<p>Cnior Mobile AB i Lindesberg utvecklar en mobil trygghetstelefon för äldre. Detta examensarbete går ut på att utforma en handsfree-enhet för denna. Handsfree-enheten ska integreras i larmknappen, som bärs av användaren runt handleden, och har kontakt med telefonen via blåtandsradio. I examensarbetet ingår att välja ut lämplig högtalare och mikrofon, hitta lösningar för smuts- och vattentålighet samt att lösa problem med ekon och bakgrundsstörningar.</p><p>En högtalare hittades som uppfyllde kraven för smuts- och vattentålighet samtidigt som den hade utmärkt frekvensgång för återgivning av tydligt tal. Vattenavrinning från högtalaren löstes genom att ett sinussvep sänds ut från högtalaren varje gång ett samtal ska kopplas upp. På så sätt pressar ljudtrycket ut vattnet från handledsknappens kavitet. Olika utformningar av ljudhålen i handledsknappens skal provades. Den bästa lösningen för vattenavrinningen var att använda sju stycken runda hål med 1,3 mm i diameter. En ljudtrycksmätning säkerställde att ljudtrycket inte blev lidande av denna utformning av ljudhålen.</p><p>Ekosläckning och bakgrundsstörningsundertryckning sköts av GSM-modulen i trygghetsmobilen. I ekosläckningens manual finns beskrivet hur ekosläckningens 24 parametrar kan justeras för att passa olika applikationer. Endast en mindre ändring av de rekommenderade parametervärdena behövdes för att ekosläckning och bakgrundsstörningsundertryckning skulle fungera tillfredställande.</p><p>Eftersom mikrofonernas datablad visade på så snarlika egenskaper överlämnades mikrofonvalet till företaget, då det kan vara klokt att låta priset avgöra.</p>

Cnior Mobile AB i Lindesberg utvecklar en mobil trygghetstelefon för äldre. Detta examensarbete går ut på att utforma en handsfree-enhet för denna. Handsfree-enheten ska integreras i larmknappen, som bärs av användaren runt handleden, och har kontakt med telefonen via blåtandsradio. I examensarbetet ingår att välja ut lämplig högtalare och mikrofon, hitta lösningar för smuts- och vattentålighet samt att lösa problem med ekon och bakgrundsstörningar. En högtalare hittades som uppfyllde kraven för smuts- och vattentålighet samtidigt som den hade utmärkt frekvensgång för återgivning av tydligt tal. Vattenavrinning från högtalaren löstes genom att ett sinussvep sänds ut från högtalaren varje gång ett samtal ska kopplas upp. På så sätt pressar ljudtrycket ut vattnet från handledsknappens kavitet. Olika utformningar av ljudhålen i handledsknappens skal provades. Den bästa lösningen för vattenavrinningen var att använda sju stycken runda hål med 1,3 mm i diameter. En ljudtrycksmätning säkerställde att ljudtrycket inte blev lidande av denna utformning av ljudhålen. Ekosläckning och bakgrundsstörningsundertryckning sköts av GSM-modulen i trygghetsmobilen. I ekosläckningens manual finns beskrivet hur ekosläckningens 24 parametrar kan justeras för att passa olika applikationer. Endast en mindre ändring av de rekommenderade parametervärdena behövdes för att ekosläckning och bakgrundsstörningsundertryckning skulle fungera tillfredställande. Eftersom mikrofonernas datablad visade på så snarlika egenskaper överlämnades mikrofonvalet till företaget, då det kan vara klokt att låta priset avgöra.

Bug Fixer is a web-based application that complements lectures with hands-on exercises that encourage students to think about the logic in programs. Bug Fixer presents students with code that has several bugs that they must fix. The process of fixing the bugs forces students to conceptually think about the code and reinforces their understanding of the logic behind algorithms. In this work, we conducted a study using Bug Fixer with undergraduate students in the CSCE1040 course at University of North Texas to evaluate whether the system increases their conceptual understanding of the algorithms and improves their Software Testing skills. Students participated in weekly activities to fix bugs in code. Most students enjoyed Bug Fixer and recommend the system for future use. Students typically reported a better understanding of the algorithms used in class. We observed a slight increase of passing grades for students who participated in our study compared to students in other sections of the course with the same instructor who did not participate in our study. The students who did not report a positive experience provide comments for future improvements that we plan to address in future work.

The focus of this thesis will be an exegesis of the term burnt offering in Old Testament. The diploma thesis deals with the location of the cult (Tent of Meeting, temple), priests in Israel, human offerings and reconstruction of ritual burnt offerings with an evaluation of particular acts based on translation and interpretation of the first chapter of Leviticus. The purpose of this work is to detect, what function and meaning this ritual had for the community of Israel, as well as what message the texts contain, with respect to burnt offerings for the current reader.

Indiscutivelmente, higiene de mãos (HM)é uma das medidads mais importantes para prevenir as Infecções Hospitalares. Além da tradicional lavagem com água e sabão, o uso do álcool tem se destacado na HM, pois, possui boa atividade antimicrobiana, dispensa pia, reduz o tempo e previne ressecamento de mãos. Das evidências científicas sobre seu uso na HM, ainda há contradições quanto à sua efetividade na presença da matéria orgânica nas mãos. Esta pesquisa foi desenvolvida com intuito de elucidar esta questão avaliando a eficácia antimicrobiana de três formulações alcoólicas (duas em forma de gel e uma líquida) nas mãos com matéria orgânica. Os trabalhos laboratoriais foram realizados no Laboratório de Pesquisas do Instituto de Ensino e Pesquisas (coleta de amostras bacterianas) e no Laboratório de Microbiologia do Departamento de Patologia Clínica do Hospital Albert Einstein (contagem bacteriana), utilizando a metodologia oficial Européia - EN 1500 modificada. Quatorze voluntários - pessoas saudáveis, sem problemas de pele nas mãos e que asinaram o \"Termo de Consentimento Livre e Esclarecido\", foram aleatorizados em três grupos e cada grupo utilizou os proidutos-testes e referência em seqüências diferentes. Os produtos-teste foram: produto A - alcool etílico sob a forma de gel a 62% (p/p), produto B - álcool etílico sob a forma de gel a 70%(p/p) e produto C - álcool etílico a 70% (p/v) glicerinado sob a forma líquida e o produto D - alcool 2-propanolol 60%, produto referência padronizado pela metodologia EN 1500. Para cada produto-teste e referência, foi realizada a seguinte seqüência de procedimentos: lavagem de mãos por um minuto com água e sabão; aplicação de 1,2 ml de sangue estéril desfibrinado de carneiro; contaminação das mãos até metade dos matacarpos no caldo tríptico de soja (TSB) com o microrganismo-desafio S. macescens ATCC 14756; coleta de amostras pré HM, friccionando os dedos na placa de Petri contendo TSB (valor inicial); HM aplicando o(s) produto(s)-teste e referência; coleta de amostras para recuperação bacteriana (valor final), com a mesma técnica da fase pré HM e cálculo do fator de redução (FR) logarítmica (log10) de S. marcescens (valor inicial - valor final). Foram realizadas análises estatísticas (teste de Wilcoxon) para verificar a equivalência entre o(s) produto(s)-teste e referência, com o nível de significância estabelecido em P=0,10, unicaudal. Os FR (log10) foram: 3,29 para o rpoduto A; 3,36 para o produto B e 3,56 para o produto C. O produto-referência, produto, produto D, promoveu FR log10 de 3,66. Os testes de Wilcoxon indicaram que há equivalência dos produtos B (P=0,198) e C (P=0,826) com o produto referência D, e que existe diferença do produto A (P=0,074) quando comparado ao produto D. Como conclusão, este estudo revelou que os produtos-teste, utilizados em mãos artificialmente sujas com matéria orgânica reduziram significativamente a colonização transitória das mãos - mais de 3 log10, redução acima de 99,9% podendo ser utilizados para HM. Estes valores são superiores aos valores de FR log10 encontrados após a lavagem de mãos com sabão não-antimicrobiano(2,7) e sabão antimicrobiano tricosan (2,8) e semelhantes aos valores de PVP-I (3,5) e clorexidina degermante (3,1). O produto A, apesar de reprovado pela metodologia oficial EN 1500, obteve o menor FR log10 (3,26), é superior aos sabões não-antimicrobianos e com triclosan e clorexidina degermante a 4%, o que indica a possibilidade de sua utilização como segunda opção. / Hand hygiene is considered the most important measure to reduce the transmission of nosocomial pathogens in health care settings. Because alcohol has excellent antimicrobial activity, requires less time, results in less skin irritation and does not require proximity to a sink, is the preferred agent for hand hygiene. In the face of scientific evidence, there\'s still contradiction concerning the effectiveness of alcohol in the hands with proteinaceous material. This research was developed in order to compare the antimicrobial activity of three alcoholic products commonly used (two alcohol-based gel and one liquid formulation) in the hands with organic material. It was conducted in the Research Laboratory (bacterial samples) and in the Microbiology Laboratory of the Clinical Pathology Department (bacterial counting) of the Hospital Albert Einstein, using modified European Standard EN 1500. The test products were: A - ethanol alcohol-based gel 62% (p/p), product B - ethanol alcohol-based gel 70% (p/p) and product C - ethanol alcohol-based liquid 70% (p/v) with glycerol 2% compared to reference product: D - alcohol 2-propanolol 60% (v/v) on artificially contaminated hands with S. marcescens ATCC 14756, using a cross-over design. Fourteen healthy volunteers, with no skin hand problems and who signed written consent form were randomized in 3 groups. For each reference and test products, the following sequence was carried through: hands were washed with soft soap, 1,2 ml of sterile sheep blood defibrinated was dispensed by sterile syringe into the hands, air-dried and immersed in the contamination fluid up to the mid-metacarpals. Bacterial sample were recovered for the inicial count by rubbing the fingertips of each hand for 1 min in the petri dish containing tryptone soya broth (TSB) . The hands were rubbed thoroughly over their entire surface (30 to 60 seconds) with 2 -3 ml of the test products. The reference product was used twice (total of 6 ml) and rubbed for 60 seconds. Both hands were rinsed in running water and excess water was drained off. Final bacterial count was obtained rubbing the fingertips of each hand for 1 min in the petri dish containing TSB. For both reference and test products, the mean log10 reduction factors (RF) were calculated (difference between the pre-value and post-value) and for testing the RF of the test products against that of reference product the Wilcoxon teste was used (level of significance was set at P=0,1, one sided) The RF log10 calculated were: 3,29 for the product A; 3,36 for the product B; 3,56 for the product C and 3,66 for the product D. The Wilcoxon test indicated that product A did not meet standard criteria (P = 0,074) and the products B (P = 0,198) and C (P = 0,826) met the EN 1500 requirement. As conclusion, this study indicated that the test products, used in hands with organic material, significantly reduced the transient flora, more than 3 log10 (99,9% of reduction), may be used for hand hygiene. These values are greater than the values of RF log10 after washing hands with plain soap (2,70) and triclosan (2,8) or similar or even exceeding when comparing with antimicrobial detergents used for hand washing, as PVP-I (3,5) or chlorhexidine 4% (3,1). Although the product A did not meet the EN 1500 criteria and had the lowest RF log10, its RF is superior to soaps (plain soap, triclosan and chlorhexidine 4%). This indicates a possibility of its usage as a second option.

Submitted by Ricardo Cedraz Duque Moliterno (ricardo.moliterno@uefs.br) on 2016-10-10T20:43:46Z No. of bitstreams: 1 DISSERTA??O FINAL - JANAINA MASCARENHAS - PDF.pdf: 6135751 bytes, checksum: 49e2f8bd4d781fa4a3090079dba67983 (MD5) / Made available in DSpace on 2016-10-10T20:43:46Z (GMT). No. of bitstreams: 1 DISSERTA??O FINAL - JANAINA MASCARENHAS - PDF.pdf: 6135751 bytes, checksum: 49e2f8bd4d781fa4a3090079dba67983 (MD5) Previous issue date: 2016-02-24 / Funda??o de Amparo ? Pesquisa do Estado da Bahia - FAPEB / The main goal of this work is to identify and describe relative clauses in 91 personal letters written between 1906 and 2000 by semi-illiterate Bahian inlanders, edited by Santiago (2012), who has called them unskilled hands (MARQUILHAS, 2000). From the analysis of the process of relative clauses construction by these writing-subject, it is intended to describe the relativizing strategies employed, observing either their similarity with popular variants of Brazilian Portuguese (TARALLO, 1983, 1993), or trying to understand whether these processes are similar to those in specific clauses of adults who are acquiring the written language, as relative clauses analyzed in studies of language acquisition by children (LESSA DE OLIVEIRA, 2008), or if it happens in both situations. To do so, the researchwas based on the theoretical assumptions of the Historical Linguistics (socio-historical perspective) as defined by Mattos e Silva (2008) and the Labovian Sociolinguistics theory (LABOV, 1972). / Esta disserta??o tem por objetivo identificar e descrever as senten?as relativas em 91 cartas pessoais, escritas entre 1906 e 2000 por sertanejos baianos semi-alfabetizados, editadas por Santiago (2012), que os define como in?beis (MARQUILHAS, 2000). A partir da an?lise do processo de constru??o das relativas por esses escreventes, pretende-se descrever as estrat?gias de relativiza??o utilizadas, observando ora a proximidade desses processos com as variantes populares do portugu?s brasileiro (TARALLO, 1983, 1993), ora buscando perceber se esses processos apontam para constru??es comuns de indiv?duos adultos em fase de aquisi??o de escrita, como constru??es pr?ximas ?s encontradas em estudos sobre aquisi??o, a exemplo do que ocorre com crian?as (LESSA DE OLIVEIRA, 2008), ou ainda, se ocorrem ambas as situa??es. Para tanto, foram mobilizados pressupostos te?ricos da Lingu?stica Hist?rica s?cio-hist?rica, nos termos definidos por Mattos e Silva (2008) e da Sociolingu?stica Laboviana (LABOV, 1972).

Cette thèse analyse la question relative au cas où, dans l'arbitrage international en matière d'investissements, dont le but principal est l'application des normes visées à la protection des investisseurs, l’État défendeur soutient que l'investissement pour lequel la protection est demandée a été obtenu au moyen d'une forme de criminalité. Dans ce contexte, la défense de l'illégalité soulevée par les État dans les contentieux d'investissement est de plus en plus courante. Cette défense fonctionne selon le schéma suivant : un État hôte enfreint les dispositions de fond que le droit international accorde aux investissements effectués dans un pays étranger, par exemple en expropriant un investisseur étranger de son investissement sans indemnité. Dans le différend qui s'ensuit devant un tribunal arbitral d'investissement, l'État défendeur invoque l'illégalité commise par l'investisseur lors de la réalisation de l'investissement pour se défendre contre la procédure arbitrale intenté contre lui. Le but principal de cette étude est celui de démontrer que des considérations systématiques de nature strictement juridique, aussi bien que de politique juridique, exigent que la défense d'illégalité dans l'arbitrage d'investissement soit strictement restreinte et qu'un tribunal ne puisse décliner d'exercer sa compétence / juridiction que dans des cas exceptionnels. Cette étude aboutit à la conclusion d'après laquelle les tribunaux d'arbitrage devraient plutôt examiner au cas par cas au stade du fond l'ensemble des circonstances soumises devant lui et procéder à une mise en balance appropriée entre les comportements de l'investisseur et ceux de l'État hôte. / This thesis addresses the question as to how an investment Tribunal is to react if, in the context of a case brought before it for breach of standards of protection of an investment, the respondent argues that the investment for which protection is sought has been secured by resorting to some form of criminality. Against this background, a defence by the Host State that has become increasingly common is the so-called Defence of Illegality. It operates on the basis of the following scheme : a Host State breaches the substantive provision that international law accord to investments made in a foreign Country, for instance by means of expropriating without compensation the investor's investment. In the ensuing dispute before an investment Tribunal, the defendant Host State raises the illegality committed by the investor in the making of the investment as defence against the breach of the substantive provisions on the protection of the investment, of which it is accused, to avoid responsibility. This thesis intends to demonstrate that both legal and policy consideration dictate that the Defence of Illegality in investment arbitration should be strictly curtailed and that a Tribunal should only decline to exercise its jurisdiction in exceptional cases. Rather, Tribunals should look at the entire set of circumstances at the merits stage and perform a proper balancing test between the conduct of the investor and the Host State.

近年來，全球氣候暖化問題嚴重，造成地球環境的變遷，加上能源安全威脅與經濟、環境永續發展的考量，世界各國對於節能減碳的議題日漸重視。車輛電動化即在減少溫室氣體排放、改善生活環境、加強能源安全及掌握產業發展轉型契機等因素驅動下，成為全球車輛發展的重要趨勢，全球電動車產業結構與產業網絡正在逐漸成形中。 本研究係針對全球主要國家政府在面對電動車這個新興產業發展時，所採取的政策進行分析與探討，並且以日本、美國、中國、德國政府政策為探討目標，從文獻回顧及專業機構報告中整理分析各國政府的產業政策，試圖探討政府的角色與定位，進一步描繪出台灣政府應該扮演的角色，並且提出建議，作為政府於制定產業政策時之參考，期能對電動車產業做出貢獻，讓台灣電動車產業在此波革命浪潮中，創造出更高的價值及競爭力。 本研究發現，電動車新興產業在發展過程中充滿許多經濟面、市場面、環境面以及技術面的發展限制，本研究在羅列出的十六項發展限制中，有高達十一項限制與政府的政策息息相關。汽車百年產業革命成功與否，業界對於政府是否能創造具有競爭優勢的發展環境要求殷切，於是在電池研發技術未臻成熟、產業各項標準尚未建立之際，各國政府紛紛伸出<看得見的那隻手>，從產業研究發展獎勵、消費市場購車、用車以及充電基礎建設普及的促成與補助，配合業者在關鍵技術發展的努力、商業模式的發展、產業群聚的形成、充電基礎建設的普及、維修體系的建置、社會大眾對於環境品質的需求、用車習慣的改變、電動車節能形象的認同……等種種助力，形成產業能量面的推升力量以及市場需求的拉力，形塑出電動車未來發展的良性循環，試圖在此領域內創造出比較優勢，促使這一波新的汽車產業革命形成。 　　值此關鍵時期，台灣政府如何提供本國產業一臂之力，期於未來世界汽車產業佔有一席之地？這是許多業者關心的議題。目前，各國政府紛紛制訂獎勵政策協助業者以及消費者對於電動車發展與使用的認同；尤其德國政府作法積極，從保持人民生活品質、解決石油倚賴問題、強化經濟傳統命脈的汽車工業，從環境結構、基礎設施到社會大眾的消費習慣宣導著手，具體規劃國家新經濟遠景，將德國塑造成世界電動車大國，這是非常值得台灣政府參考的典範。 本研究建議，電動車產業處發展初階段，眾家車廠以及各國政府皆在摸索前行中，台灣政府應參考各國政府政策後，了解台灣產業的優勢與機會，從基礎設施到新能源政策、基本軟硬體投資環境的建置著手，協助業者發展創造出友善的投資環境並且積極發展國內電動車運行，累積出屬於台灣自己的<台灣EV經驗>，協助業者強化電動車相關技術，除藉由電動車的普及來降低國內對於石油的依賴外，倘若能成功推行電動車成為國際典範，讓世界看到台灣先進的科技與環保觀念，提升國際形象，在時機成熟時，提供關鍵零件技術，利用中國的潛在市場，參與國際標準制定，創造出台灣電動車產業的發展空間。 / The worsening problem of global warming in recent years has led to the environmental changes on Earth. This fact, along with the emerging threats to energy security and the call for sustainable economic and environmental development, has drawn increasing worldwide attention on the issues of energy saving and carbon reduction. As a result, the EV (Electric Vehicle) industry is gaining increasing importance in the global automobile market, driven by various motives including reducing greenhouse gas emissions, improving living environment, safeguarding energy security and seizing the opportunities of industrial transformation. The industrial structure and network of the global EV market is gradually taking shape. The purpose of this research is to explore and analyze the policies adopted by the governments of the world’s leading countries on the emerging EV industry, focusing on Japan, the USA, China and Germany. By reviewing historical documents and professional reports, the author has probed the industrial policies of these countries, endeavoring to identify the roles of the governments in this process and, furthermore, to depict the roles and positions of the government of Taiwan. The author has also provided recommendations to the government for developing industrial policies, with the hope that the research results will contribute to the growth of the EV industry in Taiwan and the creation of higher value and competitive advantages in this revolutionary process. It is discovered in this research that a great deal of development restrictions are involved in the growing process of the emerging EV industry, respectively in the economic, market, environmental and technological fields. Among the sixteen development restrictions outlined in this research, there are as many as eleven items which are closely bound up with government policies. The success of this unprecedented industrial revolution, therefore, relies on whether the government can create a development environment with sufficient competitive advantages, which is anxiously longed for by the EV industry. Given the facts that the R&D technologies for the battery industry are not fully mature and various industrial benchmarks are yet to be established, the “visible hands” are offered by governments, one after another, to support the industry. These government initiatives include: providing incentives for industrial R&D, stimulating the consumer market, as well as facilitating and subsidizing the EV car use and recharging infrastructure. Other supportive policies include assisting the EV industry in developing key technologies, building up business models, shaping industrial clusters, expanding recharging infrastructure, establishing the maintenance/repair systems, accommodating to the public demand on environmental quality and the changes in car-using habits, promoting the identification with the energy-saving image of EV’s, etc. All these measures have turned into a pushing force that gives momentum to the industry, as well as a pulling force that booms the market. They contribute to forming a virtuous development cycle for the EV industry in future; help to create comparative advantages in this specific field; and make impossible this new wave of industrial revolution for automobiles. At this critical stage, how would the Taiwan government lend a helping hand so that the local EV industry could gain a stake in the international automobile market in future? This is an issue widely concerned by the industry. Now, many countries are offering incentive policies to help with the development of the industry and build up consumer identification with the electric cars. The German government, particularly, has taken aggressive actions. Apart from the efforts in maintaining/improving the life quality of its people, the government also endeavors to reduce the dependency on imported oil and strengthen the competitiveness of its automobile industry, which is vital to the economic growth of the country. To realize the new economic vision of the country, the German government has developed specific plans, covering various initiatives including environmental structure, infrastructure construction and consumer education, etc. The purpose is to make Germany a leading country for the EV industry. These we believe are the “best practices” to be considered by the Taiwan government. The EV industry is yet at its preliminary stage of development. Governments, as well as EV manufacturers around the world, are all endeavoring to find the right path ahead. It is recommended, therefore, that the government of Taiwan should firstly study the policies of other countries and understand the strengths and weakness of local industries. The initial efforts should be focused on constructing infrastructures, setting up new energy policies and installing the fundamental software/hardware for a friendly investment environment, so as to support the growth of the industry. The government should, in the meantime, actively promote the electric vehicles in the domestic market, build up the unique “EV Experience of Taiwan” to help improving the relevant EV technology for the local industry. Apart from reducing the country’s dependency on imported oil, the successful popularization of EV in Taiwan will also become one of the best practices in the world and contribute to the elevation of Taiwan’s international image, having showcased its advanced technologies and strong environmental awareness. With increasing sophistication, Taiwan’s EV industry also has the capabilities to provide critical spare parts technologies and to play a role, through the potential China market, in the international standard-setting process, thereby creating further expanding possibilities for the industry.

The goal of this study was to develop a quality tool for Nutrition and Dietetics Hospital Services and evaluate the hygienic sanitary conditions of these places before and after the implementation of this tool, according to the view of the internal and external auditor. Also, to evaluate the satisfaction of the internal auditors regarding the tool, check the hygienic sanitary conditions of the hands of manipulators and surfaces in contact with food after improvements and training and evaluate the satisfactionf the patients regarding the meals served after implementation of the tool. This research was divided in three studies (1 - preparation and implementation of the tool; 2 - Review of the hygienic sanitary conditions of the hands and contact surfaces; 3 - evaluation of the satisfaction of patients regarding the meals served). The sample was composed by 15 Nutrition and Dietetics Hospital Services. To establish the quality tool, we used the requirements of the laws and regulations of Brazil. The tool is composed by four support instruments, divided in: 1 - Evaluation and quality planning; 2 - A guide for the development of the Manual of Best Practices; 3 - A guide for the development of Standard Operating Procedures and Instrument; 4 - A guide for the development of the Essential Operational Controls. After the development of the tool, we performed an initial evaluation of the hygienic sanitary requirements at each site through the application of the Instrument 1 by the internal and external auditor. The technician responsible for the Nutrition and Dietetics Hospital Services was considered the internal auditor and the external auditor was a professional with experience in the food area, which evaluated all the locations. After the implementation, the internal auditors received the results of the external auditor and other instruments of the tool, and the deadline of one year for the implementation was stipulated. At the end of the deadline, the internal and external auditors applied again the instrument 1. Then, the internal auditors completed a questionnaire to evaluate their satisfaction regarding the quality tool. The evaluation of the hygienic sanitary conditions of the hands and contact surfaces was divided into two stages. First, we evaluated the requirements of hygiene and microbiological analyzes on hands and contact surfaces. Then, the locations received the results and recommendations of adequacy, which were asked to be fulfilled in two months. After this, the local that showed improvements participated in the second stage, with training and new collection of microbiological analyzes. To evaluate the satisfaction of the patients regarding the meals served, we prepared a questionnaire with classifications sucha as: Great; Fair and Poor. In the evaluation of the internal auditors, the instruments were considered Great. After the implementation of the tool there was significant increase in the percentage of overall suitability and requirements, both in the evaluation of the internal external auditor. It was found that in the percentage of overall suitability, before the application of the tool, there was a statistically significant difference in the evaluation between the auditors, and this fact was not observed after the application of the tool. In the evaluation of the meals served, it was found that in the overall average, the requirements were considered Great. It is concluded that the quality tool was effective in adjusting the criteria for the hygienic sanitary control in Nutrition and Dietetics Hospital Services, according to the view of the internal and external auditors and helped in the understanding of the internal auditors, provided a more critical view of the requirements and decreased differences between evaluators. It is seen that the hygienic sanitary conditions of the hands and contact surfaces got better. After the improvement, the patients were satisfied with the meals served due to the implementation of the tool. / O objetivo foi elaborar uma ferramenta de qualidade para Serviços de Nutrição e Dietética Hospitalar e avaliar as condições higiênico-sanitárias desses locais, antes e após a implementação desta ferramenta, na visão do auditor interno e externo. Avaliar a satisfação dos auditores internos, quanto à ferramenta. Verificar as condições higiênico-sanitárias das mãos dos manipuladores e superfícies em contato com os alimentos, após melhorias e capacitação e avaliar a satisfação dos pacientes quanto às refeições servidas, após implementação da ferramenta. Esta pesquisa foi dividida em três estudos (1- elaboração e implementação da ferramenta; 2 avaliação das condições higiênico-sanitárias das mãos e superfícies de contato; 3 avaliação da satisação dos pacientes, quanto as refeições servidas). A amostra foi composta por 15 Serviços de Nutrição e Dietética Hospitalar. Para a elaboração da ferramenta de qualidade utilizou-se os requisitos das legislações e normas do Brasil. A ferramenta foi composta por quatro instrumentos de apoio, sendo divididos em Instrumento 1 Avaliação e planejamento da qualidade; Instrumento 2 Roteiro para elaboração do Manual de Boas Práticas; Instrumento 3 - Roteiro para elaboração dos Procedimentos Operacionais Padronizados e Instrumento 4 Roteiro para elaboração dos Controles Operacionais Essenciais. Após a elaboração da ferramenta, realizou-se a avaliação inicial dos requisitos higiênico-sanitários em cada local, através da aplicação do Instrumento 1, pelo auditor interno e externo. O responsável técnico do Serviço de Nutrição e Dietética Hospitalar foi considerado o auditor interno, e o auditor externo um profissional com experiência na área de alimentos, que avaliou todos locais. Após aplicação, os auditores internos receberam os resultados da avaliação do auditor externo e os demais instrumentos da ferramenta, sendo estipulado o prazo de um ano para sua implementação. No final do prazo, o auditor interno e externo aplicaram novamente o instrumento 1. Após, os auditores internos preencheram um questionário para avaliar sua satisfação quanto à ferramenta de qualidade. A avaliação das condições higiênico-sanitárias das mãos e superfícies em contato foi dividida em duas etapas. Primeiramente, realizou-se avaliação dos requisitos de higienização e análises microbiológicas nas mãos e superfície em contato. Após, os locais receberam os resultados e recomendações de adequação, sendo estipulados dois meses para adequar-se. Posteriormente, os locais que realizaram as melhorias, participaram da segunda etapa, sendo realizada capacitação e nova coleta das análises microbiológicas. Para avaliar a satisfação dos pacientes quanto às refeições servidas, elaborou-se um questionário, sendo classificadas como: Ótimo; Regular e Ruim. Na avaliação dos auditores internos, os instrumentos foram considerados Ótimos. Após a implementação da ferramenta houve um aumento significativo no percentual de adequação geral e dos requisitos, tanto na avaliação do auditor interno e externo. Verificou-se que no percentual de adequação geral, antes da aplicação da ferramenta, houve diferença estatisticamente significativa na avaliação entre os auditores, sendo esse fato não constatado, após a aplicação da ferramenta. Na avaliação das refeições servidas, constatou-se que na média geral, os requisitos foram considerados Ótimo. Conclui-se que a ferramenta de qualidade foi eficiente na adequação dos critérios para o controle higiênico-sanitário em Serviços de Nutrição e Dietética Hospitalar, na visão dos auditores interno e externo e auxiliou no conhecimento dos auditores internos, proporcionou uma visão mais crítica dos requisitos e diminuiu as divergências entre os avaliadores. Constata-se que as condições higiênico-sanitárias das mãos e superfície em contato, melhoraram após as melhorias da lista avaliação e capacitação e pacientes encontraram-se satisfeitos com as refeições servidas, após a implementação da ferramenta.

Indiscutivelmente, higiene de mãos (HM)é uma das medidads mais importantes para prevenir as Infecções Hospitalares. Além da tradicional lavagem com água e sabão, o uso do álcool tem se destacado na HM, pois, possui boa atividade antimicrobiana, dispensa pia, reduz o tempo e previne ressecamento de mãos. Das evidências científicas sobre seu uso na HM, ainda há contradições quanto à sua efetividade na presença da matéria orgânica nas mãos. Esta pesquisa foi desenvolvida com intuito de elucidar esta questão avaliando a eficácia antimicrobiana de três formulações alcoólicas (duas em forma de gel e uma líquida) nas mãos com matéria orgânica. Os trabalhos laboratoriais foram realizados no Laboratório de Pesquisas do Instituto de Ensino e Pesquisas (coleta de amostras bacterianas) e no Laboratório de Microbiologia do Departamento de Patologia Clínica do Hospital Albert Einstein (contagem bacteriana), utilizando a metodologia oficial Européia - EN 1500 modificada. Quatorze voluntários - pessoas saudáveis, sem problemas de pele nas mãos e que asinaram o \"Termo de Consentimento Livre e Esclarecido\", foram aleatorizados em três grupos e cada grupo utilizou os proidutos-testes e referência em seqüências diferentes. Os produtos-teste foram: produto A - alcool etílico sob a forma de gel a 62% (p/p), produto B - álcool etílico sob a forma de gel a 70%(p/p) e produto C - álcool etílico a 70% (p/v) glicerinado sob a forma líquida e o produto D - alcool 2-propanolol 60%, produto referência padronizado pela metodologia EN 1500. Para cada produto-teste e referência, foi realizada a seguinte seqüência de procedimentos: lavagem de mãos por um minuto com água e sabão; aplicação de 1,2 ml de sangue estéril desfibrinado de carneiro; contaminação das mãos até metade dos matacarpos no caldo tríptico de soja (TSB) com o microrganismo-desafio S. macescens ATCC 14756; coleta de amostras pré HM, friccionando os dedos na placa de Petri contendo TSB (valor inicial); HM aplicando o(s) produto(s)-teste e referência; coleta de amostras para recuperação bacteriana (valor final), com a mesma técnica da fase pré HM e cálculo do fator de redução (FR) logarítmica (log10) de S. marcescens (valor inicial - valor final). Foram realizadas análises estatísticas (teste de Wilcoxon) para verificar a equivalência entre o(s) produto(s)-teste e referência, com o nível de significância estabelecido em P=0,10, unicaudal. Os FR (log10) foram: 3,29 para o rpoduto A; 3,36 para o produto B e 3,56 para o produto C. O produto-referência, produto, produto D, promoveu FR log10 de 3,66. Os testes de Wilcoxon indicaram que há equivalência dos produtos B (P=0,198) e C (P=0,826) com o produto referência D, e que existe diferença do produto A (P=0,074) quando comparado ao produto D. Como conclusão, este estudo revelou que os produtos-teste, utilizados em mãos artificialmente sujas com matéria orgânica reduziram significativamente a colonização transitória das mãos - mais de 3 log10, redução acima de 99,9% podendo ser utilizados para HM. Estes valores são superiores aos valores de FR log10 encontrados após a lavagem de mãos com sabão não-antimicrobiano(2,7) e sabão antimicrobiano tricosan (2,8) e semelhantes aos valores de PVP-I (3,5) e clorexidina degermante (3,1). O produto A, apesar de reprovado pela metodologia oficial EN 1500, obteve o menor FR log10 (3,26), é superior aos sabões não-antimicrobianos e com triclosan e clorexidina degermante a 4%, o que indica a possibilidade de sua utilização como segunda opção. / Hand hygiene is considered the most important measure to reduce the transmission of nosocomial pathogens in health care settings. Because alcohol has excellent antimicrobial activity, requires less time, results in less skin irritation and does not require proximity to a sink, is the preferred agent for hand hygiene. In the face of scientific evidence, there\'s still contradiction concerning the effectiveness of alcohol in the hands with proteinaceous material. This research was developed in order to compare the antimicrobial activity of three alcoholic products commonly used (two alcohol-based gel and one liquid formulation) in the hands with organic material. It was conducted in the Research Laboratory (bacterial samples) and in the Microbiology Laboratory of the Clinical Pathology Department (bacterial counting) of the Hospital Albert Einstein, using modified European Standard EN 1500. The test products were: A - ethanol alcohol-based gel 62% (p/p), product B - ethanol alcohol-based gel 70% (p/p) and product C - ethanol alcohol-based liquid 70% (p/v) with glycerol 2% compared to reference product: D - alcohol 2-propanolol 60% (v/v) on artificially contaminated hands with S. marcescens ATCC 14756, using a cross-over design. Fourteen healthy volunteers, with no skin hand problems and who signed written consent form were randomized in 3 groups. For each reference and test products, the following sequence was carried through: hands were washed with soft soap, 1,2 ml of sterile sheep blood defibrinated was dispensed by sterile syringe into the hands, air-dried and immersed in the contamination fluid up to the mid-metacarpals. Bacterial sample were recovered for the inicial count by rubbing the fingertips of each hand for 1 min in the petri dish containing tryptone soya broth (TSB) . The hands were rubbed thoroughly over their entire surface (30 to 60 seconds) with 2 -3 ml of the test products. The reference product was used twice (total of 6 ml) and rubbed for 60 seconds. Both hands were rinsed in running water and excess water was drained off. Final bacterial count was obtained rubbing the fingertips of each hand for 1 min in the petri dish containing TSB. For both reference and test products, the mean log10 reduction factors (RF) were calculated (difference between the pre-value and post-value) and for testing the RF of the test products against that of reference product the Wilcoxon teste was used (level of significance was set at P=0,1, one sided) The RF log10 calculated were: 3,29 for the product A; 3,36 for the product B; 3,56 for the product C and 3,66 for the product D. The Wilcoxon test indicated that product A did not meet standard criteria (P = 0,074) and the products B (P = 0,198) and C (P = 0,826) met the EN 1500 requirement. As conclusion, this study indicated that the test products, used in hands with organic material, significantly reduced the transient flora, more than 3 log10 (99,9% of reduction), may be used for hand hygiene. These values are greater than the values of RF log10 after washing hands with plain soap (2,70) and triclosan (2,8) or similar or even exceeding when comparing with antimicrobial detergents used for hand washing, as PVP-I (3,5) or chlorhexidine 4% (3,1). Although the product A did not meet the EN 1500 criteria and had the lowest RF log10, its RF is superior to soaps (plain soap, triclosan and chlorhexidine 4%). This indicates a possibility of its usage as a second option.