Avaliação da eficácia da implementação de um pacote de medidas na prevenção de pneumonia associada à ventilação mecânica em unidade de terapia intensiva adulta

Background: Ventilator-associated pneumonia (VAP) is a health care related infection and the second leading cause of nosocomial infections linked to morbidity and mortality rates. Therefore, the implementation of care guideline protocols has become necessary for critically ill patients in ICUs in order to provide adequate treatment. Objective: To assess the impact of a package called FAST HUG in PAV ; analyze the risk factors for occurrence of VAP in adult patients at an ICU of a private hospital ; analyze the clinical characteristics of patients who were or were not submitted to the FAST HUG ; analyze the etiology of microorganisms related to EPI ; determine the cost of hospitalization in patients with pneumonia and in patients who received the FAST HUG.Methods: The study was performed in a private hospital that has an 8-bed ICU. It was divided into two phases: before implementing FAST HUG, from August 2011 to August 2012 and after the implementation of FAST HUG, from September 2012 to December 2013. An individual form for each patient in the study was filled out by using information taken electronically from the hospital medical records. The following data for each patient was obtained: age, gender, reason for hospitalization, the use of three or more types of antibiotics, length of stay, intubation time and progress. Findings: After the implementation of FAST HUG, there was an observable decrease in the occurrence of VAP (p <0.01), as well as a reduction in mortality rates (p <0.01). It also shows that the intervention performed in the study resulted in a significant reduction in ICU hospital costs (p <0.05).Conclusion: The implementation of FAST HUG reduced the cases of VAP. Thus, decreasing costs, reducing mortality rates and length of stay, which therefore resulted in an improvement to the overall quality of care.

Efeito da concentração de sólidos e de variáveis operacionais no desempenho de um hidrociclone concentrador

The hydrocycloning operation has a goal to separate solid-liquid suspensions and liquid-liquid emulsions through the centrifugal force action. Hydrocyclones are equipment with reduced size and used in both clarification and thickening. This device is used in many areas, like petrochemical and minerals process, and accumulate advantages like versatility and low cost of maintenance. However, the demand to improve the process and to reduce the costs has motivated several studies of equipment optimization. The filtering hydrocyclone is a non-conventional equipment developed at FEQUI/UFU with objective to improve the hydrocycloning separation efficiency. The purpose of this study is to evaluate the operating conditions of feed concentration and underflow diameter on the performance of a filtering geometry optimized to minimization of energy costs. The filtration effect was investigated through the comparison between the performance of the Optimized Filtering Hydrocyclone (HCOF) and the Optimized Concentrator Hydrocyclone (HCO). Because of the resemblance of hydrocyclones performance, the filtration did not represent significant effect on the performance of the HCOF. It was found that in this geometry the decrease of the variable underflow diameter was very favorable to thickening operation. The suspension concentration of quartzite at 1.0% of solids in volume was increased about 42 times when the 3 mm underflow diameter was used. The increase on the feed solid percentage was good for decreasing the energy spent, so that a minimum number of Euler of 730 was achieved at CVA = 10.0%v. However, a greater amount of solids in suspension leads to a lower efficiency of the equipment. Therefore, to minimize the underflow-to-throughput ratio and keep a high efficiency level, it is indicated to work with dilute suspension (CVA = 1.0%) and 3 mm underflow diameter (η = 67%). But if it is necessary to work with high feed concentration, the use of 5 mm underflow diameter provides a rise in the efficiency. The HCO hydrocyclone was compared to the traditional family of hydrocyclones Rietema and presented advantages like higher efficiency (34% higher in average) and lower energy costs (20% lower in average). Finally, the efficiency curves and project equation have been raised for the HCO hydrocyclone each with satisfactory adjust.