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Introdução: O processo de esterilização hospitalar requer que os produtos para saúde sejam entregues limpos, esterilizados e secos. A ocorrência de pacotes molhados é um desvio do processo, condição inaceitável segundo a AAMI (2017). Ações arbitrárias, como adição de campo absorvente nas caixas, aumento da pressão da câmara externa, aumento do intervalo de tempo da rampa de aquecimento e aumento do intervalo de tempo de secagem, são praticadas pelos CME e engenharia em busca de uma solução, considerando o sucesso da intervenção com base na carga seca ao término do ciclo e no resultado dos indicadores químicos e biológicos satisfatórios. Frente ao exposto, questiona-se quais seriam as implicações das tais práticas adotadas para evitar pacotes molhados na segurança da esterilização a vapor e suas repercussões nas respostas dos indicadores biológicos e químicos. Objetivo: avaliar o impacto das práticas adotadas pelos CME para evitar pacotes molhados/úmidos na segurança da esterilização e suas repercussões nas respostas dos indicadores biológicos e químicos. Método: a pesquisa caracterizou-se como estudo experimental laboratorial, realizado em duas etapas. Na primeira, os estudos foram conduzidos utilizando duas procedências de resistômetro equipamento utilizado para controle de qualidade dos indicadores químicos e biológicos cuja característica é não contemplar fase de condicionamento, e na segunda, uma esterilizadora a vapor de uso hospitalar incluindo a fase de condicionamento. As variáveis independentes da pesquisa em ambas as etapas foram: presença de campos absorventes, aumento da pressão da câmara externa, aumento de tempo de secagem e aumento do tempo da rampa de aquecimento. As variáveis dependentes foram: resultado dos indicadores biológicos e químicos tipo 5 e 6 de três procedências distintas, e o resultado mecânico da relação pressão versus temperatura. Resultados: Na etapa 1 quando a resposta dos indicadores químicos e biológicos teriam a priori, precisão teórica para aprovar ou reprovar os ciclos frente a ações arbitradas pelos CME para obter material seco, na situação provocada de adição de campo absorvente e aumento da pressão da câmara externa causando o vapor superaquecido - detectado por meio da relação pressão versus temperatura 76% dos indicadores químicos não conseguiram detectar a falha, demonstrando falha na sensibilidade dos IQ 5/6 ou baixo impacto dessa intervenção. Já o IB demostrou sensibilidade maior do que os IQ 5/6, com 96% a mais de detecção de falha. O tempo de secagem adicional não interferiu na mudança esperada dos resultados dos indicadores químicos em ciclos onde o tempo de esterilização foi reduzido para metade como desafio, ao contrário dos resultados com a rampa de aquecimento estendida onde todos indicadores tiveram o resultado aprovado em meio ciclo de esterilização. Na segunda etapa, nos estudos em esterilizadora com fase de condicionamento, observou-se que a secagem adicional alterou o resultado dos indicadores químicos, mudando de reprovado para aprovado, e a condição de vapor superaquecido foi observado nos parâmetros físicos medido pelos sensores externos, mas nenhum indicador conseguiu identificar a falha, inclusive os instrumentos de controle do equipamento. Conclusões: Ações de adição de campo absorvente nas caixas e aumento da pressão da câmara externa não podem ser utilizados acriticamente, pois podem prejudicam diretamente a segurança da esterilização, inibindo a coagulação de esporos na presença de vapor superaquecido, e os IQ tipo 5/6 e IB não tem especificidade para detectar falha na esterilização frente a essas condições. Não se evidenciou riscos na segurança da esterilização pelas manobras do aumento do tempo da rampa de aquecimento e o aumento do tempo de secagem, mas sim nos resultados falso satisfatórios dos IQ 5/6 e IB nos experimentos quando o tempo de esterilização foi propositalmente reduzido pela metade.
Introduction: The hospital sterilization process requires that the health products be delivered clean, sterilized and dry. The occurrence of wet packs is a deviation from the process, an unacceptable condition according to AAMI (2017). Arbitrary actions, such as addition of an absorbent liners in boxes, jacket pressure increase, come-up duration increase and extending drying time, are practiced by CSSD and engineering in search of a solution, considering a successful intervention based on the dry load at the end of the cycle and on the satisfactory result of chemical and biological indicators. Considering the above, implications of such practices to avoid wet packages in the safety of steam sterilization and its repercussions on biological and chemical indicators responses are questioned. Objective: To evaluate the impact of the practices adopted by CSSD to avoid wet packs in the safety of sterilization and its repercussions on biological and chemical indicators responses. Method: the research was characterized as an experimental laboratory study, carried out in two stages. In the first, the studies were conducted using two different resistometers - equipment used for the quality control of chemical and biological indicators, which characteristic is not to contemplate conditioning phase, and in the second, a steam sterilizer for hospital use, including the conditioning phase. The independent variables of the research in both stages were: presence of absorbent liners, jacket pressure increase, extended drying time and increase come-up ramp time duration. The dependent variables were: result of the biological indicator and chemical indicators type 5 and 6 from three different sources, and the result of the pressure versus temperature relationship. Results: In stage 1 when the response of the chemical and biological indicators would have a priori, theoretical precision to approve or disapprove the cycles against actions arbitrated by the CSSD to obtain dry material, in the situation provoked by addition of absorbent liner and increased jacket pressure, causing superheated steam - detected by pressure versus temperature - 76% of the chemical indicators could not detect the fault, demonstrating a lack of sensitivity of CI 5/6 or a low impact of this intervention. The BI, on the other hand, showed higher sensitivity than CI 5/6, with 96% more failure detection. The additional drying time did not interfere with the expected change in chemical indicator results in cycles where the sterilization time was reduced to half as a challenge, unlike the results with the extended come-up ramp where all indicators had approved result in half cycle of sterilization. On the second stage, in the sterilizer studies with the conditioning phase, it was observed that the additional drying changed the result of the chemical indicators, changing from failed to passed, and the superheated steam condition was observed in the physical parameters measured with the external sensors, but no indicator could identify the failure, neither equipment controls. Conclusions: Actions of adding absorbent liners in the boxes and increasing jacket pressure cannot be used uncritically, since they can negatively impact on sterilization safety, inhibiting the coagulation of spores due to the presence of superheated steam, and CI type 5/6 and BI have no specificity for detecting failure to sterilization against such conditions. There were no observed risks in the safety of sterilization due to increases in time of the come-up ramp and extended drying time, but false satisfactory results in CI 5/6 and BI were observed in the experiments where sterilization time was purposely reduced by half.
Subject(s)
Sterilization , Nursing , Health Status Indicators , Equipment and SuppliesABSTRACT
Objective To explore characteristics of the elements of syndrome, the disease position and the relationship between chemical indicators and TCM syndromes of type 2 diabetic encephalopathy. Methods 2 501 cases of type 2 diabetes clinical data were collected from Guang'anmen Hospital of China Academy of Chinese Medical Sciences, Beijing University of Chinese Medicine, Dongzhimen Hospital, Dongfang Hospital, etc. in nearly 3 years, among which, 342 cases were type 2 diabetic encephalopathy. The original clinical data were double entried in epidata by two people, establishment forms in excel, factor analysis and Bayesian networks were used as data mining research methods. Results 20 elements which characteristic root more than 1 were derived by factor analysis, 68.4% were covered. Of all 20 elements, five factors belong to Yin, five factors belong to blood stasis; lassitude, shortness of breath, stool frequency were appeared when fasting glucose abnormalities; lassitude, hemiplegia were appeared when 2-hour postprandial blood glucose abnormalities;lassitude, feverish palms and soles, stool frequency, more nocturnal enuresis when glycated hemoglobin abnormalities by Bayesian networks. Conclusion The Elements of the syndrome of type 2 diabetes encephalopathy were deficiency of Yin and blood stasis; and the main positions for diabetic patients were liver, spleen and kidney. Patients with impaired fasting glucose were Qi deficiency; Patients with impaired 2-hour postprandial glucose were Qi deficiency or pathogenic wind attacking collaterals; Patients with abnormal hemoglobin were Qi deficiency and Yin deficiency.
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This paper describes various approaches to evaluating ecological risk in rivers affected by multiple chemical stressors, with emphasis on biofilm and invertebrate community responses. Metrics should be considered as different lines of evidence that, when weighted, form an advanced weight of evidence approach to establishing the environmental risk on a basin scale. Combination of field surveys to obtain observational data of communities, in situ experiments, toxicological sediment tests and a good chemical description of the medium (water and sediment) helps give an integrative view of the chemical and biological state of a river ecosystem. The greater and more distinct the variables used, the greater is our ability to identify the effects of major stressors impairing communities. Weight of evidence is an integrative methodology for tackling the challenge of determining causal relations and applying this knowledge in the decision-making processes of river management.
Este trabajo describe diferentes aproximaciones para la evaluación del riesgo ecológico en ríos afectados por múltiple contaminación química, con énfasis en la respuesta de las comunidades del biofilm e invertebrados bentónicos. Las métricas descritas se considerarían como diferentes líneas de evidencia que convenientemente ponderadas formarían un sistema de decisión (weight of evidence) para establecer el riesgo ambiental a escala de cuenca. La combinación de trabajo de campo para obtener datos de la comunidad biológica, experimentos in situ, test de exposición en sedimentos, y una buena caracterización química del medio (agua y sedimento), ayuda a tener un resultado integrado del estado biológico y químico del ecosistema fluvial. Cuantas más variables se incorporen, mejor se identificarán los efectos de las presiones químicas en el deterioro de la comunidad. Esta es una metodología integradora que permite abordar el reto de determinar las relaciones causales y aplicar este conocimiento en el proceso de toma de decisión en la gestión de las cuencas fluviales.
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A cafeicultura da região fisiográfica do Alto São Francisco (MG) vem se expandindo e demandando estudos de solos, a fim de selecionar aqueles mais aptos. Este trabalho foi realizado com os objetivos de avaliar o potencial de uso e quantificar atributos de solos cultivados com cafeeiro manejado com sistema intensivo de cultivo considerado conservacionista. Foram estudadas seis glebas de terras, nas quais foram feitas a descrição morfológica e a classificação pedológica, além do estudo de atributos físicos e químicos dos solos, e a classificação das terras segundo sua capacidade de uso. Os solos estudados foram classificados como CXbd latossólico, LVd e CXbd. O Cambissolo latossólico e os Latossolos foram enquadrados, no sistema de capacidade de uso, como pertencentes à classe IIIc-1,s-5 e os Cambissolos, pertencentes à classe VIe-1,s-1-3,c-1. O cultivo de café sob o sistema conservacionista promoveu melhorias em atributos químicos e físicos dos solos estudados e maior desenvolvimento do sistema radicular da cultura, além de redução do déficit hídrico, o que proporcionou aumento da produtividade. Os resultados confirmam uma maior potencialidade real de uso dos solos, propiciada pelo sistema conservacionista, em comparação àquele recomendado pelo sistema de capacidade de uso.
The Physiographic Area of the Upper San Francisco river valley (MG) has been expanding its coffee culture, demanding soil studies with the objective of selecting those more capable to rationalize their use and management. This work had as an objective, to evaluate the use potential and to quantify characteristics of soils cultivated with coffee plants managed under the system considered conservationist. We studied six tracts of land in which the morphological description and the pedological classification were conducted, besides the study of the soil physical and chemical characteristics, and classification of the lands according to their use capacity. The studied soils were classified as latossolic dystrophic Tb Haplic Cambisol (CXbd), dystrophic Red Latosol (LVd) and dystrophic Tb Haplic Cambisol (CXbd). The latossolic CXbd (Inceptisol) and LVd (Oxisol) were framed in the use capacity system as belonging to the class IIIc-1,s-5 and CXbd belonging to the class VIe-1,s-1-3,c-1. The cultivation of coffee under the conservationist system promoted improvements in chemical and physical characteristics of the studied soils, further supported by field measurements that revealed higher development of the culture root system and reduction of the water deficit, besides a productivity increase. The results point to a higher use potential of the soils under conservationist system in comparison with that recommended by the use capacity system.
Subject(s)
Crop Production , Land Use , Soil Characteristics , CoffeaABSTRACT
The activity of 23 samples of ethanolic brown propolis, from the State of Mato Grosso, was investigated against Escherichia coli ATCC 25922. The values of physical and chemical parameters showed significant variation among samples. The percentage of dry extract ranged from 2.6 to 27.6 percent. The index of oxidation varied from 3 to 519 seconds. All samples showed the percentage of wax higher than the limit preconized by the legislation, with values varying from 3.4 to 74.6 percent. The quantification of phenolic and flavonoid compounds, responsible for antimicrobial activity, ranged from 0.1 to 5.0 (w/w) and 0.02 to 0.66 (w/w), respectively, being that the higher the index of phenolic compounds the larger the zones of inhibition. Antibacterial activity was observed in seven out of the 23 samples, demonstrating zones of inhibition ranging from 10 to 11.3mm. For these active samples, the minimum inhibitory concentration was determined, ranging from 125 to 1000mg/mL. The value of MIC in 42.9 percent of these samples was 250mg/mL. These results contribute to the establishment of physical and chemical parameters for the regulation of brown propolis and indicate possible therapeutic applicability in the development of formulations for the treatment of infections caused by E. coli.