Infecção hospitalar em pacientes cirúrgicos de hospital universitário

Objetivo: Analisar fatores intercorrentes e a incidência da infecção em pacientes operados no Hospital Universitário da UFRN. Métodos: Foram estudados, através de protocolo previamente estabelecido, 3.120 pacientes internados que se submeteram a procedimentos cirúrgicos no período de janeiro de 1999 a outubro de 2002. Resultados: O índice de infecção hospitalar foi de 5,9%, e a topografia de maior incidência foi a ferida operatória (3,7%). Infecção respiratória ocorreu em 1,2%, urinária em 0,6% e bacteremia em 0,1%. O índice de infecção comunitária foi de 9,2%, predominando infecção urinária (5%) e respiratória (2,1%). Quanto ao grau de contaminação das feridas operatórias, as feridas limpas (1479) apresentaram infecção em 2,9%, as feridas limpascontaminadas (1277) em 6,0% dos casos, as feridas contaminadas (270) em 15,1%, e as ferida infectadas (94) resultaram em infecção em 30,75% dos casos. Conclusão: Concluiu-se que a incidência de infecção cirúrgica foi compatível com os índices na literatura mundial. A partir desses dados, ratifica-se a importância de medidas de controle de infecção hospitalar de forma sistemática, como vem sendo realizado no hospital onde o estudo foi realizado

Da colônia ao shopping: um estudo da evolução tipológica da arquitetura hospitalar em Natal

A conceptual discussion on architectural type and its role in theory and practice supports the construction of an analytical tool used for recognizing the typological evolution of hospital architecture in Western societies. The same tool is applied to analyze the typological evolution of hospital architecture in Natal, Brazil, through a sample of eighteen hospitals built in the city since the beginnings of 20th century. The conclusion is that typological evolution in Natal is almost the same as occidental one, except for a few singularities that can be explained by local social and economic development

Avaliação do potencial de formigas (Hymenoptera: formicidae) como vetores mecânicos de bactérias do gêneroSstaphylococcus no ambiente hospitalar.

In a hospital environment, these bacteria can be spread by insects such as ants, which are characterized by high adaptability to the urban environment. Staphylococcus is a leading cause of hospital infection. In Europe, Latin America, USA and Canada, the group of coagulase negative staphylococci (CoNS) is the second leading cause of these infections, according to SENTRY (antimicrobial surveillance program- EUA). In this study, we investigated the potential of ants (Hymenoptera: Formicidae) as vehicle mechanics of Staphylococcus bacteria in a public hospital, in Natal-RN. The ants were collected, day and night, from June 2007 to may 2008, in the following sectors: hospitals, laundry, kitchen, blood bank. The ants were identified according to the identification key of Bolton, 1997. For the analysis of staphylococci, the ants were incubated in broth Tryptic Soy Broth (TSB) for 24 hours at 35 º C and then incubated on Mannitol Salt Agar. The typical colonies of staphylococci incubated for 24 hours at 35 ° C in Tryptic Soy Agar for the characterization tests (Gram stain, catalase, susceptibility to bacitracin and free coagulase). The identification of CoNS was performed through biochemical tests: susceptibility to novobiocin, growth under anaerobic conditions, presence of urease, the ornithine decarboxylation and acid production from the sugars mannose, maltose, trehalose, mannitol and xylose. The antimicrobial susceptibility examined by disk-diffusion technique. The technique of Polymerase Chain Reaction was used to confirm the presence of mecA gene and the ability to produce biofilm was verified by testing in vitro using polystyrene inert surface, in samples of resistant staphylococci. Among 440 ants, 85 (19.1%) were carrying coagulase-negative staphylococci (CoNS) of the species Staphylococcus saprophyticus (17), Staphylococcus epidermidis (15), Staphylococcus xylosus (13), Staphylococcus hominis hominis (10), Staphylococcus lugdunensis (10), Staphylococcus warneri (6), Staphylococcus cohnii urealyticum (5), Staphylococcus haemolyticus (3), Staphylococcus simulans (3), Staphylococcus cohnii cohnii (2), and Staphylococcus capitis (1). No Staphylococcus aureus was found. Among the isolates, 30.58% showed resistance to erythromycin. Two samples of CoNS (2.35%), obtained from the ant Tapinoma melanocephalum collected in the post-surgical female ward, S. Hominis hominis and S. lugdunensis harbored the mecA gene and were resistant to multiple antibiotics, and the specie S. hominis hominis even showed to be a biofilm producer. This study proves that ants act as carriers of multidrug-resistant coagulase-negative Staphylococci and biofilm producers and points to the risk of the spreading of pathogenic microorganisms by this insect in the hospital environment

Hospital humano: etnografia da humanização hospitalar na perspectiva de usuários

This ethnographic work studies the experiences of patients admitted in public (PUH) and private (PRH) hospitals in the Brazilian northeastern region. 28 adult patients of different clinics participated in the study. Data were analyzed by the patient path method, consisting in a combination of complemented and articulated techniques free observation, participating observation, ethnographic interview and patient testimonials collected prospectively during the patients admissions, from their arrival and until their discharge. The analysis was carried out according to the Thematic Categories Analysis Technique and the data were interpreted pursuant to medical anthropology, healthcare humanization and healthcare promotion theoretical references. The ethical principles of Resolution 196/96 were followed. The human hospital, as revealed by the patient, highlights the significance of subjectivity. 225 (54.7%) out of 411 mentioned concepts were collected in a public hospital (PUH) and 186 (45.3%) in a private institution (PRH). The results show that the patient at the PUH and PRH ethnoevaluates different aspects of the healthcare professionals´ human and technical competence, the hospital´s functioning structure, the access to and the ethics in the financial management, and develops overcoming strategies for his stay at the hospital. This ethnoevaluation is mediated by different factors, namely: social and economic status, personality, religiosity, ironic speech, somber diagnosis and satisfied needs, prior hospital experiences and the conditions under which the interview was carried out. A pedagogic proposal for the hospital humanization must include structural, managerial and organizational changes of the offered services and use active methodologies aimed to the political resolution of problematic situations at work and the inclusion of affective and subjective factors, and become as well a tool for the collective learning. This study shows the importance for the user´s ethnoevaluation to be incorporated into the hospital management and care as a guideline in the decision making and clinical action, thus promoting practices that shall lead to a decent and humanized care. The multidisciplinary nature of this study allowed a wide understanding of the user´s perspective as a socially critical ethnoevaluator

Abordagem psicossociologica das implicações legais da infecção hospitalar e de seu controle

Pesquisas acerca das Infecções Hospitalares mostram a gravidade do problema na saúde e a existência de poucos profissionais das áreas do Direito e da Saúde especializados nas implicações jurídicas relacionadas com o controle das Infecções Hospitalares. Assim, este estudo multidisciplinar tem como objetivos: apreender as Representações Sociais das Implicações Jurídicas das Infecções Hospitalares e de seu Controle, elaboradas pelos profissionais do direito e da saúde e analisar o impacto destas representações sobre Infecções Hospitalares e seu controle no âmbito do Hospital Getúlio Vargas, em Teresina, no Estado do Piauí. Trata-se de um estudo de caráter exploratório, desenvolvido em hospital público com profissionais do Direito e da Saúde, subsidiado na Teoria das Representações Sociais, de Serge Moscovici. Os dados foram coletados através de entrevista em profundidade e da observação. As informações apreendidas foram processadas no software Alceste 4.8, possibilitando a análise lexical e estatística pela Classificação Hierárquica Descendente, que permitiu identificar no discurso classes representativas de palavras de interesse da investigação. Os resultados indicaram que os sujeitos do estudo, através das suas representações sociais, defendem os direitos dos usuários da saúde e conhecem a prática das políticas de saúde, prevenção das Infecções Hospitalares e de seu Controle. Porém, demonstraram pouca preocupação com as implicações jurídicas inerentes às sua práticas mesmo estando sujeitos a responder civil e penalmente pelas ocorrências geradas por iatrogenia no exercício da profissão

Desmame em recém-nascidos de muito baixo peso ao nascer no primeiro retorno ambulatorial após a alta hospitalar

Investigate intrahospital and neonatal determinants associated to the weaning of very low birth weight (VLBW) infants. Methods: 119 VLBW (<1500g) infants 81 were monitored from July 2005 through August 2006, from birth to the first ambulatory visit after maternity discharge. This maternity unit uses the Kangaroo Method and the Baby Friendly Hospital Initiative. Results: Out of 119 VLBW infants monitored until discharge, 88 (75%) returned to the facility, 22 (25%) were on exclusive breastfeeding (EB) and 66 (75%) were weaned (partial breastfeeding or formula feeding). Univariate analysis found an association between weaning and lower birth weight, longer stays in the NICU and longer hospitalization times, in addition to more prolonged enteral feeding and birth weight recovery period. Logistic regression showed length of NICU stay as being the main determinant of weaning. Conclusion: The negative repercussion on EB of an extended stay in the NICU is a significant challenge for health professionals to provide more adequate nutrition to VLBW infants

Risco ocupacional no contexto hospitalar

O presente estudo tem como objetivo conhecer as representações sociais sobre o risco ocupacional construídas por trabalhadores da saúde no contexto hospitalar. Trata-se de um estudo exploratório fundamentado no referencial teórico da Teoria das Representações Sociais realizado com duzentos e vinte trabalhadores da saúde pertencentes ao quadro permanente de um hospital público na cidade do Natal- RN. Os dados foram coletados através da Entrevista semi-estruturada e da Técnica da Associação Livre de Palavras. Na análise das informações utilizou-se o software Evoc 2000 e o Alceste. Os resultados indicam condições de trabalho desfavoráveis com desgaste físico e mental ao trabalhador da saúde, e, patologias pouco reconhecidas como ocupacionais em sua origem. Pode-se observar que as representações sociais construídas pelos trabalhadores da saúde, revelam o nível de conscientização desses trabalhadores referentes às consequências do ambiente de trabalho para sua saúde, referindo-se ao processo de trabalho hospitalar, como múltiplo e complexo pela dimensão tecnológica e pelos aspectos físicos, psíquicos e cognitivos

Infecção hospitalar associada ao uso de cateter venoso central e a quebra de protocolos pelos profissionais de saúde na UTI de um hospital universitário em Natal/RN

This is a study descriptive cross-sectional and quantitative approaches, which aimed to analyze the association between hospital infection rate for insertion, maintenance of central venous catheter and the breakdown of protocols (rules and routines) by health professionals assisting patients in the ICU of a university hospital in Natal / RN. The process of data collection was through observation with structured form, refers to medical records and structured questionnaires with health professionals. The results were organized, tabulated, categorized and analyzed using SPSS 14.0. The characterization of the subjects was performed using descriptive and inferential statistics, taking into account the nature of the variables, with analysis of variance (ANOVA) and Spearman correlation test, it was a discussion of the information obtained, considering the mean, standard deviation, coefficient of variance and standard error. The variables that showed a higher level of correlation were treated with the application of significance tests. As the results, 71% of participants were female and 29% male, age ranged from 18 to 85 years (52.6 ± 22.5). The insertion, there was a variation from 0 to 5 errors (1.2 ± 1.4), during maintenance, the average was 2.3 ± 0.9 errors, ranging from 0 to 4. During the insertion and maintenance of CVC, patients who had been an infection ranging from 2 to 9 mistakes (4.2 ± 1.7), since those who did not show the variation goes from 0 to 5 errors (2, 8 ± 1.5). The correlation coefficient between the risk of infection throughout the process and the risk of infection at the insertion showed strong and significant (r = 0.845 p = 0.000) and in relation to risk of infection in maintenance was moderate and significant (r = 0.551 p = 0.001). The mistakes made by professionals in the procedures for insertion and maintenance of the catheter, associated with other conditions, shown as a risk factor for the of IH

Do lixo à solidariedade : avanços e perspectivas na busca de uma nova realidade

The dissertating study about the solidarity economy has the objective to analyze the four unions responsible for the selective municipal garbage collection in Natal. It aims at verifying the consolidation of these unions as solidarity economic undertakings, revealing which progresses they have made, as well as the social and economic insertion of the garbage collectors and their process of conquering citizenship. The referred four unions had been founded and are constituted, in their majority, by collectors coming from the Cidade Nova lixão (big garbage). As it was closed in August 2004, they decided to make a union in order to collecting garbage. As what concerns the methodic and theoretic proceedings, our research has been developed with a critical perspective and a qualitative approach without discarding and quantitative one. The central analytical categories of this paper are: association, work, social exclusion and citizenship. Our research has had three articulated axis which aim was to apprehend the subject, disclosing it. The exposition of the investigative results is subdivided in four chapters. The first one approaches the main aspects of the crisis of the capital and its reflexes in the world of work. Here we deal with the question the structural unemployment coming as a result of the present economic model, the mains changes verified in the Brazilian work market, as well as levels of unemployment affecting the work market in Natal s metropolitan region. The second chapter treats of the origin, concept and revival in Brazil concerning the tradition of thought and cooperative economic organization, which has recovered the central elements of the associative thought and is nowadays studied in Latin America under the name of solidarity economy. The third chapter deals with embodiment of the collectors unions, its history, appearing and development of each union. The fourth chapter presents the relative dimensions of the analysis categories supported in the reports of institutional actors as well as the perception collectors have about the recyclable stuffs, the way they face the daily life and so on, what brings about the contradictions present in their reality. The final comments sum up the main trends and particularities of the unions researched under the light of the solidarity economy and disclose the real perspectives of social and economic insertion of these collectors and the process they follow to conquest social recognition

Mineralização de carbono e de nitrogênio provenientes de composto de lixo urbano em argissolo

Estudos da mineralização do C e do N em solos que receberam aplicação de composto de lixo urbano são importantes para avaliar o comportamento desse resíduo no solo e dar subsídios para definir as doses adequadas às culturas, com vistas em atender à necessidade de N das plantas. Foram realizados dois experimentos em condições de laboratório com o objetivo de avaliar a mineralização de C e de N em um Argissolo textura média adubado com composto de lixo urbano. No primeiro experimento, utilizou-se delineamento inteiramente ao acaso, com cinco tratamentos e três repetições, com os tratamentos constituídos de cinco doses de composto de lixo urbano, equivalentes a 0, 30, 60, 90 e 120 t ha-1. No segundo experimento, empregou-se esquema fatorial, com delineamento inteiramente ao acaso e três repetições, combinando as mesmas cinco doses de composto de lixo urbano utilizadas no primeiro experimento e 11 tempos de incubação (0, 7, 14, 28, 42, 56, 70, 84, 98, 112 e 126 dias). Os maiores aumentos de N-NO3- no solo foram obtidos até os 42 dias de incubação, independentemente da dose de composto de lixo aplicada, percebendo-se, a partir dos 70 dias, tendência de estabilização. A fração de mineralização de C-orgânico em C-CO2 menor do que 2 % em 168 dias indica que o composto de lixo urbano é material que contribui para aumentar os estoques de matéria orgânica do solo. Na ausência de adubação nitrogenada complementar, a fração de mineralização de N-orgânico de 12 % em 126 dias evidencia que o composto de lixo urbano apresenta potencial fertilizante de liberação lenta de N para as plantas.

Alterações nos atributos de fertilidade em solo adubado com composto de lixo urbano

O composto de lixo urbano é um adubo orgânico que vem sendo, com bastante freqüência, utilizado em áreas de produção de hortaliças. Assim, o objetivo deste trabalho foi avaliar o efeito da aplicação do composto de lixo urbano na fertilidade do solo, na produção de alface e no acúmulo de nutrientes nas plantas. O experimento foi realizado em casa de vegetação, em colunas de PVC, em delineamento em blocos ao acaso, com cinco tratamentos, doses de 0; 30; 60; 90 e 120 t ha-1 de composto de lixo urbano e oito repetições. As colunas receberam solo das profundidades de 0-20 (tratado com composto de lixo), 20-40 e 40-60 cm de um Argissolo, textura média, e uma muda de alface. Ao final do cultivo, colunas de quatro repetições de cada tratamento foram desmontadas e, nas demais colunas, fez-se um segundo cultivo de alface. A incorporação de composto de lixo urbano na profundidade de 0-20 cm melhorou a fertilidade do solo da própria camada em que foi aplicado e da camada de 20-40 cm, mas não alterou as características da camada de 40-60 cm. A adubação com composto de lixo urbano propiciou aumento do pH e dos teores de MO, P, K, Ca e Mg do solo, na camada de 0-20 cm, e de pH e Ca, na profundidade de 20-40 cm. A melhora da fertilidade do solo com a aplicação de composto de lixo urbano acarretou aumento de produção de alface e provocou maior acúmulo de P, K e Ca nas plantas.

Formação de mudas de eucalipto com utilização de lixo orgânico e níveis de irrigação calculados por dois métodos

O estudo das características e das possibilidades de utilização de Resíduo Sólido Urbano (R.S.U.) e mais especificamente de Resíduo Sólido Orgânico Urbano (R.S.O.U.), no Brasil e no Mundo, ainda não produziu informações que possibilitem conhecimentos suficientes para tomadas de decisões que estão sendo exigidas, em razão do crescente volume de resíduos produzidos e os impactos ao meio ambiente. Este trabalho teve o objetivo de estudar o efeito da irrigação associada ao uso de R.S.O.U. para formação de mudas de eucalipto. A pesquisa foi desenvolvida na UNESP, Câmpus de Jaboticabal - SP, sendo adotado como delineamento estatístico o esquema fatorial inteiramente casualizado. Foram utilizados 11 substratos: dois tipos de solos (um Latossolo Vermelho eutrófico e um Latossolo Vermelho distrófico), com e sem adubação química, seis misturas de solo e R.S.O.U., e um utilizando somente R.S.O.U. Sementes de eucalipto var. Citriodora Hooker foram semeadas diretamente em topetes e irrigadas com base em dois métodos de quantificação da água evapotranspirada (tanque Classe A e determinação da massa), em quatro níveis (50; 70; 100 e 130% da evapotranspiração). Os dados coletados e analisados estatisticamente demonstraram que doses acima de 20% de R.S.O.U. na mistura, em solos destinados à produção de mudas de eucalipto, causam efeitos negativos na sobrevivência das plantas.

Níveis de irrigação e de composto de lixo orgânico na formação de mudas cítricas em casa de vegetação

O presente trabalho visou a estudar o efeito da associação entre a irrigação e tipos de substratos na formação de mudas de laranjeira. O delineamento experimental utilizado foi o de blocos casualizados, com parcelas subdivididas, com quatro repetições, três níveis de irrigação e cinco tipos de substratos. Foram utilizados os seguintes substratos: 100% de casca de pínus; 80% de casca de pinus + 20% de composto de lixo orgânico; 60% de casca de pinus + 40% de composto de lixo orgânico; 20% de casca de pinus + 80% de composto de lixo orgânico, e 100% de composto de lixo orgânico. A irrigação por gotejamento foi feita com lâminas de 50%, 100% e 150% da evaporação do atmômetro modificado. A avaliação do desenvolvimento das plantas foi feita quinzenalmente, medindo-se o diâmetro do caule e a altura. Os resultados mostraram que as mudas de citrus apresentaram necessidade de água variável com os diferentes estádios de desenvolvimento e tipos de substratos, dos quais se destacou o substrato 3 (60% de casca de pinus e 40% de composto de lixo urbano), pois propiciou melhores condições para o desenvolvimento das raízes das plantas e também forneceu nutrientes, por meio da decomposição do material orgânico. A irrigação 3 (150% da evaporação do atmômetro) foi a que proporcionou o melhor desenvolvimento das mudas de laranjeira.

Narrativas infantis: o que nos contam as crianças de suas experiências no hospital e na classe hospitalar

This dissertation focuses on the narratives of children hospitalized with chronic diseases. The overall goal is to deduce, from the look of the child health care, hospital class contributions to the process of school inclusion. The research is part of the qualitative ethnographical approach and is based on the principles and research methods (auto)biographical in education and schooling in hospital. Participated in the investigation 05(five) children, aged between 06 (six) and 12 (twelve) years of age, treated at the Center for Children s Onco-Hematology, Varela Santiago Children s Hospital in Natal-RN. The corpus used for the analysis comprises five (05) narrative interviews, 03 (three) drawings made by children as well as records in the researcher s field diary. The sources were collected during the months of August 2010 to February 2011. The analysis revealed that the inclusion of the hospital class, and ensure the right to education, contributes to the construction of strategies for coping with illness and hospitalization, as it promotes autonomy, comfort, playfulness and self-knowledge, the rand the world, easing the stress of hospitalization. The figure of the teacher took the class hospital in the voices of children, a reliever and minimizing the role of double exclusion that cause illness and hospitalization, showing the contributions to (re) construction of identity and subjectivity constitution strengthened. The children interviewed said that the hospital class leave the hospital more cheerful. The playfulness and learning experiences in the hospital are seen by children as actions that go beyond the physical treatment of the disease, since it provides them with acceptance and understanding of hospitalization and illness, to give them affective security and emotional. In conclusion, the narratives of children confirm that the service class hospital ensures continuity of schooling, but they reveal, namely, that this service provides them socialization among peers and with adults, strengthening the emotional, social and cognitive biopsychosocial perspective of attention

Vivendo e aprendendo no ambiente hospitalar: Percepções de crianças sobre a doença

This study focuses on the child within the hospital environment. Its purpose is to describe children s perceptions of their illness and time in hospital and to identify their main hardships during treatment. This study has a qualitative nature and is theoretically and methodologically supported by the creative and sensitive method developed by Cabral (1998), studies by Piaget, Vygotsky and Wallon on child development, and studies conducted by Pinto (2005), Collet (2004), Chiattone (2003), Silva (2002), Lima et.al (1999) on in-patient children. For this study, 13 children between the ages of 7 and 12 at a public hospital institution specialized in child care in the city of Natal, Rio Grande do Norte, were interviewed. As a criterion for taking part in this study the children would have to have been in hospital for over three days and be fully capable of physically and emotionally interacting with the researcher at the time the interview took place. Analysis drew on the study of the empirical material made up of interviews and a field diary where notes had been entered for the children s reactions, expressions and gestures. Results show that there is some understanding, on the part of these children, of their illness, with their parents as the main informants. They accept being in hospital because they need treatment, but they realize that life becomes different especially on account of the constraints resulting from the illness and the hospital itself. The main hardships during treatment are: lack of recreational activities in the evenings and on the weekends within the hospital environment; absence of family members, especially brothers and sisters; and lack of explanation on the part of health professionals regarding some procedures as these are being carried out. Our conclusion is that children perceive illness and the hospital environment as something that changes the rhythm of their lives bringing on them perturbations, fears and anxieties. Hence, we suggest that professionals working with in-patient children should be especially prepared to deal with these children and their parents, aiming at bringing down fears and anguishes, clear their doubts and, in addition, advise the parents in respect of their children s treatment while in hospital and after hospital discharge. The hospital environment should also be cheerful and colorful and have a toy room under the coordination of persons especially prepared for that purpose