RESUMO
BACKGROUND: COVID-19 is caused by the SARS-CoV-2 virus, an emerging respiratory pathogen. The work environment represents a high-risk factor for health professionals. Given the scarcity of protective personal equipment due to global demand, decontamination and reuse studies should be carried out. Thus, the aim of this study was to evaluate the safety of a method of decontamination of N95/PFF2 respirators, especially regarding structural integrity. METHODS: N95/PFF2 respirators were subjected to hydrogen peroxide decontamination and analyzed using scanning electron microscopy and thermogravimetric analysis. Seven respirators of the same brand and lot were used, one being a control and the other six subjected to decontamination process. As for the sealing, a qualitative test was applied, in order to identify the changes in the structure that could damage the sealing of respirators. RESULTS: Indicated that the fiber morphology in all layers was not affected by the six decontamination cycles. Also, the thermal stability in the different layers was very similar. Fit testing showed that the respiradors submitted to all cycles of decontamination were approved. CONCLUSIONS: Thus, it is possible to conclude that the hydrogen peroxide decontamination method is effective, since it does not alter the physical properties of the respirators.
Assuntos
COVID-19 , Descontaminação , Reutilização de Equipamento , Humanos , SARS-CoV-2 , Ventiladores MecânicosRESUMO
BACKGROUND: Hand hygiene is considered the single most effective means of reducing healthcare-associated infections, but improving and sustaining hand hygiene compliance remains a great challenge. OBJECTIVES: To compare hand hygiene compliance before and after interventions to promote adherence in a paediatric intensive care unit (PICU) and to identify predictors of intention to perform the behaviour "hand hygiene during patient care in the PICU". METHODS: A before and after study was conducted in three phases. Based on the World Health Organization guideline for hand hygiene compliance monitoring, 1261 hand hygiene opportunities were directly observed during routine patient care by two observers simultaneously, in a nine-bed PICU in Brazil, before and after infrastructure and educational interventions. To identify predictors of healthcare professionals' intention to perform the behaviour hand hygiene during patient care, a data collection instrument was designed based on the Theory of Planned Behaviour. Statistical analyses were undertaken using Chi-square test or the Fisher's exact test and regression analysis. A significance level of 5% (p < 0.05) was applied to all analyses. RESULTS: The hand hygiene compliance rate increased significantly from 27.3% in the "pre-intervention phase" to 33.1% in "phase 1-post-intervention," to 37.0% in "phase 2-post-intervention" (p = .010). Perceived social pressure (p = .026) was a determinant factor of intention to perform the behaviour. CONCLUSIONS: Hand hygiene compliance raised significantly after infrastructure, educational, and performance feedback interventions. However, despite the significant effect of the implemented interventions, the overall hand hygiene compliance rate was low. Perceived social pressure characterised a determinant factor of intention to perform the behaviour "hand hygiene during patient care in the PICU", reinforcing the need for behaviour determinants analysis when designing promotional interventions.
Assuntos
Infecção Hospitalar/prevenção & controle , Fidelidade a Diretrizes , Higiene das Mãos , Pessoal de Saúde , Controle de Infecções/métodos , Unidades de Terapia Intensiva Pediátrica , Adulto , Brasil , Cuidados Críticos , HumanosRESUMO
OBJECTIVES: To assess the practical application of the Pediatric Surgical Safety Checklist on the preoperative period and to verify family satisfaction regarding the use of the material. METHOD: Exploratory study that aimed to analyze the use of the checklist by children who underwent surgical interventions. The sample was constituted by 60 children (from preschoolers to teens) and 60 family members. The variables related to demographic characterization, filling out the checklist, and family satisfaction, being evaluated through inferential and descriptive statistical analysis. RESULTS: Most children (71.7%) were male, with a median age of 7.5 years. We identified the achievement of 65.3% of the checklist items, 30.0% were not filled due to non-performance of the team and 4.7% for children and family reasons. In the association analysis, we found that the removal of accessories item (p = 0.008) was the most checked by older children. Regarding satisfaction, the family members evaluated the material as great (63.3%) and good (36.7%) and believed that there was a reduction of the child's anxiety (83.3%). CONCLUSION: The use of the checklist in clinical practice can change health services regarding safety culture and promote customer satisfaction.
Assuntos
Lista de Checagem , Segurança do Paciente , Pediatria , Procedimentos Cirúrgicos Operatórios , Adolescente , Ansiedade/enfermagem , Criança , Pré-Escolar , Família , Feminino , Humanos , Masculino , Procedimentos Cirúrgicos Operatórios/psicologiaRESUMO
Objectives: to assess the practical application of the Pediatric Surgical Safety Checklist on the preoperative period and to verify family satisfaction regarding the use of the material. Method: exploratory study that aimed to analyze the use of the checklist by children who underwent surgical interventions. The sample was constituted by 60 children (from preschoolers to teens) and 60 family members. The variables related to demographic characterization, filling out the checklist, and family satisfaction, being evaluated through inferential and descriptive statistical analysis. Results: most children (71.7%) were male, with a median age of 7.5 years. We identified the achievement of 65.3% of the checklist items, 30.0% were not filled due to non-performance of the team and 4.7% for children and family reasons. In the association analysis, we found that the removal of accessories item (p = 0.008) was the most checked by older children. Regarding satisfaction, the family members evaluated the material as great (63.3%) and good (36.7%) and believed that there was a reduction of the child's anxiety (83.3%). Conclusion: the use of the checklist in clinical practice can change health services regarding safety culture and promote customer satisfaction.
Objetivos: avaliar a aplicação na prática do Checklist Pediátrico para Cirurgia Segura no período pré-operatório e verificar a satisfação da família quanto ao uso do material. Método: estudo exploratório, no qual se visou analisar o uso dochecklist por crianças que seriam submetidas a intervenções cirúrgicas, sendo a amostra constituída por 60 crianças pré-escolares a adolescentes e 60 familiares. As variáveis relacionaram-se à caracterização demográfica, preenchimento do checklist e satisfação dos familiares, sendo avaliadas por meio da análise estatística descritiva e inferencial. Resultados: a maioria (71,7%) das crianças era do sexo masculino, com mediana de idade de 7,5 anos. Identificou-se consecução do checklist em 65,3% dos itens, 30,0% não foram preenchidos devido à não execução da equipe e 4,7% por motivos das crianças e familiares. Na análise de associação, verificou-se que o item da retirada de adornos (p=0,008) foi mais checado por crianças com maior média de idade. Quanto à satisfação, os familiares avaliaram o material como ótimo (63,3%) e bom (36,7%) e acreditaram que houve redução de ansiedade na criança (83,3%). Conclusão: o uso do checklist na prática clínica pode colaborar para mudanças nos serviços de saúde com relação à cultura de segurança e promover satisfação dos clientes.
Objetivos : evaluar la aplicación en la práctica del ChecklistPediátrico para la Cirugía Segura en el periodo preoperatorio y verificar la satisfacción de la familia con respecto al uso del material. Método : estudio exploratorio, cuyo objetivo fue analizar el uso delchecklist por niños que serían sometidos a intervenciones quirúrgicas, siendo la muestra compuesta por 60 niños en edad preescolar a adolescentes y 60 familiares. Las variables se relacionaron con la caracterización demográfica, llenado del checklist y satisfacción de los familiares, siendo evaluadas por medio del análisis estadístico descriptivo e inferencial. Resultados : la mayoría (71,7%) de los niños eran varones, con una edad media de 7,5 años. Se identificó el cumplimiento del checklist en el 65,3% de los ítems, el 30,0% no ha sido rellenado debido a la falta de ejecución por parte del equipo y el 4,7% por causa de los niños y familiares. En el análisis de asociación, se constató que el ítem de retirada de joyas (p =0,008) fue el más marcado por los niños con una edad media más alta. En cuanto a la satisfacción, los familiares evaluaron el material como óptimo (63,3%) y bueno (36,7%) y acreditaron que hubo una reducción de la ansiedad en los niños (83,3%). Conclusión : el uso del checklist en la práctica clínica puede contribuir a cambios en los servicios de salud con respecto a la cultura de seguridad y promover la satisfacción de los clientes.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Pediatria , Procedimentos Cirúrgicos Operatórios , Lista de Checagem , Segurança do Paciente , Ansiedade/enfermagem , Procedimentos Cirúrgicos Operatórios/psicologia , FamíliaRESUMO
Vancomycin (VCM) is indicated in combat against Gram-positive infections, but it is not considered a first-choice drug because of its adverse effects. It is believed that oxidative stress is the primary mechanism of endothelial injury and the consequent VCM toxicity, which varies from phlebitis to nephrotoxicity. Moreover, dose recommendations, dilution, rates and types of infusion are still controversial. The aim of this study was to determine the effect of different VCM dilutions in endothelial, liver and kidney injuries by biochemical parameters and histopathological analysis. Wistar rats were randomly divided into six groups and subjected to femoral vein cannulation for drug administration. Control groups received 0.9 ml of saline and the others received VCM (10mg/Kg/day) at dilutions of 5.0 and 10.0 mg/mL for 3 and 7 days. Homocysteine, hs-CRP, AST, ALT, GGT, urea, creatinine, lycopene, alpha-tocopherol, beta-carotene and retinol were analyzed. Kidney, liver and cannulated femoral vein fragments were collected.This study showed alterations in ALT which featured hepatotoxicity. However, drug dilutions were not able to show changes in other biochemical parameters. In contrast, kidney and endothelium pathological changes were observed. More studies are needed to characterize VCM induced kidney and endothelium toxicity and biochemical markers able to show such morphological modifications.
Assuntos
Antibacterianos/toxicidade , Veia Femoral/efeitos dos fármacos , Rim/efeitos dos fármacos , Rim/patologia , Fígado/efeitos dos fármacos , Vancomicina/toxicidade , Animais , Relação Dose-Resposta a Droga , Veia Femoral/metabolismo , Veia Femoral/patologia , Rim/metabolismo , Fígado/metabolismo , Fígado/patologia , Masculino , Distribuição Aleatória , Ratos WistarRESUMO
AIMS: The aims were to compare characteristics of children with peripheral intravenous catheters who developed infiltration and those who did not and to identify risk factors for developing this complication. METHOD: A retrospective cohort study carried out at a university hospital, with 338 children with peripheral intravenous catheters. Variables related to the children and therapies were investigated. RESULTS: Researchers identified infiltration in 54 children (16%). Characteristics statistically different in those who developed infiltration were the following: intravenous therapy for more than 5 days, presence of predisposing factors to peripheral venipuncture failure, history of previous infiltration, catheter readjustment to vein insertion, use of infusion pump, intermittent administrations, and shorter dwell time. CONCLUSION: Only intravenous therapy variables showed a significant relation with the occurrence of infiltration and represented risk factors for its occurrence.
Assuntos
Cateterismo Periférico/efeitos adversos , Extravasamento de Materiais Terapêuticos e Diagnósticos/epidemiologia , Infusões Intravenosas/efeitos adversos , Adolescente , Braço , Brasil/epidemiologia , Cateterismo Periférico/enfermagem , Criança , Criança Hospitalizada , Pré-Escolar , Estudos de Coortes , Extravasamento de Materiais Terapêuticos e Diagnósticos/etiologia , Extravasamento de Materiais Terapêuticos e Diagnósticos/prevenção & controle , Feminino , Mãos , Humanos , Lactente , Recém-Nascido , Infusões Intravenosas/enfermagem , Masculino , Flebite/epidemiologia , Flebite/etiologia , Flebite/prevenção & controle , Estudos Retrospectivos , Fatores de RiscoRESUMO
BACKGROUND: Considering all sources of errors that may occur during healthcare, medication errors are the most common and also the most frequent cause of adverse events. OBJECTIVE: The objective of the study was to describe the medication errors reported in a pediatric intensive care unit for oncologic patients. METHODS: This is a descriptive and exploratory study. The errors were reported by the professionals involved in the medication system in a medication error report form developed for the study. RESULTS: The sample consisted of 110 medication errors reported on 71 forms. The omission error was the most common error type reported (22.7%), followed by administration error (18.2%). No harm to patients was reported in 83.1% of the notifications. CONCLUSION: The analysis of the110 medication errors provides evidence of the context of their occurrence and the need to implement measures that can prevent or intercept these errors. IMPLICATIONS FOR PRACTICE: In an institution without adverse events report and a formal system to patient safety analysis, the implementation of a local nonpunitive approach to medication errors notification represented an important tool to patient safety promotion.
Assuntos
Unidades de Terapia Intensiva Pediátrica , Erros de Medicação/estatística & dados numéricos , Neoplasias/tratamento farmacológico , Sistemas de Notificação de Reações Adversas a Medicamentos , Brasil , Criança , Cálculos da Dosagem de Medicamento , HumanosRESUMO
OBJETIVO: Verificar o potencial hidrogeniônico (pH) de soluções de cloridrato de dobutamina sob condições ambientais que mimetizam unidades de cuidados intensivos neonatais. MÉTODOS: Analisou-se pH do fármaco em solução glicosada 5 por cento ou NaCl 0,9 por cento segundo temperatura (22 e 37 °C), luz (escuro, lâmpadas fluorescentes ambiente e equipamento de fototerapia) e equipos (incolor e âmbar) em intervalos de tempo (0, 1, 24, 48, 72 e 96 horas). RESULTADOS: Evidenciaram-se valores próximos de pH do fármaco na apresentação comercial e diluído. Obteve-se média de pH de 3,45±0,19 a 22 °C e de 3,55±0,20 a 37 °C. A média de pH das soluções mantidas no escuro foi de 3,62±0,09, na luz ambiente, de 3,63±0,07, e sob fototerapia, de 3,31±0,16. Soluções em equipos incolores tiveram média menor (3,41±0,24) do que em âmbares (3,52±0,15). Obtiveram-se menores valores de pH nas soluções sob fototerapia em equipos incolores (3,17±0,03) do que em âmbares (3,55±0,03). CONCLUSÃO: Sob a luz da fototerapia houve maior variação do pH das soluções, e o emprego de equipos âmbares minimizou tal efeito.
OBJECTIVE: To verify the hydrogen-ion potential (pH) of dobutamine hydrochloride solutions under environmental conditions similar to those of neonatal intensive care units. METHODS: We analyzed the pH of the drug diluted in 5 percent dextrose in water or 0.9 percent NaCl under different conditions of temperature (22 and 37 °C) and light (dark, fluorescent light bulbs, and phototherapy equipment), using colorless and amber intravenous sets at time intervals of 0, 1, 24, 48, 72, and 96 hours. RESULTS: The pH values of the marketed form of the drug and the diluted drug were similar. The pH means were 3.45±0.19 at 22 °C and 3.55±0.20 at 37 °C. The average of the pH according to light conditions were as follows: in the dark = 3.62±0.09, under room light = 3.63±0.07, and exposed to phototherapy = 3.31±0.16. Solutions stored in colorless intravenous sets had a lower mean (3.41±0.24) than those kept in amber intravenous sets (3.52±0.15). We found lower pH values in the solutions exposed to phototherapy using colorless intravenous sets (3.17±0.03) than in those using amber intravenous sets (3.55±0.03). CONCLUSION: There was higher variation in the pH of the solutions exposed to phototherapy, and the use of amber intravenous sets reduced such effect.
Assuntos
Dobutamina/química , Meio Ambiente , Estabilidade de Medicamentos , Concentração de Íons de Hidrogênio , Unidades de Terapia Intensiva Neonatal , Laboratórios , Luz , Soluções , TemperaturaRESUMO
OBJECTIVE: To verify the hydrogen-ion potential (pH) of dobutamine hydrochloride solutions under environmental conditions similar to those of neonatal intensive care units. METHODS: We analyzed the pH of the drug diluted in 5% dextrose in water or 0.9% NaCl under different conditions of temperature (22 and 37 degrees C) and light (dark, fluorescent light bulbs, and phototherapy equipment), using colorless and amber intravenous sets at time intervals of 0, 1, 24, 48, 72, and 96 hours. RESULTS: The pH values of the marketed form of the drug and the diluted drug were similar. The pH means were 3.45+/-0.19 at 22 degrees C and 3.55+/-0.20 at 37 degrees C. The average of the pH according to light conditions were as follows: in the dark = 3.62+/-0.09, under room light = 3.63+/-0.07, and exposed to phototherapy = 3.31+/-0.16. Solutions stored in colorless intravenous sets had a lower mean (3.41+/-0.24) than those kept in amber intravenous sets (3.52+/-0.15). We found lower pH values in the solutions exposed to phototherapy using colorless intravenous sets (3.17+/-0.03) than in those using amber intravenous sets (3.55+/-0.03). CONCLUSION: There was higher variation in the pH of the solutions exposed to phototherapy, and the use of amber intravenous sets reduced such effect.
Assuntos
Dobutamina/química , Meio Ambiente , Estabilidade de Medicamentos , Concentração de Íons de Hidrogênio , Unidades de Terapia Intensiva Neonatal , Laboratórios , Luz , Soluções , TemperaturaRESUMO
BACKGROUND: Recent progress in identification of oral microorganisms has shown that the oropharynx can be a site of origin for dissemination of pathogenic organisms to distant body sites, such as the lungs. OBJECTIVE: To compare the oropharyngeal microbiological profile, duration of mechanical ventilation, and length of stay in the intensive care unit of children receiving mechanical ventilation who had pharmacological or nonpharmacological oral care. METHODS: A randomized and controlled study was performed in a pediatric intensive unit in São Paulo, Brazil. A total of 56 children were randomly assigned to an experimental group (n=27, 48%) that received oral care with use of 0.12% chlorhexidine digluconate or a control group (n=29, 52%) that received oral care without an antiseptic. Oropharyngeal secretions were collected and cultured on days 0, 2, and 4, and at discharge. RESULTS: The 2 groups had similar demographic characteristics, preexisting underlying diseases, and pharmacological, nutritional, and ventilatory support. Gram-negative bacteria were the predominant pathogens: Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Enter-obacter species. The 2 groups did not differ significantly in the colonization of normal (P= .72) or pathogenic (P= .62) flora, in the duration of mechanical ventilation (P= .67), or in length of stay in the intensive care (P= .22). CONCLUSION: Use of chlorhexidine combined with nonpharmacological oral care did not decrease the colonization profile, duration of mechanical ventilation, or length of stay in critically ill children receiving mechanical ventilation.
Assuntos
Anti-Infecciosos Locais/administração & dosagem , Clorexidina/análogos & derivados , Higiene Bucal/métodos , Orofaringe/microbiologia , Respiração Artificial/efeitos adversos , Administração Oral , Criança , Pré-Escolar , Clorexidina/administração & dosagem , Feminino , Bactérias Gram-Negativas/crescimento & desenvolvimento , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/etiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Negativas/prevenção & controle , Humanos , Lactente , Masculino , Boca/efeitos dos fármacos , Boca/microbiologia , Orofaringe/efeitos dos fármacos , Estudos ProspectivosRESUMO
Quasi-experimental study which aimed to verify the influence of nursing activities redesign in the reduction of medication errors in three pediatrics wards of a university hospital. Types and frequencies of medication errors identified in a study carried through the wards guided the redesign and exerted the function of dependent variable in the assessment of the intervention. To errs identification 556 documents on 77 children's medical charts were analyzed. In 8550 medication doses analyzed, in 1498 (17,5%) errors were evidenced, an inferior ratio (21,1%) of the control study. Globally the intervention generated small changes in medication errors ratio and type, being effective to reduce dose omission (p< 0.0001), medication suspended by physicians and not registered as suspended for the nurses (p<0.0001) and wrong hour (p= 0,0002).
Assuntos
Erros de Medicação/prevenção & controle , Enfermagem Pediátrica/organização & administração , Enfermagem Pediátrica/normas , Algoritmos , Criança , HumanosRESUMO
Estudo quase-experimental que verificou a influência do redesenho de atividades de enfermagem para a redução de erros de medicação em três unidades de pediatria de um hospital universitário. Os tipos e freqüências de erros de medicação identificados em estudo realizado nas unidades nortearam o redesenho e exerceram função de variáveis dependentes no estudo da intervenção proposta. Foram analisadas 556 prescrições médicas nos prontuários de 77 crianças. Verificaram-se 8550 doses, em 1498 (17,5 por cento) constataram-se erros, proporção inferior (21,1 por cento) a do estudo controle. Globalmente a intervenção gerou pouca mudança na proporção e na tipologia dos erros de medicação, sendo efetiva para reduzir omissão da dose (p<0,0001), medicação suspensa pelo médico e não registrada como suspensa pela enfermagem (p<0,0001) e hora errada (p=0,0002).
Quasi-experimental study which aimed to verify the influence of nursing activities redesign in the reduction of medication errors in three pediatrics wards of a university hospital. Types and frequencies of medication errors identified in a study carried through the wards guided the redesign and exerted the function of dependent variable in the assessment of the intervention. To errs identification 556 documents on 77 children's medical charts were analyzed. In 8550 medication doses analyzed, in 1498 (17,5 percent) errors were evidenced, an inferior ratio (21,1 percent) of the control study. Globally the intervention generated small changes in medication errors ratio and type, being effective to reduce dose omission (p< 0.0001), medication suspended by physicians and not registered as suspended for the nurses (p<0.0001) and wrong hour (p= 0,0002).
Estudio casi-experimental que verificó influencia de rediseño de actividades de enfermería en la reducción de errores de medicación en tres unidades de pediatría de un hospital universitario. Los tipos y frecuencias de errores de medicación identificados en estudio realizado en las unidades fundamentaran lo rediseño y ejercieron función de variables dependientes en el estudio de la intervención propuesta. Fueron analizadas 556 prescripciones médicas en los documientos hospitalares de 77 niños. Se verificaron 8550 dosis, en 1498(17,5 por ciento) se constataron errores, proporción inferior (21,1 por ciento) a del estudio control. Globalmente la intervención generó poco cambio en la proporción y en la tipología de los errores de medicación, siendo efectiva para reducir omisión de la dosis (p< 0,0001), medicación suspensa por el médico y no registrada como suspensa por la enfermería (p < 0,0001) y hora errada (p = 0,0002).
Assuntos
Criança , Humanos , Erros de Medicação/prevenção & controle , Enfermagem Pediátrica/organização & administração , Enfermagem Pediátrica/normas , AlgoritmosRESUMO
BACKGROUND: Backrest elevation, defined as the angle of the backrest height above the horizontal position, is a common nursing intervention that is often used by subjective visual estimation in critically ill patients. OBJECTIVES: The aim of the study was to describe the magnitude of error during the subjective assessment of backrest elevation. METHODS: This prospective study was conducted in a sample of 160 subjects: 97 registered nurses, 48 undergraduate nursing students, and 15 nursing assistants. Data were collected by recording the degrees of backrest elevation identified by the subjects through an individual random presentation of the selected study angles of 20 degrees, 30 degrees, 35 degrees, 40 degrees, and 45 degrees. A measurement instrument was developed for determination of the angles. RESULTS: Of the 800 investigated angles, 14.9% were estimated accurately, 61.6% were overestimated, and 23.5% were underestimated, with an error average of 8 degrees (+/-13.5 degrees). It was determined that the larger the angle estimated, the greater the average error. A statically significant difference (P Assuntos
Leitos
, Cuidados Críticos/métodos
, Estado Terminal/enfermagem
, Postura
, Adaptação Fisiológica/fisiologia
, Adulto
, Feminino
, Humanos
, Masculino
, Pessoa de Meia-Idade
, Estudos Prospectivos
RESUMO
OBJETIVO: Verificar variabilidade na determinação da linha axilar média como ponto externo de referência (PER), por diferentes profissionais de saú de, para a aferição de pressão venosa central em crianças. MÉTODOS: Estudo descritivo e de correlação realizado em uma unidade de cuidados intensivos pediátricos de um hospital universitário. Durante a determinação da linha axilar média como PER para a aferição da pressão venosa central, cinco avaliações realizadas no mesmo paciente por profissionais de saúde e uma realizada por um avaliador treinado foram comparadas. O resultado foi um total de 120 indicações de 44 profissionais de saúde, 17 (38,6 por cento) auxiliares e técnicos de enfermagem, 16 (36,3 por cento) enfermeiros e 11 (25,1 por cento) médicos, além de 24 identificações realizadas por avaliador treinado. Os dados foram analisados utilizando os testes do qui-quadrado, ANOVA, Kruskall-Wallis e teste t, fixando o nível de significância em 5 por cento. RESULTADOS: Houve diferença significante entre as identificações realizadas pelos profissionais de saúde e pelo avaliador (p < 0,001). Comparando a variabilidade das medidas realizadas pelos profissionais, 56 (46,7 por cento) foram menores do que a identificação do avaliador (variação de -0,5 até -9), 44 (36,7 por cento) foram maiores (variação de 0,5 até 4) e 20 (16,7 por cento) foram coincidentes (variação nula). Não se identificou influência da categoria profissional sobre a concordância entre os PER indicados (p = 0,899), tampouco na variabilidade observada (p = 0,778). Observou-se, contudo, que profissionais com maior tempo de experiência em unidades de cuidados intensivos demonstraram uma tendência a maior variabilidade com as medidas dos avaliadores. CONCLUSÃO: Verificou-se variabilidade nas indicações da linha axilar média como PER entre os profissionais e o avaliador treinado. A variabilidade não foi influenciada pela categoria profissional e quanto maior o tempo de experiência do profissional, maior...
OBJECTIVE: To investigate the variability in the establishment of the midaxillary line as external reference point (ERP), by different healthcare workers, for the measurement of central venous pressure in children. METHODS: Descriptive and correlational study carried out in a pediatric intensive care unit of a teaching hospital. During the establishment of the midaxillary line as ERP for central venous pressure measurement, five assessments of the same patient made by healthcare workers and one assessment made by a trained evaluator were compared. A total of 120 assessments were made by 44 healthcare workers, 17 (38.6 percent) by nursing assistants and nursing technicians, 16 (36.3 percent) by nurses and 11 (25.1 percent) by physicians, in addition to 24 assessments made by the trained evaluator. The data were analyzed using the chi-square test, ANOVA, Kruskal-Wallis test and t test. Significance level was set at 5 percent. RESULTS: There was statistically significant difference between the assessments made by healthcare workers and by the evaluator (p < 0.001). The comparison of the variability in the measurements made by healthcare workers revealed that 56 (46.7 percent) measurements were lower than those obtained by the evaluator (range from -0.5 to -9), 44 (36.7 percent) were higher (range from 0.5 to 4) and 20 (16.7 percent) were concordant (zero variability). Professional category did not influence the concordance between the ERPs (p = 0.899), or the variability observed (p = 0.778). However, the measurements made by professionals with greater experience in intensive care tended to differ more sharply from those made by the evaluators. CONCLUSION: The indications of the midaxillary line as ERP presented variations when measured by the healthcare team and by the trained evaluator. Variability was not influenced by professional category, and the more experienced the healthcare worker, the greater the probability for underestimation of the ERP...
Assuntos
Criança , Pré-Escolar , Humanos , Lactente , Veia Axilar/fisiologia , Determinação da Pressão Arterial/normas , Pressão Venosa Central/fisiologia , Análise de Variância , Distribuição de Qui-Quadrado , Pessoal de Saúde/normas , Unidades de Terapia Intensiva Pediátrica , Padrões de Referência , Estatísticas não ParamétricasRESUMO
OBJECTIVE: To investigate the variability in the establishment of the midaxillary line as external reference point (ERP), by different healthcare workers, for the measurement of central venous pressure in children. METHODS: Descriptive and correlational study carried out in a pediatric intensive care unit of a teaching hospital. During the establishment of the midaxillary line as ERP for central venous pressure measurement, five assessments of the same patient made by healthcare workers and one assessment made by a trained evaluator were compared. A total of 120 assessments were made by 44 healthcare workers, 17 (38.6%) by nursing assistants and nursing technicians, 16 (36.3%) by nurses and 11 (25.1%) by physicians, in addition to 24 assessments made by the trained evaluator. The data were analyzed using the chi-square test, ANOVA, Kruskal-Wallis test and t test. Significance level was set at 5%. RESULTS: There was statistically significant difference between the assessments made by healthcare workers and by the evaluator (p < 0.001). The comparison of the variability in the measurements made by healthcare workers revealed that 56 (46.7%) measurements were lower than those obtained by the evaluator (range from -0.5 to -9), 44 (36.7%) were higher (range from 0.5 to 4) and 20 (16.7%) were concordant (zero variability). Professional category did not influence the concordance between the ERPs (p = 0.899), or the variability observed (p = 0.778). However, the measurements made by professionals with greater experience in intensive care tended to differ more sharply from those made by the evaluators. CONCLUSION: The indications of the midaxillary line as ERP presented variations when measured by the healthcare team and by the trained evaluator. Variability was not influenced by professional category, and the more experienced the healthcare worker, the greater the probability for underestimation of the ERP. According to the results of this study, such situations may compromise both the efficacy of this procedure and patient safety.
Assuntos
Veia Axilar/fisiologia , Determinação da Pressão Arterial/normas , Pressão Venosa Central/fisiologia , Análise de Variância , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Pessoal de Saúde/normas , Humanos , Lactente , Unidades de Terapia Intensiva Pediátrica , Padrões de Referência , Estatísticas não ParamétricasRESUMO
Renal transplantation has been described as the main treatment for children with end-stage renal disease. Traditionally, infants and small children represented a high-risk group with poor allograft survival. However, studies conducted mainly in developed countries have been demonstrated improvements in allograft survival rates. The aim of this study was to identify demographic characteristics of recipients and kidney donors and to analyse the outcomes of children who received postoperative care following renal transplantation in one Paediatric Intensive Care Unit (PICU). This retrospective study was carried out in a university hospital in Brazil. The data were collected through reviewing the follow up of medical records of recipients and kidney donors between 1988 and 2002. Chi-square or Fisher exact tests were used to analyse differences in outcome between living and donor transplants, whereas Mann-Whitney and Kruskal-Wallis tests were used to compare differences in outcome by age groups and by the number of complications affecting recipients. A total of 44 children were admitted for renal transplantation. Within this group, the median age was 10.1(+/-3.2) years, 63.6% were men and 38% were non-Caucasians. In contrast, the donor group had a median age of 17.5(+/-12.5) years, of which 51.3% were male, 56.8% were Caucasian and 70.5% were cadaver donors. The average length of PICU stay was 31.4 h, with complications being identified in the majority of the transplanted children. The occurrence of four or more complications was significantly associated with acute rejection (p= 0.009). In conclusion, the main outcomes of this study were similar to those observed in developed countries, in terms of acute rejections (52.3%), dialysis resumption (31.8%), graft loss (29.5%), chronic rejections (9.1%) and death (4.5%). Complications during PICU stay were significantly linked to the occurrence of acute rejection.
Assuntos
Unidades de Terapia Intensiva Pediátrica , Transplante de Rim/efeitos adversos , Transplante de Rim/mortalidade , Complicações Pós-Operatórias/mortalidade , Adolescente , Brasil , Distribuição de Qui-Quadrado , Criança , Estado Terminal/enfermagem , Feminino , Rejeição de Enxerto , Sobrevivência de Enxerto , Hospitais Universitários , Humanos , Incidência , Transplante de Rim/métodos , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia , Probabilidade , Prognóstico , Estudos Retrospectivos , Medição de Risco , Estatísticas não Paramétricas , Análise de Sobrevida , Doadores de Tecidos , Resultado do TratamentoRESUMO
OBJECTIVE: The purpose of this study was to verify the noise level at a PICU. METHODS: This prospective observational study was performed in a 10 bed PICU at a teaching hospital located in a densely populated district within the city of São Paulo, Brazil. Sound pressure levels (dBA) were measured 24 hours during a 6-day period. Noise recording equipment was placed in the PICU access corridor, nursing station, two open wards with three and five beds, and in isolation rooms. The resulting curves were analyzed. RESULTS: A basal noise level variation between 60 and 70 dBA was identified, with a maximum level of 120 dBA. The most significant noise levels were recorded during the day and were produced by the staff. CONCLUSION: The basal noise level identified exceeds International Noise Council recommendations. Education regarding the effects of noise on human hearing and its relation to stress is the essential basis for the development of a noise reduction program.
Assuntos
Ambiente de Instituições de Saúde , Unidades de Terapia Intensiva Pediátrica , Ruído Ocupacional , Criança , Equipamentos e Provisões , Humanos , Ruído Ocupacional/prevenção & controle , Estudos ProspectivosRESUMO
OBJETIVO: Verificar o nível de ruídos em uma unidade de cuidados intensivos pediátricos. MÉTODOS: Estudo observacional e prospectivo realizado em uma unidade de cuidados intensivos pediátricos de 10 leitos de um hospital universitário da cidade de São Paulo, Brasil. Os níveis de ruídos foram medidos por meio de equipamento instalado no corredor de acesso à unidade de cuidados intensivos pediátricos, posto de enfermagem, duas salas com três e cinco leitos, bem como nas unidades de isolamento. O equipamento utilizado foi calibrado para registrar a pressão do som em dBA, durante 24 horas, por 6 dias. Os dados foram analisados de acordo com as curvas gráficas registradas pelo equipamento. RESULTADOS: Foi identificado um nível basal de ruídos de 60 a 70 dBA, com pico de 120 dBA. Os níveis mais elevados foram identificados no período diurno, decorrentes da atividade e comunicação dos profissionais. CONCLUSÃO: Os níveis de ruídos identificados excederam as recomendações do International Noise Council, da Organização Mundial da Saúde. A educação sobre os efeitos prejudiciais de ruídos na audição humana e sua relação com o estresse constituem as bases para a implementação de programas de redução de ruídos.
Assuntos
Humanos , Criança , Ambiente de Instituições de Saúde , Unidades de Terapia Intensiva Pediátrica , Ruído Ocupacional , Equipamentos e Provisões , Estudos Prospectivos , Ruído Ocupacional/prevenção & controleRESUMO
This prospective, randomized and controlled study verified the influence of three dressing regimens on the dwell time of peripheral intravenous catheters (PIC) in children. The study groups were composed of dressings with sterile gauze (EG 1), with sterile transparent film (EG 2) and with hypoallergenic adhesive tape (CG). Variables were selected to control for variables related to children, professionals and intravenous therapy characteristics. The 150 PIC that composed the sample were inserted in 68 children, predominantly of preschool age, male, with brown skin color, eutrophic and with gastrointestinal system diseases. The majority of the PIC was installed by nursing auxiliaries in veins of the dorsal arch of the hand. The type of dressing exerted a significant influence (p = 0.022) on the average dwell time of the studied PIC: EG 1 (46.12 hours), EG 2 (29.53 hours) and CG (38.18 hours), concluding that the dressing with sterile gauze maintained the catheter inserted for a longer time.