Teaching-Learning Programs to Prevent and Control Infections Related to Long-Term Central Venous Access Device in Cancer Patients: A Systematic Review

OBJECTIVES

To evaluate the effectiveness of teaching-learning programs for cancer patients and/or their caregivers or family in preventing and controlling infections associated with long-term central venous access devices.

DATA SOURCES

This systematic review used the CINAHL, Cochrane Library, EMBASE, LILACS, and MEDLINE via PubMed portal, Scopus, and Web of Science. Google Scholar was used for the gray literature search. The included studies were analyzed, and the obtained data were qualitatively synthesized. The risk of bias was assessed using Cochrane tools: RoB 2 and ROBINS-I. The certainty of the evidence was evaluated using the GRADE. The review protocol was registered in PROSPERO (CRD42021267530).

CONCLUSION

The teaching-learning programs were implemented through theoretical-practical and theoretical dimensions in five and two studies, respectively. The risk of bias in the studies was low, moderate, severe, and high in one, three, two, and one of them, respectively. The certainty was very low. Teaching-learning programs on central venous access devices care for cancer patients and/or their caregivers or families could be effective in reducing infection rates.

IMPLICATIONS FOR NURSING PRACTICE

This systematic review addressed the teaching-learning programs for preventing and controlling infections associated with long-term central venous access devices. We identified that the most programs were effective in reducing the infection rates. The results may influence the clinical practice of oncology nurses, and consequently, the educational strategies and methods provided not only to these patients but for caregivers and families.

Educational technologies for teaching hand hygiene: Systematic review

AIM

To gather available scientific evidence on technologies used to teach hand hygiene to professional populations and lays involved in health care in the hospital setting. This systematic review was designed as proposed by Preferred Reporting Items for Systematic Reviews and Meta-Analysis, included studies reporting primary, original, quantitative research findings with no date limit and written in English, Spanish or Portuguese. The search was performed in the following electronic databases: Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica dataBASE, Literatura Latino-Americana e do Caribe em Ciências da Saúde, US National Library of Medicine, Scopus, Web of Science, Google Scholar and ProQuest. The eligibility criteria were applied independently by two reviewers to select the studies, first by reading the titles and abstracts on the Rayyan platform and then by full text reading of the eligible studies. After a descriptive analysis, the studies were subjected to critical evaluation of their methodological quality using JBI tools.

RESULTS

Seven studies were included, addressing various methods for teaching hand hygiene using different technological resources, such as audiovisual electronic devices, videos, virtual reality, and gamification using tablets and smartphones, in different populations.

CONCLUSION

Using technologies to teach hand hygiene considerably helps patients, visitors, and relatives in learning the procedures and efficiently improves hand hygiene compliance rates among healthcare professionals, creating evidence-based repetitive learning opportunities for patients and caregivers.

Prevalence of adverse events in pronated intubated adult COVID-19 patients: A systematic review with meta-analysis

AIM

To present the pooled estimated prevalence of adverse events in pronated intubated adult COVID-19 patients.

DESIGN

A systematic review and meta-analysis.

DATA SOURCES

This study used the Cochrane Library, CINAHL, Embase, LILACS, Livivo, PubMed, Scopus, and Web of Science databases as data sources.

METHODS

The studies were meta-analysed using JAMOVI 1.6.15 software. A random-effects model was used to identify the global prevalence of adverse events, confidence intervals and the heterogeneity data. Risk of bias was assessed using the Joanna Briggs Institute tool, and the certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach.

RESULTS

Of the 7904 studies identified, 169 were included for full reading, and 10 were included in the review. The most prevalent adverse events were pressure injuries (59%), haemodynamic instability (23%), death (17%) and device loss or traction (9%).

CONCLUSION

The most prevalent adverse events in mechanically ventilated pronated patients with COVID-19 are pressure injuries, presence of haemodynamic instability, death and device loss or traction.

IMPLICATIONS FOR THE PATIENT CARE

The evidence identified in this review can help improve the quality and safety of patient care by helping to design care protocols to avoid the development of adverse events that can cause permanent sequelae in these patients.

IMPACT

This systematic review addressed the adverse events related to prone position in intubated adult COVID-19 patients. We identified that the most prevalent adverse events in these patients were pressure injuries, haemodynamic instability, device loss or traction and death. The results of this review may influence the clinical practice of nurses who work in intensive care units and, consequently, the nursing care provided not only to COVID-19 patients but for all intubated patients due to other reasons in intensive care units.

REPORTING METHOD

This systematic review adhered to the PRISMA reporting guideline.

PATIENT OR PUBLIC CONTRIBUTION

As this is a systematic review, we analysed data from primary studies conducted by many researchers. Thus, there was no patient or public contribution in this review.

Postoperative complications in adult patients undergoing surgery with confirmed infection by SARS-CoV-2: An integrative review

Objective:

to analyze the evidence available in the literature about postoperative complications in adult patients undergoing surgical procedures with confirmed infection by SARS-CoV-2.

Method:

an integrative literature review conducted in the CINAHL, EMBASE, LILACS, PubMed, Scopus and Web of Science databases, as well as in the gray literature. The references identified were exported to the EndNote manager and, subsequently, to the Rayyan web application for study selection. The stages of sampling, categorization of studies, evaluation of the studies included, interpretation of the results and knowledge synthesis were performed by two reviewers independently and in a masked manner. The data were analyzed descriptively.

Results:

of the 247 articles identified, 15 were selected to comprise this review. The prevalent postoperative complications in patients infected with SARS-CoV-2 were the following: cough, dyspnea and hypoxia, need for invasive mechanical ventilation or not, admission to the intensive care unit and death.

Conclusion:

the most reported postoperative complications in the studies evaluated were respiratory-related, followed by cardiovascular complications. The importance of preoperative screening for COVID-19 is highlighted, as well as of the monitoring and tracking of confirmed cases in the postoperative period, as these actions exert an impact on reducing the occurrence of complications related to SARS-CoV-2.

Perioperative Blood Transfusion and Occurrence of Surgical Site Infection: An Integrative Review

The aim of this integrative review was to locate, assess, and synthesize available evidence of the relationship between perioperative allogeneic blood transfusion and the occurrence of surgical site infection among adult patients undergoing elective surgery. After a comprehensive search of relevant databases and a review of the studies this yielded, we used a validated instrument to extract data from the 25 studies in our final sample. The clinical and surgical variables that were significantly and more frequently associated with the occurrence of surgical site infection among patients who received blood transfusions during the perioperative period were female sex, older age, and higher body mass index. Our findings indicate a lack of consensus on the hemoglobin levels that indicate a blood transfusion is necessary.

Inalação da fumaça cirúrgica: coorte de sinais e sintomas em residentes

Resumo Objetivo Analisar os sinais e sintomas apresentados por médicos residentes das clínicas cirúrgicas e anestesiologia expostos à fumaça cirúrgica. Métodos Estudo de coorte prospectivo realizado com médicos residentes expostos a fumaça cirúrgica em um hospital universitário. Houve um acompanhamento durante 17 meses dos residentes ingressantes nos anos de 2015 e 2016, que atendiam aos critérios de estar regularmente matriculado na residência de clínica cirúrgica ou anestesiologia e não ser tabagista. O instrumento de coleta de dados foi composto de dados sociodemográficos e acadêmicos e dos sinais e sintomas relacionados com a inalação da fumaça cirúrgica, citados na literatura. A análise de dados ocorreu de forma descritiva e inferencial, por testes estatísticos e medidas de efeito. Resultados A amostra foi composta por 39 residentes, cuja maioria era do sexo masculino (56,4%) e idade abaixo dos 30 anos (74,3%). Prevaleceram residentes da ginecologia e obstetrícia (30,8%), seguidos de cirurgia geral (28,2%) e anestesiologia (20,5%). Ardência na faringe (p=0,030), náusea e vômito (p=0,018) e irritação dos olhos (p=0,050) incidiram ainda no primeiro ano de residência. O risco de desenvolver ardência de faringe foi 7,765 vezes (p=0,019) no sexo feminino em relação ao masculino. Conclusão Os sinais e sintomas analisados incidiram em até 12 meses do início da residência e o risco de apresentar ardência de faringe foi maior no sexo feminino, o que indica a exposição aos riscos da inalação da fumaça cirúrgica e, portanto, a necessidade de adoção de medidas de proteção individuais e coletivas.

Signs and symptoms related to inhalation of surgical smoke in the nursing team

ABSTRACT Objective: To compare the prevalence of signs and symptoms related to inhalation of surgical smoke among surgical technologists and non-surgical technologists nursing professionals. Method: A cross-sectional study with 46 professionals from a university hospital. To evaluate the prevalence, an instrument with signs/symptoms related to the inhalation of electrocautery smoke was used. To verify the comparison between the prevalence of signs/symptoms, the Fisher’s exact test was performed. Results: Higher prevalence of all signs/symptoms among surgical technologists, with a statistically significant difference between the act of instrumenting with the presence of at least one signs/symptoms related to inhalation of surgical smoke (p=0.01); eye irritation (p=0.02); irritation of nasal mucosa and oral cavity (p=0.03); headache (p=0.04). Conclusion: The presence of problems related to surgical smoke in nursing workers elicits more attention. Implications for practice: Health units must be aware of the risk of such exposure and take measures to preventing it.

Frequency of change of chlorhexidine-impregnated gel dressings for central venous catheters in critically ill patients

Abstract Objectives: To identify the frequency of change of chlorhexidine-impregnated gel dressings applied in central venous catheter insertion sites, describe reasons for dressing changes, and identify the amount of dressings used per adult patients admitted to an intensive care unit. Methods: Descriptive study consisting of daily record of occurrence evaluation, reason for dressing change and quantity used per patient, between April and December 2014. Descriptive statistical analysis was used. Results: A total of 159 dressings were applied at the insertion site of 64 central venous catheters whose mean frequency of dressing changes was 3.04 days. The mean number of dressing per patient was 3.1, but 83 unscheduled changes occurred before 7 days of stay, due to detachment, wetness, soiling, and loss of dressing. Conclusion: The frequency of dressing changes was less than seven days, resulting in greater quantities of dressings per patient. Detachment was the most common reason for unscheduled dressing changes.