Percepción de los trabajadores acerca del sistema de seguridad y salud en el trabajo en un hospital de III nivel, Bogotá-Colombia. 2014.

Objetivo: Evaluar la percepción que tienen los trabajadores acerca del sistema de seguridad y salud en el trabajo en la población asistencial y administrativa en un Hospital de III nivel de atención., Bogotá-Colombia. Materiales y métodos: Estudio de corte transversal en población de trabajadores asistenciales y administrativos. Se aplicó el “Cuestionario Nórdico Sobre Seguridad en el Trabajo NOSACQ 50 Spanish” validado. La muestra fue probabilística estratificada aleatoria, en 308 trabajadores (230 asistenciales y 78 administrativos). Resultados: El promedio de edad fue 39.5± 12 años, con mayor frecuencia de género femenino (74.68%), estado civil soltero (38.96%) y nivel educativo técnico (34.40%). La percepción que tienen los trabajadores acerca del sistema de seguridad y salud en el trabajo fue independiente de su tipo de actividad laboral administrativa y asistencial (p>0.05), la mayor percepción en ambos grupos fue la confianza de los trabajadores en la eficacia del sistema de seguridad (2.71 y 2.77), y las de menor percepción presentaron el empoderamiento de seguridad de gestión (2.35 y 2.46) y la seguridad como prioridad de los empleados y rechazo del riesgo (2.35 y 2.40). Conclusiones: Los trabajadores del Hospital tienen un nivel adecuado de buena percepción acerca de los aspectos de seguridad y salud en el trabajo donde se evidenció que la fortaleza es la confianza de los trabajadores en la eficacia del sistema y la debilidad del sistema se encuentra en la falta de empoderamiento y rechazo al riesgo.

Comportamiento del manejo de la provisión de unidades de glóbulos rojos en un hospital público Bogotá, dc. 2011

Introducción: Uno de los problemas que afrontan los hospitales públicos de Bogotá es la insuficiencia de unidades de glóbulos rojos- UGR “O”; este trabajo pretendió evaluar a través de indicadores, el comportamiento del manejo de inventarios de sangre en un Hospital público de tercer nivel. Método: Estudio descriptivo restrospectivo, a partir de registros de Red Distrital de Sangre, banco de sangre Hemocentro Distrital y del servicio de transfusión del Hospital. La evaluación de gestión del inventario y eliminación se hizo con el universo de UGR; para la obtención de: reserva/transfusión, tiempo/reserva y la transfusión no isogrupo, se utilizó una muestra del universo de pruebas cruzadas completas (6.575), Resultados: El Hospital recibió 4.644 UGR, con 4.719 transfundidas, reflejando inconsistencias en estos datos. La participación de transfusiones por servicio fue: Urgencias 22,6%(n=1072), cirugía 21,6%(n=1025), UCI adulto 19,2%(n=912), medicina interna del 17,6%(n=836), ginecología del 6,8%(n=323). El indice WAPI fue de 0,19%(n=9) UGR incineradas, el tiempo de reserva a 24 horas o menos del 65,7%, mayor de 24 horas y menor de 48 horas el 4,2%, mayor de 48 horas y menor de 72 horas el 0,6% y sin información disponible 29,5%; la reserva transfusión del 73%; la transfusión no Isogrupo correspondió 5,1% (n=18), distribuida: prueba cruzada incompatible 1,7%(n=6), protocolo pediatría/neonatología 2%(n=7); Urgencia vital 1,4%(n=5). Conclusiones: Comparado con otros estudios se encontró buen desempeño de los indicadores Wapi (0.19%) y Reserva/trasfusión (73%). No se evaluó demanda satisfecha y utilización componente UGR por registros inconsistentes; en tiempo/reserva la información es crítica para validar el resultado.

Caracterización de los pacientes con catéter venoso central en un hospital universitario de cuarto nivel en Bogotá 2011 - 2013

Introducción: La utilización de catéteres venosos centrales (CVC) en la unidad de cuidado intensivo tiene gran importancia y amplio uso, son fuente de apoyo para la realización de varia actividades, pero con un gran potencial de complicaciones, por lo cual es fundamental conocer todos los aspectos relacionados con su uso, para así poder controlarlas. Métodos: Realizamos un estudio descriptivo de corte transversal con el objetivo de caracterizar los pacientes que requirieron CVC en el Hospital Universitario Fundación Santa Fe de Bogotá durante junio de 2011 y mayo de 2013, describimos sus complicaciones asociadas tanto mecánicas como infecciosas, determinamos la tasa de bacteriemia, gérmenes causales y sus patrones de resistencia. Resultados: Se colocaron 2.286 CVC, el 52,9% en hombres, la media de edad fue 58,9 años. El total de las complicaciones ascienden al 4,5%, infecciosas 4,0% y mecánicas 0,6%. Dentro de las mecánicas solo encontramos inmediatas, no tardías. Con respecto a las infecciosas encontramos infección del sitio de inserción y bacteriemia. Se documentó una tasa de bacteriemia de 3,4 por 1000-días catéter en 2013, en disminución con respecto a 2012 (3,9) y 2011 (4,4). El microorganismo mas frecuentemente aislado fue el Staphylococcus Coagulasa Negativo con patrón usual de resistencia. Conclusión: Las complicaciones asociadas al uso de CVC en el HUFSFB, se presentan en menor frecuencia a las descritas internacionalmente; la tasa de bacteriemia asociada al CVC ha disminuido año tras año, posiblemente asociado al cuidado mas estricto posterior a la implementación de protocolos de manejo.

Factores asociados a mortalidad en pacientes colombianos con enfermedades autoinmunes en la unidad de cuidado intensivo, de un hospital de tercer nivel en Bogotá Colombia

Antecedentes: El interés en las enfermedades autoinmunes (EA) y su desenlace en la unidad de cuidado intensivo (UCI) han incrementado debido al reto clínico que suponen para el diagnóstico y manejo, debido a que la mortalidad en UCI fluctúa entre el 17 – 55 %. El siguiente trabajo representa la experiencia de un año de nuestro grupo en un hospital de tercer nivel. Objetivo: Identificar factores asociados a mortalidad particulares de los pacientes con enfermedades autoinmunes que ingresan a una UCI, de un hospital de tercer nivel en Bogotá, Colombia. Métodos: El uso de análisis de componentes principales basado en el método descriptivo multivariado y análisis de múltiple correspondencia fue realizado para agrupar varias variables relacionadas con asociación significativa y contexto clínico común. Resultados: Cincuenta pacientes adultos con EA con una edad promedio de 46,7 ± 17,55 años fueron evaluados. Los dos diagnósticos más comunes fueron lupus eritematoso sistémico y esclerosis sistémica, con una frecuencia de 45% y 20% de los pacientes respectivamente. La principal causa de admisión en la UCI fue la infección seguido de actividad aguda de la EA, 36% y 24% respectivamente. La mortalidad durante la estancia en UCI fue del 24%. El tiempo de hospitalización antes de la admisión a la UCI, el choque, soporte vasopresor, ventilación mecánica, sepsis abdominal, Glasgow bajo y plasmaféresis fueron factores asociados con mortalidad. Dos fenotipos de variables fueron definidos relacionadas con tiempo en la UCI y medidas de soporte en UCI, las cuales fueron asociadas supervivencia y mortalidad. Conclusiones: La identificación de factores individuales y grupos de factores por medio del análisis de componentes principales permitirá la implementación de medidas terapéutica de manera temprana y agresiva en pacientes con EA en la UCI para evitar desenlaces fatales.

O Cuidador de Enfermagem e o Cuidar em Uma Unidade de Terapia Intensiva; The Nursing Caregiver and the Caring in Intensive Care Units

There are several aggressive factors in Intensive Care Units (ICU), which reach not only patients, but the nursing caregivers, since they participate in complex procedures and death of patients. Nursing caregivers may have difficulties on their daily work routine that can influence the way of care. The goal of this study was to identify the aspects of nursing caregivers working in adult ICU. It is a describe-exploratory study with qualitative approach, developed among 21 ICU adult nursing caregivers of a school hospital in Paraná. The data were collected in May and July, 2009 by recorded and transcribed semi-structured interviews. Four categories for analysis were identified: the aspects of ICU assistance, the meaning of healthcare for the nursing caregivers, the understanding of healthcare positive aspects and disclosing the difficulties of caring. The results revealed that caring is related to some factors such as mixed feelings, the mental and physical damage caused by stress; the understanding of total caring, scientific-technique procedures, family engagement in the assistance and humanization. The positive aspects are related to the welfare due to satisfaction in the work done and recognition of work. The difficulties involved death situations, psychological and biological damages, establishing links with patients and the uncaring toward the nursing caregivers.

A actuação do enfermeiro como gestor na unidade de terapia intensiva do Hospital Regional do Baixo Amazonas-Santarém-Pará-Brasil : um estudo de caso

Estudo descritivo que teve como objetivo avaliar a atuação do enfermeiro como gestor da Unidade de Terapia Intensiva do Hospital Regional do Baixo Amazonas Dr. Waldemar Pena – HRBA, o qual obteve o selo de Acreditado em Nível 1 em 2012. Para a obtenção dos dados utilizou-se um questionário elaborado com 10 perguntas subjetivas e aplicado aos enfermeiros gerentes que atuam nas Unidades de Terapia Intensiva e CTI do HRBA. Verificou-se nesse estudo que são indivíduos na faixa etária de 25 a 45 anos, com predominância do gênero feminino, com especialização em áreas diversas da enfermagem. Na atuação no setor de gerência, os enfermeiros estabelecem prioridades, direcionando sua equipe para os atendimentos assistenciais complexos aos pacientes, ficando o trabalho burocrático para ser realizado por último. Os entraves relatados são a insatisfação e o desgaste no exercício da função de gerente da unidade devido ao excesso de funcionários sem experiência em UTI, falta de autonomia, dupla jornada de trabalho, excesso de burocracia entre outras situações que se tornam motivos de estresse. Concluiu-se que a atuação do enfermeiro como gerente se respalda na função assistencial ao paciente através de cuidados diretos e indiretos e na organização dos trabalhos burocráticos na Unidade de Terapia Intensiva.

Errors associated with the preparation of aseptic products in UK hospital pharmacies: lessons from the national aseptic error reporting scheme

Background Pharmacy aseptic units prepare and supply injectables to minimise risks. The UK National Aseptic Error Reporting Scheme has been collecting data on pharmacy compounding errors, including near-misses, since 2003. Objectives The cumulative reports from January 2004 to December 2007, inclusive, were analysed. Methods The different variables of product types, error types, staff making and detecting errors, stage errors detected, perceived contributory factors, and potential or actual outcomes were presented by cross-tabulation of data. Results A total of 4691 reports were submitted against an estimated 958 532 items made, returning 0.49% as the overall error rate. Most of the errors were detected before reaching patients, with only 24 detected during or after administration. The highest number of reports related to adult cytotoxic preparations (40%) and the most frequently recorded error was a labelling error (34.2%). Errors were mostly detected at first check in assembly area (46.6%). Individual staff error contributed most (78.1%) to overall errors, while errors with paediatric parenteral nutrition appeared to be blamed on low staff levels more than other products were. The majority of errors (68.6%) had no potential patient outcomes attached, while it appeared that paediatric cytotoxic products and paediatric parenteral nutrition were associated with greater levels of perceived patient harm. Conclusions The majority of reports were related to near-misses, and this study highlights scope for examining current arrangements for checking and releasing products, certainly for paediatric cytotoxic and paediatric parenteral nutrition preparations within aseptic units, but in the context of resource and capacity constraints.

Errors associated with preparation of adult and paediatric parenteral nutrition in UK hospital pharmacies

Rationale: In UK hospitals, the preparation of all total parenteral nutrition (TPN) products must be made in the pharmacy as TPNs are categorised as high-risk injectables (NPSA/2007/20). The National Aseptic Error Reporting Scheme has been collecting data on pharmacy compounding errors in the UK since August 2003. This study reports on types of error associated with the preparation of TPNs, including the stage at which these were identified and potential and actual patient outcomes. Methods: Reports of compounding errors for the period 1/2004 - 3/2007 were analysed on an Excel spreadsheet. Results: Of a total of 3691 compounding error reports, 674 (18%) related to TPN products; 548 adult vs. 126 paediatric. A significantly higher proportion of adult TPNs (28% vs. 13% paediatric) were associated with labelling errors and a significantly higher proportion of paediatric TPNs (25% vs. 15% adult) were associated with incorrect transcriptions (Chi-Square Test; p<0.005). Labelling errors were identified equally by pharmacists (42%) and technicians (48%) with technicians detecting mainly at first check and pharmacists at final check. Transcription errors were identified mainly by technicians (65% vs. 27% pharmacist) at first check. Incorrect drug selection (13%) and calculation errors (9%) were associated with adult and paediatric TPN preparations in the same ratio. One paediatric TPN error detected at first check was considered potentially catastrophic; 31 (5%) errors were considered of major and 38 (6%) of moderate potential consequence. Five errors (2 moderate, 1 minor) were identified during or after administration. Conclusions: While recent UK patient safety initiatives are aimed at improving the safety of injectable medicines in clinical areas, the current study highlights safety problems that exist within pharmacy production units. This could be used in the creation of an error management tool for TPN compounding processes within hospital pharmacies.

Outcomes of newborns admitted in the intensive care unit at a public hospital

Background: We evaluated the outcome of newborns admitted in the neonatal Intensive Care Unit (ICU) in Diadema, Brazil. Methods: We evaluated 72 newborns, data were extracted from research forms, newborns` hospital records, mothers interviews, domiciliary inquiry made with the responsible for the newborn care, and paediatric accompaniment cards. Results: 48.93% presented low birth weight, 48% were considered to have normal birth weight and 2% had a birth weight higher than 4000g. Concerning gestational age, 57.44% were younger than 37 weeks old. During hospitalisation, newborn had appointments with doctors from other specialties (inter-appointments), around 40% were cardiologists. After hospital discharge 82.98% were referred to local primary health care units, and the main specialities were cardiology and neurology. Among the newborns evaluated 85.11% were accompanied by paediatric health care units. Conclusion: The implementation of a specialised newborn health accompaniment program in Brazil after ICU discharge is important for positive outcomes regarding newborns growth and development.

Hospital-acquired human bocavirus in infants

Human bocavirus (HBoV) is a respiratory pathogen that affects young children. We screened 511 nasopharyngeal aspirates for hospital-acquired HBoV from infants hospitalised with respiratory infection from January to December 2008. Among 55 children with HBoV infection, 10 cases were hospital-acquired. Compared with the community-acquired cases, coinfection with other respiratory viruses in these patients was uncommon. HBoV should be considered for inclusion in screening protocols for nosocomial childhood respiratory infections, especially in intensive care units. (C) 2010 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.

Infecção hospitalar no Centro de Tratamento Intensivo Geral de um hospital escola da Região Sul do Brasil

Objetivos Avaliamos a incidência de infecção hospitalar no CTI clínico-cirúrgico de um hospital escola no sul do Brasil. Foram utilizadas taxas ajustadas para o tempo de permanência dos pacientes e para o tempo de exposição aos procedimentos invasivos. Também investigamos a influência da causa básica de internação (trauma, neurológico e clínico-cirúrgico) nas taxas de infecções. Material e Métodos Os pacientes internados no CTI Clínico-cirúrgico de março a dezembro de 1999, foram prospectivamente seguidos para a detecção de infecção hospitalar. Para o diagnóstico de infecção hospitalar utilizou-se as definições do Centro de Controle e Prevenção de Doenças dos EUA (CDC) e as taxas foram calculadas de acordo com a metodologia NNIS (Sistema Nacional de Vigilância Epidemiológica). Resultados Foram acompanhados 686 pacientes (4201 pacientes-dia). Ocorreram 125 infecções hospitalares, sendo que a incidência global foi de 18,2% ou 29,8 infecções por 1000 pacientes-dia. Os sítios de infecção mais freqüente foram: pneumonia (40%), infecção urinária (24%) e septicemia primária (12,8%). As taxas de infecções hospitalares, associadas aos procedimentos invasivos, foram as seguintes: 32,2 pneumonias por 1000 ventiladores mecânico-dia, 9,7 infecções urinárias por 1000 sondas vesicais-dia e 7 septicemias por 1000 cateteres venosos centrais-dia. A incidência global de infecção nos pacientes com trauma (26,8) e neurológicos (20,7%) foi superior quando comparada com o grupo clínico-cirúrgico (12,2%), p < 0,001. Conclusões Encontramos altas taxas de infecções relacionadas com os procedimentos invasivos neste CTI. A causa básica de internação influenciou as taxas de infecção, sugerindo a necessidade de analisar-se estratificadamente os pacientes em CTI clínico-cirúrgico.

Prevalence and antimicrobial resistance patterns of methicillin-resistant staphylococci (MRS) isolated in a Veterinary Teaching Hospital in Brazil

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Úlcera de pressão em pacientes internados em um hospital universitário em Natal/RN: condições predisponentes e fatores de risco

The pressure ulcers (PU), also known as decubitus ulcers, are defined as injuries caused by the constant pressure exerted on a particular point of the body, causing impairment of blood supply with a decrease or interruption of tissue irrigation, causing occlusion of blood vessels and capillaries, ischemia and cell death. This is a descriptive study with longitudinal design, and panel type, with quantitative approach that aimed to examine the association between predisposing conditions (PC), intrinsic factors (IF) and extrinsic factors (EF) with the occurrence of PU, in hospitalized patients in the Intensive Care Unit (ICU), pain clinical, surgical clinical and neurology wards of a university hospital. The study population was composed of all patients who were restricted to bed during the period from December 2007 to February 2008. The study was approved by the Ethics Committee of HUOL / UFRN (No 135/07). The data-collection took place through a structured formulary of observation, data from medical records and physical examination of patients skins. The results were organized in SPSS 15.0 software, tabulated, categorized and analyzed by descriptive and inferential statistics. Of the 30 patients studied, 43.3% had been hospitalized in the pain clinical and surgical clinic wards, 20.0% in the ICU, 20.0% in the ICU / ward and 16.7% in neurology, being the length of hospitalization in those units of 7 to 18 days (63.3%) and from 19 to 30 days (36.7%), predominantly female and aged ≥ 60 years (60.0%). 19 PU were diagnosed in 43.3% of patients monitored, being 38.5% with one PU between 7 to 18 days and 46.2% with two or more between 19 to 30 days of hospitalization, showing significant relationship (ρ-value = 0029) between length of hospital stay and the number of PU. Was found an association of 35.7% of the PC (cardio-respiratory, hematological, metabolic and psychogenic), IF (age group, oedema, skin changes in humidity and change of body temperature) and EF (type of mattress and strength of body pressure) for all patients studied, statistically significant (ρ-value = 0001), between the average scores in patients with and without PU, with reason chance to 12.0 for the development of PU and there was moderate correlation ( r = 0618) in the presence of this association. Results show the influence of the multiplicity of factors and conditions on the occurrence of PU, which brings us to reflect on the assistance focused on prevention and reduction of these injuries which will encourage the reduction of hospitalization length, physical and psychological suffering, and the possibility of improving the clinical condition of the patient.

Conhecimento dos enfermeiros do Hospital Universitário Onofre Lopes sobre sistematização da assistência de Enfermagem

Nursing as a profession goes in search on quality of their care through new frameworks, trying to break postures of the health care system so fragmented in the care. To change professional practices, it is necessary to build their own knowledge grounded on Nursing Care System. The aim of this study was to analyze the influence of nurses' knowledge on care systematization in nursing in the University Hospital Natal-RN. It is an analytical descriptive study carried out at the Onofre Lopes University Hospital (HUOL), Natal-RN, 2010, the sample was composed of 40 active nurses working in hospitalization units of the hospital, the inclusion criteria were being in the monthly scale sector and agree to participate in the study. The non-participant observation and another interview were used for collecting data, statistical analysis was descriptive and inferential with reliability test, Pearson test, chi-square and Fischer, the variables that correlated were analyzed in a model Multiple logistic , calculating odds ratio. The results were: predominance of female professionals (90%), predominantly in the age range 39-46 years (37.5%), nurses who have the undergraduate degree at the Federal University of Rio Grande do Norte (80%), and who have expertise training as a minimal degree (62.5%). Among the surveyed, the knowledge showed significance with the graduation time (p = 0.018) and time working in HUOL (p = 0.036). The majority of the professionals surveyed do not know which organ is responsible for the SAE legislation (52.5%), aware of the steps needed to build the nursing diagnosis (92.5%), understand the characteristics of nursing planning (90% ). However the same professionals do not perform physical examination in patients (50.0%) did not classify the clinical findings (68.4%), and identify the problems encountered as a classification (13.2%). The planning of nursing care is carried out by verbal order of nurses (82.5%), 41% of the professionals assess only the intervention stage, in other words, the actions taken. Regarding the practical application of nursing records 53% of nurses do not realize records, 30.8% is incomplete, the other held notes (p = 0.003). The nurses know the nursing process (90% of appropriate responses), despite the actions defined by the theory are not applied in practice. Investigators believe the condition of the hospital teacher (22.5%) could positively affect the implementation of the SAE associated with the interest of professionals (20%). Of the respondents, 17.5% accept as truth the lack of facilities to assist the SAE implementation in the hospital. It was concluded that nurses know the theory that underlies the SAE and the nursing process, but do not develop the service know as well, there is need for action to boost the SAE implementation as practice of nurses in the hospital investigated

No caleidoscópio o estresse da equipe de enfermagem da UTI de um Hospital Universitário em Natal-RN

This study aimed to analyze stress on nursing staff of intensive care at the Teaching Hospital Onofre Lopes. The study sample consisted of thirty-eight (38) nursing professionals, including technicians and nurses working in the ICU of the hospital Data were collected between September to November 2011 in two stages.The first was the application of the Lipp Stress Symptoms Inventory (LSSI), which allowed us to measure the stress phase in which each team member was. After that, data were tabulated in Microsoft Excel spreadsheets and analyzed according to the 2010 inventory guidelines proposed by the author. After this analysis it was possible to complete the second phase of the research, which consisted of a semi-structured interview designed for those workers who were in the second phase of stress, resistance. Data analysis was based on Bardin 2004 content analysis, enabling the creation of categories based on grouping the ideas present in the interviewees' statements. It was found that the study population was mostly female (78.9%) aged from 30 to 39 years (50%), married (52.3%) and with dual-employment (65.7%). The most predominant phase, according to the Lipp inventory, was the stress resistance, present in 44.7% of the team and having as most predominant physical symptoms the constant feeling of physical exhaustion, verified in 16.8% of the participants, and psychological, the excessive irritability and emotional sensitivity in 26.3%. Regarding the qualitative data it was possible to establish three categories and four subcategories, with the following categories: the stressors of the workplace, overwork and the interpersonal relationships of the nursing staff in the ICU. And as subcategories: Routine care in the ICU; Pressures and Individual Charges; double journey: professional reflections on daily life, the night shift nursing staff and the body suffers, the manifestations of stress; deficient communication between team members. Thus, this study allowed the visualization of the stress phenomenon on nursing staff of the Teaching Hospital Onofre Lopes as a kaleidoscope of thoughts, feelings and experiences perceived by these professionals in different areas of their lives. It was also verified that the strengthening of the stress theme among nursing professionals need to be exploited and stimulated in several nursing areas of discussion so these workers are encouraged to take better care of themselves so they can take care of others health