Submitted by admin tede (tede@pucgoias.edu.br) on 2018-10-17T19:47:56Z No. of bitstreams: 1 CLÁUDIA VARÃO DA CUNHA.pdf: 2356352 bytes, checksum: a297816df85722edef287690ba509017 (MD5) / Made available in DSpace on 2018-10-17T19:47:56Z (GMT). No. of bitstreams: 1 CLÁUDIA VARÃO DA CUNHA.pdf: 2356352 bytes, checksum: a297816df85722edef287690ba509017 (MD5) Previous issue date: 2017-11-27 / The Tegumentary Leishmaniasis Americana is one of the most important skin affections in Brazil, not only for the high frequency, but also by causing anatomical deformities. This study aimed to analyze the eco-epidemiological profile of Tegumentary Leishmaniasis Americana (TLA) in the region of Tocantina, in the period between 2007 to 2016. This region belongs to the administrative area of the State of Maranhão, in the Northeast of Brazil, and is located in the extreme west of the State. This is a descriptive epidemiological study that used a quantitative approach. Reported cases of TLA were registered in the region of Tocantina in the period of 2007 to 2016. The study population comprised 100% of the reported cases of Tegumentary Leishmaniasis Americana. The results showed that there was a decrease in the number of cases during this period, and that 2016 presented with the lowest number of reported cases. The municipalities most affected were Imperatriz and Itinga do Maranhão. The demographic profile of the TLA cases consisted of brown male subjects with low educational level and age between 30 to 59 years. Concerned to the type of input and the clinical form registered, the cases were classified as new cases, with a few cases of recurrence. As regards to epidemiological classification, it was observed that the cases were imported, since the infection occurred outside the area of residence of the affected subjects. With respect to the diagnosis, in most cases it was achieved through direct parasitological examination. However, it was possible to note that in a significant number of cases this exam was not completed, as well as the Montenegro Intradermoreação (MIDR) and the histological analysis. In relation to the evolution of the TLA cases, the cure was notified, and the death cases were related to other causes. Based on the results, it was possible to conclude that the cases of LTA are under-reported in the studied region, and that failure in diagnosis, prevention and control of the disease are observed, requiring more attention from the health managers, since the region is highly endemic. / A Leishmaniose Tegumentar Americana é uma das infecções dermatológicas mais importantes no Brasil, não somente pela frequência, mas também pelas deformidades que causam. Diante disso, o estudo teve por objetivo analisar o perfil ecoepidemiológico da Leishmaniose Tegumentar Americana (LTA) na Região Tocantina, período de 2007 a 2016. Essa região consiste numa área administrativa do estado do Maranhão, localizada no extremo oeste do Estado. Trata-se de um estudo com enfoque ecoepidemiológico descritivo com abordagem quantitativa, dos casos notificados de LTA na Região Tocantina no período de 2007 a 2016. A população estudada foi de 100% dos casos notificados de leishmaniose tegumentar americana. Os resultados revelaram que houve uma diminuição no número de casos de LTA nesse período, e que o ano de 2016 apresentou o menor número de casos notificados. Os municípios mais afetados da região foram Imperatriz e Itinga do maranhão. Quanto ao perfil sociodemográfico dos casos de LTA consistia em homens, pardos, com baixa escolaridade e faixa etária entre 30 a 59 anos. Em relação ao tipo de entrada e a forma clínica observou-se que eram casos novos, com poucos casos de recidiva e na forma cutânea. No que se refere à classificação epidemiológica dos casos observou-se que eram casos importados, pois a infecção ocorreu fora da zona de residência do indivíduo afetado. No que tange ao diagnóstico, na maioria dos casos foi feito por meio do exame parasitológico direto. Porém, foi possível observar um número significante de casos em que não ocorreu a realização deste exame, como também a Intradermorreação de Montenegro (IDRM) e o histopatológico. Em relação à evolução da LTA, os casos apresentaram cura, e os óbitos notificados tinham relação com outras causas. Diante dos resultados, conclui-se que há subnotificações dos casos de LTA, bem com falhas no diagnóstico, prevenção e controle da doença, o que exige melhorias por parte dos gestores, uma vez que a região é altamente endêmica.

Postoperative surgical site infections are common complications in the operating room. Infections prolong hospital stays, heighten costs, and increase morbidity and mortality. The purpose of this evidence-based quality improvement project was to develop policy, program, and practice guidelines to prevent surgical site infections in vascular surgery patients. Rosswurm and Larrabee's change model was used to develop materials using the best evidence for the recommended practice changes. The Plan, Do, Check, Act model was selected to guide quality improvement. The project goal was to decrease the surgical site infection rate to below the national average. Products of the project include policy, protocol, and practice guidelines developed based on recommended practices of the Association of periOperative Registered Nurses and current peer-reviewed literature. An interdisciplinary project team of institutional stakeholders was used to insure context-relevant operationalization of the evidence in practice. The team was assembled, led in a review of relevant literature, and convened regularly until project products were finished. Three scholars with expertise in the content area were then identified by the project team and asked to validate the content of developed products. Products were revised according to expert feedback. Implementation and evaluation plans were developed by the project team to provide the institution with all necessary process details to carry out the practice change. The evaluation plan advises using a retrospective chart review to compare rates of infection between patients receiving chlorhexidine skin preparation with showers and preoperative chlorhexidine cloths alone. A positive outcome could contribute to positive social change by decreasing preventable infections.

The overall aim of this research was to explore why some hospitals are more successful than others at reducing the acquisition rates of multidrug-resistant organisms. Using a socio-ecological perspective on health systems adapted from works in ecological restoration, ecosystems management, and healthcare, a participatory comparative case study design was employed. The study was collaboratively conducted on a surgical unit at a Netherlands hospital with very low rates of multidrug-resistant organisms and a surgical unit in a Canadian hospital with higher rates of these pathogens. The cases were selected on the basis that they were both academic health sciences centres of similar size in publicly funded systems; yet, they reported differing rates of MDRO infections. Research methods included a total of six unit observations, nine practitioner-led photo walkabouts of the units (n=13), six photo elicitation focus groups with practitioners (n=26), and the review of relevant policies and procedures and related infection prevention and control data. Common findings across both cases include the perceived importance of engaged leadership, the presence of environmental design issues, a lack of antibiotic prescribing restrictions, and the frequent use of workarounds that may be problematic for infection prevention and control. Disparate findings between cases include differences in ratios of hospital beds per capita, bed occupancy rates, staffing practices, equipment cleaning processes, bed cleaning systems (centralized versus manual) and the presence, in one hospital, of an active grass roots Hygiene in Practice group engaging practitioners in several ongoing activities to promote infection prevention and control. There is a lack of comparable findings between the two cases on hand hygiene audit protocols, surveillance strategies, reporting of acquisition rates, and the nature and extent of high risk populations for community-acquired methicillin-resistant Staphylococcus aureus in the two hospitals catchment areas. The findings and methodological challenges identified in this study suggest that case selection in future comparative infection prevention and control case studies should be based on an expanded list of criteria. These criteria should include comparable audits, surveillance, and reporting practices and comparable demographic and other relevant data, such as data on the agricultural practices within and demographic attributes of vulnerable populations within the hospital catchment areas.

Infectious diseases control is one of the most important medical issues since the outbreak of SARS. The Hong Kong and China governments are awaked from the miserable event and a series of reforms relevant to infection control and public hygiene are thus established in order to face further challenges and potential threat in the future. In terms of strengthening health care system, re-orientation of healthy public policy, increment of community participation, building personal health skills as well as reinforcement of global communication and cooperation, there are drastically improvements regarding capacity for combating hazards due to emergence of novel infectious agents and diseases in both regions. This literature review aims to portrait current operating measures for infection control and public health practices in Hong Kong and the mainland China, and provides evaluation of the effectiveness and feasibility of these activities. / published_or_final_version / Public Health / Master / Master of Public Health

No description available.

The aim of this study is to investigate similarities and dissimilarities in the preschools work to prevent infections through hygiene in a municipality. The study was done through a survey of handhygiene among preschool-pedagogues and by analysing written instructions in the preschools and how these are being followed. The results from the survey show that both similarities and dissimilarities exist, both between and within preschools in the municipality. Most pedagogues wash their hands after changing diapers and before eating meals, but not before eating fruits. There is a considerable variation both within and between preschools in their use of handdesinfection and handglowes. Handhygiene instructions for pedagogues and children are missing in many preschools. The response from preschool headmasters to written hygiene instructions was low. Current written instructions in handhygiene could be more detailed. The education in handhygiene among pedagogues has shortages. / Syftet med studien är att undersöka likheter och olikheter i hur handhygien används i det smittförebyggande arbetet på förskolor inom en kommun. Studien görs genom en enkätundersökning om handhygien bland pedagoger samt genom att undersöka vad som står i de skriftliga hygienanvisningarna på förskolorna och hur dessa efterföljs. Resultatet från enkätundersökningen visar att både likheter och olikheter finns såväl mellan som inom förskolorna i kommunen. De flesta pedagoger tvättar händerna efter blöjbyten och före mat, detta gäller dock inte handtvätt då frukt ska ätas. Det föreligger stora skillnader både inom och mellan förskolorna då handdesinfektion och användning av handskar är aktuella. En tredjedel av pedagogerna anser att skriftliga anvisningar om handhygien saknas. 38 % av förskoleavdelningarna anser att det saknas skriftliga rutiner för barnens handhygien. Svarsfrekvensen från förskolecheferna på skriftliga hygienanvisningar var låg. Aktuella anvisningarna om handhygien kunde vara mer utförliga. Utbildning inom handhygien bland pedagogerna har brister.

Many severe clinical conditions encountered in Africa involve the effects of iron overload on diseases (AIDS, TB etc) and vital organs (e.g., liver). To intervene successfully in the HIV pandemic, knowledge of AIDS pathogenesis and factors that stimulate or inhibit viral replication are crucial. Iron overload is believed to cause serious damage during HIV infection. Indeed, it is believed that the metal is required by infected cells to synthesize viral particles. The consequences of excess iron in vivo include the stimulation of microorganism growth, an increase in oxidative stress and an impairment of immune system function. Iron chelation have been reported to modulate some of these effects. In a project designed to assess the effect of in vitro iron overload (also synonymously referred to as iron loading) on HIV infection, cells (HIV-infected and controls) were directly loaded with iron and desferrioxamine (DFO, an iron chelator) respectively or combined. We then performed experiments to investigate the effects of these chemicals on host cell defenses and viral replication. Effective iron loading of all cell lines used was confirmed by emission spectroscopy. Through viability assays using tetrazolium salts, flow cytometric analysis of apoptosis and necrosis using Annexin-V, and specialised ELISAS; the effect of iron loading on host cell viability, survival or death and cytokine production was studied. The effect of iron loading on virus infectivity was also investigated by looking at core protein (p24) levels and reverse transcriptase (RT) activity. Prior to the start of the bioassays, several dyes were compared during identical procedures to find an effective and consistently functional dye assay for the assessment of cell growth/viability or proliferation. Viability assays provided a qualitative picture of events while flow cytometric analysis allowed us to compare viability with specific types of cell death (apoptosis/necrosis). Excess iron in the form of 500ƒÝM FeSO4-7H2O in addition to serum iron was found to be non-toxic to cells alone but detrimental to HIV-infected cells. Equimolar amounts of DFO inhibited cell growth, cytokine production and viral replication. Our results indicate that Fe loading stimulates viral replication. Iron chelation on the other hand decreased HIV replication suggesting a possible area for further therapy research using iron chelators in situations of iron loading in the presence of HIV/AIDS. / Dr. Debra Meyer

Infections are a major source of morbidity and cause of mortality during the post-operative phase for patients. Wound infections are the second most commonly encountered type of nosocomial, hospital-acquired, infection in the United States (Nichols, 2007:8). Owing to the fact that wound infection may be induced, such as, by not applying infection control and sterile technique principles in the operating room complex, it is imperative to implement infection control principles and apply sterile technique principles. The researcher noticed that some of the sterile technique principles were not carried out in the operating room complex which lead to the necessity to assess the knowledge of registered nurses’ regarding the implementation of infection control and sterile technique principles. The main goal of the study was to explore and describe the knowledge of registered nurses’ in two private hospitals in the Nelson Mandela Metropole, related to infection control and sterile technique principles in the operating room complex. Following the analysis of the data, the researcher made recommendations for changes to be made to the existing infection control guidelines in the operating room complex. The research design was quantitative, explorative, descriptive and contextual in nature. The sample consisted of all the registered nurses known as scrub nurses, in the operating room complex. The unit managers were excluded from the study, because the researcher utilized their assistance with the handing out and collecting of the questionnaires because, not all scrub nurses were at work at the same time. Firstly a pilot study was conducted (in both private hospitals) to confirm the reliability of the data collection instrument. Data was collected by means of a questionnaire that was self-administered and consisted out of three sections: Section A – Biographical Data; Section B – Knowledge Base Related to Infection Control Principles and Section C – Knowledge Base Related to the Principles of Asepsis. The researcher consulted experts to ensure the reliability and validity of the questionnaires and to ensure that the iv questionnaires would measure what it is intended to measure and that it will remain consistent. The data obtained from the questionnaires was analyzed by means of statistical and inferential analysis and included descriptive statistics with the assistance of a statistician. Following the analysis of the data, recommendations for changes to be made to the existing infection control guidelines in the operating room complex was made. This was done with relevant literature and the guidelines were discussed with experts in the field. The researcher ensured that all the legal and ethical requirements, such as the participants’ right to privacy, were maintained throughout the study.

Aim: To assess and compile current knowledge and recommendations forinfection prevention and control (IPC) in dentistry during the COVID-19pandemic. Furthermore, to assess whether previous knowledge about IPC hascontributed to constructing evidence-based measures for IPC that can beuniversally applicable. Also, identifying knowledge gaps that need to beaddressed regarding IPC to be used effectively in future pandemics.Method: Searches were made in PubMed, Web of Science, Scopus, Cochrane,and Embase, according to PRISMA guidelines. There were no time or publicationtype restrictions. Studies that met the inclusion criteria were read in full text andresulted in 44 included articles. Quality assessment and risk of bias (RoB) wereperformed using checklists by AMSTAR-2 and ROBIS.Results: The four main recommended measures for IPC in dentistry were: triage,personal protective equipment, antimicrobial mouthwash before the procedure,and surface disinfection. Most of the included studies were literature reviews withlow quality and a high RoB.Conclusion: Measures taken during this pandemic were based on evidence,previous knowledge, and subjective opinions. However, there were limitations inthe included studies as their evidence was of lower quality and had a high RoB.Future research is needed to minimize the risk of infection spreading in dentistryduring the pandemic. The lack of research on SARS-COV-2 was considered aknowledge gap that should be addressed to be used effectively in futurepandemics. This present study shows that IPC policies were to some extent basedon evidence but not regarding the current virus. / Syfte: Syftet med studien var att bedöma och sammanställa nuvarandekunskapsläget samt rekommendationerna för infektionspreventionen och kontroll(IPC) inom tandvården under COVID-19 pandemin. Vidare var syftet attgenomföra en bedömning av huruvida tidigare kunskap om infektionspreventionhar bidragit till att konstruera evidensbaserade åtgärder för infektionspreventionsom kan bli universellt applicerbara. Dessutom, att identifiera kunskapsluckorsom behöver åtgärdas gällande infektionsprevention och kontroll för att effektivtkunna användas för framtida pandemier.Material och metod: Sökningar gjordes i PubMed, Web of Science, Scopus,Cochrane och Embase, enligt PRISMA riktlinjer. Det fanns inga tids- ellerpublikationstypsbegränsningar. Studier som uppfyllde inklusionskriterierna lästesi fulltext och resulterade i 44 inkluderade artiklar. Kvalitetsbedömning och riskenför bias av de inkluderade studierna utfördes med hjälp av checklistor avAMSTAR-2 och ROBIS.Resultat: De fyra främsta rekommenderade åtgärderna för IPC inom tandvårdenvar: triage, personlig skyddsutrustning, antimikrobiell munsköljning föreproceduren samt ytdesinfektion. De flesta av de inkluderade studierna varlitteraturöversikter med låg kvalitet och hög risk för bias.Slutsats: Åtgärder som vidtogs under denna pandemi baserades på både bevis ochtidigare kunskap men också subjektiva åsikter. Det fanns dock begränsningar i deinkluderade studierna på grund av att deras evidens inte var av god kvalitet samthade en hög RoB. Framtida forskning behöver göras för att minimera risken förinfektionsspridning inom tandvården under COVID-19-pandemin. Brist påforskning om SARS-COV-2 ansågs vara en kunskapslucka som måste åtgärdasför att effektivt kunna användas för framtida pandemier.

Many airborne diseases such as Coronavirus variants are spread from person to person by indoor air movement. This is of particular concern in healthcare environments such as hospitals. There is a significant body of research that suggests that indoor ventilation strategies such as personalized ventilation systems my help reduce the spread of these viruses. While there are studies related to the efficacy of air movement from personalized ventilation, there are very few studies that explore how best to integrate these systems into the design process for hospital patient rooms. This study focuses on how to integrate personalized ventilation (PV) and displacement ventilation (DPV) systems into patient room design. The aims of this study are to first, develop a procedure using the Choosing By Advantages approach to make design decisions related to the implementation for personalized ventilation and displacement ventilation in private and semi-private patient rooms to prevent cross-infection. Secondly, using this approach, design solutions are proposed for patient room layouts with PV and DPV in different locations. The study proposes the best locations and components of the PV and DPV ventilation air supply and exhaust. Further practical models/simulation rooms are required to test the impact of PV systems on patients' and nurses' daily activities. / Master of Science / Many airborne diseases such as Coronavirus variants are spread from person to person by indoor air movement. This is of particular concern in healthcare environments such as hospitals. New personalized ventilation systems place ventilation air directly at the patient bed and consequently can reduce the spread of these viruses by effectively managing in-room air movement. This study explores how best to make design decisions for the implementation of personalized ventilation systems into hospital patient rooms. Applying this decision-making approach, design solutions are proposed that integrate personalized ventilation with commonly used displacement ventilation in patient rooms.