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- ItemEmbargoÁgua de torneira na limpeza de feridas de pele em ratos: influência na colonização microbiana(Universidade Federal de São Paulo (UNIFESP), 2010-08-25) Resende, Margarida Maria de Carvalho [UNIFESP]; Hochman, Bernardo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction: the question is if the use of tap water to cleanse skin wounds may increase microbial colonization. Objective: To investigate the influence of the use of tap water in the microbial colonization in cleansing skin wounds in rats. Methods: A sample of rats with skin wound in the back, 2.4cm in diameter. The wounds were cleansed daily with a sterile solution of sodium chloride 0.9% in 20 rats in the control group, Saline group, or with tap water in 20 rats in the study group, Water group. Sequential samples were taken for microbiological analysis. The Fischer and Mann-Whitney tests were used. Results: micro-organisms had grown in 49% of the samples in Saline group and in 47% of samples of the wate group (p = 0.39). The growth was respectively for Saline group and Water group: on thioglycolate 75% and 83% (p = 0.43); on hypertonic mannitol agar in 47% and 53% (p = 0.83), with 2.335 and 1.990 colony forming units (CFU) (p = 0.99), on blood agar in 82% and 90% (p = 0.70) with 23.550 and 35.715 CFU (p = 0.23); Teague agar in 10% and 7 % (p = 0.17) with 432 and 203 CFU (p = 0.45) on Sabouraud agar 28% and 25% (p = 0.83). In both groups there was no significant difference in growth of Bacillus subtilis, Staphylococcus sp, Aureobasidium sp, Penicillium sp and Cladosporium sp. Conclusion: The use of tap water to cleanse skin wounds in rats does not alter the microbial colonization in relation to the use of sterile solution of sodium chloride 0.9%.
- ItemAcesso aberto (Open Access)Ambiente virtual de aprendizagem na educação continuada em enfermagem(Escola Paulista de Enfermagem, Universidade Federal de São Paulo (UNIFESP), 2010-10-01) Silva, Lúcia Marta Giunta da [UNIFESP]; Gutiérrez, Maria Gaby Rivero de [UNIFESP]; De Domenico, Edvane Birelo Lopes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)This study is a report of a learning experience that had as objective to describe how was structured the virtual learning environment Moodle for training at work. This is a semi-distance education project for controlling a surgical site infection, oriented to the nurses of a university hospital. The study was organized having as a base the interactionist Skopos Model and on humanist principles. The activities were organized on topics aimed at: informing and updating the central aspects of the topic; generating problematization of situations and extend the individual and collective discussion; promoting integration; and encouraging a joint development of a proposal for action. The Moodle resources helped to select the teaching strategies to update knowledge, to generate ideas, and to promote the integration and collective construction of propositions.
- ItemAcesso aberto (Open Access)Application time for postoperative wound dressing following breast augmentation with implants: study protocol for a randomized controlled trial(Biomed Central Ltd, 2015-01-27) Mendes, Denise de Almeida [UNIFESP]; Veiga, Daniela Francescato [UNIFESP]; Veiga-Filho, Joel [UNIFESP]; Fonseca, Fernando Elias Martins; Paiva, Luiz Francisley de; Novo, Neil Ferreira; Loyola, Ana Beatriz Alkmin Teixeira; Ferreira, Lydia Masako [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Univ Vale SapucaiBackground: Breast augmentation with silicone implants is one of the most frequently performed cosmetic surgeries worldwide. Surgical site infection (SSI) remains an important complication of this procedure. One of the most important risk factors for SSI is the presence of microorganisms on the skin surrounding the wound. Guidelines by the Centers for Disease Control (CDC) recommend that surgical wounds be covered with a sterile dressing for 24 to 48 hours. However, a recent study showed that the application of a dressing for six days after breast reduction reduced wound colonization by coagulase-negative staphylococci.Methods/Design: A randomized clinical trial was designed to assess two protocols of postoperative wound care to determine how the application duration of the postoperative dressing influences wound colonization in patients undergoing breast augmentation with silicone implants. Women aged between 18 and 60 years who are candidates for breast augmentation with silicone implants will be randomly allocated to group I (n = 48), in which the dressing will be removed on the first postoperative day, or group II (n = 48), in which the dressing will be removed on the sixth postoperative day. Cutaneous colonization will be assessed by cultures of samples of skin flora taken from the wound region. the incidence of SSI, using standardized CDC criteria, and the perceptions of patients towards the dressing will be secondary outcomes.Discussion: An important component of SSI prevention is to minimize all possible risk factors, and the application of postoperative dressing plays a key role in this endeavor. the results of this clinical trial may help to standardize postoperative wound care after breast augmentation with silicone implants.
- ItemAcesso aberto (Open Access)Avaliação da estrutura e processo assistencial de enfermagem na prevenção e controle da infecção de sítio cirúrgico em pacientes submetidas à cirurgia oncológica de mama(Universidade Federal de São Paulo (UNIFESP), 2009-10-28) Silva, Lúcia Marta Giunta da [UNIFESP]; Gutiérrez, Maria Gaby Rivero de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction: High rates of infection can reflect low health service quality. The fact that previous studies performed at the same location of the present study found surgical site infection rates (SSI) ranging from 14.1% to 22% raised questions about the possibility of the nursing care structure and process to affect those rates. After obtaining this first answer, another question emerged, concerning the capacity of an inservice training program be able to encourage the participants, by means of an interactive dynamics, to develop proposals or projects from making changes. Objectives: To evaluate nursing care structure and process in preventing and managing SSI; and evaluate an inservice training program for nurses involved in the context of the identified problems, using interactive educational strategies aiming at the prevention and control of this complication. Method: This intervention study was approved by the UNIFESP Research Ethics Committee under register 1486/07, and was developed in two stages. The first stage consisted of and observation and analysis study, performed by means of inspections of the structure and process at the Gynecology Oncomastology Units at Hospital São Paulo (HSP), between August 2007 and March 2008. This stage was described in the first article that composes this dissertation. The second stage used a quali-quantitative approach and was performed from October 2008 to September 2009. It consisted of the structure, development, and evaluation of the educational project in a virtual environment for the Training Program at Work for nurses of the referred hospital units, in SSI control, based on the Skopos Model, and organized based on the resources of the Moodle environment. The data regarding this stage was described in the three subsequent articles that comprise the dissertation. Results: The evaluation of the nursing care structure and process showed that the normative document were in agreement with the literature; however, the physical structure and the nursing care processes of the studied locations presented important limitations, which had a negative impact on the development of adequate health care processes to prevent SSI. In terms of the structure and use of a virtual learning environment in continuing nursing education, Moodle showed to be valuable in structuring a nursing training program, which sought to stand apart from a unilateral and hierarchical communication model. The evaluation of goal achievement and content adequacy of the referred program was performed by four nurses who participated in the process. The nurses found that the program presents clear benefits and the main limiting factors associated with inservice training. In addition, although new educational strategies, particularly if interactive, are welcome, the professionals preferred in-person meetings. Finally, using the HFMEA® and the Ishikawa diagram permitted to analyze four nursing care processes and their forms of failure: 1) scheduling a surgery through the Oncomastology Unit; 2) Surgery Patient Admission and Discharge Flow at the Gynecology Hospitalization Unit; 3) Performing Outpatient Surgical Procedures; 4) Outpatient Return Appointments for Surgery Patients. In addition, it was possible to make a list of improvement actions that were initiated based on the discussions held during the training program. Conclusions: The study results evidenced the need to review the nursing care process and to make the structure adequate with a view to meet the standards for SSI prevention and control. As for the inservice training program, the experience of using educational technology at the referred institution was feasible and provided the chance for group analyses about the problematic situation, as well as the proposal of actions for its solution. However, just as any innovative process, there is a pathway to be constructed so that nurses, who are used to training programs that are expositive, performed on-site and focused on previously determined objectives become capable of benefiting from interactive, collaborative, and project-based strategies.
- ItemAcesso aberto (Open Access)Contaminação de halos doadores córneo-esclerais em ceratoplastia penetrante no Hospital de Clínicas de Porto Alegre(Conselho Brasileiro de Oftalmologia, 2008-02-01) Borowsky, Cláudia Martins; Wallau, Anelise Dutra [UNIFESP]; Reetz, Aline; Kwitko, Sérgio [UNIFESP]; Rymer, Samuel; Locatelli, Claudete Inês; Universidade Federal do Rio Grande do Sul Hospital de Clínicas de Porto Alegre; Universidade Federal de São Paulo (UNIFESP); Universidade de Passo Fundo; Hospital de Clínicas de Porto Alegre; UFRGS Faculdade de Medicina; UFRGS Hospital de Clínicas de Porto Alegre; UFRGSPURPOSE: To determine the incidence of positive corneoscleral rim cultures preserved in Optisol GS medium, to identify pathogens involved and possible recipient eye infection. METHODS: A hundred sixty-three corneoscleral rim cultures penetrating keratoplasties performed from January 2001 to January 2003 in the Hospital de Clínicas de Porto Alegre were reviewed. Enucleations and corneal storage were done as aseptic as possible and gentamicin 0.3% was instilled. Corneoscleral rim was divided into two segments, half was inoculated into Sabouraud broth and the other half into thioglycolate broth; inoculation into blood agar, chocolate agar and MacConkey agar was done later if necessary for pathogen identification. The receiver's eye data were reviewed. RESULTS: There were eleven positive cultures (6.7%) out of 163 evaluated corneoscleral rim cultures. Of these, four were Staphylococcus epidermidis, one was Staphylococcus aureus, one was Serratia sp., one was Pseudomonas aeruginosa and the other four were different subtypes of Candida (two Candida sp., one Candida albicans and one Candida parapapilosis). All pathogens were resistant to gentamicin. None of the eleven cases of positive corneoscleral rim cultures resulted in ocular infection at the receiver's eyes (six months follow-up). CONCLUSIONS: We found low rates of positive corneoscleral rim cultures after penetrating keratoplasty at the Porto Alegre Clinical Hospital. The most frequent involved pathogens were Staphylococcus sp and Candida sp. Although we did not identify any postoperative infection at the receiver's eyes, we recommend corneoscleral rim culture for guidance of postoperative infection, a rare but possible devastating ocular event.
- ItemAcesso aberto (Open Access)Dressing wear time after breast reconstruction: study protocol for a randomized controlled trial(Biomed Central Ltd, 2013-02-22) Veiga, Daniela Francescato [UNIFESP]; Veiga-Filho, Joel; Damasceno, Carlos Americo Veiga; Sales, Edilaine Maria Leci; Morais, Thiago Bezerra; Almeida, Wania Eliza; Novo, Neil Ferreira; Ferreira, Lydia Masako [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Univ Vale do SapucaiBackground: One of the major risk variables for surgical site infection is wound management. Understanding infection risk factors for breast operations is essential in order to develop infection-prevention strategies and improve surgical outcomes. the aim of this trial is to assess the influence of dressing wear time on surgical site infection rates and skin colonization. Patients' perception at self-assessment will also be analyzed.Methods/Design: This is a two-arm randomized controlled trial. Two hundred breast cancer patients undergoing immediate or delayed breast reconstruction will be prospectively enrolled. Patients will be randomly allocated to group I (dressing removed on postoperative day one) or group II (dressing removed on postoperative day six). Surgical site infections will be defined by standard criteria from the Centers for Disease Control and Prevention (CDC). Skin colonization will be assessed by culture of samples collected at predefined time points. Patients will score dressing wear time with regard to safety, comfort and convenience.Discussion: the evidence to support dressing standards for breast surgery wounds is empiric and scarce. CDC recommends protecting, with a sterile dressing for 24 to 48 hours postoperatively, a primarily closed incision, but there is no recommendation to cover this kind of incision beyond 48 hours, or on the appropriate time to shower or bathe with an uncovered incision. the results of the ongoing trial may support standard recommendations regarding dressing wear time after breast reconstruction.
- ItemSomente MetadadadosFatores de risco para recidiva de infecção de sítio cirúrgico em pós-operatório de osteossíntese após trauma(Universidade Federal de São Paulo (UNIFESP), 2011-03-30) Dell'Aquila, Adriana Macedo [UNIFESP]; Pereira, Carlos Alberto Pires [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objectives: To evaluate, in postoperative osteosynthesis patients after trauma, the clinical-epidemiological and microbiological aspects, and the risk factors for the relapse of surgical site infection (SSI) of the patients treated according to the protocol of the osteo-articular infections at São Paulo Hospital – Federal University of São Paulo. Methods: through the retrospective were evaluated all episodes of surgical site infection that occurred from December, 2004 to December, 2008 in post-trauma patients undergoing osteosynthesis, admitted at the orthopedics department of São Paulo Hospital. The procedures that progressed to deep infection or organ / space were treated with cycles of at least 4 to 6 weeks of antibiotic therapy and followed until one year after surgery. For the analysis of risk factors related to relapse of infection after treatment was used univariate and multivariate analysis model. Results: Of the 436 patients with osteoarticular infections, 117 (26.8%) had infections after osteosynthesis. Of these, 110 patients were included with osteoarticular infections after osteosynthesis, and the majority were male (84.5%) aged 18-89 years, average 39.8 years. Few were smokers (33.6%) and alcoholics (9.1%) and most (73.6%) had no underlying disease. Motorcycle accident was the most prevalent (44.5%), 90.0% had one or two fractures, 51.8% had joint involvement and 53.6% fractures were not exposed. There was a higher prevalence of infection in the tibia / fibula, especially for the proximal and the malleolar segment (44B3 and 42C2). Most underwent one surgery only (89.1%), without conversion (87.2%), and 54.5% of plate / screw or plate / screw / Kirshner wire, with duration of surgery more than two hours (81.8%). Antibiotic prophylaxis was inadequate in 76.4% and in 76.4% the surgical repair was performed in the first five days of admission. In 37 patients the causative agent was isolated, Staphylococcus (S. aureus and SCN) was the most frequent (38.8%). In 83 (75.4%) patients were able to start antimicrobial treatment of infection in less than five days of onset of symptoms and ciprofloxacin and clindamycin were the most common. Relapses of infection in 34 (30.9%) of 110 patients, of which 19 (17.3%) persisted with infection at the end of one year follow-up and only 10 (9.1%) did not consolidate the fracture. In univariate analysis was found as a risk factor for relapse of the SSI the performance of more than one surgery to stabilize the affected limb (OR 3,7 IC95=1,1-12,7 p=0,045), the presence of converting osteosynthesis (OR 3,6 IC95=1,1-11,3 p=0,023), the internal synthesis (OR 3,0 IC95=0,99-9,2 p=0,043) and longer duration of surgery (OR 0,4 IC95=0,1-1,6 p=0,029). In multivariate analysis, the only variable independently associated with SSI relapse was duration of surgery (OR 1,3 IC95=1,1-1,7 p=0,015). Conclusions: After one year of follow-up, using a protocol, the majority of patients showed cure of the infection and only 9.1% did not consolidate the fracture. Relapse of infection occurred in one third of patients. The only independent risk factor associated with relapse of infection was prolonged surgery.
- ItemSomente MetadadadosLow level laser therapy (AlGaInP) applied at 5J/cm(2) reduces the proliferation of Staphylococcus aureus MRSA in infected wounds and intact skin of rats(Soc Brasileira Dermatologia, 2013-01-01) Silva, Daniela Conceição Gomes Gonçalves e [UNIFESP]; Plapler, Helio [UNIFESP]; Costa, Mateus Matiuzzi da; Silva, Silvio Romero Gonçalves e [UNIFESP]; Sa, Maria da Conceicao Aquino de; Silva, Benedito Savio de Lima e [UNIFESP]; Fac Inspirar Petrolina; Universidade Federal de São Paulo (UNIFESP); Natl Inst Med Care & Social Welf INAMPS; Universidade Federal de Sergipe (UFS); Fed Univ Vale do Sao Francisco Fdn UNIVASFBACKGROUND: Laser therapy is a low cost, non-invasive procedure with good healing results. Doubts exist as to whether laser therapy action on microorganisms can justify research aimed at investigating its possible effects on bacteria-infected wounds.OBJECTIVE: To assess the effect of low intensity laser on the rate of bacterial contamination in infected wounds in the skin of rats.METHODS: An experimental study using 56 male Wistar rats. The animals were randomly divided into eight groups of seven each. Those in the infected groups were infected by Staphylococcus aureus MRSA in the dorsal region. Red laser diode (AlGaInP) 658nm, 5J/cm(2) was used to treat the animals in the treated groups in scan for 3 consecutive days. Samples were drawn before inoculating bacteria and following laser treatment. For statistical analysis we used the nonparametric Wilcoxon (paired data) method with a significance level of p < 0.05.RESULTS: The statistical analysis of median values showed that the groups submitted to laser treatment had low bacterial proliferation.CONCLUSION: The laser (AlGaInP), with a dose of 5J/cm(2) in both intact skin and in wounds of rats infected with Staphylococcus aureus MRSA, is shown to reduce bacterial proliferation.
- ItemAcesso aberto (Open Access)Tempo de permanência do curativo após mamoplastia redutora: influência na colonização, na infecção da ferida operatória e na opinião das pacientes(Universidade Federal de São Paulo (UNIFESP), 2010-08-25) Veiga Filho, Joel [UNIFESP]; Sabino Neto, Miguel [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background: There is controversy in the literature regarding the treatment of surgical wounds, which includes different approaches to wound management, such as “not to dress the wound” to “leave the dressing in place for 24-48 hours” or “until sutures are removed”. Objective: To evaluate the effect of the length of time the dressings were left in place after reduction mammaplasty on skin colonization, surgical site infection, and patient opinion. Methods: Seventy patients undergoing reduction mammaplasty were randomly divided into two groups: group PO1 (dressing was removed on the first postoperative day) and group PO6 (dressing was removed on the sixth postoperative day). Skin colonization was detected by culture of samples collected at predefined time points. Surgical site infections were classified according to the guidelines of the Centers for Disease Control and Prevention (CDC). Patient satisfaction was assessed on postoperative day 13. Results: A larger number of colony-forming units were measured in group PO1 on postoperative day 6. Nine (12.9%) patients had surgical site infection (seven from group PO1, and two from group PO2). In group PO1, 66% of the patients chose to keep the dressing for one day, while 83% of the patients in group PO6 chose to keep the dressing for six days. Conclusions: Higher colonization levels were observed in group PO1 on the sixth postoperative day. There was no difference in surgical site infection between groups. Most of the patients chose to keep the dressing in place for six days postoperatively, and felt it was safer.