Estratégia multimodal, observação para promoção: revisão integrativa / Multimodal strategy, observation for promotion: an integrative review

O estudo objetivou evidenciar a influencia da utilização da observação na estratégia multimodal para promoção da higienização das mãos. Foi realizada uma revisão integrativa, para responder a seguinte questão: Qual a influência da observação na melhoria da adesão à higienização das mãos? O estudo foi realizado em abril de 2016, O critério de inclusão os artigos na íntegra nos idiomas inglês, português ou espanhol nas bases dado MEDLlNE, LlLACS, PUBMED, SCOPUS, CINAHL e portal BVS e CAPES com seleção de 16 artigos, entre 2010 e 2015. Foram excluídos os artigos repetidos e que não utilizavam a observação como estratégia para melhoria da higienização das mãos .. Resultados: A utilização da observação como ferramenta da estratégia multimodal para promoção da higienização das mãos direciona as intervenções junto aos profissionais de acordo com as necessidades no ponto de assistência. Conclusão: A aplicação ,/ de ferramentas como um roteiro de observação e formulário de observação em conjunto com as tecnologias e ações educativas podem influenciar diretamente na escolha de estratégias que visa melhoria da adesão dos profissionais de saúde à higienização das mãos...

The study aim to highlight the influence of the use of the observation in multimodal strategy for promotion of hand hygiene. It was performed an integrative review, to answer the following question: What is the influence of the observation in improving adherence to hand hygiene? The study was carried out in April 2016, the inclusion criteria articles in full in english, portuguese or spanish in the bases given MEDLlNE, LlLACS, PUBMED, SCOPUS, CINAHL and VHL portal and CAPES with selection of 16 articles. between 2010 and 2015. We excluded articles repeated and who did not use the note as a strategy for improving hand hygiene. Results: The use of observation as a tool of multimodal strategy for promotion of hand hygiene directs the interventions with the professionals in accordance with the needs at the point of care. Conclusion: the application of tools like a roadmap of observation and form for observation in conjunction with the technologies and educational actions can directly influence the choice of strategies aimed at improving the adherence of health professionals to hand hygiene...

El objetivo del estudio para resaltar la influencia de la utilización de la observación en la estrategia rnultimodal para la promoción de la higiene de las manos. Se realizó una revisión integradora, que conteste a la siguiente pregunta: Cuál es la influencia de la observación en la mejora de la adherencia a la higiene de las manos? El estudio se llevó a cabo en abril de 2016, los criterios de inclusión de artículos en inglés, portugués o espanol dadas en las bases MEDLlNE, LlLACS, PUBMED, SCOPUS, CINAHL Y BVS portal y CAPES con selección de 16 artículos, entre 2010 Y 2015. Se excluyeron los artículos repetidos y que no utilice la nota como una estrategia para mejorar la higiene de las manos. Resultados: El uso de la observación como una herramienta de estrategia multimodal para la promoción de la higiene de manos dirige las intervenciones con los profesionales de acuerdo con las necesidades en el punto de cuidados. Conclusión: la aplicación de herramientas como una guía de observación y formar para la observación en conjunción con las tecnologías y acciones educativas pueden influir directamente en la elección de las estrategias encaminadas a mejorar la adherencia de los profesionales de la salud para la higiene de las manos...

Implementación de la estrategia "Atención Limpia es Atención Segura" en un hospital de tercer nivel en Medellín, Colombia / Implementation of the strategy "Clean Care is Safer Care" in a third level hospital in Medellín, Colombia

Introduction: Hand hygiene is the most cost-effective and simple measure of preventing healthcare associated infections (HAI). The approach to improve low compliance must be through multimodal interventions such as the "Clean Care is Safer Care" strategy (WHO). Aim: To estimate the efficacy of a multimodal strategy in improving hand hygiene in five wards of a tertiary care hospital in Medellín, Colombia (2008-2010). Methods: Quasi-experimental before-after study. Results: Hand hygiene compliance significantly increased after the intervention (82 to 89%, p = 0.007). The knowledge score increased from a median of 26 (IQR=22-28) to 30 (IQR=26-32, p = 0.001). Alcohol-based hand rub consumption increased significantly from 10.5 liters to 58.1 liters per 1000 patient-days [incidence ratio (IR) = 2.39, 95% CI = 1.99; 2.88]. Monthly HAI rates showed no significant variations during the same period [IR = 0.90, 95% CI = 0.71; 1.13]. Discussion: This and other recent studies demonstrate that implementing a multimodal strategy for hand hygiene significantly increases compliance with this measure, irrespective of type of health worker or hospital department. Conclusions: Implementing a multimodal strategy we achieved significant increases in hand hygiene compliance but mild or no significant variations in monthly HAI rates.

Introducción: La higiene de manos es una medida costo-efectiva para prevenir las infecciones asociadas a la atención de salud (IAAS). Para mejorar el cumplimiento se recomienda implementar estrategias multimodales como "atención limpia es atención segura" de la OMS. Objetivo: Estimar el efecto de la estrategia multimodal en cinco unidades de un hospital de tercer nivel en Medellín, Colombia (2008-2010). Métodos: Estudio cuasi-experimental antes y después. Resultados: El cumplimiento general con la higiene de manos aumentó de forma significativa en el período posterior a la implementación (82 a 89%, p = 0,007). El puntaje de conocimientos aumentó entre los dos períodos de tiempo (Mediana = 26, RIC = 22-28 vs Mediana = 30, RIC = 26-32; p = 0,001). El consumo de alcohol aumentó de 10,5 litros a 58,1 litros por 1.000 pacientes/día [razón de incidencias (RI) = 2,39; 95% CI = 1,99; 2,88]. Las tasas mensuales de IAAS no mostraron variaciones [RI = 0,90; 95% CI = 0,71; 1,13]. Discusión: Este estudio demuestra que la implementación de una estrategia multimodal para la higiene de manos aumenta significativamente el cumplimiento con esta medida, independientemente del tipo de trabajador y el servicio hospitalario. Conclusión: Con la estrategia multimodal se aumentó significativamente el cumplimiento con la higiene de manos.

Clinical study of perioperative multimodal strategy to prevent deep vein thrombosis in patients undergoing total knee replacements retrospective / 重庆医学

Objective To explore the more effective measures for the prevention of deep vein thrombosis (DVT ) by comparing the different efficacy between the multimodal strategy and liberal measures .Methods From July 2011 to June 2013 ,medical records of 289 patients who had accepted total knee replacement (TKR) were collected .Patients were divided into two groups according to whether exploring to the multimodal strategy or liberal measures after TKR .The multimodal strategy consisted of sequentially used perioperative intermittent pneumatic compression ,intermittent pneumatic compression ,and postoperative continues femoral nerve block analgesia .Patients in group A were treated during July 2011 to June 2012 ,and accepted liberal measures for the prevention of DVT .Patients in group B were treated after June 2012 ,and accepted multimodal strategy .The data of each group were collected for statistical analysis on the following aspects :DVT occurrence rate ,DVT distribution ,age ,gender ,body mass index ,disease ,operation duration ,volume of blood loss and transfusion during operation phase ,drainage volume after TKR .Results The DVT occurrence rate of patients in group B were significantly lower than that of patients in group A (P0 .05) .Conclusion The multimodal strategy consisted of sequentially used perioperative intermittent pneumatic compression ,postoperative low molecular weight heparin ,and postoperative continues femoral nerve block analgesia is more effective than liberal measures for the prevention of DVT .

Estudio multimodal de higiene de manos en un hospital pediátrico de tercer nivel / Multimodal study of hand hygiene in a third level pediatric hospital

Introducción. El apego de los profesionales de la salud a la higiene de manos, en general, es menor a 60%, a pesar de la sencillez y la efectividad de esta medida. Las actividades de capacitación son desestimadas por ser consideradas una estrategia demasiado convencional. El objetivo de el presente trabajo fue evaluar el apego en la higiene de manos en los trabajadores de un hospital a través de implementar una estrategia tipo multimodal. Métodos. Se realizó un estudio de series temporales, que incluyó tres periodos de observación en 3 años. Se implementaron 5 componentes en paralelo: cambios en infraestructura, disponibilidad de los insumos, capacitación y educación para los profesionales de la salud, monitoreo de las prácticas de higiene de manos y retroalimentación, recordatorios. Resultados. En el primer estudio (2009) la prevalencia de lavado de manos fue de 53.84; menos del 10% lo llevó a cabo en los 5 momentos. Para el segundo periodo en junio 2010, (n = 204) la prevalencia fue 62.74; 13.23% lo realizó en los 5 momentos. En 2011 la prevalencia fue 51; 38.9% lo hizo en los 5 momentos (p < 0.05). Conclusiones. Al implementar un proceso multimodal se incrementó el cumplimiento de forma significativa, sin modificarse la prevalencia.

Background. Despite the simplicity and cost-effectiveness of hand hygiene, compliance is less than 60% in health care workers. Training activities are rejected because they are considered too conventional. The aim of this study was to implement a multimodal hand hygiene strategy to assess compliance in health care workers. Methods. A time-series study was performed including three observation periods during 3 years. Five components were implemented in parallel: changes in infrastructure, availability of supplies, training and education for health care workers, monitoring hand hygiene practices and feedback were recorded. Results. During the first period (2009), the prevalence of hand washing was 53.84; less than 10% complied with the five moments. For the second period in June 2010 (n = 204), the prevalence was 62.74; 13.23% complied with the five moments. In 2011 the prevalence was 51; 38.9% complied with the five moments (p < 0.05). Conclusions. After implementing a multimodal strategy, compliance increased significantly with a similar prevalence.