Uso do sistema de custo baseado em atividades para gerenciar a esterilização de materiais / Use of the costing system based on activities to manage material sterilization

Objetivos: comparar os custos diretos envolvidos nas tecnologias de Esterilização à Baixa Temperatura (EBT)utilizadas na CME de um Hospital Universitário, bem como avaliar a relação custo-benefício envolvida no emprego desta tecnologia. Método: estudo exploratório, descritivo, observacional, de abordagem qualitativa, com dados obtidos em uma Central de Esterilização (CE) de um hospital universitário. Para a análise dos custos, utilizou-se a metodologia de Custos Baseados em Atividades (ABC). Resultados: encontraram-se os valores de R$ 303,72 para o ciclo de esterilização de Vapor de Baixa Temperatura de Formaldeído, R$ 424, 28para o ciclo de Óxido de Etileno e R$ 485,32 para o ciclo de Peróxido de Hidrogênio de Plasma Gás. Conclusão: o vapor de formaldeído foi a tecnologia mais econômica em custo/ciclo e custo/litro e a metodologia ABC se mostrou eficaz para gerenciar, planejar e controlar os volumes e custos de uma CE.

Incidencia, estancia hospitalaria y factores de riesgo asociados a la aparición de fístula faringocutánea poslaringectomía / Incidence, hospital stay and risk factors associated with the occurrence of pharyngo-cutaneous fistula after total laryngectomy

Introducción y objetivos: La fístula faringocutánea (FFC) constituye uno de los principales problemas para los pacientes sometidos a laringectomía total. Son numerosos los factores de riesgo descritos y asociados a la aparición de la FFC, sin embargo algunos de ellos se encuentran en discusión. El objetivo es analizar la incidencia de la FFC, la estancia hospitalaria y los factores de riesgo asociados en los pacientes intervenidos de laringectomía total en un hospital de segundo nivel. Métodos: Estudio analítico observacional en una cohorte retrospectiva. Se incluyeron todos los pacientes intervenidos de laringectomía total entre los años 2006 y 2011. Se tuvieron en cuenta variables sociodemográficas, clínicas y la mayoría de los factores de riesgo estudiados en la literatura por otros autores (traqueostomía, estadificación tumoral, quimio/radioterapia previa, etc.). Los análisis estadísticos se llevaron a cabo mediante el programa SPSS® v.15.0 y el Epidat® v.3.1. Resultados: Se analizaron 70 laringectomías totales. La incidencia de FFC en el período de estudio fue del 48,6%. Hubo diferencias significativas entre la estancia hospitalaria media de los pacientes con y sin FFC. Se encontró como único factor de riesgo para la aparición de la FFC la presencia de adenopatías lo corregionales afectadas [RR= 1,60 (1,006-2,54)]. Conclusión: La aparición de FFC se encuentra asociada a la presencia de adenopatías locorregionales afectadas, y no se asocia con la traqueostomía, la administración de radio/quimioterapia previa a la intervención o la localización tumoral (AU)

Introduction and objectives: Pharyngo-cutaneous fistula (PCF) is one of the main problems for patients undergoing total laryngectomy. There are many risk factors described and associated with the appearance of PCF; however, some of these are currently under discussion. The aim of this work is to analyse the incidence of PCF, hospital stay and associated risk factors in patients undergoing total laryngectomy in a secondary hospital. Methods: This was an observational study in a retrospective cohort. We included all patients who underwent total laryngectomy between 2006 and 2011. We considered sociodemographic and clinical items, and most of the risk factors studied in the literature by other authors (tracheostomy, tumour stage, chemotherapy or radiotherapy before surgery, etc.). Statistical analyses were performed using SPSS® 15.0 and Epidat® 3.1. Results: We analysed 70 total laryngectomies. The incidence of PCF in the time period studied was 48.6%. There were significant differences between the mean hospital stay of patients with and without PCF. Affected locoregional lymph nodes were found to be the only risk factor for the occurrence of PCF [RR=1.60 (1.006-2.54)]. Conclusion: The incidence of PCF is associated with the presence of affected locoregional lymph nodes. It is not associated with tracheostomy, administration of radio/chemotherapy before surgery or tumour location (AU)

[Incidence, hospital stay and risk factors associated with the occurrence of pharyngo-cutaneous fistula after total laryngectomy]. / Incidencia, estancia hospitalaria y factores de riesgo asociados a la aparición de fístula faringocutánea poslaringectomía.

INTRODUCTION AND OBJECTIVES: Pharyngo-cutaneous fistula (PCF) is one of the main problems for patients undergoing total laryngectomy. There are many risk factors described and associated with the appearance of PCF; however, some of these are currently under discussion. The aim of this work is to analyse the incidence of PCF, hospital stay and associated risk factors in patients undergoing total laryngectomy in a secondary hospital. METHODS: This was an observational study in a retrospective cohort. We included all patients who underwent total laryngectomy between 2006 and 2011. We considered sociodemographic and clinical items, and most of the risk factors studied in the literature by other authors (tracheostomy, tumour stage, chemotherapy or radiotherapy before surgery, etc.). Statistical analyses were performed using SPSS(®) 15.0 and Epidat(®) 3.1. RESULTS: We analysed 70 total laryngectomies. The incidence of PCF in the time period studied was 48.6%. There were significant differences between the mean hospital stay of patients with and without PCF. Affected locoregional lymph nodes were found to be the only risk factor for the occurrence of PCF [RR=1.60 (1.006-2.54)]. CONCLUSION: The incidence of PCF is associated with the presence of affected locoregional lymph nodes. It is not associated with tracheostomy, administration of radio/chemotherapy before surgery or tumour location.

Tuberculosis in migrant populations. A systematic review of the qualitative literature.

BACKGROUND: The re-emergence of tuberculosis (TB) in low-incidence countries and its disproportionate burden on immigrants is a public health concern posing specific social and ethical challenges. This review explores perceptions, knowledge, attitudes and treatment adherence behaviour relating to TB and their social implications as reported in the qualitative literature. METHODS: Systematic review in four electronic databases. Findings from thirty selected studies extracted, tabulated, compared and synthesized. FINDINGS: TB was attributed to many non-exclusive causes including air-born transmission of bacteria, genetics, malnutrition, excessive work, irresponsible lifestyles, casual contact with infected persons or objects; and exposure to low temperatures, dirt, stress and witchcraft. Perceived as curable but potentially lethal and highly contagious, there was confusion around a condition surrounded by fears. A range of economic, legislative, cultural, social and health system barriers could delay treatment seeking. Fears of deportation and having contacts traced could prevent individuals from seeking medical assistance. Once on treatment, family support and "the personal touch" of health providers emerged as key factors facilitating adherence. The concept of latent infection was difficult to comprehend and while TB screening was often seen as a socially responsible act, it could be perceived as discriminatory. Immigration and the infectiousness of TB mutually reinforced each another exacerbating stigma. This was further aggravated by indirect costs such as losing a job, being evicted by a landlord or not being able to attend school. CONCLUSIONS: Understanding immigrants' views of TB and the obstacles that they face when accessing the health system and adhering to a treatment programme-taking into consideration their previous experiences at countries of origin as well as the social, economic and legislative context in which they live at host countries- has an important role and should be considered in the design, evaluation and adaptation of programmes.

Calidad de la información en el proceso del consentimiento informado para anestesia / Quality of information in the process of informed consent for anesthesia

Objetivos Valorar la calidad de la información recibida sobre los contenidos que se detallan en el documento de consentimiento informado que han firmado previamente los pacientes, mediante las respuestas que estos dan a un cuestionario abierto. Material y métodos Estudio transversal de una muestra de pacientes oncológicos ingresados para cirugía en el Hospital Universitario San Cecilio de Granada durante el año 2011. Tras comprobar los criterios de inclusión y recabar su consentimiento se recogieron datos demográficos y del proceso, y un cuestionario ad hoc para valorar la calidad y comprensión de la información suministrada en el consentimiento informado. Resultados Se estudiaron 150 pacientes. La mayoría (109 de 150) contestó que había recibido suficiente información, con un lenguaje adecuado y la posibilidad de preguntar dudas, pero solo el 44,7% contestó correctamente a 3 o más de las 4 cuestiones realizadas sobre problemas relacionados con la anestesia. Se asociaron a la asimilación de la información recibida el nivel de estudios universitario, el conocimiento de la intervención a realizar, haber recibido información sobre los problemas derivados de la anestesia, considerar que la información recibida había sido suficiente y en un lenguaje adecuado. Conclusiones A pesar de la obtención sistemática del consentimiento informado, casi la mitad de los pacientes ignora los riesgos de la anestesia. Se asociaron con la calidad de la respuesta fundamentalmente las variables relacionadas con la información recibida, pero no las características del paciente (AU)

Objectives To assess the quality of the information that patients receive in the informed consent document signed prior to surgery. Material and methods Cross-sectional study of a sample of cancer patients admitted for surgery at the University Hospital San Cecilio of Granada in 2011. After checking the inclusion criteria and obtaining their consent, demographic data were collected and procedure data, and a questionnaire «ad hoc» to assess the quality and comprehensiveness of the information provided in the informed consent.Results150 patients were studied. The majority (109 over 150) said they had received sufficient information, in appropriate language, and had the opportunity to ask questions, but only 44.7% correctly answered three or more issues related to anesthesia. University education level, knowledge of the intervention, information about the anesthesia problems and appropriate language were associated. Conclusions Although systematic informed consent was performed, half of the patients did not comprehend the anesthesia risks. Variables primarily related to the information received were associated with the quality of the response, but not with patient characteristics (AU)

[Quality of information in the process of informed consent for anesthesia]. / Calidad de la información en el proceso del consentimiento informado para anestesia.

OBJECTIVES: To assess the quality of the information that patients receive in the informed consent document signed prior to surgery. MATERIAL AND METHODS: Cross-sectional study of a sample of cancer patients admitted for surgery at the University Hospital San Cecilio of Granada in 2011. After checking the inclusion criteria and obtaining their consent, demographic data were collected and procedure data, and a questionnaire «ad hoc¼ to assess the quality and comprehensiveness of the information provided in the informed consent. RESULTS: 150 patients were studied. The majority (109 over 150) said they had received sufficient information, in appropriate language, and had the opportunity to ask questions, but only 44.7% correctly answered three or more issues related to anesthesia. University education level, knowledge of the intervention, information about the anesthesia problems and appropriate language were associated. CONCLUSIONS: Although systematic informed consent was performed, half of the patients did not comprehend the anesthesia risks. Variables primarily related to the information received were associated with the quality of the response, but not with patient characteristics.

Esterilización por baja temperatura y sus aplicabilidades / Low temperature sterilization and its applicabilities

Los métodos de esterilización a baja temperatura son muy utilizados, actualmente, para la esterilización de los materiales termosensibles. Este articulo es una revisión bibliográfica que tiene el objetivo de identificar, en la literatura científica, las evidencias de la actividad antimicrobiana, toxicidad, eventos adversos y laaplicabilidad de las tecnologias de esterilización a baja temperatura. La búsqueda de los articulos, fue realizada por medio de la consulta a la base de datos Medline y Google Académico, desde el año 2006 hata octubre de 2009. Para la búsqueda de los articulos, se utilizaron palabras controladas en el idioma inglés y el operador AND para la especificidad del tema que se queria consultar. Fueron leídos y analizados quince articulos en sus totalidades, cuyos los resultados son: (1) El proceso de esterelización por plasma presentó resultados positivos mediante el proceso de esterilización por óxido de etileno; (2) Hay pérdidas en las propriedades en reprocesamiento de catéter de hemodinámica; (3) Falta de reglamentación y seguridad para el reprocesamiento de los materiales de un solo uso; (4) El óxido de etileno no es eficiente en la esterilización de superficies óseas

Construcción y validación de un cuestionario para medir conductas, conocimientos y actitudes sobre la higiene de las manos en personal sanitario en formación / Construction and validation of a questionnaire to measure behavior, knowledge and attitudes on hand hygiene in health personnel training

Fundamento: La higiene de manos en el contexto sanitario es un comportamiento complejo. Rara vez se ha determinado el papel conjunto de los conocimientos y las actitudes como predictores de la conducta de higiene de manos. El objetivo principal del trabajo es la descripción de la elaboración de un cuestionario sobre higiene de manos y el análisis de sus propiedades de medida. Método: Estudio instrumental en el que se diseñó y validó un cuestionario. Se llevó acabo en enero de 2009. Éste constó finalmente de 50 ítems que evalúan la intención de conducta antes y después del contacto con el paciente, los conocimientos declarativos y las actitudes sobre la higiene de manos. Se aplicó a 431 estudiantes de ciencias de la salud de la Universidad de Granada. Resultados: Se han realizado tres análisis factoriales, obteniendo finalmente un valor de convergencia general que explica el 46,01% de la varianza total y una alta fiabilidad (a=0,843). Existe correlación entre los conocimientos y la intención de conducta antes y después del contacto con el paciente (p<0,01). A su vez, la actitud sólo correlaciona con la intención de conducta antes (p<0,05). La conducta de higiene de manos se refiere con una media mayor después de la realización de diversas actividades sanitarias que antes de las mismas (4,26 y 3,96 respectivamente). Tanto los conocimientos declarativos como las actitudes predicen significativamente la intención de conducta, en particular la conducta antes del contacto con el paciente (R2=0,100; Beta estandarizado 0,256 para conocimientos y 0,145 y para actitudes). Conclusiones: El cuestionario muestra una elevada consistencia interna. Se ha obtenido una herramienta válida para evaluar la intención de conducta, los conocimientos y las actitudes sobre higiene de manos en estudiantes de ciencias de la salud. La herramienta detecta deficiencias en conocimientos básicos en los estudiantes(AU)

Background: Hand hygiene in the health context is a complex behaviour. There have been rarely given the role of the knowledge and attitudes as predictors of hand hygiene behaviour. The main objective of this work is the description of the development of a questionnaire on hand hygiene and the analysis of their measurement properties. Method: An instrument which was designed and validated a questionnaire. It was held in January 2009. It finally has had 50 items that assess risk behaviour intention before and after contact with the patient, declarative knowledge and attitudes about hand hygiene. It has been applied to 431 students of health sciences at the University of Granada. Results: There were three factor analysis, ultimately obtaining a general convergence value that explains 46.01% of the total variance and high reliability (a=0,843). There is correlation between knowledge and behavior intentions before and after patient contact (p <0.01).In turn, the attitude correlates only with behavioral intention before (p <0.05). The hand hygiene behavior refers to a higher mean after the completion of various health activities before the same (4.26 and 3.96 respectively). Both declarative knowledge and attitudes significantly predict behavioral intention, in particular the conduct before the contact with the patient (R2 = 0.100, standardized Beta 0.256 for knowledge and 0.145 for attitudes). Conclusions: The questionnaire shows high internal consistency. We have obtained a valid tool for assessing risk behavior, knowledge and attitudes about students’ hand hygiene in health sciences. The tool detects deficiencies in basic skills in students(AU)

[Construction and validation of a questionnaire to measure behavior, knowledge and attitudes on hand hygiene in health personnel training]. / Construcción y validación de un cuestionario para medir conductas, conocimientos y actitudes sobre la higiene de las manos en personal sanitario en formación.

BACKGROUND: Hand hygiene in the health context is a complex behaviour. There have been rarely given the role of the knowledge and attitudes as predictors of hand hygiene behaviour. The main objective of this work is the description of the development of a questionnaire on hand hygiene and the analysis of their measurement properties. METHOD: An instrument which was designed and validated a questionnaire. It was held in January 2009. It finally has had 50 items that assess risk behaviour intention before and after contact with the patient, declarative knowledge and attitudes about hand hygiene. It has been applied to 431 students of health sciences at the University of Granada. RESULTS: There were three factor analysis, ultimately obtaining a general convergence value that explains 46.01% of the total variance and high reliability (a = 0,843). There is correlation between knowledge and behavior intentions before and after patient contact (p < 0.01).In turn, the attitude correlates only with behavioral intention before (p < 0.05). The hand hygiene behavior refers to a higher mean after the completion of various health activities before the same (4.26 and 3.96 respectively). Both declarative knowledge and attitudes significantly predict behavioral intention, in particular the conduct before the contact with the patient (R² = 0.100, standardized Beta 0.256 for knowledge and 0.145 for attitudes). CONCLUSIONS: The questionnaire shows high internal consistency. We have obtained a valid tool for assessing risk behavior, knowledge and attitudes about students' hand hygiene in health sciences. The tool detects deficiencies in basic skills in students.