Submitted by Debora Cristina Paulela null (deborapaulela@fmb.unesp.br) on 2016-04-26T19:50:22Z No. of bitstreams: 1 dissertação final 25 abril 2016 - Debora Paulela.pdf: 12506409 bytes, checksum: 45cdb3803d7c8e715c69e23e171fff62 (MD5) / Approved for entry into archive by Felipe Augusto Arakaki (arakaki@reitoria.unesp.br) on 2016-04-28T19:03:32Z (GMT) No. of bitstreams: 1 paulela_dc_me_bot.pdf: 12506409 bytes, checksum: 45cdb3803d7c8e715c69e23e171fff62 (MD5) / Made available in DSpace on 2016-04-28T19:03:32Z (GMT). No. of bitstreams: 1 paulela_dc_me_bot.pdf: 12506409 bytes, checksum: 45cdb3803d7c8e715c69e23e171fff62 (MD5) Previous issue date: 2016-02-26 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Introdução. Banho no leito é um procedimento executado rotineiramente pela equipe de enfermagem, para atender às necessidades de higiene e conforto. Infere-se a técnica convencional, com uso de baldes, bacias, água, sabonete, luvas e compressas, contribuir para aumento das taxas de infecção hospitalar. A tecnologia descartável para banho no leito propõe prevenir contaminação de uma área corporal com microrganismos provenientes de outra, assim como infecções cruzadas. Objetivo. Avaliar a efetividade dos banhos no leito convencional e descartável sobre a microbiota do paciente hospitalizado, assim como a estimativa de tempo de execução e custo dos mesmos. Métodos. Pesquisa clínica, prospectiva, caso-controle, randomizada, aprovada pelo Comitê de Ética em Pesquisa e Registro Brasileiro de Ensaio Clínico (ReBEC). Realizou-se este estudo na Unidade de Acidente Vascular Cerebral do Hospital das Clínicas da Faculdade de Medicina de Botucatu, com amostra de 40 pacientes acamados e randomizados em dois grupos com 20 participantes: grupo A (controle - banho no leito convencional) e grupo B (intervenção - banho no leito descartável). A tecnologia avaliada foi da marca Bag Bath®. Invólucro contendo oito compressas pré-umidificadas com água, surfactantes não iônicos, vitamina E, dexpanthenol, conservantes e fragrâncias, destinadas uma para cada área do corpo. Resultados. Pode-se comprovar a efetividade da tecnologia descartável para banho no leito, sobre a evolução da microbiota da pele de pacientes hospitalizados. Uma vez que, 90% dos participantes que receberam exclusivamente a intervenção, tiveram a pele protegida de bactérias colonizadoras, ao contrário dos submetidos ao banho no leito convencional, que apresentaram 80% das culturas positivadas. Análise estatística demonstrou que, enquanto a carga microbiana dos participantes do Grupo B reduziu com a intervenção descartável, aumentou significantemente nos do Grupo A, que haviam recebido banhos no leito convencional (p<0,001). Conclusões. O banho no leito com uso de tecnologia descartável, da marca testada, mostrou-se significantemente efetivo sobre a carga microbiana da pele de pacientes hospitalizados, quando comparado ao banho convencional. Refutou-se as hipóteses do banho no leito descartável apresentar tempo de execução e custo menores, quando comparado com o convencional. Recomenda-se a realização de novos estudos sobre essas variáveis, por entende-las importantes no dimensionamento de recursos humanos em enfermagem, assim como na decisão por escolhas de insumos hospitalares. / Introduction. Bed bath is a procedure performed routinely by nursing staff to meet the needs of hygiene and comfort. A conventional technique is inferred, using buckets, basins, water, soap, gloves and pads, contributing to increased hospital infection rates. The disposable bed bath technology proposes to prevent contamination of a body area with microorganisms from another, and cross-infection. Goal. Evaluate the effectiveness of the baths in conventional and disposable bed on the microbiota of hospitalized patients, as well as the estimated run time and cost thereof. Methods. Clinical, prospective, case-control, randomized research, approved by the Research Ethics Committee and Brazilian Registry of Clinical Trial (Rebec). We conducted this study in Stroke Unit of the Hospital of the Botucatu School of Medicine, with sample of 40 bedridden patients randomized into two groups with 20 participants: group A (control - bath in the conventional bed) and group B (intervention - bath in disposable bed). The technology of the brand Bag Bath was evaluated®. Containing eight pads pre-moistened with water, nonionic surfactants, Vitamin E, Dexpanthenol, preservatives and fragrances, one for each intended area of the body. Results. One can prove the effectiveness of disposable technology for bed bath on the evolution of microflora of the skin of hospitalized patients. Since 90% of participants who received only the intervention had skin protected from colonizing bacteria, unlike subjected to the bath in the conventional bed, which showed 80% of positive cultures. Statistical analysis showed that, whereas the microbial load of the participants in Group B decreased with disposable intervention, increased significantly in Group A, who had received baths in conventional bed (p <0.001). Conclusions. Bed bath with the use of disposable technology, tested brand, proved to be significantly effective on the microbial load of the skin of hospitalized patients, when compared to conventional bath. The hypothesis of disposable bed bath present shorter run time and lower costs when compared with the conventional has been refuted. It is recommended to carry out further studies on these variables, to understand their importance on the design of human resources in nursing, as well as the decision by hospital supplies choices. / FAPESP: 2014/25099-2

Orientador: Alessandro Lia Mondelli / Resumo: Introdução. Banho no leito é um procedimento executado rotineiramente pela equipe de enfermagem, para atender às necessidades de higiene e conforto. Infere-se a técnica convencional, com uso de baldes, bacias, água, sabonete, luvas e compressas, contribuir para aumento das taxas de infecção hospitalar. A tecnologia descartável para banho no leito propõe prevenir contaminação de uma área corporal com microrganismos provenientes de outra, assim como infecções cruzadas. Objetivo. Avaliar a efetividade dos banhos no leito convencional e descartável sobre a microbiota do paciente hospitalizado, assim como a estimativa de tempo de execução e custo dos mesmos. Métodos. Pesquisa clínica, prospectiva, caso-controle, randomizada, aprovada pelo Comitê de Ética em Pesquisa e Registro Brasileiro de Ensaio Clínico (ReBEC). Realizou-se este estudo na Unidade de Acidente Vascular Cerebral do Hospital das Clínicas da Faculdade de Medicina de Botucatu, com amostra de 40 pacientes acamados e randomizados em dois grupos com 20 participantes: grupo A (controle - banho no leito convencional) e grupo B (intervenção - banho no leito descartável). A tecnologia avaliada foi da marca Bag Bath®. Invólucro contendo oito compressas pré-umidificadas com água, surfactantes não iônicos, vitamina E, dexpanthenol, conservantes e fragrâncias, destinadas uma para cada área do corpo. Resultados. Pode-se comprovar a efetividade da tecnologia descartável para banho no leito, sobre a evolução da microbiota da pele d... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction. Bed bath is a procedure performed routinely by nursing staff to meet the needs of hygiene and comfort. A conventional technique is inferred, using buckets, basins, water, soap, gloves and pads, contributing to increased hospital infection rates. The disposable bed bath technology proposes to prevent contamination of a body area with microorganisms from another, and cross-infection. Goal. Evaluate the effectiveness of the baths in conventional and disposable bed on the microbiota of hospitalized patients, as well as the estimated run time and cost thereof. Methods. Clinical, prospective, case-control, randomized research, approved by the Research Ethics Committee and Brazilian Registry of Clinical Trial (Rebec). We conducted this study in Stroke Unit of the Hospital of the Botucatu School of Medicine, with sample of 40 bedridden patients randomized into two groups with 20 participants: group A (control - bath in the conventional bed) and group B (intervention - bath in disposable bed). The technology of the brand Bag Bath was evaluated®. Containing eight pads pre-moistened with water, nonionic surfactants, Vitamin E, Dexpanthenol, preservatives and fragrances, one for each intended area of the body. Results. One can prove the effectiveness of disposable technology for bed bath on the evolution of microflora of the skin of hospitalized patients. Since 90% of participants who received only the intervention had skin protected from colonizing bacteria, unlike subjec... (Complete abstract click electronic access below) / Mestre

Handwashing frequency may result in harmful effects on the skin, promoting the increase of the prevalence of nosocomial important microorganisms. This study purpose was to assess the quantitative and qualitative changes of the total microbiota (both permanent and transient) from hands of nursing professionals and university laboratory technicians and students due to the irritant action provoked by frequent washing and/or wearing gloves. Sixty health professionals were enrolled from whom collections were performed by the sterile polyethylene bag, before and after washing hands with 3 mL of nonantimicrobial soap for 30 seconds. In the group formed by students and laboratory technicians (n=30), these collections were performed before and after consecutive washings with water and soap. Damaged hands health professionals hands contamination was higher when compared with healthy hands. Hygiene proved to be efficient in both students and laboratory technicians without complaints of irritation after successive washings, a fact not seen among health care workers. Nurses with damaged hands presented higher frequency of S. aureus, Gram negative bacteria and yeast than the healthy ones (P>0.05), as well as the sum of these microorganisms (P=0.07) and presence of S. haemolyticus (P=0.02). The frequency of S. aureus and antimicrobial resistant Gram negative bacteria was higher among nurses damaged hands. The irritation caused on the skin by the frequent washing and/or wearing of gloves may cause changes of hands microbiota and should be considered when choosing hygiene products. / A freqüência da lavagem de mãos pode resultar em efeitos prejudiciais na pele promovendo aumento da prevalência de microrganismos de importância hospitalar. Os objetivos deste trabalho foram avaliar quantitativa e qualitativamente as alterações na microbiota total (residente e transitória) das mãos de profissionais de enfermagem e estudantes universitários e técnicos de laboratório associadas à ação irritante provocada pela freqüente lavagem e/ou uso de luvas. Foram incluídos 60 profissionais de saúde, nos quais foram realizadas coletas, pelo método do saco estéril de polietileno, antes e após a lavagem com 3 mL de sabão não medicamentoso, por 30 segundos. No grupo constituído por estudantes e técnicos de laboratório (n=30), estas coletas foram realizadas antes e após lavagens consecutivas com água e sabão. A contaminação das mãos de profissionais de saúde com danos na pele foi maior em relação às sadias. A higiene se mostrou eficiente nos estudantes e técnicos de laboratório sem queixas de irritação após lavagens sucessivas, fato não observado entre profissionais de saúde. Enfermeiras com mãos com danos apresentaram maior freqüência de S. aureus, bacilos Gram-negativos e fungos leveduriformes do que as sadias (P>0,05), assim como quanto à soma destes microrganismos (P=0,07) e a presença de S. haemolyticus (P=0,02). A freqüência de S. aureus e bacilos Gram-negativos resistentes aos antibióticos foi maior nas mãos lesadas de enfermeiras. A irritação causada na pele devido à lavagem freqüente e/ou uso de luvas pode provocar alterações da microbiota das mãos e deve ser considerada pelas instituições quando da escolha de produtos de higiene. / Mestre em Imunologia e Parasitologia Aplicadas

O objetivo desta tese foi avaliar a influências da exposição a diversos fatores de risco e ocorrência de infecção hospitalar (IH) e examinar fatores de risco relacionados às pneumonias associadas ao uso de ventilador mecânico (PAV) em crianças críticas. Usamos os métodos de estudo prospectivo envolvendo uma coorte de 268 crianças menores de três anos, realizado em unidade de pacientes graves, de janeiro de 1997 e setembro de 2000. Aplicou-se técnica de regressão de Poisson para estimar razões de risco e estratégia de abordagem hierárquica para identificar fatores de risco associados à IH. Apenas para 179 crianças críticas que usaram ventilador mecânico, aplicou-se a regressão de Cox para estimar razões de risco e identificar fatores de risco associados à PAV. Os resultados apresentaram 74 infecções hospitalares diagnosticadas no total, com taxa de incidência de 48,1 IH por 1000 pacientes-dia. Foi determinante para ocorrência de infecção hospitalar, idade superior a dois anos (Razão de Risco) [RR]: 2,66; intervalo de confiança [IC]: 95%: 1,46-4,58), uso de sonda vesical (RR: 2,92; IC 95%: 1,47-5,80), uso de nutrição parenteral (RR: 1,90; IC 95%: 1,15-3,13), realização de broncoscopia (RR: 1,84; IC 95%: 1,03-3,27), tempo de exposição ao cateter vascular central (RR: 2,36; IC 95%: 1,18-4,71) e ao ventilador mecânico (RR: 1,72; IC 95%: 0,94-3,15). Observou-se PAV em 29 crianças (16,3%), com taxa de incidência de 29,3 casos por 1000 dias de ventilação mecânica (IC 95%: 20,34-42,11), dos quais 50% dos eventos ocorreram até o quinto dia de ventilação. A taxa de risco diária aumentou até um máximo de 2,3%, observada no 7 dia de ventilação, e reduziu a partir daí. Foram fatores de risco para PAV na análise multivariada hierarquizada, idade acima de 1 ano (RR: 3,49; IC 95%; 1,64-7,45), cirurgia do aparelho digestivo (RR: 5,05; IC 95%; 2,17-11,78) e nutrição parenteral (RR: 2,68; IC 95%: 1,24-5,8). /exposição a antibióticos antes da internação conferiu proteção (RR: 0,29; IC 95%: 0,13-0,66). Concluímos que os resultados encontrados neste estudo indicam que a influência do tempo de exposição é determinante para a ocorrência de infecções hospitalares e está associado aos processos de cuidados do paciente crítico. Políticas institucionais direcionadas ao controles e prevenção das IH devem fazer de estratégias fundamentais para a qualidade da assistência e segurança do paciente internado. Vigilância de Saúde Pública e componentes longitudinais de estudo de fatores de risco para infecções hospitalares e para pneumonias associadas ao ventilador podem ajudar avaliar prognósticos e planejar e testar medidas preventivas, concentrando-se esforços na primeira semana de ventilação. / The objective of this thesis is evaluate the influence of exposure to some risk factors and the occurrence of nosocomial infections (NI) and to examine risk factors for ventilator-associated pneumonia (VAP) in critically ill children. We use the prospective study was carried out on 268 children less than three years old, at a pediatric intensive care unit, from January 1997 to September 2000. Poisson regression and hierarchized multivariate analysis were performed to estimate incidence rate ratios and to identify risk factors associated to nosocomial infections. To 178 children only, who were ventilated, Cox regression was performed to estimate hazards ration and to identify risk factors for VAP. Our results were 74 nosocomial infections were diagnosed, and the overall incidence of NI cases was 48.1 per 1000 patient-days. The final model showed as predictors of nosocomial infections were age over two (incidence rate ratio [IRR]: 2.66, confidence interval [CI] 95%:1.46- 4.58), urinary tract catheter (IRR: 2.92; CI 95%: 1.47-5.8), parenteral nutrition use (IRR: 1.90; CI 95%: 1.15-3.13), bronchoscope use (IRR: 1.84; CI 95%: 1.03-3.27), central catheters exposure time (IRR: 1,72; CI 95%: 0.94-3.15), 29 childrem (16.3%) developed VAP and the overall incidence was 29.3 per 1000 ventilator-days (OC 95%: 29.34-42.11); 50% of all cases had happened until day 5 of ventilator. The daily hazard risk increased to 2.2% at day 7, and decreased after that. Risk factors of VAP in hierarchized multivariate analysis were age over one (hazards ratio [HR]: 3.49; IC 95%: 1.64-7.45), digestive surgery (HR: 5.05; CI 95%: 2.17-11.78), parenteral nutrition (HR: 2.68; IC 95% 1.24-5.80). Exposure to antibiotics conferred protection (HR: 0.29; IC 95%: 0.13-0.65). Our conclusion is: the results suggest that the influence of the exposure time is determinant of nosocomial infections occurrence, and it is healthcare associated in critically ill patients. Institutional politics might be aimed at prevention and control activities, as strategy to promote healthcare quality and patient safety. Public health surveillance and longitudinal studies of risk factors for ventilator-associated pneumonias can help to assess prognosis, and devise and test preventive strategies, and efforts might be concentrated on the first week of ventilation assistance.

The degree work is concentrated on the problems of the epidemic as to acute viral gastro-enteritides of nosocomial nature occurring in the Mental Home Bohnice in the years 2003 {--} 2009. I chose for my work the methodology of quantitative research in the form of an epidemiological descriptive study with the technique ``data collection and analysis{\crq}q. The infectious diarrhoeal affections are very current all the time and great importance in developing and even in advanced countries of the world. About 5 {--} 10 million people are dying of diarrhoea often connected with undernourishment in developing countries of Asia, Africa and Latin America per year, whereof 4,6 millions are children aged up to 5 years. The infection diarrhoeal affections in advanced countries of the world are important mainly as to their high frequency because they represent the second most frequent infection just behind the infection of air passages. The theoretical part of the work is concentrated on general characterization of the acute viral gastro-enteritis, on the process of spreading, on the most frequent aetiologic agents and on the new possibilities of diagnosis and therapy. The attention is also paid to the observance of antiepidemical measures and rules fixed in the hygienic and antiinfectious regimen, that prevent further spreading of the diseases in the case that an epidemic has broken out. In this connection, the basic profile and structure of the Mental Home Bohnice is also presented inclusive of important facts concerning the hospitalized patients. These patients form a very specific group of persons in respect to the occurrence of epidemics caused by viral diarrhoeal diseases as they are hospitalized in an isolated environment often for long term and their heath condition depends on psychiatric diagnosis. The performed investigation resumes the general judgement on the problems of epidemics caused by the acute viral gastro-enteritides in the Mental Home. It determines the most frequent aetiologic agents giving rise to this disease and analyzes these epidemics in relation to the age and sex of the patients. Another aim of the work was to explain the seasonal nature of the epidemics and to evaluate the efficiency of antiepidemical measures taken in this establishment. It is necessary to conclusion that the epidemical occurrence of viral gastro-enteritides was registered in Mental Home Bohnice even before the year 2003, but the aetiologic agents could not be specified in greater detail owing to the possibilities of virologic diagnostics being at disposal at that time.

Sepsis represents a serious medical, but also social problem. Hundreds of thousands of patients die from serious sepsis and septic shock every year. Patients with serious sepsis are treated at intensive care units and their treatment is long, costly and low efficient. These are the reasons why prevention of sepsis focused on prevention and effective treatment of nosocomial infections or timely solution of another problem, e.g. a shock is so much stressed. Nosocomial infections affect about 30 per cent of patients at intensive care units and may cause serious diseases, sepsis or even death. This thesis deals with the possibilities nurses have to influence sepsis, particularly by adherence to aseptic procedures and prevention of nosocomial infection, which might consequently develop in nosocomial sepsis. Combination of quantitative and qualitative methods was used for the research. There were two goals set for the quantitative research. 1. To find whether obstacles occur in adherence to proper aseptic procedures in nursing work as prevention of nosocomial infection occurrence and subsequent septic conditions in patients hospitalized at intensive medicine workplaces. 2. To map the weak points in adherence to proper aseptic procedures in nursing work in intensive care. The goals led to hypotheses H1 Obstacles obstructing thorough adherence to proper aseptic procedures in nursing work exist in intensive care. H2 Non-adherence to aseptic procedures occurs in nursing work at intensive medicine workplaces as a consequence of lack of time for particular interventions. The research sample consisted of nurses from the intensive care workplaces ARD and ICU from 8 hospitals. Questioning method through the questionnaire technique was used for data collection. 342 questionnaires were distributed in total. Hypothesis 1 was refuted, hypothesis 2 was refuted. We found that no obstacles obstructing adherence to proper aseptic methods occur, we mapped the weak points in adherence to proper aseptic procedures in nursing work in intensive care. There were two goals set for the qualitative research. GOAL 3 To find what measures preventing occurrence of nosocomial infection and subsequent septic conditions in patients hospitalized at intensive medicine workplaces are taken by department managements. GOAL 4 To find out how department management deals with possible occurrence of nosocomial infection and subsequent septic conditions in patients hospitalized at intensive medicine workplaces. The following research questions were set. 1. What are the measures preventing occurrence of nosocomial infection and subsequent septic conditions in patients hospitalized at intensive medicine workplaces taken by department managements? 2. How does department management solve possible occurrence of nosocomial infection and subsequent septic conditions in patients hospitalized at intensive medicine workplaces? The research sample consisted of 5 departmental nurses and 5 head nurses from intensive care workplaces from the same hospitals where the quantitative research took place. The research was performed by semi-standardized interview. The research questions were answered. A manual for nurses called ?Recommendation for nurses in prevention of nosocomial infection and nosocomial sepsis not only at intensive care units? was elaborated upon study of these issues and the performed research. A thought map for department management illustrating prevention and solution of nosocomial infection and nosocomial sepsis was also elaborated. Both the document and the research results will be provided particularly to the managements of the hospitals that took part in our research. The thesis may also be helpful to nurses, students and other interested people to gain overall insight into the issue.

Estudo de desenvolvimento metodológico de elaboração e validação de medidas de avaliação em saúde, que teve como finalidade contribuir com novas políticas de controle e prevenção de infecção hospitalar (CIH). Para tanto, foram construídos e validados três indicadores de avaliação de práticas de controle e prevenção da infecção hospitalar do trato urinário associada a cateter, conforme duas etapas metodológicas. Na primeira, tendo como referência bases conceituais de indicadores clínicos e medidas de avaliação em saúde, foram elaborados os indicadores: 1-Indicação e Permanência do Cateterismo Vesical (IUIC); 2- Condições de Manutenção do Cateterismo Vesical (IUMN) e 3- Infra-Estrutura para Procedimento de Cateterismo Vesical (IUIF). Na segunda etapa estes indicadores foram submetidos à validação de conteúdo, por meio de um método de validação opinativa de um grupo de nove especialistas, constituído de médicos e enfermeiras, com conhecimento e experiência em controle de infecção hospitalar, e representantes das áreas hospitalar, acadêmica, órgão governamental e entidades associativas. A validação foi realizada com o julgamento de cada indicador a partir de um instrumento previamente elaborado, que contemplava as seguintes etapas: I- Conteúdo do construto (manual operacional) do indicador; II- Atributos do conjunto do indicador; III- Componentes do indicador. O indicador 3 foi submetido, ainda, a mais uma etapa, referente à valoração, pelos juízes, de cada um de seus componentes. Foi previamente estabelecido um consenso mínimo de 75% de julgamento favorável dos juízes, de cada uma destas etapas. Em cada etapa solicitava-se também comentários e sugestões para ajuste dos indicadores. Nos resultados, os indicadores 1 e 2 obtiveram consenso favorável mínimo na grande maioria dos aspectos sob avaliação de cada etapa. Nos aspectos que não obtiveram consenso favorável mínimo as sugestões e comentários efetuados pelos juízes tornaram possível o ajuste destes indicadores e sua validação de conteúdo, sem necessidade de retorno aos juízes para novo julgamento. O indicador 3, apesar de ter obtido amplo consenso favorável nas etapas II e III, o mesmo não ocorreu em vários aspectos referentes à etapa I, assim como na valoração de relevância dos seus componente individuais. Além disto, os comentários e sugestões efetuados constataram a problemática deste indicador para avaliar adequadamente o que ele se propunha. Por este motivo, ele não pôde ser validado, na forma de construção originalmente apresentada. / This is a study on the methodological development of elaboration and validation of measures to evaluate health aiming to contribute to new control rules and to prevent nosocomial infection (CIH). Then, three evaluation indicators of control and prevention of nosocomial infection in the urinary tract associated to a catheter were built in accordance with two methodological phases. In the first phase, based on the conceptual basis of clinical indicators and evaluation measures in health, the indicators were elaborated: 1 - Indication and Permanence of Vesical Catheterism (IUIC); 2 – Maintenance Conditions of Vesical Catheterism (IUMN) and 3 – Infrastructure for procedures of Vesical Catheterism (IUIF). In the second phase, these indicators were submitted to a content validation by means of a validation method according to one group of nine experts, constitued of physicians and nurses, with knowledge and experience in nosocomial infection and representatives of the hospital, academic and governmental areas and associative institutions. The validation was performed according to judgment of each indicator based on a instrument previously elaborated, consisting of: I- Construct Content (operational guidebook) of the indicator; II- Features of the indicator set; III- Components of the indicator. The indicator 3 was still submitted to one more phase regarding valorization of each component, according to the judges. A minimum consensus of 75% of favorable arbitration from the judges was previously established for each phase. In each phase it was also asked comments and suggestions to adjust indicators. In the results, indicators 1 and 2 obtained a minimum favorable consensus in the great majority of the evaluating aspects for each phase. The aspects which did not obtain the minimum favorable consensus, suggestions and comments made by the judges made possible an adjustment of these indicators and their content validation, with no need of the judges to return for a new arbitration. The indicator 3, in spite of obtaining a comprehensive favorable consensus in the phases II and III, the same did not occur in many aspects of the phase I as well as in the relevance valoration of its individual components. Additionally, the comments and sugestions performed, considered the problematic of this indicator to adequatly evaluate its objective. Therefore, it could not be validated on its original construction.

Introdução: Educação é precisamente a atividade que pode expandir as estratégias de prevenção das Infecções Relacionadas à Assistência a Saúde (IRAS). As infecções da corrente sanguínea associadas a cateter (ICSC) são consideradas as mais importantes IRAS no cenário da assistência crítica por estarem associadas com altas taxas de mortalidade de pacientes sob cuidados intensivos. A interação existente entre entender como o conhecimento é adquirido e qual a melhor maneira de se ensinar, sugere uma mudança na prática tradicional do ensino. Partindo do pressuposto de que toda mudança provém de planejamento, execução, avaliação e implementações de melhoria, este estudo surge com a intenção de responder a seguinte questão de pesquisa: Quais métodos e técnicas de ensino se mostraram eficazes na redução das taxas de ICSC?. Objetivo: Identificar e caracterizar os métodos e técnicas de ensino utilizados em treinamentos para equipes de saúde envolvidas diretamente com a prevenção de ICSC. Método: Trata-se de uma Revisão Integrativa da Literatura (RIL) com a estruturação de uma questão de pesquisa conforme a estratégia PICO, sendo utilizados descritores controlados padronizados. As seguintes bases foram pesquisadas: PubMed/MEDLINE, CINAHL, LILACS, Embase, ERIC e Web of Science. Os artigos incluídos atenderam à critérios pré definidos, incluindo avaliação de qualidade metodológica. Resultados: O número total de referências encontradas foi de 300 e, 10 artigos (3,3%) foram incluídos como amostra final a ser analisada. O Método Expositivo foi utilizado por 100% da amostra. Observou-se que 80% optaram pela Técnica de Ensino Verbal, Ilustração (60%), Simulação (30%) e Exemplificação (20%). O Método de Elaboração em Conjunto configurou o segundo método mais utilizado pelos autores (80%). As técnicas de ensino mais exploradas nessa categoria foram a Conversa Dialogada (80%), Lista de discussões via internet (30%) e Aula Expositiva Dialogada (20%). Simpósio e Painel não foram testados. O Método de Ensino para Trabalho Individual foi o terceiro método mais explorado pelos autores (60%), sendo que a Técnica de Ensino mais utilizada foi a Revisão (50%), seguidos pelo Estudo Dirigido e Ficha Didática (10%). Portfólios, Mapa Conceitual, Solução de Problemas, Estudos de Caso e Pesquisas não foram exploradas como objetos de intervenção. Os Métodos de Ensino para Trabalho em Grupo e Atividades Especiais, com suas respectivas técnicas de ensino, não foram considerados em nenhum dos estudos analisados. Quanto aos recursos utilizados nas intervenções, o Feedback foi contemplado em 60%, seguidos pelo uso de cartazes, checklist a beira-leito, módulos de auto estudo (30%) e informativos, pôsteres, adesivos coloridos, carros e kits de inserção de CVC e internet (20%). Para os Métodos de Análise das intervenções realizadas, todos os estudos incluídos apresentaram as taxas de ICSC, seguidos pela Avaliação de Desempenho Pré e Pós Intervenção (60%), Auditorias e Testes Pré e Pós (50%), Checklist (40%), Indicadores gerais de IRAS, Avaliação diagnóstica prévia (20%) e Inspeção (10%). Conclusão: Os Métodos e Técnicas de Ensino utilizados nos estudos incluídos na presente pesquisa favoreceram a redução de ICSC. Entretanto, devido a uso combinado de diferentes métodos não foi possível identificar um método que isoladamente tenha sido mais eficaz / Introduction: Education is precisely the activity that can expand the strategies Healthcare Associated Infections (HAI). Catheter-related bloodstream infections (CRBSI) are considered to be the most important HAI in the critical care setting being associated with the high mortality rates of patients under intensive care. The interaction between the understanding of how knowledge is acquired and what would be the better way to teach, suggests a need for change in the traditional practices in teaching. Assuming that all changes should come from planning, implementation, evaluation and improving implementations, this study seeks to answer the following research question: \"What are the methods and teaching techniques that have proved to be effective in reducing CRBSI rates?\". Objective: Identify and describe the methods and teaching techniques used in training healthcare workers directly involved in the prevention of CRBSI. Method: This is an Integrative Review of Literature (IRL) with the structuring of a research question according to the PICO strategy which used standardized controlled descriptors. The following databases were searched: PubMed/MEDLINE, CINAHL, LILACS, EMBASE, ERIC and Web of Science. The articles that are included met the pre-defined criteria, including a methodological quality assessment. Results: Three hundred references were found and 10 articles (3.3%) were included as the final sample to be analyzed. The Expository Method was used by 100% of the sample. It was observed that 80% opted to the Verbal Teaching Technique, Illustration (60%), Simulation (30%) and Exemplification (20%). The Preparation Group Method configured the second method used the most by the authors (80%). The most explored teaching techniques in this category were the Dialogued Conversation (80%), List of discussions by internet (30%) and Dialogued Exposition Class (20%). Symposium and Panel were not tested. The teaching method for Individual Work was the third method further explored by the authors (60%), and the Review was the most used teaching technique on this category (50%), followed by the Directed Study and Teaching Sheet (10%). Portfolios, Concept Map, Problem Solving, Case Studies and Research where not explored as objects of intervention. The teaching methods for Group Work and Special Activities, with their respective teaching techniques were not considered in any of the studies analyzed. As for the resources used in the interventions studies, the Feedback was contemplated in 60%, followed by the use of banners, a bedside checklist, self study modules (30%) and newsletters, posters, colored stickers, car with the insertion kits of central lines and the internet (20%). According to the analysis methods for the implemented interventions, all included studies showing their CRBSI rates, followed by the Performance Assessment - Pre and Post Intervention (60%), Audits and Testing Before and After (50%), Checklist (40%), General HAI indicators, Prior diagnostic evaluation (20%) and Inspection (10%). Conclusion: The Methods and Teaching techniques used in the included studies from this research favored the reduction of CRBSI. However, due to the combined use of different methods, it was not possible to identify a method that alone was more effective

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-07-20T17:55:58Z No. of bitstreams: 1 deboragotardeloaudebertdelage.pdf: 9011857 bytes, checksum: 40da384fb904d1cd5d1c29aa7006bab5 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-07-22T15:24:01Z (GMT) No. of bitstreams: 1 deboragotardeloaudebertdelage.pdf: 9011857 bytes, checksum: 40da384fb904d1cd5d1c29aa7006bab5 (MD5) / Made available in DSpace on 2016-07-22T15:24:01Z (GMT). No. of bitstreams: 1 deboragotardeloaudebertdelage.pdf: 9011857 bytes, checksum: 40da384fb904d1cd5d1c29aa7006bab5 (MD5) Previous issue date: 2011-03-11 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / As infecções hospitalares (IH’s) são um desafio na saúde pública e por isso é fundamental que as atividades de prevenção e controle das IH’s permaneçam na linha de frente e na base das instituições hospitalares. Para que estas ações sejam efetivas é imprescindível a instalação e manutenção de um Programa de Controle de Infecções Hospitalar (PCIH) que sustente e qualifique estas ações e atividades mínimas de controle e prevenção. Portanto, este estudo de abordagem qualitativa teve como objeto de investigação o Programa de Controle de Infecções Hospitalar (PCIH) em instituições de saúde públicas, privadas e filantrópicas no município de Juiz de Fora. Os objetivos foram: avaliar o Programa de Controle de Infecção Hospitalar (PCIH) em instituições de saúde privadas, públicas e filantrópicas do município de Juiz de Fora e sua relação com a prática dos profissionais dos Serviços e Comissões de Controle de Infecção hospitalar; conhecer o PCIH de instituições hospitalares públicas, privadas e filantrópicas do município de Juiz de Fora; conhecer as ações da Vigilância Sanitária de Juiz de Fora no que tange o controle das infecções hospitalares e analisar as percepções dos profissionais de saúde que atuam nas CCIH’s e SCIH’s sobre as ações de controle e prevenção das IH’s. Os dados foram coletados em dois momentos: primeiramente, para caracterização dos PCIH’s, utilizamos uma manual operacional e planilha de indicadores e posteriormente para coleta dos relatos dos profissionais, utilizamos entrevista semiestruturada. Para análise das entrevistas utilizamos a técnica de análise temática que permitiu-nos definir as seguintes categorias de análise: percepção dos profissionais na organização dos SCIH’s e CCIH’s; atividades de controle de infecção desempenhadas pelos profissionais do SCIH e da CCIH; o controle e prevenção em IH: o lugar da educação permanente; a fiscalização das Infecções hospitalares e sua relação com a Vigilância Sanitária e o desafio no controle das Infecções Hospitalares. Foi possível observar que na realidade estudada os PCIH’s apresentam diversas inconformidades, e grandes são os desafios apontados pelos sujeitos. É preciso pensar o PCIH como parte fundamental para uma melhor assistência em saúde nas instituições hospitalares. É essencial que não apenas a instituição de saúde valorize o controle de infecção, mas que todos profissionais de saúde realmente entendam a importância do PCIH e sua relação no controle e prevenção das infecções hospitalares. / Nosocomial infections (NI’s) are a public health challenge and therefore, it is fundamental that prevention and control actions remain on the front line and on the basis of hospital institutions. For these actions to be effective it is of utmost importance to implement and maintain a Nosocomial Infections Control Programme (NICP) that may support and qualify them. This study of qualitative approach aims to investigate the NICP in public and private health institutions in the city of Juiz de Fora. The objectives are: to evaluate the Nosocomial Infections Control Programme (NICP) of public, private and philantropic hospital institutions in the city of Juiz de Fora and its relationship with the practice of professionals of Nosocomial Infections Control Commissions (NICC´s) and Services (NICS´s); to know the NICP of public, private and philantropic hospital institutions of Juiz de Fora; to know the actions of Juiz de fora Health Surveillance Agency concerning the control of nosocomial infections and to analyse the perceptions of health professionals that work in the NICC’s and NICS’s over the actions of control and prevention of NI’s. The data was collected in two moments: primarily, in order to characterize the NICP’s, we utilized an operational manual and indicators spreadsheets and, posteriorly, in order to collect the professional’s reports, we used semi-structured interview. For the analyses of the interviews we used the thematic analysis technique, wich allowed us to define the following categories: professional’s perception over the organization of NICC’s and NICS’s; the control and prevention of NI’s; the importance of continuing education; inspection of nosocomial infections and its relationship with Health surveillance and the challenge of controlling nosocomial infections. It was possible to observe that in the studied reality, the NICP’s shows many nonconformity's, and grand are the challenges pointed out by the subjects. It is necessary to view the NICP as a fundamental part of a better health assistance in hospital institutions. It is essential that not only the health institution values the infection control, but that all health professionals in fact understand the importance of the NICP and its relationship with the control and prevention of nosocomial infections.

Les chambres implantables sont des dispositifs médicaux utilisés pour l’'administration de produits de chimiothérapie et/ou de nutrition parentérale. Comme la plupart des implants médicaux, ces dispositifs peuvent être à l’'origine d’infections nosocomiales. L’'objectif de la thèse a été d’'étudier la contribution des modifications physico-chimiques de surface de matériaux à base de titane sur l’'adhérence de microorganismes. Des surfaces présentant différentes caractéristiques ont été élaborées et l’'adhérence de la bactérie Staphylococcus aureus et de la levure Candida albicans a été testée in vitro en conditions statiques. Des surfaces modèles de TiO2 présentant des rugosités à l’'échelle du nanomètre et du micromètre ont été élaborées avec des wafers de silicium revêtues d’'un film mince d’'oxyde de titane déposé par pulvérisation cathodique. Des surfaces d’'alliages de titane grade 2 et grade 5 ont été modifiées par polissage, sablage ou électroérosion, créant différentes morphologies. Il est apparu que le nombre de microorganismes adhérents changeait certes avec la rugosité, mais était fonction de la morphologie de surface des matériaux et de la taille du microorganisme. Des surfaces lisses de TiO2 ont ensuite été fonctionnalisées par greffage moléculaire pour modifier le caractère hydrophile/hydrophobe de surface. L’'étude de l’'adsorption de protéines du plasma sanguin, par QCM, a permis de mieux expliquer l’'adhérence de bactéries et de levures sur ces surfaces. L’'influence de la nutrition parentérale et des produits de chimiothérapie sur les surfaces a aussi été étudiée afin de se rapprocher des conditions d’'utilisation des chambres implantables. / Totally implantable venous-access ports are medical devices used for the administration of chemotherapy drugs and/or parenteral nutrition. Infections can occur and it is indispensable in modern-day medical practice to prevent and reduce the rare infectious complications. In this context, the goal of this work was to study the contribution of the modification of physico-chemical properties of titanium based surfaces on the adherence of microorganisms. Surfaces with different characteristics were produced and the adherence of the bacterium Staphylococcus aureus and the yeast Candida albicans was studied in vitro in static conditions. Model surfaces made of titanium dioxide with roughness from nanometer to micrometer were elaborated using silicon wafers recovered with a thin film of titanium dioxide deposited by plasma vapor deposition. Titanium alloy surfaces (Ti grade 2 and Ti grade 5) were modified by polishing, grit-blasting or wire erosion, to create different surface morphologies. In vitro studies were performed and it was found that the number of adhering microorganisms changed with roughness, but more importantly with the surface morphology of the biomaterials and microorganisms size. Flat titanium dioxide thin films were then functionalized by molecular grafting to modify the hydrophobicity of the surface. Study of plasma protein adsorption, by QCM, allowed to better explain the adherence of bacteria and yeast onto these surfaces. The influence of parenteral nutrition and chemotherapy drugs was also studied in order to better approach the real conditions of totally implantable venous-access ports.