapassou 50% por três vezes. No período de intervenção, a prevalência média de pacientes colonizados por ERC passou para 21%, com uma mediana semanal do Rn de 0,42 (intervalo: 0 a 2,1). Conclusões: As simulações ajudaram a estabelecer e atingir metas específicas para controlar as altas taxas de prevalência de ERC e reduzir a transmissão de ERC dentro da unidade. O modelo foi capaz de prever os resultados observados. Este é o primeiro estudo em controle de infecção que mede a maioria das variáveis de um modelo matemático na vida real e o aplica como uma ferramenta de apoio à decisão para a intervenção / Objective: To reduce the transmission of carbapenem-resistant Enterobacteriaceae (CRE) in an intensive care unit with interventions based on simulations by a mathematical model. Design: Before-after trial with a 44-week baseline period and a 24 week intervention period. Setting: Medical Intensive Care unit (ICU) of a tertiary care teaching hospital. Participants: All patients admitted to the unit. Methods: We developed a model of transmission of CRE in an ICU and measured all necessary parameters for the model input. Goals of compliance with hand hygiene and with isolation precautions were established based on simulations. An intervention focused on achieving these goals was conducted with weekly auditing and feedback. Results: The goals for compliance with hand hygiene and contact precautions were reached on the third week of the intervention period. During baseline period, the calculated R0 was 11, median prevalence of patients colonized by CRE in the unit was 33% and exceeded 50% on three occasions. In the intervention period, median prevalence of colonized CRE patients was 21%, with a median weekly Rn of 0.42 (range: 0 to 2.1). Conclusions: The simulations helped to establish and to achieve specific goals in order to control the high prevalence rates of CRE and reduce CRE transmission within the unit. The model was able to predict the observed outcomes. This is the first study in infection control to measure most variables of a model in real life and to apply the model as a decision support tool for intervention

Introdução: As infecções relacionadas à assistência à saúde (IRAS) estão entre as principais causas de morte e aumento de estados de morbidez em doentes hospitalizados. Os recém-nascidos são suscetíveis a infecção, pois seus mecanismos de defesa ainda não estão maduros e ocupam um ambiente em que antibióticos e procedimentos invasivos são freqüentes. As mãos são consideradas as principais vias de disseminação de IRAS e a eficaz higienização é a medida importante para evitar as infecções. A capacitação e educação permanente dos profissionais de saúde são ferramentas essenciais para a construção de resultados positivos e o ambiente simulada desponta como estratégia pedagógica. Objetivo: Avaliar a efetividade de uma intervenção educativa em cenário simulado no aumento da adesão à higiene das mãos pela equipe de enfermagem e na redução das IRAS em uma Unidade de Terapia Intensiva Neonatal (UTIN). Método: Estudo quase-experimental, com abordagem quantitativa, que incluiu todos os profissionais de enfermagem da UTIN de um hospital universitário terciário no interior paulista. A pesquisa foi aprovada por Comitê de Ética em Pesquisa e desenvolvida em três etapas, incluindo a avaliação da adesão à higienização das mãos conforme os cinco momentos recomendados pela Organização Mundial da Saúde (OMS), antes e após intervenção educativa em cenário simulado com casos clínicos contextualizados com a realidade do serviço. As taxas de IRAS foram computadas em uma série histórica de 35 meses, sendo apenas o último mês no pós intervenção. Os dados foram analisados pelo programa STATA, com uso de estatística descritiva. Resultados: Na etapa pré intervenção, os profissionais realizaram a higiene das mãos em 41,2% das vezes, valor que aumentou após a simulação para 59,7% de ações realizadas conforme indicação. A técnica executada para higiene das mãos aumentou de 76,6% para 85,2% de conformidade após intervenção. A higiene das unhas e extremidades ainda é a maior fragilidade dos participantes na execução da técnica. Todas as categorias profissionais tiveram aumento entre 17 a 19% na adesão à higienização das mãos, com significância estatística na comparação pré e pós intervenção: p<0,001 para enfermeiros e técnicos de enfermagem; p=0,005 para auxiliares de enfermagem. Na análise da higiene das mãos, em três dentre os cinco momentos recomendados pela OMS as médias de adesão aumentaram significativamente, sendo antes (p<0,001) e após (p=0,008) o contato com o RN e após o contato com superfícies (p<0,001). As médias de adesão antes do procedimento asséptico (de 57,6% para 72,7%) e após exposição a fluídos (de 77,3% para 95,5%) aumentaram, apesar de não haver significância estatística. A taxa de IRAS no mês subsequente a intervenção (8,5%) não decresceu em comparação ao mês anterior a intervenção (7,8%), sendo que tais taxas foram relativamente inferiores em 19 dos 35 meses de coleta. Conclusão: Confirma-se a hipótese primária que a taxa de adesão à higiene das mãos pela equipe de enfermagem aumentou após a intervenção educativa em cenário simulado, em comparação com a taxa antes da intervenção, todavia, rejeitase a hipótese secundária, pois a taxa de IRAS não reduziu no mês subseqüente a intervenção educativa, em comparação com a taxa no mês pré intervenção / Background:The infections acquired in healthcare environments not only increase morbidity in hospitalized patientsbut also causea great number of deaths. Newborns (NBs) are susceptible to infection due to their immature defense mechanisms allied to the high frequency of antibiotics prescription and invasive procedures. As hands are considered the key dissemination pathway of healthcare-associated infections (HAI), the effective hand hygiene compliance is the most important measure to prevent infections. Healthcare professionals training and permanent education, mainly those based on simulation strategies, are essential tools to achieveour main goal, that is healthcare associated infections control.Objective:To evaluate the effectiveness of an educational intervention, in a simulated scenario, in the increase of hand hygiene adherence by the nursing team and in the reduction of HAI in a Neonatal Intensive Care Unit (NICU).Method:Quasi-experimental study with a quantitative approach including all nursing professionals at the NICU of a tertiary university hospital in the countryside of the São PauloState. After the approval by the Ethics Research Committee, the study was developed in three phases, including the evaluation of hand hygiene adherence in a simulation setting according to the five moments recommended by WHO, before and after the educational intervention, based on local clinical cases. HAI rates have been computed in a historical series of the 35 months, being only last month in post-intervention. Data were analyzed using the software STATA, using descriptivestatistics.Results: In the pre-intervention phase, the professionalsperformedhand hygiene in 41,2% of times,which increased after simulation, with 59.7% of actions performed as indicated.In relation to the technique employed for hand hygiene, it moved from 76.6% to 85.2% of conformance after intervention. Thehygiene of nails and extremitiesis still the greatest fragility of the participants performing the technique. All professionals categories had between 17 to 19% of increasing the hand hygiene compliance, with statistical significance in the pre and post intervention comparison: p<0,001 for nurses and nursing technicians; p=0,005 for nursing assistant. The analysis of the hand hygiene in three out of the five moments recommended by WHO,showed that the average of adherence significantly increased, being before (p<0,001) and after (p=0,008) the contact with NBs and after the contact with surfaces (p<0,001). The averages of adherence before aseptic procedure (57,6% to 72,7%) and after exposure to fluids (77,3% to 95,5%) increased, however without statistical significance.The HAI rates in the following month of intervention (8,5%) did not drop compared to the month before the intervention (7,8%), and these rates were relatively lower in 19 out of the 35 months of data collect. Conclusion: The primary hypothesis was confirmed, as the adherence hand hygiene through the nursing team increased post educational intervention in simulated scenario, in comparison with the rates before the intervention. However, the secondary hypothesis was rejected, because the HAI rates did not reduced in the following month of educational intervention, in comparison with the rates in the pre-intervention month

Introdução. Afastamentos associados com as doenças infecciosas estão entre as principais causas de absenteísmo de escolares. A legislação atual não dispõe sobre os conteúdos ou as disciplinas que deveriam abordar a importância da higiene das mãos para se evitar a transmissão de doenças infecciosas, tornando necessário investigar como as escolas lidam com o assunto. Objetivo. Expor algumas reflexões sobre os Parâmetros Normativos e Matrizes Curriculares, especificamente o tema transversal relacionado à saúde e contextualizar as condições de infraestrutura para higiene nas escolas do ensino fundamental do Município de Uberaba, MG. Material e métodos. Primeiramente, realizou-se uma análise documental seguida de uma revisão integrativa da literatura. Posteriormente, conduziu-se um estudo observacional-seccional (diagnóstico situacional). Para a busca foram utilizadas as bases de dados periódicos CAPES, SciELO, LILACS, MEDLINE, PubMed, CINAHL e Ministério da Educação. A observação estruturada ocorreu em visitas agendadas nas escolas, e foi utilizado um instrumento de observação validado. Os dados foram submetidos à análise descritiva. Resultados. A educação é garantida pela Constituição de 1.988 a todos os brasileiros, demonstrando uma preocupação do Estado em manter as crianças nas escolas. Entretanto, a legislação relacionada com o ensino dos temas transversais e questões de saúde surgiu somente dezenove anos mais tarde. Atualmente, as matrizes escolares tratam do tema higiene nos conteúdos de Ciências e Educação Física, porém esse assunto também foi encontrado em Geografia e História. Pesquisas internacionais mostram que as crianças têm baixa adesão na higienização das mãos, o que pode favorecer o surgimento de doenças infecciosas e parasitárias. As escolas do município de Uberaba que foram visitadas possuíam infraestrutura adequada, porém os insumos para a higiene das mãos não eram, em sua maioria, disponibilizados nos banheiros. Conclusão. A legislação mostra a preocupação do Estado com a Educação e a Saúde dos escolares, entretanto, parece haver um hiato na aplicabilidade entre essas leis e a prática. A revisão da literatura internacional revela que as intervenções educativas no ensino fundamental acarretam redução do absenteísmo por infecções. Todavia, as publicações nacionais não permitiram estabelecer tal associação. As escolas estudadas oferecem a infraestrutura física para a higiene dos escolares, entretanto, serão necessários esforços adicionais para conscientizar profissionais e escolares para a disponibilização e uso adequado dos insumos requeridos para a higiene das mãos / Introduction. Clearances associated with infectious diseases are among the leading causes of school absenteeism. The current legislation does not dispose of the contents and subjects that should address the importance of hand hygiene to prevent the transmission of infectious diseases, making it necessary to investigate how schools deal with this issue. Objective. Expose some reflections on the Regulatory Parameters and Course curricula, specifically health related cross-cutting themes, and contextualize the infrastructure conditions for hygiene in primary schools of the city of Uberaba, Minas Gerais, Brazil. Methodology. First, we carried out a document analysis followed by an integrative literature review. Subsequently it was conducted an observational-sectional study (situation analysis). For the search we used the CAPES databases (journals and theses and dissertations), SciELO, LILACS, MEDLINE, PubMed, CINAHL, Ministry of Education and the Brazilian Digital Library of Theses and Dissertations (BDTD). The structured observation occurred in scheduled visits in schools, and we used a validated instrument of observation. Data were submitted to descriptive analysis. Results. Education is guaranteed by the Constitution of 1988 to all Brazilians, demonstrating a concern of the state to keep children in schools. However, the legislation related to the teaching of cross-cutting issues and health issues emerged only nineteen years later. Currently, the school headquarters deal with the subject hygiene in content Sciences and Physical Education, but this subject has also been found in Geography and History. International research shows that children have lower compliance in hand hygiene, which can encourage the emergence of infectious and parasitic diseases. Schools in the city of Uberaba that were visited had adequate infrastructure, but the inputs for hand hygiene were not mostly available in the bathrooms. Conclusion. The Brazilian law shows the state\'s concern for the Education and the Health of school, however, there seems to be a gap in the applicability of these laws and practice. The international literature review reveals that educational interventions in primary education entails reducing absenteeism infections. However, national publications have failed to establish such an association. The studied schools provide the physical infrastructure for the hygiene of the students, however, additional efforts are needed to educate professionals and school for the appropriate provision and use of items necessary for hand hygiene

Bakgrund: Vårdrelaterade infektioner (VRI) är ett stort problem i Sverige och resten av världen och en av de viktigaste patientsäkerhetsfrågorna. Det leder till ett ökat lidande för patienten, längre vårdtider samt stora kostnader för samhället. Hälften av de VRI som sker kan förebyggas med åtgärder som bland annat följsamheten till basala hygienrutiner. Trots riktlinjer är följsamheten låg. Hälso-och sjukvården ska vara av god kvalitet med hög hygienisk standard. En av sjukvårdspersonalens viktigaste uppgifter är att förhindra att vårdskador sker och undvika onödigt lidande för patienten. Därför är det av stor vikt att ta reda på vilka faktorer som påverkar hälso- och sjukvårdspersonalens följsamhet till basala hygienrutiner. Syfte: Litteraturöversiktens syfte var att belysa olika faktorer som kan påverka hälso- och sjukvårdspersonals följsamhet till basala hygienrutiner på en akutmottagning (AKM). Metod: Denna studie har genomförts som en litteraturöversikt på 13 vetenskapliga artiklar av kvantitativ design. Av dessa har tolv artiklar sökts fram genom databaserna Cinahl och PubMed och en genom sekundär sökning. Resultat: Resultatet visar på att det finns flera faktorer som påverkar hälso- och sjukvårdspersonalens följsamhet till basala hygienrutiner på en AKM. Fyra huvudfaktorer som framkom var Miljön, Kunskap och utbildning, Attityder till basala hygienrutiner och Förbättringsarbete. Slutsats: Följsamheten till basala hygienrutiner var låg och det fanns flera faktorer som påverkade att hälso- och sjukvårdspersonalen inte följde de riktlinjer som fanns. / Background: Nosocomial infections are a huge problem in Sweden and the rest of the world and the most important issue of patient safety. These infections can lead to increased patient suffering, prolonged hospital stays and higher costs for the society. Half of the nosocomial infections that happens can be prevented with measures, such as the compliance with basic hygiene routines. Despite the guidelines, the compliance is low. Healthcare must be of good quality and have a high hygienic level and preventing injury is one of the most important tasks of healthcare personnel to prevent suffering. Therefore, it is very important to find out what factors affect compliance of the staff with basic hygiene routines. Aim: The purpose of the literature review is to highlight various factors that may affect the compliance of healthcare personnel with basic hygiene routines in emergency department. Method: This study has been formed as a literature review based on 13 scientific articles quantitative design. 12 of these have been found when search through the databases Cinahl and Pubmed and one by manual search. Findings: The result shows that there are several factors that affect healthcare personnel compliance of basic hygiene routines in an emergency department. Four head factors that showed are Environment, Knowledge and education, Attitudes to basic hygiene routines, and Improvement. Conclusion: The compliance of basic hygiene routines is low and there are several factors that affect that healthcare personnel does not follow the guidelines that is available.

Hospital Acquired Infections (HAI) are a global patient safety challenge, costly to treat, and affect hundreds of millions of patients annually worldwide. It has been shown that the majority of HAI are transferred to patients by caregivers' hands and therefore, can be prevented by proper hand hygiene (HH). However, many factors including cognitive load, cause caregivers to forget to cleanse their hands. Hand hygiene compliance among caregivers remains low around the world. In this thesis I showed that it is possible to build a wearable accelerometer-based HH reminder system to identify ongoing nursing activities with the patient, indicate the high-risk activities, and prompt the caregivers to clean their hands. Eight subjects participated in this study, each wearing five wireless accelerometer sensors on the wrist, upper arms and the back. A pattern recognition approach was used to classify six nursing activities offline. Time-domain features that included mean, standard deviation, energy, and correlation among accelerometer axes were found to be suitable features. On average, 1-Nearest Neighbour classifier was able to classify the activities with 84% accuracy. A novel algorithm was developed to adaptively segment the accelerometer signals to identify the start and stop time of each nursing activity. The overall accuracy of the algorithm for a total of 96 events performed by 8 subjects was approximately 87%. The accuracy was higher than 91% for 5 out of 8 subjects. The sequence of nursing activities was modelled by an 18-state Markov Chain. The model was evaluated by recently published data. The simulation results showed that the high-risk of cross-contamination decreases exponentially by frequency of HH and this happens more rapidly up to 50%-60% hand hygiene rate. It was also found that if the caregiver enters the room with high-risk of transferring infection to the current patient, given the assumptions in this study, only 55% HH is capable of reducing the risk of infection transfer to the lowest level. This may help to prevent the next patient from acquiring infection, preventing an infection outbreak. The model is also capable of simulating the effects of the imperfect HH on the risk of cross-contamination.

Hospital Acquired Infections (HAI) are a global patient safety challenge, costly to treat, and affect hundreds of millions of patients annually worldwide. It has been shown that the majority of HAI are transferred to patients by caregivers' hands and therefore, can be prevented by proper hand hygiene (HH). However, many factors including cognitive load, cause caregivers to forget to cleanse their hands. Hand hygiene compliance among caregivers remains low around the world. In this thesis I showed that it is possible to build a wearable accelerometer-based HH reminder system to identify ongoing nursing activities with the patient, indicate the high-risk activities, and prompt the caregivers to clean their hands. Eight subjects participated in this study, each wearing five wireless accelerometer sensors on the wrist, upper arms and the back. A pattern recognition approach was used to classify six nursing activities offline. Time-domain features that included mean, standard deviation, energy, and correlation among accelerometer axes were found to be suitable features. On average, 1-Nearest Neighbour classifier was able to classify the activities with 84% accuracy. A novel algorithm was developed to adaptively segment the accelerometer signals to identify the start and stop time of each nursing activity. The overall accuracy of the algorithm for a total of 96 events performed by 8 subjects was approximately 87%. The accuracy was higher than 91% for 5 out of 8 subjects. The sequence of nursing activities was modelled by an 18-state Markov Chain. The model was evaluated by recently published data. The simulation results showed that the high-risk of cross-contamination decreases exponentially by frequency of HH and this happens more rapidly up to 50%-60% hand hygiene rate. It was also found that if the caregiver enters the room with high-risk of transferring infection to the current patient, given the assumptions in this study, only 55% HH is capable of reducing the risk of infection transfer to the lowest level. This may help to prevent the next patient from acquiring infection, preventing an infection outbreak. The model is also capable of simulating the effects of the imperfect HH on the risk of cross-contamination.

Made available in DSpace on 2014-12-17T14:46:57Z (GMT). No. of bitstreams: 1 GabrielaSMM_DISSERT.pdf: 1308781 bytes, checksum: c4efdf44a5581756293b964676423dd6 (MD5) Previous issue date: 2012-10-26 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico / O estudo teve como objetivo validar instrumentos para avalia??o do conhecimento e habilidade acerca da higieniza??o simples das m?os (HSM). Estudo quantitativo, metodol?gico, desenvolvido em duas etapas: levantamento da literatura para subsidiar a constru??o de dois instrumentos para avalia??o o conhecimento e a habilidade sobre HSM, sendo um question?rio do conhecimento com 12 quest?es objetivas e um roteiro estruturado composto por 14 passos da t?cnica; e a segunda com a identifica??o e sele??o dos ju?zes e submiss?o dos instrumentos para avalia??o. Para identifica??o dos ju?zes foi realizado contato com as coordena??es dos cursos de enfermagem das universidades do Rio Grande do Norte e solicitado contato dos docentes das disciplinas de semiologia e/ou semiot?cnica da enfermagem. A amostra foi composta por 27 ju?zes, adotados como crit?rios de inclus?o: enfermeiros, docentes da disciplina de semiologia e/ou semiot?cnica, m?nimo de um ano de experi?ncia, sendo da Universidade Federal do Rio Grande do Norte/UFRN, Universidade Estadual do Rio Grande do Norte e uma universidade particular do Estado do Rio Grande do Norte. A avalia??o dos itens dos instrumentos ocorreu a partir da classifica??o em adequado, adequado com altera??es e inadequado; nos dois ?ltimos casos deveriam ser explicitadas sugest?es para melhoria dos itens e a avalia??o geral de cada instrumento a partir de 10 requisitos. Ap?s a avalia??o foi realizada a valida??o de conte?do com aplica??o do ?ndice Kappa e ?ndice de Validade de Conte?do (IVC), aceitando ?ndices superiores a 0,61 e 0,75, respectivamente. Este estudo obteve parecer favor?vel do Comit? de ?tica em Pesquisa do Hospital Universit?rio Onofre Lopes (CAAE n? 0002.0.294.000-10). Os dados coletados foram organizados em planilha eletr?nica, exportados para o software estat?stico e analisados por meio de estat?stica descritiva. O levantamento da literatura contemplou 19 estudos, predominaram artigos cient?ficos, entre 2008 a 2010, com distribui??o mundial, p?blico alvo de profissionais da sa?de. Quanto ?s caracter?sticas dos instrumentos, destacaram-se: dados sociodemogr?ficos; conhecimentos sobre higieniza??o das m?os (HM); t?cnica de HM; revis?es sobre HM e recomenda??es para melhoria da pr?tica. Evidenciou-se varia??o na t?cnica de HM com ?gua e sab?o. Das 12 quest?es do conhecimento, tr?s atingiram n?vel perfeito de concord?ncia (Kappa e IVC = 1,00). As demais foram consideradas adequadas com altera??es, sendo as principais sugest?es sobre clareza das quest?es. Dos 14 itens do roteiro estruturado, oito n?o atigiram n?vel perfeito de concord?ncia, mas todos estavam dentro dos valores de IVC e Kappa estabelecidos. As sugest?es tratavam especialmente sobre o vocabul?rio e clareza dos itens. Na avalia??o geral dos instrumentos, o question?rio do conhecimento obteve IVC de 0,91 e Kappa de 0,82, e o roteiro estruturado IVC de 0,95 e Kappa de 0,91. Os instrumentos podem ser considerados v?lidos quanto ao conte?do, sendo satisfat?rios e adequados para a mensura??o do conhecimento e da habilidade sobre a HSM, demonstrando a import?ncia de se realizar valida??o pr?via do instrumento de avalia??o