The role of primary care in the prevention and control of healthcare associated infections

Little research has been conducted to date on the role of primary health care (PHC) in the prevention of healthcare associated infections (HCAIs). The present article is a theoretical study of the principle of primum non nocere and aims to promote reflection on the role of PHC in HCAI prevention with emphasis on practical recommendations. The indirect and direct roles of PHC in HCAI prevention are debated in light of this guiding principle. With respect to the indirect role of PHC, we discuss the issues of hospital-centrism and ambulatory care-sensitive conditions. The article outlines a number of challenges faced by health services related to PHC’s direct role in HCAI prevention, highlights seven key components of HCAI prevention programmes within the PHC sphere and provides practical recommendations for HCAI control and prevention.


Usage of Calendula officinalis in the prevention and treatment of radiodermatitis: a randomized double-blind controlled clinical trial

OBJECTIVE To evaluate the efficacy of Calendula officinalis in relation to Essential Fatty Acids for the prevention and treatment of radiodermatitis. METHOD This is a randomized double-blind controlled clinical trial with 51 patients with head and neck cancer in radiotherapy treatment divided into two groups: control (27) and experimental (24). RESULTS There is statistically significant evidence (p-value = 0.0120) that the proportion of radiodermatitis grade 2 in Essential Fatty Acids group is higher than Calendula group. Through the Kaplan-Meier survival curve we observed that Essential Fatty Acids group has always remained below the Calendula group survival curve, due to the lower risk of developing radiodermatitis grade 1, which makes the usage of Calendula more effective, with statistical significance (p-value = 0.00402). CONCLUSION Calendula showed better therapeutic response than the Essential Fatty Acids in the prevention and treatment of radiodermatitis. Brazilian Registry of Clinical Trials: RBR-237v4b.

Disinfection with sodium hypochlorite in hospital environmental surfaces in the reduction of contamination and infection prevention: a systematic review

OBJECTIVETo search for evidence of the efficiency of sodium hypochlorite on environmental surfaces in reducing contamination and prevention of healthcare-associated infection HAIs.METHODSystematic review in accordance with the Cochrane Collaboration.RESULTSWe analyzed 14 studies, all controlled trials, published between 1989-2013. Most studies resulted in inhibition of microorganism growth. Some decreased infection, microorganism resistance and colonization, loss of efficiency in the presence of dirty and surface-dried viruses.CONCLUSIONThe hypochlorite is an effective disinfectant, however, the issue of the direct relation with the reduction of HAIs remains. The absence of control for confounding variables in the analyzed studies made the meta-analysis performance inadequate. The evaluation of internal validity using CONSORT and TREND was not possible because its contents were not appropriate to laboratory and microbiological studies. As a result, there is an urgent need for developing specific protocol for evaluating such studies.

Evaluation of adherence to measures for the prevention of surgical site infections by the surgical team

AbstractOBJECTIVEEvaluate pre- and intraoperative practices adopted by medical and nursing teams for the prevention of surgical infections.METHODA prospective study carried out in the period of April to May 2013, in a surgical center of a university hospital in Belo Horizonte, Minas Gerais.RESULTS18 surgeries were followed and 214 surgical gloves were analyzed, of which 23 (10.7%) had postoperative glove perforation detected, with 52.2% being perceived by users. Hair removal was performed on 27.7% of patients in the operating room, with the use of blades in 80% of the cases. Antibiotic prophylaxis was administered to 81.8% of patients up to 60 minutes prior to surgical incision. An average of nine professionals were present during surgery and the surgery room door remained open in 94.4% of the procedures.CONCLUSIONPartial adhesion to the recommended measures was identified, reaffirming a need for greater attention to these critical steps/actions in order to prevent surgical site infection.

Patient safety and the prevention of skin and mucosal lesions associated with airway invasive devices

AbstractOBJECTIVETo analyze the care implemented by the nursing team to promote the safety of adult patients and prevention of skin and mucosal lesions associated with the presence of lower airways invasive devices.METHODStudy with qualitative and quantitative approach, descriptive and exploratory type, whose investigative scenarios were adult inpatient units of a hospital in the West Frontier of Rio Grande do Sul. The study subjects consisted of nurses, nursing technicians and nursing assistants.RESULTSA total of 118 professionals were interviewed. We highlight the observed specific care with endotracheal tube and tracheostomy, management and assessment of the cuff and the criteria used to secretion aspiration.CONCLUSIONThere is a superficial nursing work in the patient direct care and a differentiation in relation to the perception of nurse technicians, especially those working in the intensive care unit, who presented major property and view of the patient's clinical status.

Soil fauna as an indicator of soil quality in forest stands, pasture and secondary forest

The interactions between soil invertebrates and environmental variations are relatively unknown in the assessment of soil quality. The objective of this study was to evaluate soil quality in areas with different soil management systems, based on soil fauna as indicator, in Além Paraíba, Minas Gerais, Brazil. The soil invertebrate community was sampled using pitfall traps, in the dry and rainy seasons, from areas with five vegetation types (acacia, mimosa, eucalyptus, pasture, and secondary forest). The abundance of organisms and the total and average richness, Shannon's diversity index, the Pielou uniformity index, and change index V were determined. The fauna was most abundant in the areas of secondary forest and mimosa plantations in the dry season (111.3 and 31.7 individuals per trap per day, respectively). In the rainy season, the abundance of organisms in the three vegetation types did not differ. The highest values of average and total richness were recorded in the secondary forest in the dry season and in the mimosa stand in the rainy season. Shannon's index ranged from 1.57 in areas with acacia and eucalyptus in the rainy season to 3.19 in the eucalyptus area in the dry season. The uniformity index was highest in forest stands (eucalyptus, acacia and mimosa) in the dry season, but higher in the rainy season in the pasture and secondary forest than in the forest stands. The change index V indicated that the percentage of extremely inhibited groups was lowest in the area with mimosa, both in the dry and rainy season (36 and 23 %, respectively). Of all forest stands, the mimosa area had the most abundant soil fauna.

EFFECT OF WATER AVAILABILITY ON SOIL MICROBIAL BIOMASS IN SECONDARY FOREST IN EASTERN AMAZONIA

Soil microbial biomass (SMB) plays an important role in nutrient cycling in agroecosystems, and is limited by several factors, such as soil water availability. This study assessed the effects of soil water availability on microbial biomass and its variation over time in the Latossolo Amarelo concrecionário of a secondary forest in eastern Amazonia. The fumigation-extraction method was used to estimate the soil microbial biomass carbon and nitrogen content (SMBC and SMBN). An adaptation of the fumigation-incubation method was used to determine basal respiration (CO2-SMB). The metabolic quotient (qCO2) and ratio of microbial carbon:organic carbon (CMIC:CORG) were calculated based on those results. Soil moisture was generally significantly lower during the dry season and in the control plots. Irrigation raised soil moisture to levels close to those observed during the rainy season, but had no significant effect on SMB. The variables did not vary on a seasonal basis, except for the microbial C/N ratio that suggested the occurrence of seasonal shifts in the structure of the microbial community.