Prevención de infecciones asociadas a cuidados de la salud en pacientes quemados / Prevention of healthcare-associated Infections in burn patients

Las infecciones asociadas a cuidados de la salud (IACS) son una de las complicaciones más importantes que presentan los pacientes gran quemados. Aumentan su morbimortalidad, la duración de su estadía, el consumo de antimicrobianos y los costos hospitalarios. Las tasas reportadas de IACS son muy variables entre los distintos países y centros de atención.El ánimo de esta publicación es brindar el material necesa-rio y actualizado de las medidas de control de infecciones que se deben implementar en la atención de los quemados ya que no es fácil disponer de información sobre este tema.En la presente revisión se analizaron estudios de distin-tas poblaciones, adultos y niños, con diferentes tipos que-maduras y diversos lugares de atención. Se utilizó como material de referencia las recomendaciones vigentes de la Sociedad Internacional de injurias por Quemaduras (ISBI, por su sigla inglés) y se adicionaron publicaciones y expe-riencias de grupos de trabajo local e internacional referen-tes en el tema.Se describen cinco tipos de medidas de control y preven-ción de IACS: medidas generales, medidas de higiene am-biental, prevención de la infección de los lechos de las que-maduras, profilaxis antibiótica y medidas de prevención de neumonía, infecciones asociadas a catéteres vasculares y vesicales en quemados. Es esencial implementar un enfoque proactivo y multidisci-plinario del control de infecciones en la atención de estos pacientes, generando recomendaciones adaptadas a la realidad de cada centro de salud, destinadas a disminuir las transmisión cruzada de microorganismos, utilizar los antimicrobianos tópicos y sistémicos en forma adecuada, disminuir la multirresistencia, reducir las IACS y su mor-talidad

Healthcare-associated infections (HAIs) are one of the most important complications of severe burn patients. They increase their morbidity and mortality, length of stay, antimicrobial consumption, and hospital costs. Re-ported rates of IACS vary widely across countries and care settings.The purpose of this publication is to provide the nec-essary and up-to-date material on the infection control measures that should be implemented in the care of burn patients, since it is not easy to have information on this subject.In this review, we analysed studies of different popula-tions, adults and children, with different types of burns and different places of care. The current recommenda-tions of the International Society of Burn Injuries (ISBI) were used as reference material, and publications and experiences of local and international working groups on the subject were added. Five types of IACS control and prevention measures are described: General mea-sures, Environmental hygiene measures, Prevention of infection of burn injuries, Antibiotic prophylaxis and pre-vention measures for pneumonia, infections associated with vascular and bladder catheters in burn patients.Conclusion: It is essential to implement a proactive and multidisciplinary approach to infection control in the care of these patients, generating recommendations adapted to the reality of each health center, aimed at reducing cross-transmission of microorganisms, using typical and systemic antimicrobials appropriately, reduc-ing multiresistance, reducing HAIs and their mortality

Higiene das mãos dos profissionais de saúde: perspectivas do estudante de enfermagem no papel de paciente/familiar / Higiene de manos de los profesionales de la salud: perspectiva de estudiantes de enfermería en el papel de paciente/familiar / Healthcare professionals' hand hygiene: perspectives of nursing student's in patients/relatives role

Resumo Objetivo Investigar as opiniões e atitudes dos estudantes de enfermagem no papel de pacientes ou familiares de pacientes, a respeito do comportamento de higiene das mãos dos profissionais de saúde e da participação dos pacientes na campanha de higiene das mãos. Métodos Estudo transversal prospectivo realizado entre 2021-2022 no Nursing Department, Faculty of Health Sciences, de duas universidades turcas. A amostra do estudo foi composta por 330 alunos. Os dados foram coletados por meio de questionário autoaplicável. A taxa de resposta do questionário foi de 89,43%. O teste qui-quadrado foi utilizado na análise dos dados. Resultados A média de idade dos estudantes foi de 19,80±1,30 anos, 76,1% eram do sexo feminino, 50,9% afirmaram ter recebido instrução sobre Infecções Associadas aos Cuidados de Saúde (IACS). Enquanto 30,1% dos estudantes relataram realizar a higiene das mãos "9 a 11 vezes" em sua vida diária, 54,6% relataram "12 a 15 vezes" no hospital, e 96,4% dos estudantes se perguntaram se os profissionais de saúde realizavam a higiene das mãos antes de fornecer cuidados durante as internações. De acordo com 30,5% dos estudantes, lembretes dos pacientes e seus familiares sobre a realização da higiene das mãos antes do contato com os pacientes os deixariam satisfeitos. Houve diferença estatisticamente significativa entre a instrução anterior dos estudantes sobre IACS e a higiene das mãos como cuidado importante a pacientes hospitalizados (p<0,05). Conclusão Os estudantes de enfermagem apresentaram conhecimento suficiente sobre a higiene das mãos e uma atitude positiva frente aos comportamentos de higiene das mãos dos profissionais de saúde. Estudantes de enfermagem como pacientes e familiares dos pacientes podem ser incluídos nas campanhas de higiene das mãos dos profissionais de saúde, desde que as etapas do programa sejam bem planejadas.

Resumen Objetivo Investigar las opiniones y actitudes de los estudiantes de enfermería en el papel de pacientes o familiares de pacientes respecto al comportamiento de higiene de manos de los profesionales de la salud y de la participación de los pacientes en la campaña de higiene de manos. Métodos Estudio transversal prospectivo realizado entre 2021 y 2022 en el Nursing Department, Faculty of Health Sciences, de dos universidades turcas. La muestra del estudio estuvo compuesta por 330 alumnos. Los datos se recopilaron mediante cuestionario autoaplicado. El índice de respuesta del cuestionario fue de 89,43 %. Se utilizó la prueba ji cuadrado en el análisis de los datos. Resultados El promedio de edad de los estudiantes fue de 19,80±1,30 años, el 76,1 % era de sexo femenino, el 50,9 % afirmó haber recibido instrucción sobre infecciones asociadas a los cuidados de la salud (IACS). Mientras el 30,1 % de los estudiantes relató realizar la higiene de manos "9 a 11 veces" en su vida diaria, el 54,6 % relató "12 a 15 veces" en el hospital, el 96,4 % de los estudiantes se preguntó si los profesionales de la salud realizaban la higiene de manos antes de brindar cuidados durante las internaciones. El 30,5 % de los estudiantes estuvo satisfecho con los recordatorios de los pacientes y sus familiares sobre la realización de la higiene de manos antes del contacto con los pacientes. Hubo diferencia estadísticamente significativa entre la instrucción anterior de los estudiantes sobre IACS y la higiene de manos como cuidado importante en pacientes hospitalizados (p<0,05). Conclusión Los estudiantes de enfermería presentaron conocimientos suficientes sobre la higiene de manos y una actitud positiva frente a los comportamientos de higiene de manos de los profesionales de la salud. Puede incluirse a los estudiantes de enfermería como pacientes y familiares de los pacientes en las campañas de higiene de manos de los profesionales de la salud, siempre que las etapas del programa estén bien planificadas.

Abstract Objective To investigate the views and attitudes of nursing students, as patients or relatives, on healthcare professionals' hand hygiene behavior and patient participation hand hygiene campaign. Methods This prospective cross-sectional study was conducted in the nursing departments of the health and science faculties at two Turkish universities between 2021-2022. The study sample comprised 330 students. Data were collected using a self-administered questionnaire. The response rate of the questionnaire was 89.43%. Chi-square test was used in data analysis. Results The mean age of students was 19.80±1.30 years, 76.1% were female, 50.9% stated they had received education regarding healthcare-associated infections (HAI). While 30.1% of students reported they performed hand hygiene "9-11 times" in their daily lives, 54.6% reported performing "12-15 times" in the hospital, and 96.4% of students expressed wondering if healthcare professionals performed hand hygiene before offering care during hospitalizations. Among students, 30.5% stated that reminders from patients and their relatives about performing hand hygiene before contact with patients would make them happy. There was a statistically significant difference between students' previous training in HAIs and hand hygiene as an important inpatient care (p<0.05). Conclusion Nursing students had sufficient knowledge of hand hygiene and a positive attitude towards hand hygiene behaviors of healthcare professionals. Nursing students, such as patients and their relatives, can be included in hand hygiene campaigns for healthcare professionals, provided that the program steps are well planned.

Long-term care facilities for older people and the COVID-19 pandemic: epidemiological data and preventive measures / Instituições de longa permanência para idosos e a pandemia de COVID-19: dados epidemiológicos e medidas preventiva

Objectives: The COVID-19 pandemic has challenged society, especially residents of long-term care facilities (LTCF). This study investigated rates of infection, hospitalization, and death due to COVID-19 among LTCF residents and staff in Minas Gerais, Brazil and identified strategies to control the spread of the disease.Methods: This cross-sectional study collected data from 164 LTCF (6017 older adults). The owners or managers were invited to answer an electronic questionnaire. The questionnaire included 55 items, divided into 3 sections.Results: Of the participating LTCF, 48.7%, 39.6%, and 32.3% reported COVID-19 infections, hospitalizations, and deaths, respectively, among residents, while 68.9%, 7.3%, and 1.2% reported COVID-19 infections, hospitalizations, and deaths, respectively, among staff. Preventive measures were identified and classified as organizational, infrastructural, hygiene items/personal protective equipment, and staff training.Conclusion: The strategies used in the daily routines of LTCF during the pandemic were classified. The challenges experienced in Brazilian facilities were similar to those observed worldwide. The results highlight the importance of continuity and the need to improve protective measures for LTCF residents, especially in low- and middle-income countries

Objetivos: A pandemia da COVID-19 tem sido desafiadora para a sociedade, principalmente para aqueles que residem em Instituições de Longa Permanência (ILPI). Este estudo teve como objetivo descrever as taxas de infecção, hospitalização e óbito por COVID-19 entre idosos e funcionários de ILPI de Minas Gerais/Brasil e identificar estratégias de prevenção e controle da disseminação da doença.Metodologia: Este estudo transversal foi realizado com 164 ILPI (6.017 idosos). Os gestores ou proprietários foram convidados a responder ao questionário eletrônico. O questionário incluiu 55 itens, divididos em três seções.Resultados: Entre as ILPI estudadas, 48,7% confirmaram a infecção por COVID-19 em idosos, resultando em 39,6% de internação e 32,3% de óbito entre os infectados. Além disso, 68,9% das ILPI confirmaram infecção por COVID-19 na equipe, com 7,3% de internação e 1,2% de óbito. As medidas preventivas foram identificadas e classificadas como organizacionais, infraestrutura, itens de higiene e equipamentos de proteção individual e treinamento de pessoal contra a COVID-19.Conclusão: Essas medidas revelaram estratégias e barreiras vivenciadas no cotidiano das ILPI durante a pandemia. As ILPI no Brasil passaram por desafios semelhantes aos observados mundialmente. Os resultados destacaram a importância da continuidade e melhoria das medidas de proteção para idosos em ILPI, especialmente em países de baixa e média renda

Incidencia de infecciones relacionadas a la bula de filtración en pacientes con trabeculectomía / Incidence of Filtration Bullae-related Infections in Trabeculectomy Patients

Objetivo: Determinar la incidencia de infecciones relacionadas a la bula de filtración en pacientes sometidos a trabeculectomía; así como su comportamiento clínico. Métodos: Se realizó un estudio descriptivo longitudinal y retrospectivo. El universo estuvo comprendido por 1320 ojos con trabeculectomía y muestra conformada por 7 ojos con diagnóstico de infección relacionada a la bula de filtración operados en el Centro Oftalmológico de Villa Clara desde enero del 2012 hasta diciembre del 2021. Resultados: La incidencia global de infección en la bula de filtración fue de 0,53 por ciento. La incidencia de blebitis y de blebitis-endoftalmitis fue 0,15 por ciento y 0,38 por ciento, respectivamente. Los hombres fueron los más afectados y la edad media fue de 64,7 años. En todos los casos, la infección se presentó de forma tardía con una media de 4,1 años. El 57,1 por ciento tuvo una agudeza visual mejor corregida al inicio de la infección de movimiento de manos. Se reportó crecimiento bacteriano en un 57,1 por ciento, el estafilococo coagulasa negativo fue el germen más frecuente. El control de la infección se logró en 6 pacientes mientras 2/3 de ellos no tuvo mejoría de la agudeza visual mejor corregida a la resolución de la infección, todos con blebitis-endoftalmitis. Conclusiones: Las infecciones relacionadas a la bula de filtración son poco comunes. Se presentan con frecuencia años después de la cirugía filtrante y con mala agudeza visual. Los ojos con blebitis-endoftalmitis tienen una pobre recuperación visual a pesar del tratamiento(AU)

Purpose: To determine the incidence of filtration bullae-related infections in patients undergoing trabeculectomy; as well as their clinical behavior. Methods: A longitudinal and retrospective descriptive study was performed. The universe was comprised of 1320 eyes with trabeculectomy and the sample consisted of 7 eyes with a diagnosis of infection related to the filtration bulla operated at the Villa Clara Ophthalmologic Center between January 2012 and December 2021. Results: The overall incidence of infection in the filtration bullae was 0.53 percent. The incidence of blebitis and blebitis-endophthalmitis was 0.15 percent and 0.38 percent, respectively. Males were the most affected and the average age was 64.7 years. In all cases, the infection presented late with a average age of 4.1 years. Fifty-seven point one percent had best corrected visual acuity at the onset of hand motion infection. Bacterial growth was reported in 57.1 percent, coagulase negative staphylococcus was the most frequent germ. Infection control was achieved in 6 patients while 2/3 of them had no improvement of best corrected visual acuity at resolution of infection, all with blebitis-endophthalmitis. Conclusions: Infections related to filtration bullae are uncommon. They occur frequently years after filtering surgery and with poor visual acuity. Eyes with blebitis-endophthalmitis have poor visual recovery despite treatment(AU)

Cuidados de enfermagem em pacientes queimados nas unidades de terapia intensiva / Nursing care in burned patients in intensive care units / Cuidados de enfermería en pacientes quemados en unidades de cuidados intensivos

Objetivo: evidenciar os cuidados de enfermagem descritos na literatura nacional e internacional que são aplicados em pacientes queimados em terapia intensiva. Método: revisão integrativa, realizada no período de fevereiro a dezembro de 2020, nas bases de dados eletrônicas US National Library of Medicine, Medical Literature Analysis and Retrieval System Online e Biblioteca Virtual em Saúde. Resultados: foram selecionados oito artigos, os quais foram categorizados em Cuidados de Enfermagem com a pele em pacientes queimados, Cuidados de Enfermagem com a mobilidade em pacientes queimados e Cuidados de Enfermagem em pacientes queimados em relação à dor, dispositivos e prevenção de complicações. Conclusão: os cuidados de enfermagem para pacientes queimados em terapia intensiva estão intensamente atrelados aos cuidados com as lesões de pele e seus desdobramentos, assim como a prevenção de infecções.

Objective: to highlight the nursing care described in the National and International Literature that is applied to burned patients in intensive care. Methods: integrative review, carried out from February to December, 2020, using the following electronic bases: US National Library of Medicine, Medical Literature Analysis and Retrieval System Online and Biblioteca Virtual em Saúde. Results: it was selected eight articles, which were categorized into Nursing Care for skin in burned patients, Nursing Care for mobility in burned patients and Nursing Care for burned patients in relation to pain, devices and prevention of complications. Conclusion: nursing care for burned patients in intensive care is associated to the care of skin lesions and their consequences, as well as the prevention of infections.

Objetivo: destacar los cuidados de enfermería descritos en la literatura nacional e internacional que se aplican en pacientes quemados en cuidados intensivos. Método: revisión integradora, realizada de febrero a diciembre de 2020, en las bases de datos electrónicas US National Library of Medicine, Medical Literature Analysis and Retrieval System Online y Virtual Health Library. Resultados: se seleccionaron ocho artículos, los cuales se clasificaron en Cuidados de Enfermería con la Pelea en Pacientes Enfermos, Cuidados de Enfermería con la Movilidad en Pacientes Enfermos y Cuidados de Enfermería en Pacientes Enfermos en relación con el dolor, los dispositivos y la prevención de complicaciones. Conclusión: los cuidados de enfermería a los pacientes quemados en cuidados intensivos están intensamente ligados al cuidado de las lesiones cutáneas y sus desdoblamientos, así como a la prevención de infecciones.

Use and management of disinfectants by dentists in San Luis Potosi, Mexico, during the covid-19 pandemic / Uso y manejo de desinfectantes por odontólogos de San Luis Potosí, México durante la pandemia covid-19

Introduction: Chlorine, ethyl alcohol, and quaternary ammonium are disinfectants with antiviral activity against SARS-Cov2. However, there are no previous reports of their use and handling for cleaning and disinfection in dental offices. Objetive: To determine the use and management of disinfectants in critical and non-critical areas used by dentists in San Luis Potosí, Mexico, during the COVID-19 pandemic. Material and Methods: A validated cross-sectional survey was applied online to 100 dentists in San Luis Potosí between February and June 2021. Participants were informed about the handling of personal data according to the standard DOF regulations (DOF 07-05-2010). Results: A total of 100 dentists were included in the study, 63% female and 37% male, with a mean age of 26 years. The most widely used disinfectants during the pandemic in critical areas were Lysol® and 0.1% sodium hypochlorite in non-critical areas. Eighty-five percent of dentists know the adverse effects of inappropriate use of disinfectants, 72% did not have any sign or symptom associated with the use of disinfectants. The most used protection barrier was gloves (97%). Sixty-seven per cent of dentists disposed of disinfectant waste down the drain. Conclusion: Sodium hypochlorite and quaternary ammonium compounds and/or ethanol are used to clean non-critical and critical areas in dental offices. However, appropriate measures for their management are not adopted. It is necessary to implement educational strategies to improve the use and management of disinfectants in dental practice.

Introducción: Cloro, alcohol etílico y amonio cuaternario son desinfectantes que muestran actividad antiviral contra el SARS-Cov2, sin embargo, no existen reportes previos de su uso y manejo para la limpieza y desinfección en clínicas dentales. Objetivo: Determinar el uso y manejo de los desinfectantes en áreas críticas y no críticas empleados por los odontólogos en San Luis Potosí durante la COVID-19. Material y Métodos: Encuesta transversal validada y aplicada on-line a 100 odontólogos de San Luis Potosí durante febrero-junio 2021. Se informó a los participantes sobre el manejo de datos personales de acuerdo a la norma (DOF 05-07-2010). Resultados: Se incluyeron un total de 100 odontólogos, 63% del sexo femenino y 37% del sexo masculino, con una edad promedio de 26 años. Los desinfectantes más utilizados durante la pandemia en las áreas críticas fueron el Lysol® y el hipoclorito de sodio al 0.1% en áreas no críticas. El 85% de los odontólogos conocen los efectos adversos del uso inadecuado de los desinfectantes, 72% no tuvieron algún signo o síntoma asociado al uso de desinfectantes. La barrera de protección más utilizada fueron los guantes (97%). El 67% de los odontólogos eliminó los desechos de desinfectantes por la coladera. Conclusión: Para la limpieza de las áreas no críticas y críticas en las clínicas dentales se utilizan el hipoclorito de Sodio y compuestos de amonio cuaternario y/o etanol, sin embargo, no se utilizan las medidas adecuadas para su manejo. Es necesario implementar estrategias educativas para mejorar el uso y manejo de desinfectantes en la práctica dental.

Knowledge of and adherence to standard precautions in a hemodialysis unit: a cross-sectional study

Abstract BACKGROUND: Standard precautions (SPs) are recommended safety measures for healthcare professionals to follow, with a view to preventing healthcare-related infections (HCRIs) and for their own protection. Inadequate adherence to these measures can lead to occurrences of occupational accidents and HCRIs. OBJECTIVES: To ascertain the knowledge of and adherence to SP measures among the nursing staff of a hemodialysis service and the relationship of these variables to occurrences of work accidents with biological material. DESIGN AND SETTING: Descriptive cross-sectional and correlational study with a quantitative approach developed in a hemodialysis clinic in Minas Gerais. METHODS: Data were collected through sociodemographic questionnaires and questionnaires on knowledge of and adherence to SPs. RESULTS: 29 professionals participated in the study. It is noteworthy that all of them had already participated in training related to SPs. However, no relationship was identified between knowledge of (15.17 points) and adherence to (71.86 points) SPs. In addition, inferential analysis showed that there was a relationship between suffering a work accident with biological material and the sociodemographic data and knowledge of and adherence to standard precautions. CONCLUSION: Knowledge of the SPs that had been established did not mean mastery of the subject. Despite positive results regarding adherence, factors requiring improvement were observed. It was possible to infer the characteristics that gave rise to greater risk of occurrences of accidents at work. Thus, this study showed the importance of assessing knowledge of and adherence to SP, in order to optimize and direct continuing education towards resolving occupational exposure.

Transmission modes of severe acute respiratory syndrome coronavirus 2 and implications for infection control: a review

The complete picture regarding transmission modes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is unknown. This review summarises the available evidence on its transmission modes, our preliminary research findings and implications for infection control policy, and outlines future research directions. Environmental contamination has been reported in hospital settings occupied by infected patients, and is higher in the first week of illness. Transmission via environmental surfaces or fomites is likely, but decontamination protocols are effective in minimising this risk. The extent of airborne transmission is also unclear. While several studies have detected SARS-CoV-2 ribonucleic acid in air samples, none has isolated viable virus in culture. Transmission likely lies on a spectrum between droplet and airborne transmission, depending on the patient, disease and environmental factors. Singapore's current personal protective equipment and isolation protocols are sufficient to manage this risk.

Patient participation in compliance with hand hygiene by health professionals: an integrative review / Participação do paciente na adesão à higiene das mãos pelos profissionais de saúde: revisão integrativa / Participación de los pacientes en la adherencia a la higiene de manos por parte de los profesionales sanitarios: una revisión integradora

Background and objectives: Healthcare-associated Infections are a global health concern. Although the best strategy for its prevention is hand hygiene (HH), there is still low compliance by health professionals in the execution of the correct technique. In order to improve compliance with HH, the World Health Organization (WHO) implemented the multimodal strategy, which emphasizes patient participation in health services, in order to encourage professionals to wash their hands. With this, we sought to verify the impact of the implementation of educational strategies with patient involvement and participation in compliance with hand hygiene by health professionals. Methods: An integrative literature review in the CINAHL, LILACS, PubMed, Scopus and WOS databases. Results: The present sample comprised eight international studies that empowered patient participation with intervention strategies on HH and studies in which patients provided feedback on compliance assessment, which reflected in greater compliance with HH by health professionals. Conclusion: Educational interventions with patient participation and involvement proved to be effective for health professionals to comply with HH, especially when all components of the multimodal strategy were adequately addressed.(AU)

Justificativa e objetivos: As infecções relacionadas à assistência à saúde são um problema de saúde mundial. Embora a melhor estratégia para sua prevenção seja a higiene das mãos (HM), nota-se ainda baixa adesão dos profissionais de saúde na execução da técnica correta. Com o propósito de melhorar a adesão a HM, a Organização Mundial de Saúde (OMS) implementou a estratégia multimodal, que ressalta a participação do paciente nos serviços de saúde, a fim de incentivarem os profissionais a higienizar as mãos. Com isso, buscamos verificar o impacto da implementação de estratégias educativas com o envolvimento e participação do paciente na adesão à higienize das mãos por profissionais de saúde. Métodos: Revisão integrativa da literatura nas bases de dados CINAHL, LILACS, PubMed, Scopus e WOS. Resultados: Compuseram a presente amostra oito estudos internacionais, que empoderaram a participação do paciente com estratégias de intervenção sobre HM e estudos no qual o paciente foi provedor de feedback de avaliação da adesão, o que refletiu em maior adesão à HM pelos profissionais de saúde. Conclusão: Intervenções educativas com a participação e envolvimento do paciente se mostraram eficazes para adesão à HM pelos profissionais de saúde, em especial, quando todos os componentes da estratégia multimodal foram adequadamente contemplados.(AU)

Justificación y objetivos: Las infecciones relacionadas con la asistencia sanitaria son un problema de salud mundial. Aunque la mejor estrategia para su prevención es la higiene de manos (HM), aún existe una baja adherencia por parte de los profesionales sanitarios en la ejecución de la técnica correcta. Para mejorar la adherencia a la HM, la Organización Mundial de la Salud (OMS) implementó la estrategia multimodal, que enfatiza la participación del paciente en los servicios de salud, con el fin de incentivar a los profesionales a lavarse las manos. Con esto, buscamos verificar el impacto de la implementación de estrategias educativas con la implicación y participación del paciente en la adherencia a la higiene de manos por parte de los profesionales sanitarios. Métodos: Revisión integradora de la literatura en las bases de datos CINAHL, LILACS, PubMed, Scopus y WOS. Resultados: La presente muestra estuvo conformada por ocho estudios internacionales que empoderaron la participación del paciente con estrategias de intervención en HM y estudios en los que el paciente brindó retroalimentación sobre la evaluación de la adherencia, lo que se reflejó en una mayor adherencia a la HM por parte de los profesionales de salud. Conclusión: Las intervenciones educativas con participación e involucramiento del paciente demostraron ser efectivas para que los profesionales de la salud se adhieran a la HM, especialmente cuando todos los componentes de la estrategia multimodal se abordaron adecuadamente.(AU)

CO² filtration during pneumoperitoneum inflation and deflation in patients undergoing laparoscopy during the COVID-19 pandemic / Filtragem do CO² durante a insuflação e esvaziamento do pneumoperitônio em pacientes submetidos a videolaparoscopia durante pandemia de COVID-19

ABSTRACT The current Covid-19 pandemic has been the most discussed topic of the year, mostly about protection and ways to avoid dissemination of the virus. In the healthcare system, especially in the operating rooms, the viability of laparoscopic surgery was questioned, mostly because of the transmission through aerosol. This article tries to suggest a way to minimize risks of laparoscopic surgery, during this situation, by using electrostatic filters, a simple, effective and low cost alternative.

RESUMO A atual pandemia do Covid-19 tem sido o assunto mais discutido do ano de 2020, principalmente no que se refere a proteção e as formas de limitar a disseminação do vírus. No cenário hospitalar, mais especificamente no centro cirúrgico, a viabilidade da cirurgia laparoscópica foi questionada, em relação a transmissibilidade do vírus por aerossol. Este artigo sugere uma forma de minimizar os riscos em cirurgias laparoscópicas durante esse cenário, com o uso de filtros eletrostáticos de ventilação mecânica. Uma alternativa simples, eficaz e de baixo custo.

A importância da higienização das mãos dos acompanhantes de pacientes / The importance of hand hygienization of patient caregivers

Objetivo: Revisar a literatura científica especializada no que se refere à higienização das mãos (HM) dos acompanhantes de pacientes que recebem algum tipo de serviço de saúde. Metodologia: Trata-se de uma revisão narrativa da literatura, realizada através de busca ativa nas bases de dados SciELO, Google Acadêmico e Periódicos CAPES, utilizando os descritores: acompanhantes de pacientes, higiene das mãos, patients escorts e hand hygiene. Resultados: Foi constatado que a literatura se concentra em situações às quais os pacientes pertencem à pediatria, devido à relativa facilidade em encontrar textos que versam quanto à instrução parental acerca da HM. No entanto, houve dificuldades em alcançar resultados que envolvessem pacientes adultos e/ou idosos. Conclusão: É importante realizar mais pesquisas que estudem o hábito da HM por parte dos acompanhantes de pacientes. A escassez de obras relacionadas à temática, mais especificamente no que tange aos acompanhantes de pacientes adultos e/ou idosos, evidencia a omissão de preparo do corpo de profissionais de saúde em atentar-se a tal parte tão crucial para a prevenção das infecções relacionadas à assistência à saúde

Objective: Review the specialized scientific literature regarding hand hygiene (HH) of caregivers of patients receiving some type of health service. Methodology: It is a narrative literature review accomplished through active search in databases SciELO, Google Schoolar and Periódicos CAPES, under the descriptors: acompanhantes de pacientes, higiene das mãos, patients escorts and hand hygiene. Results: It was found that the literature focuses on situations in which patients belong to pediatrics, due to the relative ease in finding texts that deal with parental instruction about HH. However, there were difficulties in achieving results involving adult and/or elderly patients. Conclusion: More research is needed to study the habit of HH by caregivers of patients. The scarcity of works related to the theme, specifically with regard to caregivers of adult and/or elderly patients, shows the omission of preparation of the body of health professionals to pay attention to such a crucial part for the prevention of healthcare-related infections

Environmental cleaning to prevent COVID-19 infection. A rapid systematic review

ABSTRACT BACKGROUND: Faced with a pandemic, all healthcare actions need to reflect best practices, in order to avoid high transmissibility, complications and even hospitalizations. For hospital environments, the products recommended and authorized by regulatory institutions for environmental cleaning and disinfection need to be highly effective. OBJECTIVE: To identify, systematically evaluate and summarize the best available scientific evidence on environmental cleaning to prevent COVID-19 infection. DESIGN AND SETTING: A systematic review of studies analyzing cleaning products that inactivate coronavirus, conducted within the evidence-based health program of a federal university in São Paulo (SP), Brazil. METHODS: A systematic search of the relevant literature was conducted in the PubMed, EMBASE, Cochrane Library, CINAHL and LILACS databases, for articles published up to May 27, 2020, relating to studies evaluating cleaning products that inactivate coronavirus in the environment. RESULTS: Seven studies were selected. These analyzed use of 70% alcohol, detergent, detergent containing iodine, household bleach, sodium hypochlorite, hydrogen peroxide, chlorine dioxide, glutaraldehyde, ultraviolet irradiation and plasma air purifier. The effectiveness of treating sewage with sodium hypochlorite and chlorine dioxide was also evaluated. CONCLUSION: Disinfection of environments, especially those in ordinary use, such as bathrooms, needs to be done constantly. Viral inactivation was achieved using chlorine-based disinfectants, alcohol, detergents, glutaraldehyde, iodine-containing detergents, hydrogen peroxide compounds and household bleaches. Alcohol showed efficient immediate activity. In sewage, sodium hypochlorite had better action than chlorine dioxide. REGISTRATION NUMBER: DOI: 10.17605/OSF.IO/YC5P4 in the Open Science Framework.

Medidas para Prevenir el COVID-19 en el Consultorio Dental / Measures to Prevent COVID-19 in the Dental Office

RESUMEN: El 11 de marzo del 2020, la OMS reconoció al COVID-19 como pandemia mundial. El coronavirus (COVID-19) ha desafiado a los sistemas de salud y demanda una rápida reacción de respuesta, ante el aumento de infectados. El ámbito del trabajo odontológico, está sujeto a un riesgo significativo de contaminación cruzada y difusión de esta enfermedad, siendo muy importante las estrictas medidas de protección. El objetivo de esta revisión es informar sobre las medidas que se deben realizar durante los tratamientos dentro del consultorio dental para prevenir la propagación del COVID-19.

ABSTRACT: On March 11, 2020, the WHO recognized COVID-19 as a global pandemic. The coronavirus (COVID-19) has challenged health systems and demands a quick response reaction, due to the increase in infected people. The field of dental work is subject to a significant risk of cross contamination and spread of this disease, with strict protection measures being very important. The aim of this review is to inform about the measures that must be carried out during treatments in the dental office to prevent the spread of COVID-19.

Recomendaciones en la Atención de Pacientes en Cirugía Maxilofacial Durante la Pandemia de COVID-19 (SARS-CoV-2) / Recommendations in the Care of Patients in Maxillofacial Surgery During the COVID-19 Pandemic (SARS-CoV-2)

RESUMEN: La nueva enfermedad por coronavirus 2019 (COVID-19) es la última patología de preocupación internacional. Originada en Wuhan, China, se extendió rápidamente a nivel mundial, razón por la cual fue declarada una emergencia de salud pública. Sus síntomas principales son fiebre, tos, dolor de garganta, dificultad respiratoria, fatiga, malestar general y la anosmia, que ha sido incorporada recientemente. Sin embargo, también se han descrito múltiples casos asintomáticos que han alarmado a la población general. Esta enfermedad, se caracteriza por su alta tasa de contagio y su mecanismo de propagación es el contacto cercano entre personas y a través de fluidos corporales como la saliva y secreciones de las vías aéreas. El personal de salud es especialmente vulnerable a la infección debido a su gran exposición a las secreciones oronasales de los pacientes, sobre todo, aquellas especialidades médicas y odontológicas cuyo campo de acción se centra en estas áreas, siendo la cirugía oral y maxilofacial una de ellas, teniendo un alto riesgo de transmisión de SARS-CoV-2. Por lo tanto, es fundamental para este personal, seguir protocolos de prevención y control de infecciones, junto con una correcta anamnesis, examen y diagnóstico de los pacientes que permita establecer una priorización en las atenciones quirúrgicas, disminuyendo la propagación del virus. El objetivo de esta revisión es conocer las recomendaciones básicas para la priorización de pacientes y el cuidado en los procedimientos quirúrgicos por parte del equipo de cirugía maxilofacial durante la pandemia por COVID-19.

ABSTRACT: The new coronavirus disease 2019 (COVID-19) is the latest pathology of international concern. Originating in Wuhan, China, it spread rapidly worldwide, which is why it was declared a public health emergency. Its main symptoms are fever, cough, sore throat, shortness of breath, fatigue, general discomfort, and anosmia, which has been recently incorporated. However, multiple asymptomatic cases have also been described that have alarmed the general population. This disease is characterized by its high contagion rate and its propagation mechanism is close contact between people and through bodily fluids such as saliva and airway secretions. Health personnel are especially vulnerable to infection due to their high exposure to patients' oronasal secretions, especially those medical and dental specialties whose field of action focuses on these areas, oral and maxillofacial surgery being one of them, having a high risk of transmission of SARS-CoV-2. Therefore, it is essential for these personnel to follow infection prevention and control protocols, together with a correct anamnesis, examination, and diagnosis of patients, which allows prioritizing surgical care, reducing the spread of the virus. The objective of this review is to know the basic recommendations for patient prioritization and care in surgical procedures by the maxillofacial surgery team during the COVID-19 pandemic.

Infection Control in the Dental Practice with Emphasis on Intraoral Scanners and Semi-Critical Complex Instruments / Control de Infecciones en la Práctica Dental Con Énfasis en Escáneres Intraorales e Instrumentos Complejos Semicríticos

ABSTRACT: We present an integrative review of the literature conducted to find and analyse specific measures for disinfection and/or sterilization of intraoral complex instruments, applicable to intraoral scanners. We performed a two-stage search in the PubMed/MEDLINE, SciELO, REDALYCS, and LILACS databases, and the Google Scholar website, which included full articles in Spanish, Portuguese, and English. The strategy associated the terms 'disinfection', 'biosecurity', 'decontamination', and (a) 'intraoral scanners', and (b) other 'semi-critical' intraoral complex instruments, according to the American Dental Association definition (e.g., 'turbine', etc). Strategy (a) produced just one outcome, whereas (b) produced nine articles, which only suggested low-level disinfectants.The lack of empirically based protocols that allow effective microbiological control makes it necessary to create a new categorization for these instruments when trying to comply with American Dental Association recommendations for dental practice.

RESUMEN: Presentamos una revisión integradora de la literatura realizada para encontrar y analizar medidas específicas de desinfección y / o esterilización de instrumentos complejos intraorales, aplicables a los escáneres intraorales. Realizamos una búsqueda en dos etapas en las bases de datos PubMed / MEDLINE, SciELO, REDALYCS y LILACS, y en el sitio web Google Scholar, que incluía artículos completos en español, portugués e inglés. La estrategia asoció los términos 'desinfección', 'bioseguridad', 'descontaminación' y (a) 'escáneres intraorales', y (b) otros instrumentos complejos intraorales 'semicríticos', según la definición de la Asociación Dental Ameri- cana (p. Ej., 'turbina', etc.). La estrategia (a) produjo un solo resultado, mientras que (b) produjo nueve artículos, que solo sugirieron desinfectantes de bajo nivel. La falta de protocolos de base empírica que permitan un control microbiológico efectivo hace necesario crear una nueva categorización para estos instrumentos, cuando se trata de cumplir con las recomendaciones de la Asociación Dental Americana para la práctica dental.

Manejo del síndrome coronario agudo durante pandemia por COVID ­ 19 / Management of acute coronary syndrome during COVID ­ 19 pandemic

INTRODUCTION: Acute Myocardial Infarction is a medical emergency, being his early and adequate treatment highly effective mainly in relation to reperfusion therapy. Unfortunately, COVID ­ 19 pandemic, has brought changes in its management due to availability of conditioned hemodynamic rooms, infection risk of the professionals, patient conditions and availability of critical unit beds. A review of the topic was made aimed to give a guide for the management of these patients with the available tools. MATERIALS AND METHOD: A review of the topic was made using the Medline/ Pubmed platform, in English and Spanish. Further, published articles in journals as The journal of the American college of cardiology and Circulation were included. CONCLUSIONS: The reperfusion strategies must be used according to the clinical context of the patient. In the acute myocardial infarction with ST elevation, fibrinolytic treatment may be chosen in low risk and without hemodynamic instability. In patients with hemodynamic instability, not eligible for fibrinolytic treatment or in whom this therapy fails, percutaneous angioplasty is indicated considering the protection of personnel. In the case of acute myocardial infarction without ST elevation, the treatment by urgent percutaneous angioplasty is considered in cases of hemodynamic instability or malignant arrhythmias.

SARS-CoV-2 and pregnancy: A review of the facts / SARS-CoV-2 e gestação: uma revisão dos fatos

Abstract Objective The present comprehensive review aims to show the full extent of what is known to date and provide a more thorough view on the effects of SARS-CoV2 in pregnancy. Methods Between March 29 and May, 2020, the words COVID-19, SARS-CoV2, COVID- 19 and pregnancy, SARS-CoV2 and pregnancy, and SARS and pregnancy were searched in the PubMed and Google Scholar databases; the guidelines from well-known societies and institutions (Royal College of Obstetricians and Gynaecologists [RCOG], American College of Obstetricians and Gynecologists [ACOG], International Society of Ultrasound in Obstetrics & Gynecology [ISUOG], Centers for Disease Control and Prevention [CDC], International Federation of Gynecology and Obstetrics [FIGO]) were also included. Conclusion The COVID-19 outbreak resulted in a pandemic with > 3.3 million cases and 230 thousand deaths until May 2nd. It is caused by the SARS-CoV2 virus and may lead to severe pulmonary infection and multi-organ failure. Past experiences show that unique characteristics in pregnancy make pregnant women more susceptible to complications from viral infections. Yet, this has not been reported with this new virus. There are risk factors that seem to increase morbidity in pregnancy, such as obesity (body mass index [BMI] > 35), asthma and cardiovascular disease. Current reports describe an increased rate of pretermbirth and C-section. Vertical transmission

Resumo Objetivo A presente revisão detalhada busca fornecer dados objetivos para avaliar o que se sabe até o momento e possibilitar uma visãomais ampla dos efeitos do SARSCoV2 na gravidez. Métodos Entre 29 demarço e 2 de maio de 2020, foi realizada uma busca nos bancos de dados PubMed e Google Scholar com as palavras COVID-19, SARS-CoV2, COVID-19 e gravidez, SARS-CoV2 e gravidez, e SARS e gravidez. As recomendações dos principais órgãos sobre o tema também foram acessadas. Conclusão O surto de COVID-19 resultou em uma pandemia com> 3.3 milhões de casos e 230 mil mortes até 2 de maio. É uma condição causada pelo vírus SARS-CoV2 e pode levar ao acometimento pulmonar difuso e à falência de múltiplos órgãos. Características únicas da gestante tornam essa população mais propensas a complicações de infecções virais. Até o momento, essa tendência não foi observada para esse novo vírus. Os fatores que parecem estar associados à maior morbidade materno-fetal são obesidade (índice demassa corporal [IMC] > 35), asma e doença cardiovascular. Há descrição de aumento de parto prematuro e parto cesáreo. Não se pode descartar a possibilidade de transmissão vertical da doença, devido a relatos de positividade de reação em cadeia de polimerase (RT-PCR) de swab nasal, RT-PCR de líquido amniótico e imunoglobulina M (IgM) de recém-nascidos. Tratamentos devem ser analisados caso a caso, dada a falta de qualidade de estudos que comprovem a sua eficácia e segurança na gravidez. O corpo clínico deve utilizar equipamentos de proteção individual (EPI) ao manusear pacientes suspeitos ou confirmados e ficar atento aos sinais de descompensação respiratória.

Impact of the COVID-19 pandemic in the time to endoscopy in patients with upper gastrointestinal bleeding / Impacto de la pandemia de COVID-19 en el tiempo hasta la endoscopia en pacientes con hemorragia digestiva alta

ABSTRACT Introduction : During the COVID-19 pandemic, endoscopic procedures are associated with a high risk of SARS-CoV-2 infection. However, in cases of upper gastrointestinal bleeding (UGIB), priority should be given to an early endoscopy. Objective : The main objective was to compare the time since arrival at the hospital and the performance of the endoscopy between both groups. Materials and methods : We performed a retrospective study. Data contains information of patients who attended to the hospital with UGIB and underwent an endoscopy between October 19th, 2019 and June 6th, 2020. Patients were divided into 2 phases: pre-pandemic and pandemic. The time between arrival at the hospital and the performance of the endoscopy in both phases were compared as well as other indicators such hospital stay and in-hospital mortality. Results : With information from 219 patients, the median age was 69 years. 154 and 65 endoscopies were performed in pre-pandemic and pandemic phase, respectively. The time between arrival at the hospital and the performance of the endoscopy was significantly longer during the pandemic (10.00 vs. 13.08 hours, p-value = 0.019). Nevertheless, there were no significant differences in hospital stay or mortality. Conclusion : The management of patients with UGIB during the COVID-19 pandemic is complex and requires the application of clinical judgment to decide the best timing to perform an endoscopy without affecting patient care.

RESUMEN Introducción : Durante la pandemia de COVID-19, los procedimientos endoscópicos se asocian con un alto riesgo de infección por SARS-CoV-2. Sin embargo, en casos de hemorragia digestiva alta (HDA), se debe dar prioridad a una endoscopia precoz. Objetivo : El objetivo principal fue comparar el tiempo transcurrido desde la llegada al hospital y la realización de la endoscopia entre ambos grupos. Materiales y métodos : Realizamos un estudio retrospectivo. Los datos contienen información de pacientes que acudieron al hospital con HDA y fueron sometidos a endoscopia entre el 19 de octubre de 2019 y el 6 de junio de 2020. Los pacientes se dividieron en 2 fases: prepandémica y pandémica. Se comparó el tiempo transcurrido entre la llegada al hospital y la realización de la endoscopia en ambas fases, así como otros indicadores como la estancia hospitalaria y la mortalidad intrahospitalaria. Resultados : Con información de 219 pacientes, la mediana de edad fue de 69 años. Se realizaron 154 y 65 endoscopias en fase prepandémica y pandémica, respectivamente. El tiempo entre la llegada al hospital y la realización de la endoscopia fue significativamente mayor durante la pandemia (10,00 frente a 13,08 horas, valor de p = 0,019). Sin embargo, no hubo diferencias significativas en la estancia hospitalaria ni en la mortalidad. Conclusión : El manejo de pacientes con HDA durante la pandemia de COVID-19 es complejo y requiere la aplicación del juicio clínico para decidir el mejor momento para realizar una endoscopia sin afectar la atención del paciente.