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.

Impacto na epidemiologia da sepse tardia após a mudança do protocolo de antimicrobianos em uma UTIN de um serviço universitário

Advances in neonatology resulted in reducing the mortality rate and the consequent increase in survival of newborn pre terms (PTN). On the other hand, there was also a considerable increase in the risk of developing health care-related infection (HAI) in its most invasive, especially for bloodstream. This situation is worrying, and prevent the occurrence of it is a challenge and becomes one of the priorities in the Neonatal Intensive Care Unit (NICU). Sepsis is the main cause of death in critical neonates and affects more than one million newborns each year, representing 40% of all deaths in neonates. The incidence of late sepsis can reach 50% in NICUs. Currently the major responsible for the occurrence of sepsis in developed countries is the coagulase negative Staphylococcus (CoNS), followed by S. aureus. The cases of HAIs caused by resistant isolates for major classes of antimicrobial agents have been increasingly frequent in the NICU. Therefore, vancomycin has to be prescribed more frequently, and, today, the first option in the treatment of bloodstream infections by resistant Staphylococcus. The objectives of this study were to assess the impact on late sepsis in epidemiology III NICU after the change of the use of antimicrobials protocol; check the frequency of multiresistant microorganisms; assess the number of neonates who came to death. This study was conducted in NICU Level III HC-UFU. three study groups were formed based on the use of the proposed late sepsis treatment protocol, with 216 belonging to the period A, 207 B and 209 to the C. The work was divided into three stages: Period A: data collected from neonates admitted to the unit between September 2010 to August 2011. was using treatment of late sepsis: with oxacillin and gentamicin, oxacillin and amikacin, oxacillin and cefotaxime. Period B: data were collected from March 2012 to February 2013. Data collection was started six months after protocol change. Due to the higher prevalence of CoNS, the initial protocol was changed to vancomycin and cefotaxime. Period C: data were collected from newborns inteerne in the unit from September 2013 to August 2014. Data collection was started six months after the protocol change, which occurred in March 2013. From the 632 neonates included in this study, 511 (80,8%) came from the gynecology and obstetrics department of the HC-UFU. The mean gestational age was 33 weeks and the prevailing sex was male (55,7%). Seventy-nine percent of the studied neonates were hospitalized at the NICU HC-UFU III because of complications related to the respiratory system. Suspicion of sepsis took to hospitalization in the unit of 1,9% of newborns. In general, the infection rate was 34,5%, and the most frequent infectious sepsis syndrome 81,2%. There was a tendency to reduce the number of neonates who died between periods A 11 and C (p = 0,053). From the 176 cases of late sepsis, 73 were clinical sepsis and 103 had laboratory confirmation, with greater representation of Gram positive bacteria, which corresponded to 67.2% of the isolates and CoNS the most frequent micro-organism (91,5%). There was a statistically significant difference in the reduction of isolation of Gram positive microorganisms between periods A and C (p = 0,0365) as well as in reducing multidrug-resistant CoNS (A and B period p = 0,0462 and A and C period, p = 0,158). This study concluded that: the CoNS was the main microorganism responsible for the occurrence of late sepsis in neonates in the NICU of HC-UFU; the main risk factors for the occurrence of late sepsis were: birth weight <1500 g, use of PICC and CUV, need for mechanical ventilation and parenteral nutrition, SNAPPE> 24 and length of stay more than seven days; the new empirical treatment protocol late sepsis, based on the use of vancomycin associated cefepime, it was effective, since promoted a reduction in insulation CoNS blood cultures between the pre and post implementation of the Protocol (A and C, respectively); just as there was a reduction in the number of newborns who evolved to death between periods A and C.

Análise do uso de escalas nas simulações de processos de estampagem

The purpose of using software based on numerical approximations for metal forming is given by the need to ensure process efficiency in order to get high quality products at lowest cost and shortest time. This study uses the theory of similitude in order to develop a technique capable of simulating the stamping process of a metal sheet, obtaining results close to the real values, with shorter processing times. The results are obtained through simulations performed in the finite element software STAMPACK®. This software uses the explicit integration method in time, which is usually applied to solve nonlinear problems involving contact, such as the metal forming processes. The technique was developed from a stamping model of a square box, simulated with four different scale factors, two higher and two smaller than the real scale. The technique was validated with a bending model of a welded plate, which had a high simulation time. The application of the technique allowed over 50% of decrease in the time of simulation. The results for the application of the scale technique for forming plates were satisfactory, showing good quantitative results related to the decrease of the total time of simulation. Finally, it is noted that the decrease in simulation time is only possible with the use of two related scales, the geometric and kinematic scale. The kinematic scale factors should be used with caution, because the high speeds can cause dynamic problems and could influence the results of the simulations.

Métodos de extração de fósforo e micronutrientes em latossolos com uso de energia ultrassônica

Assessing the soil nutrient availability to plants under lab conditions is one of the main challenges to Soil Fertility and Chemistry, due to the complex behavior and the interaction of the soil properties. Many extractant solutions associated with mechanical forms of agitation have been proposed, showing different correlations with plant growth and nutrients absorption. Using ultrasonic energy is a agitation procedure of the soil:extractant solution suspension (based on the cavitation phenomenon). It allows the establishment of relations between the amount of extracted nutrient and the ultrasonic energy level. Thus, this work aims: to evaluate the effect of cavitation intensity on the extraction of P, Zn, Cu, Mn and Fe in soil samples from five Latosols under different uses around Uberlândia and Uberaba, Minas Gerais State; to obtain extracting curves as function of ultrasonic energy levels; and to obtain an index from extracting curves to expresses the nutrient retention by the soil solid phase. A soil-solution suspension (ratio 1:10) was sonicated using a probe ultrasound equipment under different combinations of power and time: i) 30 W for 35, 70, 140 and 280 s; ii) 50 W for 21, 42, 84 and 168 s; and iii) 70 W for 15, 30, 60 and 120 s. The extractant solutions used were Mehlich-1 (for all elements), Olsen and distilled water for P. After each sonication, P concentration was quantified by molybdenum blue colorimetric method and Zn, Cu, Mn and Fe by flame atomic absorption spectrophotometry. The cavitation intensity did not affect the P extraction, only the total energy applied. The P extraction was influenced by extractant solution, decreasing as follows: Mehlich-1>Olsen>water. In cultivated Latosols, the P extraction increased linearly with ultrasonic energy, and the slope of the 1:1 linear regression reflects the P retention in the soil. The Zn and Fe extractions were influenced only by total energy applied. Mn and Cu extractions were influenced by both cavitation intensity and total ultrasonic energy. Soils containing similar amounts of P, Cu, Zn, Mn, and Fe may have a different extraction rate. Likewise, soils containing different amounts of those elements may have the same extraction rate.