Reutilización de barrera de tela de algodón estéril en la práctica clínica: estudio observacional longitudinal / Reusing sterile cotton fabric barriers in the clinical practice: an observational and longitudinal study / Reuso de barreira estéril de tecido de algodão na prática clínica: estudo longitudinal observacional

Objetivo: analizar las características de barrera física y biológica de los campos de algodón utilizados como sistema de barrera estéril después de ser sometidos a múltiples usos y procesos en la práctica clínica. Método: estudio observacional longitudinal de seguimiento y evaluación de tela 100% algodón, utilizada como sistema de barrera estéril en un hospital de mediano porte. Se recolectaron muestras antes del uso (después de tres lavados) y después de tres, seis, nueve, 12 y 15 meses de uso y se evaluaron el número, grosor e integridad de los hilos, peso, absorción de agua y penetración húmeda de microorganismos. Resultados: después de 85 lavados, no cambió el número de hilos, aumentó el número de fibras deshilachadas y el volumen de agua absorbida. La prueba microbiológica mediante la metodología estándar alemana obtuvo un resultado negativo y la de penetración húmeda de microorganismos no mostró cambios significativos con el tiempo, a pesar de que una fracción de células microbianas pasó a través de las muestras de doble capa. Conclusión: las propiedades físicas de la tela 100% algodón utilizada como sistema de barrera estéril cambiaron con el uso/procesamiento; sin embargo, no interfirieron significativamente con los resultados obtenidos en las pruebas realizadas a la barrera microbiológica hasta los 85 lavados.

Objective: to analyze the physical and biological barrier characteristics of cotton fields used as a sterile barrier system after multiple use and processing cycles in the clinical practice. Method: an observational and longitudinal study to monitor and evaluate 100% cotton fabric used as a sterile barrier system in a medium-sized hospital. Samples were collected before use (after three washes) and at three, six, nine, 12 and 15 months of use and evaluated for the number, thickness and integrity of threads, weight, water absorption and wet penetration by microorganisms. Results: after 85 washes, the number of threads remained unchanged, and the shredded fibers and the water volume absorbed were increased. The microbiological test using the German standard methodology obtained a negative result and wet penetration by microorganisms did not show significant changes over time, although a percentage of the microbial cells passed through the double-layer samples. Conclusion: the physical properties of 100% cotton used as a sterile barrier system changed with use/processing cycles; however, these alterations did not significantly interfere with the results obtained by the tests performed on the microbiological barrier up to 85 washes.

Objetivo: analisar as características de barreira física e biológica de campos de algodão, que são utilizados como sistema de barreira estéril, após múltiplos usos e processamentos na prática clínica. Método: estudo longitudinal observacional de acompanhamento e de avaliação de tecido 100% algodão que foi utilizado como sistema de barreira estéril em um hospital de médio porte. Amostras foram coletadas antes do uso (após três lavagens) e com três, seis, nove, 12 e 15 meses de uso e avaliadas quanto ao número, à espessura e à integridade dos fios, peso, absorção de água e penetração úmida de micro-organismos. Resultados: após 85 lavagens, o número de fios permaneceu inalterado, porém aumentaram-se as fibras desfiadas e o volume de água absorvido. O teste microbiológico utilizando metodologia padrão alemão obteve resultado negativo; já o de penetração de úmida de micro-organismos não apresentou mudanças significativas ao longo do tempo, embora uma fração das células microbianas tenham passado pelas amostras de dupla camada. Conclusão: as propriedades físicas do tecido 100% algodão, utilizado como sistema de barreira estéril, alteraram com usos/processamentos; entretanto essas não interferiram significativamente nos resultados obtidos pelos testes realizados na barreira microbiológica até 85 lavagens.

Factores que intervienen en la aparición de infecciones en heridas quirúrgicas de pacientes intervenidos en el hospital general milagro en el periodo de agosto 2020 a enero 2021 / Factors intervening in the appearance of infections in surgical wounds of patients operated at the milagro general hospital in the period from august 2020 to january 2021

El Ecuador mantiene una alta tasa de mortalidad derivada de las infecciones de heridas quirúrgicas, las post cesárea son las que se presentan comúnmente, donde las bacterias cada vez evolucionan mecanismos de resistencia a los antibióticos. Objetivo: analizar los factores que intervienen en la aparición de infección en herida quirúrgica. Materiales y Métodos: investigación tipo inductivo-deductiva al analizar variables cuantitativas; y la aplicación del razonamiento, con el que se obtuvieron generalizaciones del tema en estudio Resultados: Sexo el 35 % Mujeres y el 65% Varones, el 25 % tienen edad de 15 a 40 años, el 45 % tienen de 41 a 60 años, y el 30 % tienen de 61 años y más. Con respecto al nivel de educación, 50 % no tiene educación, 25% primaria, 15% secundaria y 10% superior, según la residencia el 75% vive en zona rural y 25 % en zona urbana. La mayoría de los procedimientos quirúrgicos involucrados en la complicación de infecciones de la herida fueron de emergencia en un 93,3%; mientras que las que se presentaron en electivas respondieron al 6,7%. Se observó que el 80% de las cirugías realizadas son clasificadas como cirugías limpias contaminadas, y un 20% cirugías contaminadas. Las mismas que tiene un alto riesgo de infectarse el SQ. Conclusiones: A pesar de que las acciones preventivas de preparación de piel y asepsia ­ antisepsia previa al acto quirúrgico se cumplen, las infecciones de la herida quirúrgica se siguen dando en una parte de pacientes intervenidos en el Hospital General Milagro(AU)

Ecuador maintains a high mortality rate derived from surgical wound infections, post-cesarean sections are the ones that commonly occur, where bacteria increasingly evolve mechanisms of resistance to antibiotics. Objective: to analyze the factors that intervene in the appearance of infection in surgical wounds. Materials and Methods: inductive-deductive type research when analyzing quantitative variables; and the application of reasoning, with which generalizations of the subject under study were obtained Results: Sex 35% Women and 65% Men, 25% are between 15 and 40 years old, 45% are between 41 and 60 years old, and 30% are 61 and older. Regarding the level of education, 50% have no education, 25% primary, 15% secondary and 10% higher, according to residence, 75% live in rural areas and 25% in urban areas. Most of the surgical procedures involved in the complication of wound infections were emergency in 93.3%; while those who attended electives responded to 6.7%. It was observed that 80% of the surgeries performed are classified as clean contaminated surgeries, and 20% contaminated surgeries. The same ones that have a high risk of becoming infected with SQ. Conclusions: Although the preventive actions of skin preparation and asepsis - antisepsis prior to the surgical act are fulfilled, infections of the surgical wound continue to occur in a part of patients operated on at the Hospital General Milagro(AU)

Effects of different aseptic procedures on occurrence of central venous catheter-related infections in non-surgical patients: a retrospective cohort study / 中华麻醉学杂志

Objective:To evaluate the value of implementing strict aseptic operation procedures in preventing central venous catheter-related infections.Methods:This retrospective cohort study consisting of non-surgical patients who underwent central venous catheterization from 2015 to 2019 were conducted.The patients were divided into 2 groups according to routine aseptic procedures and strict aseptic procedures, the patients between 2015 and 2017 served as routine aseptic procedure group (group C), and the patients between 2017 and 2019 served as strict aseptic procedure group (group E ). The occurrence of central venous catheter-related infections (local infection, bloodstream infection) was recorded within 6 days after catheterization.Results:Compared with group C, the incidence of central venous catheter-related local infection was significantly decreased (1.79% vs. 0.48%, P<0.001; the rate ratio being 0.27 ranged in 0.10-0.30), while no significant change was found in the incidence of central venous catheter-related bloodstream infection in group E (0.29% vs. 0.19%, P>0.05). The cumulative incidence of central venous catheter-related infections was 0.67%(<1.00%) in group E. Conclusions:Implementation of strict aseptic procedures during central venous catheterization can further reduce the occurrence of central venous catheter-related infections, which has significant clinical value.

Role of prophylactic antibiotics in elective surgeries and postoperative surgical infections

Background: Health care associated infections (HAIs) present a significant source of preventable morbidity and mortality. More than 30% of all HAIS are represented by surgical site infections (SSIs) making them most common sub types between 1.9% and 2.7% of all surgical patients. Joseph Lister “the man who made surgery safe” introduced antiseptic method for safe surgeries. As many are now considering antibiotics “wonder drug” which covers the surgical techniques and having asepsis. Extensive indiscriminate use of antibiotics has resulted in developing resistance.Methods: Study conducted in about 100 cases in various surgical units having various surgical procedures. Only clean cases are taken. A single stat dose of first generation cephalosporin 1gm given IV at the time of giving anesthesia. Postoperative any signs and symptoms like infections, fever with chills, wound discharge are observed. If any evidence of wound infection is present, accordingly sent for culture and sensitivity and suitable antibiotics are given.Results: In our study 5 patients had fever with serous discharge 2 patients showed no growth, 3 patients had got growth positive (2- staphylococcus aurous, 1- pseudomonas). Hence our infection rate is 3%.Conclusions: Single dose prophylaxis has got definite advantage to overcome the postoperative wound sepsis. Prolonged antibiotic therapy should be avoided as it has got no added advantages over single dose antibiotic.

Safety alert for hospital environments and health professional: chlorhexidine is ineffective for coronavirus

SUMMARY An alarming fact was revealed by recent publications concerning disinfectants: chlorhexidine digluconate is ineffective for disinfecting surfaces contaminated by the new coronavirus. This is a finding that requires immediate disclosure since this substance is widely used for the disinfection of hands and forearms of surgeons and auxiliaries and in the antisepsis of patients in minimally invasive procedures commonly performed in hospital environments. The objective of this study is to compare the different disinfectants used for disinfection on several surfaces, in a review of worldwide works. Scientific studies were researched in the BVS (Virtual Health Library), PubMed, Medline, and ANVISA (National Health Surveillance Agency) databases. The following agents were studied: alcohol 62-71%, hydrogen peroxide 0.5%, sodium hypochlorite 0.1%, benzalkonium chloride 0.05-0.2%, povidone-iodine 10%, and chlorhexidine digluconate 0.02%, on metal, aluminum, wood, paper, glass, plastic, PVC, silicone, latex (gloves), disposable gowns, ceramic, and Teflon surfaces. Studies have shown that chlorhexidine digluconate is ineffective for inactivating some coronavirus subtypes, suggesting that it is also ineffective to the new coronavirus.

RESUMO Um dado alarmante revelado por publicações a respeito dos agentes desinfetantes: o digluconato de clorexidina é ineficaz para desinfecção de superfícies contaminadas por coronavírus. Trata-se de uma constatação que reclama imediata divulgação, uma vez que essa substância é amplamente usada para degermação de mãos e antebraços dos cirurgiões e auxiliares e na antissepsia dos pacientes, em procedimentos minimamente invasivos, comumente em ambientes hospitalares. O objetivo deste trabalho foi comparar os diferentes desinfetantes usados para desinfecção em diversas superfícies em revisão de trabalhos mundiais. Foram pesquisados trabalhos científicos na BVS (Biblioteca Virtual de Saúde), PubMed, Medline e Anvisa (Agência Nacional de Vigilância Sanitária). Foram estudados os seguintes agentes: álcool 62-71%, peróxido de hidrogênio 0,5%, hipoclorito de sódio 0,1%, cloreto de benzancônio 0,05-0,2%, iodo povidina 10% e digluconato de clorexidina 0,02%, em superfícies de metal, alumínio, madeira, papel, vidro, plástico, PVC, silicone, látex (luvas), avental descartável, cerâmica e teflon. Os estudos demonstraram que o digluconato de clorexidina é ineficaz para a inativação de alguns subtipos de coronavírus, sugerindo que também seja ineficaz contra o novo coronavírus.

Flora bacteriana después del lavado de manos quirúrgico. Estudio piloto / Bacterial flora after surgical hand scrubbing. A pilot study

RESUMEN Introducción: La técnica de lavado de manos quirúrgico es imprescindible para la prevención de las infecciones posoperatorias en el sitio de la intervención, lo que constituye un problema actual y en evolución. Objetivo: Determinar la técnica de lavado de manos quirúrgico con mayor eficacia sobre la flora bacteriana en estudiantes de cirugía. Métodos: Ensayo controlado, aleatorio, de tratamientos no farmacológicos. Se seleccionaron 12 estudiantes de cirugía de la Facultad de Odontología, Universidad de San Martín de Porres, que cumplían con los criterios de inclusión y exclusión. Los estudiantes se dividieron en dos grupos y se les asignó una técnica de lavado de manos quirúrgico: Grupo A: técnica de una fase, y Grupo B: técnica tradicional (tres fases); para ambas técnicas se utilizó escobilla y jabón en barra. Resultados: En el medio de cultivo agar manitol salado, la técnica tradicional presentó una mediana de 52 000 UFC/mL con un mínimo de 10 000 UFC/mL y un máximo de 56 800 UFC/mL, en comparación con la técnica de una fase que presentó 19 600 UFC/mL con un mínimo de 4 400 UFC/mL y un máximo de 38 000 UFC/mL, con un valor de p= 0,117. En el agar MacConkey, la técnica tradicional presentó una mediana de 300 UFC/mL con un mínimo de 0 UFC/mL y un máximo de 18 000 UFC/mL, en comparación con la técnica de una fase que presentó 0 UFC/mL, con un valor de p= 0,054. Conclusiones: No se mostraron diferencias estadísticamente significativas en ambos grupos(AU)

ABSTRACT Introduction: Surgical hand scrubbing is indispensable to prevent postoperative infection at the intervention site, a problem both current and in progress. Objective: Determine the most effective surgical hand scrubbing technique against bacterial flora among surgery students. Methods: A controlled randomized study was conducted of non-pharmacological treatments. Twelve surgery students were selected from the School of Dentistry at the University of San Martín de Porres who met the inclusion and exclusion criteria. The students were divided into two groups and assigned one of two surgical hand scrubbing techniques: Group A: one-step technique and Group B: traditional technique (three steps). Both techniques used bar soap and a brush. Results: In the culture medium mannitol salt agar, the traditional technique obtained a median of 52 000 CFU/mL, with a minimum 10 000 CFU/mL and a maximum 56 800 CFU/mL, whereas the one-step technique obtained a median of 19 600 CFU/mL, with a minimum of 4 400 CFU/mL and a maximum of 38 000 CFU/mL (p= 0.117). In MacConkey agar, the traditional technique obtained a median of 300 UFC/mL, with a minimum of 0 CFU/mL and a maximum of 18 000 CFU/mL, whereas the one-step technique obtained 0 UFC/mL (p= 0.054). Conclusions: No statistically significant differences were found in the groups(AU)

Higienização simples e o uso do álcool 70% no controle de microrganismos das mãos em universitários da área da saúde / Simple hygiene and use of alcohol 70% in the control of microorganisms of the hands in students of the health area

Objetivo: Verificar a eficácia da lavagem das mãos no controle de disseminação de microrganismos em universitários da área da saúde. Métodos: Delineamento experimental, utilizando como antissépticos água e sabão e álcool 70% (gel e líquida). Os procedimentos de lavagem simples das mãos e uso de álcool 70% foram distribuídos em cinco grupos: Grupo sem lavagem das mãos (MS); Grupo lavagem simples das mãos com água e sabão (LS); Grupo lavagem das mãos com água e sabão e uso de álcool 70% (líquido) (LSA70), Grupo lavagem das mãos com água e sabão e uso de álcool 70% (gel) (LSAG) e Grupo apenas com uso de álcool gel (MAG). Resultados: Participaram do estudo 125 universitários. Foi observada significância estatística quando comparado os seguintes grupos: MS vs. MAG (p < 0,001), MS vs. LSA70 (p < 0,001), LS vs. MAG (p < 0,05), MS vs. LSAG (p < 0,001), LSAG vs. MAG (p < 0,001) e LSAG vs. LSA70 (p < 0,05). Conclusão: O álcool 70% foi eficaz na redução de crescimento de microrganismos em relação à lavagem simples das mãos. O álcool em forma de gel demonstrou ter melhor resultado quando aplicado sem a lavagem previa das mãos enquanto que o álcool na forma líquida foi mais eficaz após a lavagem das mãos. (AU)

Objective: To verify the effectiveness of hand washing in the control of dissemination of microorganisms in health university students. Methods: Experimental design, using water and soap and 70% alcohol (gel and liquid) as antiseptics. The procedures of simple hand washing and alcohol use 70% were distributed in five groups: Group without hand washing (MS); Simple washing hands group with soap and water (LS); Group washing of hands with soap and water and use of alcohol 70% (liquid) (LSA70), Group washing with soap and water and use of alcohol 70% (gel) (LSAG) and Group with alcohol gel use only (MAG). Results: 125 university students participated in the study. Statistical significance was observed when compared to the following groups: MS vs. MAG (p < 0.001), MS vs. LSA70 (p < 0.001), LS vs. MAG (p < 0.05), MS vs. LSAG (p < 0.001), LSAG vs. MAG (p < 0.001) and LSAG vs. LSA70 (p < 0.05). Conclusion: Alcohol 70% was effective in reducing the growth of microorganisms in relation to simple hand washing. Alcohol in the form of a gel was shown to have a better outcome when applied without prior handwashing, whereas alcohol in liquid form was more effective after handwashing. (AU)

Clinicopathological and ALVAL score analysis of pseudotumor-like tissue around aseptic joint arthroplasty / 中华病理学杂志

Objective@#To analyze the clinicopathological features of pseudotumor-like tissue around aseptic joint arthroplasty and aseptic lymphocytic vasculitis-associated lesions (ALVAL) scores. The characters of wear granules were observed.@*Methods@#Total 122 cases were retrieved from the surgical pathology files between May 2015 and August 2018 in the department of pathology in Beijing Jishuitan Hospital, which included the knee joint arthroplasty (10 cases) and hip arthroplasty (112 cases). There were 62 females and 60 males. Patients′ age ranged from 29 to 86 years (mean 56 years). The pseudotumor-like tissue around aseptic joint arthroplasty were stained with HE and analyzed by two ALVAL score systems. The characters of wear granules were observed by light microscope and polarized light.@*Results@#The cohort included 62 females and 60 males. Patients′ age ranged from 29 to 86 years (mean 56 years). Compbell-ALVAL system includes synovial lining,inflammatory infiltrate and tissue organization. The scores were: low (0-4): 18cases; moderate (5-8): 101 cases; high (9-10): 3 cases. Oxford-ALVAL system only evaluated the inflammatory infiltrate,and the scores were:0 grade:56 cases; 1 grade:51 cases; 2 grade: 12 cases; 3 grade:3 cases. Cases with high score in the Compbell-ALVAL system were concordant with the 3 grade of the Oxford-ALVAL system. Under light microscope,the metal particles were small black granules; the polyethylene fibers were needle-like and easily visible in polarized light. The polymethylmethacrylate showed clear spaces because of particle melting.@*Conclusions@#The Compbell-ALVAL scoring system is based on the histologic analysis of pseudotumor-like tissue around aseptic joint arthroplasty, and the Oxford-ALVAL scoring systems is based on lymphocytic response. The wear particles could be differentiated by the features in the light microscope.

Higiene de manos en la práctica sanitaria en un contexto local ecuatoriano / Hands hygiene in health practice in a local Ecuadorian context

Las infecciones asociadas con la atención en salud se relacionan a dificultades con la higiene de manos del personal sanitario antes y después de estar en contacto con un paciente. Se reali-zó una investigación descriptiva, con enfoque mixto, con el objetivo de caracterizar la higie-ne de manos en unidades de salud donde realizan práctica formativa y preprofesional los estudiantes de la Facultad de Ciencias de la Salud de la Universidad Nacional de Chimbora-zo, en la ciudad de Riobamba, Ecuador, durante el período comprendido entre septiembre a diciembre de 2017. La población en estudio estuvo conformada por la totalidad de docentes titulares, ocasionales y de apoyo (220) que durante el período de estudio laboraron en el contexto investigado; de la cual, siguiendo un muestreo no probabilístico del tipo intencional, se escogió una muestra de 59 profesores de las unidades docentes asistenciales involucradas. Al indagar el conocimiento que, sobre las principales causas de colonización de gérmenes en el paciente poseen los encuestados, se observó baja percepción referida por los participantes respecto al riesgo de transmisibilidad cruzada a través de las manos y la necesidad de desa-rrollar competencias para la correcta realización de esa técnica. El lavado de manos con base alcohólica, y el tiempo mínimo que dedican los participantes a la fricción de las manos con ese tipo de gel, evidenció que de forma mayoritaria la efectúan por un período de veinte segundos.

Infections associated with health care are related to difficulties with hands hygiene of health personnel before and after being in contact with a patient. A descriptive research with a mixed approach was performed in order to characterize hands hygiene in health units where students of the Faculty of Health Sciences of Universidad Nacional de Chimborazo carry out training and pre-professional practice, during the period September-December 2017. The study population was made up of all of the regular, occasional and support professors (220) who worked in the Faculty of Health Sciences during the study period. 59 teachers from the teaching units involved was chosen by the means of a non-probabilistic sampling of the intentional type. After applying the survey related to the main causes of colonization of germs in the patient, the interviews showed a low perception referred by the participants regarding the risk of cross transmissibility through the hands and the need to develop compe-tences for the correct realization of that technique. The accomplishment of the hand washing with alcoholic base, and the minimum time that the participants dedicated to the friction of the hands with this type of gel evidenced that in a majority way they did it for a period of twenty seconds.

Development and test of medical gas terminal filter device / 医疗卫生装备

Objective To develop a N95 filter device for medical gas terminal to remove bacteria,viruses,particles and impurities from medical gas so as to purify medical gas to sterile grade.Methos The device was composed of a filter element and a shell,and the two parts were gifted with cylindrical shape to enlarge filtration area and reduce airflow resistance.The filter element had its length being 110 mm and diameter being 40 mm,and was composed of a tubular plastic frame and high-performance N95 filter cotton with high filtration rate.The top of the filter element was fixed to the inlet end of the device,and the bottom was fastened to the outlet end by splicing.The device with a total length of 150 mm had its shell and joint made of plastics,and was 110-mm long at the inlet end and 60-mm long at the outlet end.The outside diameter of the device was 60 mm,the connection thread at the middle of the device was 20-mm long,and the cones at the two ends had a 30-mm diameter.The joints at the ends had their sizes being 5 mm according to industrial standard,which were used to connect the device with the oxygen tube.Results The device had the filtration rate being higher than 99.9％ for both particle filtration efficiency and bacterial filtration efficiency,and the desired requirements were met.Conclusion The device gains advantages when filtering bacteria,virus and particles,and thus is worthy promoting clinically.

Avaliação das Práticas de Higienização por Estudantes de Medicina da Universidade Federal da Bahia (Brasil) durante Atendimento Clínico / Assessment of Hygiene Practices Employed by Medical Students at the Federal University of Bahia (Brazil) during Clinical Service

RESUMO A adesão às normas de higienização é um aspecto importante na prática clínico-hospitalar dos profissionais de saúde. Este estudo avaliou a conduta de 160 estudantes de Medicina do Internato da Faculdade de Medicina da Bahia, da Universidade Federal da Bahia, por meio de um questionário com 22 questões objetivas. Dos 160 questionários incluídos na pesquisa, 76% dos entrevistados autoavaliaram seu conhecimento sobre as normas de higienização como “excelente” e “bom”; contudo, apenas 50% realizam a higienização das mãos antes e após contato com o paciente. Cerca de 55% não concordam com a criação de um novo componente curricular específico para essa temática. As características demográficas da amostra foram diferentes quanto ao sexo em relação a outros estudos, prevalecendo no presente estudo o sexo masculino e faixa etária de 20 a 40 anos. Observam-se resultados divergentes quanto ao conhecimento dos estudantes sobre as normas de higiene e à sua conduta na prática médica. Alguns fatores que levam à não adesão à técnica asséptica pelos estudantes são a abordagem teórica sobre higienização e biossegurança em período diferente do da prática, falta de fiscalização, carência de insumos e materiais, e má conduta de alguns profissionais de saúde.

ABSTRACT Adherence to hygiene standards is an important aspect of health professionals’ clinical and hospital practice. In this study, we evaluated the behavior of 160 students completing a medical internship at the Faculty of Medicine of Bahia of the Federal University of Bahia, by means of a questionnaire containing 22 objective questions. Of the 160 participants in the survey, 76% assessed their own knowledge of hygiene standards as “excellent” or “good”; however only 50% performed hand hygiene before and after patient contact. Around 55% did not agree with the suggestion of creating a new specific curricular component on the theme. The demographic characteristics of the sample varied in gender in terms of other studies, with a prevalence of male students and an age range of 20-40. We observed divergent results regarding the students’ knowledge of the hygiene standards and their conduct thereof in medical practice. Several factors leading to the students’ failure to undertake aseptic practice are the fact that the theory of Hygiene and Biosafety is taught at a different time to its practice, as well as the lack of supervision, lack of supplies and materials and misconduct on the part of some health professionals.

Actualización en técnica aséptica y uso de antibióticos profilácticos en procedimientos quirúrgicos ambulatorios que comprometan piel y mucosas / Aseptic techniques for minor surgical procedures: an update

Aseptic techniques are those practices designed to reduce the risk of surgical site infection (SSI), defined as such, all those that occur within the first 30 days of the procedure. While the patient’s risk of developing an SSI in dermatologic surgery is low since many of the procedures are considered sterile, there are different factors associated with an increased or decreased risk of developing SSI. The characteristics of the surgical wound (such as involving infected or inflamed tissue or when breaks in the aseptic technique occur), patient characteristics (such as age, comorbidities, medication use and smoking) and procedure factors (such as setting, surgical technique, type of procedure, duration and body region involved). In this article we discuss the management of potential sources of infections such as personnel (hand washing, dressing), preparation of the patient, maintenance of a clean surgical environment, sterilization and the use of antiseptic solutions. Similarly, the current indications for prophylactic antibiotics for these procedures are considered.

Avaliação da Resistência a Antimicrobianos de Staphylococcus Coagulase Negativa Encontrados nas Grades dos Leitos em uma Unidade de Terapia Intensiva / Evaluation of the Antimicrobial Resistance of Coagulase-Negative Staphylococci Found in the Bars of the Beds in an Intensive Care Unit

Infecção hospitalar é toda infecção adquirida durante a internação hospitalar, geralmente provocada pela própria microbiota humana, que sedesequilibra com os mecanismos de defesa em decorrência da doença, dos procedimentos invasivos (soros, cateteres e cirurgias) e do contatocom o ambiente hospitalar. Este estudo objetivou determinar a distribuição dos microrganismos encontrados nas grades dos leitos em umaunidade de terapia intensiva e a resistência a antimicrobianos no grupo de microrganismo de maior incidência. Realizado em uma unidade deterapia intensiva de um hospital público filantrópico no estado de São Paulo, na cidade de Araraquara, onze leitos foram submetidos à coleta emsuas grades de proteção laterais. A maior prevalência foi do grupo Staphylococcus coagulase negativo (54,2%), Staphylococcus aureus (29,2%),seguido da classe de bacilos Gram-negativos (12,5%) e com menor incidência o gênero Streptococcus sp. (4,2%). Os Staphylococcus coagulasenegativos isolados apresentaram 84,6% de resistência à clindamicina, 76,9% à eritromicina, 38,5% à cefoxetina, 38,5% ao norfloxacino, 30,8%à rifampicina, 23% ao levofloxacino, 7,7% à nitrofurantoína e todos os isolados exibiram sensibilidade à tetraciclina e à vancomicina. Eentreos patógenos isolados como causadores de infecção hospitalar neste estudo, destacou-se o grupo dos Staphylococcus coagulase negativo, queapresentou maior incidência e alto espectro de resistência, sendo um patógeno emergente causador de infecção hospitalar.

Nosocomial infection is all infection acquired during the entire hospitalization, usually caused by the human microbiota, that unbalances thedefense mechanisms as a result of the disease, invasive procedures (physiological serum, catheters and surgeries) and from the contact withthe hospital environment. This study aimed to determine the distribution of micro-organisms found in the bars of the beds in an intensive careunit and the antimicrobial resistance of microorganism of higher incidence. Performed in an intensive care unit of a hospital charity in theState of São Paulo, in the city of Araraquara, eleven beds were submitted for collection at their side protection bars. The highest prevalencewas the group of coagulase-negative Staphylococci (54.2%), Staphylococcus aureus (29.2%), followed by the class of gram-negative bacilli(12.5%) and lower the genus Streptococci sp. (4.2%). The coagulase-negative Staphylococci isolates showed resistance to clindamycin, 84.6%,76.9% to erythromycin, 38.5% to cefoxetin, 38.5% to norfloxacin, 30.8% to rifampicin, 23% to the levofloxacin, 7.7% to nitrofurantoin and allthe isolates exhibited sensitivity to tetracycline and vancomycin. Among the pathogens isolated as causing nosocomial infection in this study,the group of coagulase-negative Staphylococci presented higher incidence and high resistance spectrum, being an emerging pathogen causingnosocomial infection

Hand Hygiene Compliance of Healthcare Workers in a Pediatric Intensive Care Unit.

We conducted an observational study over 11 months to assess the hand-hygiene compliance of health-care workers in a Pediatric intensive care unit. The overall compliance was 80.9%, which decreased with increase in workload (79.2% vs. 82.9%). Assessment of hand hygiene compliance helps understand the gaps in practices followed by healthcare workers, and plan effective protocols.

Realismo pictórico y medicina: las dos clínicas quirúrgicas de Thomas Eakins / Painting realism and medicine: the two surgical clinics of Thomas Eakins

Realism is a painting style that began with Millet and Courbet in politically convulsed France in the middle of the nineteenth century. In the second half of that century, the pragmatic and democratic tradition of the United States fostered the careers of many realist painters, including that of Thomas Eakins. Eakins, trained in France, developed his career completely associated with Philadelphia at a time when this city was in the vanguard of American emerging industry, culture and medicine. Eakins The clinic of Dr. Gross and the The clinic of Dr. Agnew are icons of these developments and symbolize a perfect union of art and medicine. Both paintings permit the viewer to appreciate the artist s mastery, originality and Americanism while simultaneously tracking the progress of surgery as evidenced by the introduction of asepsis, anesthesia and nursing. Eakins mastery is revealed by its use of some European Old Masters approaches to portray medical professionals undertaking their daily duties in their work environments with critical and unadorned vision. This combination of vision and skills led Eakins to create a highly original yet analytical art. Unfortunately, his representations were far ahead of his time and resulted in under appreciation of his paintings and a censorious reaction to their content. His contemporaries rejection of Eakins work negatively affected his career as a painter, as a teacher and even his private life. This judgment was overturned in subsequent years and by the twentieth century Eakins was recognized as an American master without parallel.

Video Surveillance Audit of Hand-washing Practices in a Neonatal Intensive Care Unit.

Objective: To audit hand-washing practices by video-surveillance. Methods: Six main steps (step 2 to step 7) of World Health Organization’s hand hygiene technique with soap and water were used for evaluation. Handwashing was categorized as excellent, acceptable and unacceptable.Results: Of 1081 recordings, 403 (37.3%) were excellent, 521 (48.2%) were acceptable and 157 (14.5%) were unacceptable handwash. Unacceptable handwashing was more prevalent in the night in comparison to daytime (17.5% vs 12.5%). Thirteen people washed their face after washing their hands.Conclusion: Innovative interventions are required to improve handwashing during night shifts.

Adesão da equipe de enfermagem à higienização das mãos: fatores motivacionais / The nursing team’s compliance with hand hygiene: motivational factors

Estudo descritivo, com os objetivos de verificar fatores motivacionais à adesão na higienização das mãos por equipe de Enfermagem de hospital público de Londrina, PR, Brasil, em 2012, e de propor estratégias para sua melhoria. Participaram 135 profissionais de Enfermagem, que forneceram informações sobre identificação profissional, educação permanente e realização da higienização das mãos. A motivação para adesão à higiene das mãos esteve vinculada à satisfação na vida pessoal de 45 (33,3%) e no trabalho de 58 (42,9%), assim como a autonomia à realização dos cuidados de Enfermagem por 76 (56,3%). Os fatores motivacionais influenciadores na adesão à prática de higienização das mãos foram: desenvolvimento/crescimento profissional, interesse pelo trabalho, flexibilidade para priorizar as ações de cuidado, autonomia e participação nas decisões. Estes devem ser considerados no planejamento da educação permanente para melhoria da adesão à higienização das mãos, bem como a qualidade da assistência prestada...

This descriptive study aimed to verify factors which motivate compliance with hand hygiene on the part of the nursing team in a publichospital in Londrina, PR, Brazil, in 2012, and to propose strategies for improving this. A total of 135 nursing professionals participated,providing information on professional identification, continuing education, and the undertaking of hand hygiene. Themotivation for complying with hand hygiene was linked to satisfaction in personal life for 45 (33.3%) and to satisfaction inthe work for 58 (42.9%), as well as to autonomy for undertaking the nursing care, for 76 (56.3%). The motivational factorswhich influence compliance with the practice of hand hygiene were: professional development/growth, interest in the work,flexibility for prioritizing the care actions, autonomy, and participation in the decisions. These must be taken into accountin planning the continuing education, so as to improve compliance with hand hygiene, as well as the quality of the careprovided...

Estudio descriptivo, cuyos objetivos fueron verificar factores motivacionales a la adhesión a la higiene de las manos por equipo deenfermería en hospital público de Londrina, PR, Brasil, en 2012, y proponer estrategias para su mejoría. Participaron 135 profesionalesde enfermería, que fornecieron informaciones sobre identificación profesional, educación permanente y realización de la higiene de lasmanos. La motivación para adhesión a la higiene de las manos estuvo vinculada a la satisfacción en la vida personal, 45 (33,3%); y enel trabajo, 58 (42,9%); y autonomía en la realización de la atención de enfermería, 76 (56,3%). Los factores motivacionales que fueron:desarrollo/crecimiento profesional, interés por el trabajo, flexibilidad para priorizar las acciones de cuidado, autonomía y participaciónen las decisiones. Estos deben ser considerados en el planeamiento de la educación permanente para mejoría de la adhesión a la higienede las manos, así como la calidad de la asistencia prestada...

La enfermera y la visión de seguridad del paciente en el quirófano en aspectos relacionados con la asepsia y la técnica estéril / Nursing staff and patient security vision in the operating room regarding asepsis and sterile technique / O recurso humano de enfermagem e a visão de segurança dos pacientes na sala de cirurgia nos aspectos vinculados com assepsia e técnica estéril

El profesional de enfermería en la mayoría de los casos tiene a su cargo y es de su responsabilidad hacer una supervisión y comprobación periódica de los diversos procesos administrativos y operativos, de aplicación rigurosa de las normas y principios de asepsia y antisepsia quirúrgica. Es de vital importancia la aplicación de la técnica aséptica para evitar que las personas que ingresan por cualquier procedimiento quirúrgico adquieran infecciones en razón a la susceptibilidad en particular en el quirófano. Estos principios son de obligatoriedad conocer y aplicar, no por unos pocos sino por todo el personal que labora en el quirófano. Es responsabilidad de los profesionales de la salud y del personal auxiliar que ayuda en los quirófanos cumplir y hacer cumplir las normas establecidas para brindar un ambiente seguro a toda persona que necesita de una intervención quirúrgica. Todos los procesos necesitan ser evaluados y auditados para verificar sus resultados.

The nurse in most cases is responsible and it is their responsibility to do oversight and regular review of the various administrative and operational processes, implementing rigorous standards and principles of aseptic surgery. It is vital to the implementation of aseptic technique to prevent people entering for any surgical procedure due to infections acquired susceptibility in particular in the OR. These principles are compulsory learning and applying, not the few but for all staff working in the operating room. It is the responsibility of health professionals and support staff in operating rooms to help implement and enforce the rules established to provide a safe environment to everyone who needs surgery. All processes need to be evaluated and audited to verify their results.

O profissional de enfermagem, na maioria dos casos, encarrega- se da supervisão e comprovação periódica dos diversos processos administrativos e operacionais, da aplicação rigorosa das normas e princípios de assepsia e antissepsia cirúrgica. É fundamental a aplicação da técnica asséptica para evitar que as pessoas que entram para realizarem qualquer procedimento cirúrgico adquiram infecções por causa da particular condição da sala de cirurgia. É mandatório aprender e aplicar esses princípios, não apenas por uns poucos, mas por todo o pessoal trabalhando na sala de cirurgia. Os profissionais da saúde e os auxiliares que trabalham na sala de cirurgia são responsáveis por cumprir e fazer cumprir as normas estabelecidas para oferecer um ambiente seguro a qualquer pessoa que precise de intervenção cirúrgica. Todos os processos precisam ser avaliados e auditados para verificar os resultados.

Métodos para detecção de fungos e assepsia de sementes de Schizolobium amazonicum (Caesalpinioideae) / Methods to detection of fungi and asepsis of Schizolobium amazonicum (Caesalpinioideae) seeds

As sementes constituem-se insumos biológicos extremamente importantes para a propagação vegetal e, consequentemente, a qualidade sanitária destas assume grande relevância. O objetivo do presente trabalho foi comparar os métodos do papel de filtro e do meio BDA na incubação de sementes para avaliar a qualidade sanitária e a influência da assepsia das sementes sobre o teste de sanidade, emergência e desenvolvimento de plântulas de Schizolobium amazonicum. Foram testados os métodos do papel de filtro (blotter test) e do meio de cultura Batata-Dextrose-Ágar (BDA), com e sem assepsia das sementes. A influência da assepsia foi avaliada por meio dos testes de emergência de plântulas, velocidade de emergência e desenvolvimento de plântulas (comprimento, matéria fresca e matéria seca da raiz e da parte aérea). Aspergillus flavus, Aspergillus niger, Penicillium griseofulvum, Penicillium sp. e Pestalotiopsis sp. podem se associar com sementes de paricá; o meio de cultura BDA é adequado para o desenvolvimento dos fungos nas sementes dessa espécie; a assepsia das sementes reduz a população de microrganismos contaminantes, favorece o teste de sanidade, não influencia a emergência das plântulas, podendo ser benéfica ao estabelecimento das mudas.

Seeds are essential components for vegetal propagation and, in this way, seed sanitary quality assumes fundamental importance. The aim was to compare the blotter test and BDA methods to incubate seeds to evaluate sanitary quality, the influence of seed disinfection on sanitary test, emergence and seedling development of Schizolobium amazonicum. For determination of microrganisms associated with seeds were tested the methods of paper filter (blotter test) and medium Potato Dextrose Agar (PDA), with aseptic and non-aseptic seeds. The influence of asepsi were evaluated trough seedling emergence test, speed of seedling emergence and seedling development (length, fresh matter and dry matter of root and shoot). Aspergillus flavus, A. niger, Penicillium griseofulvum, Penicillium sp. and Pestalotiopsis sp. can be associated with parica seeds; PDA method is the most suitable to fungi development on this seeds specie; surface sterilization of seeds reduce microrganisms, assist the sanitary test, not affect seed germination and seedling development, but can be benefic to seedling establishment.

Descrição das práticas de prevenção da infecção Hospitalar por anestesiologistas em um hospital universitário / Description of nosocomial infection prevention practices by anesthesiologists in a university hospital

JUSTIFICATIVA E OBJETIVOS: Os anestesiologistas desempenham importante papel na prevenção de infecções hospitalares. Na prática anestésica, rotineiramente são ultrapassadas as barreiras fisiológicas, possibilitando a contaminação do paciente por micro-organismos e o desenvolvimento de infecção. A não adesão às práticas recomendadas pode facilitar a transmissão de micro-organismos. É importante descrever as práticas de profilaxia da infecção hospitalar relacionadas ao ato anestésico executadas por médicos anestesiologistas. MÉTODO: Foram distribuídos questionários estruturados, preenchidos pelo próprio anestesiologista de forma voluntária e anônima. RESULTADOS: Dentre os 112 anestesiologistas, 75 por cento responderam ao questionário. A máscara cirúrgica é usada por 95,2 por cento, 96,3 por cento usam luvas frequentemente, 98,8 por cento usam luva estéril para bloqueio do neuroeixo, 91,3 por cento adotam a técnica estéril para punção venosa central, 95,1 por cento lavam as mãos entre os casos, 91,6 por cento procuram manter estéril a cânula de intubação orotraqueal, 96,3 por cento descartam o propofol em seringa ao final de cada anestesia, 30 por cento limpam os frascos para uso no neuroeixo e 19,8 por cento para uso endovenoso. CONCLUSÕES: As práticas de profilaxia de infecção hospitalar apresentaram boa adesão e, para melhorá-las, é necessário realizar campanhas educacionais multidisciplinares.

BACKGROUND AND OBJECTIVES: Anesthesiologists play an important role in the prevention of nosocomial infections. In anesthetic practice, physiologic barriers are routinely breached, allowing patient contamination with microorganisms and the consequent development of infection. The lack of adhesion to recommended practices can facilitate transmission of microorganisms. It is important to describe prophylactic practices of anesthesiarelated nosocomial infections performed by anesthesiologists. METHODS: Structured questionnaires were distributed to be answered voluntarily and anonymously by anesthesiologists. RESULTS: Among 112 anesthesiologists, 75 percent answered the questionnaire. Surgical mask is used by 95.2 percent of anesthesiologists, 96.3 percent wear gloves frequently, 98.9 percent wear sterile gloves for neuraxial block, 91.3 percent use sterile technique for central venous puncture, 95.1 percent wash their hands between cases, 91.6 percent try to maintain the endotracheal tube sterile, 96.3 percent discard the prefilled propofol syringe at the end of each anesthesia, 30 percent clean the vials before using it in the neuraxial blocks, and 19.8 percent clean the vials before intravenous use. CONCLUSIONS: Respondents showed good adhesion to practices of nosocomial infection prophylaxis and to improve them educational multidisciplinary campaigns are necessary.

JUSTIFICATIVA Y OBJETIVOS: Los anestesiólogos desempeñan un importante papel en la prevención de las infecciones hospitalarias. En la práctica anestésica, y de forma rutinaria, se rebasan las barreras fisiológicas, posibilitando la contaminación del paciente por microorganismos y el desarrollo de las infecciones. Si no se respetan las prácticas recomendadas, se puede facilitar la transmisión de los microorganismos. Es importante describir las prácticas de profilaxis de la infección hospitalaria que se relacionan con el acto anestésico y que son hechas por los médicos anestesiólogos. MÉTODO: Se distribuyeron cuestionarios estructurados, rellenados por el propio anestesiólogo de forma voluntaria y anónima. RESULTADOS: Entre los 112 anestesiólogos, 75 por ciento de ellos respondieron al cuestionario. La máscara quirúrgica la usa un 95,2 por ciento, y el 96,3 por ciento usan guantes con frecuencia. Un 98,8 por ciento usan guantes estériles para el bloqueo del neuro eje, un 91,3 por ciento adoptan la técnica estéril para punción venosa central, un 95,1 por ciento se lavan las manos entre los casos, un 91,6 por ciento intentan mantener estéril la cánula de intubación orotraqueal, el 96,3 por ciento descartan el propofol en la jeringuilla al final de cada anestesia, el 30 por ciento limpian los frascos para el uso en el neuro eje, y el 19,8 por ciento queda para uso endovenoso. CONCLUSIONES: Las prácticas de profilaxis de infección hospitalaria presentaron una buena adhesión y para mejorarlas, es necesario realizar campañas educativas multidisciplinarias.