Safety and efficacy of silicone tape for indwelling urinary catheter fixation in intensive care patients-A randomized clinical trial

BACKGROUND

Critically ill patients are more vulnerable to medical adhesive-related skin injuries (MARSI), whose prevention is a constant challenge and one of the main quality indicators of nursing care. MARSI associated with indwelling urinary catheter (IUC) fixation is a relevant adverse event, mainly because of the constant involuntary traction and high skin vulnerability of the fixation site. Silicone adhesive tape has appreciable qualities for fragile skin among the range of adhesives, leading to the inference that it reduces the risk of MARSI.

AIM

To compare silicone adhesive tape for IUC fixation with acrylate tape regarding its safety and efficacy.

STUDY DESIGN

This was a randomized controlled trial blinded to the patients and evaluator. Data were collected from an intensive care unit (ICU) of a tertiary university hospital in Brazil. Patients with IUC and no MARSI at the fixation site were considered eligible. The omega (Ω) fixation technique was used for IUC fixation. A total of 132 participants were enrolled and divided into two research groups: 66 patients in the intervention group (silicone tape) and 66 in the control group (acrylate tape). Outcomes were the incidence of MARSI, patient outcome in the ICU and hospital and partial, total and overall spontaneous detachment of the tapes.

RESULTS

The overall incidence of MARSI was 28%, with 21% in the silicone group and 35% in the acrylate group, with no statistically significant difference (p = .121), including the severity of the lesions (p = .902). However, partial (p = .003) and overall (p < .001) detachment of the tapes were more frequent in the silicone group.

CONCLUSIONS

Silicone tape is no safer than acrylate tape for IUC fixation and is less adhesively effective.

RELEVANCE TO CLINICAL PRACTICE

There is no evidence to support the extensive use of silicone tape in this context.

Analysis of factors associated with hematopoietic stem-cell retransplantation: a case-control study

OBJECTIVE

to analyze the factors associated with the failure of Hematopoietic Stem Cell Transplantation (HSCT) in patients undergoing Hematopoietic Stem Cell Retransplantation (HSCR).

METHOD

this study implemented a quantitative approach and was a case-control type which addressed patients undergoing HSCR. To do so, a paired sample of two controls was used for each case (2:1). The case group consisted of the medical records of all patients who underwent HSCR (28) and the control group (56) of those who underwent only one transplant. Three variables guided the pairing: gender, diagnosis and type of transplant.

RESULTS

a total of 24 (85.71%) patients in the case group were re-transplanted due to disease relapse and four (14.29%) due to graft failure. There was a statistical difference in the analysis between patients who did not use ursodeoxycholic acid, opioid analgesics and immunosuppressants. The need for HSCR among those who used these medications inappropriately was 16.12, 12.79 and 4.5 times more likely, respectively, than those who used them correctly.

CONCLUSION

there was a difference regarding the reasons which led to the retransplantation and the analyzed subjects, and this study concluded that the predictive reason for retransplantation in the studied sample was disease relapse.

Clinical-Epidemiological Characteristics and Mortality in Patients with Sickle Cell Anemia: A Retrospective Cohort Study of 1980 at 2018

Purpose

To analyze the clinical-epidemiological characteristics and mortality in patients with sickle-cell anemia (SCA).

Patients and Methods

A cohort study with retrospective data, conducted in two reference hospitals for SCA treatment from January 1980 to December 2018, recorded in two reference services. With a 5% significance level, the Chi-Square and Student’s t-tests were employed in the inferential statistical analysis.

Results

A total of 128 patients with SCA were studied. Diagnosis up to the fifth day of life was made in 10 patients. There were 19 deaths, of which 12 (63.2%) were female, and the average age at death was 27.05 (± 14.78) years. The leading causes of death were septic shock and cardiogenic shock. The use of invasive medical devices was considered a risk factor for death (RR=2.63; 95% CI=1.16–5.96; p=0.018), and monitoring time up to 20 years presented a 31% reduction in the risk of dying (RR=0.31; 95% CI=0.12–0.82; p=0.011) when compared to the monitoring of more than 20 years.

Conclusion

These findings are to be considered in the treatment of patients with SCA, mainly regarding early diagnosis and access to the treatment immediately afterward, since they are fundamental in improving survival and reducing severe complications.

HIV/AIDS and the social determinants of health: a time series study

ABSTRACT Objective: To analyze the time trend, spatial distribution, and the cases of human immunodeficiency virus/acquired immunodeficiency syndrome cases with social determinants of health. Methods: Ecological and analytical study, carried out based on the cases of human immunodeficiency virus/acquired immunodeficiency syndrome notified in a state in the Brazilian Midwest, from 2009 to 2018. The study used descriptive analysis, polynomial regression, and geospatial analysis. Results: In 10 years, there were 9,157 notifications, growing each year. There was a growing trend for both sexes (p<0.001, r2=0.94). The City Human Development Index was related to the higher number of cases (city of notification, p=0.01; and city where the person lives, p=0.02). The highest concentration was in cities that house health macro-regions. Conclusion: Social determinants have a relationship with the time trend and the spatial distribution of cases and can direct strategies for prevention and care.

Analysis of factors associated with hematopoietic stem-cell retransplantation: a case-control study

Objective:

to analyze the factors associated with the failure of Hematopoietic Stem Cell Transplantation (HSCT) in patients undergoing Hematopoietic Stem Cell Retransplantation (HSCR).

Method:

this study implemented a quantitative approach and was a case-control type which addressed patients undergoing HSCR. To do so, a paired sample of two controls was used for each case (2:1). The case group consisted of the medical records of all patients who underwent HSCR (28) and the control group (56) of those who underwent only one transplant. Three variables guided the pairing: gender, diagnosis and type of transplant.

Results:

a total of 24 (85.71%) patients in the case group were re-transplanted due to disease relapse and four (14.29%) due to graft failure. There was a statistical difference in the analysis between patients who did not use ursodeoxycholic acid, opioid analgesics and immunosuppressants. The need for HSCR among those who used these medications inappropriately was 16.12, 12.79 and 4.5 times more likely, respectively, than those who used them correctly.

Conclusion:

there was a difference regarding the reasons which led to the retransplantation and the analyzed subjects, and this study concluded that the predictive reason for retransplantation in the studied sample was disease relapse.

Analysis of the temporal trend of mortality from sickle cell anemia in Brazil

ABSTRACT Objectives: To analyze the temporal trend of mortality from sickle cell anemia in Brazil, by region, in the period 1997-2017. Methods: epidemiological study, with an ecological design, with a temporal trend, carried out with data from the Mortality Information System. For descriptive analysis, absolute and relative frequencies were used. In the correlation analysis, the ANOVA test was used, followed by Tukey’s post-test. The temporal trend was obtained using the cubic polynomial regression test. Results: 6,813 deaths from sickle cell anemia were registered. Brown individuals (50.87%) were more frequent, with a predominance of males (50.4%), aged between 25 and 34 years and a higher incidence of deaths in the Midwest (0.25/100 thousand inhabitants). The time curve showed an increasing trend of deaths in the country between 1997 and 2015 (R2 = 0.98). Conclusions: sickle cell anemia showed increasing mortality in the 21 years analyzed and alerts health professionals and managers.

Análisis de factores asociados al Retrasplante de Células Madre Hematopoyéticas: un estudio de caso-control

Resumen Objetivo: analizar los factores asociados con el fracaso del Trasplante de Células Madre Hematopoyéticas (TCMH) en pacientes sometidos al Retrasplante de Células Madre Hematopoyéticas (RCMH). Método: estudio cuantitativo de tipo caso-control que abordó pacientes sometidos al RCMH. Para esto, se utilizó una muestra pareada de dos controles para cada caso (2:1). El grupo caso estuvo formado por los registros médicos de todos los pacientes que fueron sometidos al RCMH (28) y el grupo control (56) por los que fueron sometidos a un solo trasplante. Tres variables guiaron el emparejamiento: género, diagnóstico y tipo de trasplante. Resultados: un total de 24 (85.71%) pacientes en el grupo caso fueron retransplantados debido a la recaída de la enfermedad y 4 (14.29%) por el fracaso del injerto. Hubo una diferencia estadística en el análisis entre los pacientes que no usaron ácido ursodesoxicólico, analgésicos opioides e inmunosupresores. La necesidad de RCMH entre los que usaron estos medicamentos de manera inapropiada se encontraba 16,12 - 12,79 y 4,5 veces más probable, respectivamente, que aquellos que los usaron correctamente. Conclusión: hubo diferencia en cuanto a las razones que llevaron al retrasplante de los sujetos analizados. Este estudio concluyó que la razón predictiva del retrasplante, en la muestra estudiada, fue la recidiva de la enfermedad.

Consumption of sexually explicit media and unprotected anal sex in men who have sex with men

This study aimed to evaluate the influence of bareback sexually explicit media (SEM) consumption on anal sex without a condom by men who have sex with men (MSM). To this end, a page was created on the Facebook® social network with a link that directed interested parties to a questionnaire. Cisgender men, aged 18 years and over, who had sex with other men in the last 12 months, were included. Data were collected in 2017 and analyzed using univariate and bivariate inferential statistics and multivariate logistic regression. A total of 2,248 MSM participated in the research, with a mean age of 24.4 years and a mean number of 3.9 partners in the last 30 days. Having multiple sexual partners (ORa: 9.4; 95% CI 3.9-22.4), preferring movies with bareback scenes (ORa: 2.6; 95% CI 1.5-4.6), considering this practice a fetish and realizing it (ORa: 3.52; 95% CI 2.3-5.4), having casual partnerships (ORa: 1.8; 95% CI 1.5-1.9) and being aware of the partner's negative serological status for HIV (ORa: 1.4; 95% CI 1.1-2.3) were factors that increased the likelihood of engaging in anal sex without a condom. Thus, we found an association between the consumption of bareback SEM and sex without a condom among MSM.

Cornea donation process and tissue quality for transplantation

Introduction

The quality of the corneal tissue can be influenced by several factors inherent to the recipient, donor, and to the donation and transplantation process. The donated corneal tissue can be classified by its quality as excellent, good, regular, bad, or unacceptable for transplantation, evaluating it in a slit lamp.

Objective

To analyze the relationship between the clinical and sociodemographic variables of the donors and the donation process and the classification of the quality of the corneal tissue collected for transplantation.

Methods

This is an epidemiologic study, retrospective cohort type, which addressed the process of cornea donation by the Human Eye Tissue Bank in a reference service in Northeast Brazil. The sample consisted of corneas processed by the Human Eye Tissue Bank of Rio Grande do Norte (n = 419). For descriptive and inferential analysis, the study used the Statistical Package for the Social Sciences (SPSS) software, version 25.0, and considered a significance level of 0.05. Logistic regression analysis was used for the adjustment of the final model.

Results

It was verified that the epidemiological profile showed a prevalence of individuals with a mean age of 42.54 years old, male (73.99%), and living in the metropolitan region of the state capital (75.66%). When analyzing the relationship between the clinical and sociodemographic variables of the donors, it was identified that those aged 45 years old or less had better quality corneas (excellent and good), while the chronological variables were predictive factors for corneas of regular and bad qualities.

Conclusion

The identification of the factors inherent to the donation process and predictors of corneal tissue quality contribute to minimizing the risk of transplantation and to a better ocular prognosis.

Physical violence and verbal abuse against nurses working with risk stratification: characteristics, related factors, and consequences

OBJECTIVE

to analyze the characteristics, related factors, and consequences of physical violence and verbal abuse against nurses working with risk stratification.

METHODS

a cross-sectional, descriptive and quantitative study carried out with 80 nurses who work with risk stratification in emergency services. Data were collected using an adapted instrument and analyzed using (uni)bivariate inferential statistics.

RESULTS

companions were the main perpetrators of verbal abuse (86.1%); and patients inflicted physical violence (100%). Professionals with up to five years of experience are 74% less likely to suffer physical violence (p=0.029). Women suffer 5.83 times more verbal abuse than men (p=0.026). Sadness (15.8%) and fear of the aggressor (15.3%) were the main consequences of verbal abuse; and fear of the aggressor (22.2%) and stress (22.2%) were results of physical violence.

CONCLUSION

violence is influenced by institutional, professional and client aspects. Therefore, coping with it requires multidimensional strategies.

Broad Diversity of Fungi in Hospital Water

INTRODUCTION

Some studies have reported the occurrence of microorganisms isolated from water. Considering these microorganisms, fungi are known to occur ubiquitously in the environment, including water, and some are pathogenic and may cause health problems, especially in immunocompromised individuals. The aim of this study was to identify fungi in hospital water samples and to correlate their presence with the concentration of free residual chlorine.

METHODS

Water samples (100 mL) were collected from taps (n = 74) and water purifiers (n = 14) in different locations in a university hospital. Samples were filtered through a nitrocellulose membrane and placed on Sabouraud dextrose agar and incubated for 24 hours at 30°C. Fungi were identified according to established methods based on macroscopic and microscopic characteristics (filamentous) and physiological tests (yeasts). Free chlorine residual content was measured at the time of sample collection.

RESULTS

Seventy species of fungi were identified in the water samples and about 56% of the water samples contained culturable fungi. Cladosporium oxysporum, Penicillium spinulosum, and Aspergillus fumigatus were the most common filamentous fungi. Aureobasidium pullulans and Candida parapsilosis were the most common yeasts. Chemical analyses revealed that free residual chlorine was present in 81.8% of the samples within recommended concentrations. Among samples from water purifiers, 92.9% showed low levels of free residual chlorine (<0.2 mg/L). There was no significant association between chlorine concentrations (either within or outside the recommended range) and the presence of filamentous fungi and yeasts.

CONCLUSIONS

This study showed that hospital water can be a reservoir for fungi, some of which are potentially harmful to immunocompromised patients. Free residual chlorine was ineffective in some samples.

Effectiveness of clinical surface cleaning and disinfection: evaluation methods

OBJECTIVE

To discuss the methods employed to evaluate the effectiveness of clinical surface cleaning and disinfection (C&D).

METHOD

This is a theoretical reflection based on scientific studies and the experience of the authors. Knowledge and current gaps, the need for further studies, and practical application of the methods were approached.

RESULTS

There are four main methods used to evaluate the effectiveness of clinical surface C&D: visual inspection, fluorescent markers, microbiological cultures, and adenosine triphosphate (ATP) bioluminescence. The first two are used to evaluate the process and to predict adherence to protocols by the staff, and the last two are employed to evaluate the results, therefore being the most relevant to assess the risk of infection.

FINAL CONSIDERATIONS

The ideal method was not found, because all of them showed limitations. There is a need for strategies to optimize the precision of these methods.

Wide diversity of fungal species found in wellwater for human consumption: an analytical cross-sectional study

BACKGROUND

Fungi are ubiquitous in the environment. They are able to grow in water and many of them may be opportunistic pathogens.

OBJECTIVE

The aims were to identify fungi in registered wells (RWs) and nonregistered wells (NRWs) that tap into groundwater; and to correlate the results from physicochemical assays on this water (free residual chlorine and pH) with the presence of fungi.

DATA AND SETTING

Analytical cross-sectional quantitative study on groundwater wells in São José do Rio Preto, São Paulo, Brazil.

METHODS

52 samples of 500 ml of water were collected from RWs and 107 from NRWs. These were sent to a microbiology laboratory to identify any fungi that were present. In addition, free residual chlorine and pH were measured immediately after sample collection. Several statistical analysis tests were used.

RESULTS

Fungal contamination was present in 78.8% of the samples from RWs and 81.3% from NRWs. Filamentous fungi were more prevalent than yeast in both types of wells. There was no significant difference in presence of fungi according to whether chloride and pH were within recommended levels in RWs; or according to whether pH was within recommended levels in NRWs. Furthermore, there was no statistical difference in the levels of fungal contamination between RWs and NRWs.

CONCLUSION

Both RWs and NRWs are potential reservoirs for many types of fungi. Many of these may become opportunistic pathogens if they infect immunosuppressed individuals. Furthermore, this study confirms that fungi are able to grow even when chlorine and pH parameters are within the standards recommended.

Correlação entre métodos de monitoramento de limpeza e desinfecção de superfícies ambulatoriais

Resumo Objetivo Avaliar a correlação entre cultura microbiológica, teste de ATP por bioluminescência e inspeção visual na monitorização da eficiência da limpeza e da desinfecção de superfícies de uma unidade ambulatorial e determinar o valor de corte de ATP-bioluminescência capaz de indicar superfície limpa em relação à avaliação microbiológica. Métodos Estudo exploratório, longitudinal e correlacional. Foram realizadas 720 avaliações em cinco superfícies antes e após a limpeza e a desinfecção. Nos resultados, foram realizadas análises de duas proporções, a correlação de Spearman e a curva ROC. Resultados Ocorreram proporções semelhantes (p≥0,05) entre as taxas de reprovação apenas entre ATP-bioluminescência e contagem de colônias aeróbias (CCA) quando somadas as avaliações de todas as superfícies antes e depois da limpeza e da desinfecção. Houve correlação significativa entre os métodos de quantificação de ATP e a contagem microbiana para o balcão da recepção e a maca. A análise ROC indicou que a quantificação de ATP apresentou resultado significativo na comparação com a CCA (p=0,044). Conclusão Embora discreta, houve correlação significativa entre os métodos de quantificação de ATP e contagem microbiana para duas superfícies. Sugere-se que superfícies que apresentam valores ≤49 unidades relativas de luz estão limpas.

Are nurses updated on the proper management of patients with sepsis?

Abstract Objective: To evaluate nurses' knowledge about the definitions of Sepsis-3 and updates to the Surviving Sepsis Campaign. Methods: This descriptive study was carried out from July to August 2018, with 30 nurses from four wards of a large university hospital. For data collection, we created, structured, and validated a questionnaire composed of socio-demographic/occupational data and knowledge test. Results: Only 16.6% of the professionals received in-service training on the subject. There was no implementation of sepsis protocols in the institution, although 96.6% of the participants considered their implementation necessary. Professionals aged ≥35 years old had a higher level of knowledge about the new definition of sepsis (p=0.042). The knowledge about volume resuscitation (p=0.001) and use of vasopressors (p=0.025) was greater in those with ≥10.5 years of experience in the profession. Nurses from the clinical units presented a higher level of knowledge about the organic dysfunctions caused by sepsis (p=0.025). Conclusion and implications for the practice: Nurses do not have satisfactory knowledge for the proper identification, treatment, and clinical management of sepsis. There is a need for greater professional, institutional, and political incentives to implement a permanent education and the sepsis protocol.

Efficiency of cleaning and disinfection of surfaces: correlation between assessment methods

OBJECTIVE

to assess the correlation among the ATP-bioluminescence assay, visual inspection and microbiological culture in monitoring the efficiency of cleaning and disinfection (C&D) of high-touch clinical surfaces (HTCS) in a walk-in emergency care unit.

METHOD

a prospective and comparative study was carried out from March to June 2015, in which five HTCS were sampled before and after C&D by means of the three methods. The HTCS were considered dirty when dust, waste, humidity and stains were detected in visual inspection; when ≥2.5 colony forming units per cm2 were found in culture; when ≥5 relative light units per cm2 were found at the ATP-bioluminescence assay.

RESULTS

720 analyses were performed, 240 per method. The overall rates of clean surfaces per visual inspection, culture and ATP-bioluminescence assay were 8.3%, 20.8% and 44.2% before C&D, and 92.5%, 50% and 84.2% after C&D, respectively (p<0.001). There were only occasional statistically significant relationships between methods.

CONCLUSION

the methods did not present a good correlation, neither quantitative nor qualitatively.

Hospital infection control programs: assessment of process and structure indicators

OBJECTIVE

To assess hospital infection control committees in relation to structure and process indicators of hospital infection control programs.

METHOD

Descriptive, cross-sectional study conducted with hospital committees registered in the National Registry of Healthcare Facilities. Primary and secondary data collection was conducted through structured interview using validated instruments and verification of documents, respectively.

RESULTS

Fourteen committees participated in the research. Mean values of conformity of 80.58% were evidenced for the technical-operational structure assessment indicator, 60.77% for the infection control and prevention operational guidelines indicator, 81.59% for the epidemiological surveillance system assessment indicator, and 63.44% for hospital infection control and prevention activities assessment indicator.

CONCLUSION

Among the four instruments applied to assess hospital infection control programs, only two presented results with more than 80.0% of conformity: those related to the epidemiological surveillance and technical-operational structure assessments.

PREVENÇÃO DE LESÃO POR PRESSÃO: AÇÕES PRESCRITAS POR ENFERMEIROS DE CENTROS DE TERAPIA INTENSIVA

RESUMO Objetivo: descrever as ações de enfermagem prescritas por enfermeiros para a prevenção de lesões por pressão e sua ocorrência em centros de terapia intensiva. Método: estudo transversal, descritivo e analítico, de abordagem quantitativa conduzido em duas instituições hospitalares de ensino de Campo Grande, Brasil. A coleta ocorreu entre março e junho de 2016 com 104 participantes. Os dados foram submetidos à análise estatística. Resultados: foi encontrada associação estatística entre as ações de mudança de decúbito, aplicação de cobertura hidrocoloide em região sacral, realização de higiene externa, troca de fixação do cateter orotraqueal e/ou cateter nasoenteral e inspeção da pele com a ausência de lesões por pressão. A ocorrência de lesões por pressão foi encontrada em 49% dos clientes em ambas as instituições. Conclusão: a elaboração e implementação de protocolos, o acompanhamento dos registros e dos grupos de maior risco são estratégias que direcionam a prescrição de ações preventivas adequadas para lesões por pressão.

Effectiveness of ATP bioluminescence assay for presumptive identification of microorganisms in hospital water sources

Background

Laboratory analysis of organisms in water include arduous methods, such as the multiple tube and membrane filter. The ATP bioluminescence system, proposes a new way of measuring cellular material in water by measuring adenosine triphosphate (ATP) levels, which are expressed in relative light units (RLU). The ATP bioluminescence assay has been increasingly used to assess the microbiological safety of the hospital environment. However, there are few studies investigating the use of this methodology to evaluate the microbiological quality of water. The objective of the present study was to verify whether ATP, as measured by the 3 M™ Clean-Trace Water™ ATP test, can be used as an alternative tool for presumptive testing for the presence of microorganisms in hospital water.

Methods

Water samples (N = 88) were collected from faucets (74) and water purifiers (14) in a university hospital. The sample were filtered by the membrane filter technique (100 mL for bacterial analysis and 100 mL for fungal analysis) and then submitted to ATP bioluminescence assay to the determine quantity of RLU in each sample. In order to compare RLU and the presence of microorganisms, a receiver operating characteristic (ROC) curve was used to calculate sensitivity and specificity (levels higher than 90% were considered significant). In addition, control tests were conducted to compare RLU to the quantities of bacterial and fungal organisms added to distilled water (ANOVA and Tukey’s tests; p ≤ 0.05). This inoculum was compared to RLU emission, and the data were analyzed by calculating the Pearson’s correlation coefficient, with a 95% confidence interval.

Results

In the present study, 94.3% of the water samples presented bacterial growth. Of these, 15.6% showed heterotrophic bacteria above recommended levels and fungal contamination was detected in 55.6% of samples. Sensitivity and specificity of the samples were not significant (< 90%), and the correlation between ATP and the presence of these microorganisms in the samples (hospital water) was not significant, whereas, in distilled water, the results revealed a significant difference (p < 0.0001).

Conclusions

These results demonstrated that the ATP test cannot be used as an alternative tool for presumptive assessment of the presence of microorganisms in water.

[Collection of tracheal aspirate: safety and microbiological concordance between two techniques]

OBJECTIVE

To evaluate the safety of the performance of the traditional and protected collection techniques of tracheal aspirate and to identify qualitative and quantitative agreement of the results of microbiological cultures between the techniques.

METHOD

Clinical, prospective, comparative, single-blind research. The sample was composed of 54 patients of >18 years of age, undergoing invasive mechanical ventilation for a period of ≥ 48 hours and with suspected Ventilator Associated Pneumonia. The two techniques were implemented in the same patient, one immediately after the other, with an order of random execution, according to randomization by specialized software.

RESULTS

No significant events occurred oxygen desaturation, hemodynamic instability or tracheobronchial hemorrhage (p<0.05) and, although there were differences in some strains, there was qualitative and quantitative agreement between the techniques (p<0.001).

CONCLUSION

Utilization of the protected technique provided no advantage over the traditional and execution of both techniques was safe for the patient.

[Quality of nursing care in intensive care unit at a university hospital]

This cross-sectional study aimed to identify and analyze the quality of nursing care in an adult general intensive care unit (ICU) at a university hospital. Data were collected from 23 clients with ICU length of stay > or = 72 hours, from June to November 2012, through an Operational Audit Script and quality of care classified according to the index of positivity (IP) as follows: IP = 100%. desirable care; 90-99%: appropriate care; 80-89%: safe care; 70-79%: limitrophe care, and > 70%: tolerable care. Thus, the quality of care provided was rated as tolerable, as the global average was 61.71%. Furthermore, it was found that the best IP was assigned to the item equipment use (100%) and the worst to the item physical activities (17.39%). This study established the diagnosis of the status of nursing practices in the studied environment, which is a critical step in planning strategies and actions aimed at improving the quality of care provided.

RESIDÊNCIA MULTIPROFISSIONAL EM SAÚDE: A BUSCA PELA INTEGRALIDADE

Este estudo objetivou relatar a experiência vivenciada na implantação do Programa de Residência Multiprofissional em Saúde, Área de Concentração Atenção ao Paciente Crítico, da Universidade Federal de Mato Grosso do Sul, quanto à organização, caminhos traçados e desafios encontrados na formação da primeira turma de residentes, entre 2010 e 2011. As residências multiprofissionais em saúde destacam-se entre as principais estratégias utilizadas para o alcance da integralidade. No Programa as equipes – duas ao todo – foram compostas por um profissional de cada área: Enfermagem, Farmácia, Fisioterapia, Nutrição e Odontologia. Cada equipe atendia, no mínimo, três pacientes considerados críticos e selecionados conforme critérios clínicos. Depois, cada residente procedia avaliação específica de sua área e, em conjunto, elaboravam o plano terapêutico singular. Melhor integração com a equipe médica constitui-se um dos desafios a serem alcançados. Esta residência explorou novos horizontes e preencheu algumas lacunas do processo de produção de saúde local

HEMODIALYSIS TREATMENT-RELATED CHRONIC COMPLICATIONS IN HYPERTENSIVE PEOPLE: INTEGRATIVE REVIEW

Objetivo: Identificar e analisar as principais complicações crônicas relacionadas ao tratamento hemodialítico em pacientes hipertensos, bem como as estratégias de prevenção. Método: Trata-se de uma revisão integrativa da literatura realizada nos bancos BVS, BDENF, MEDLINE e SCIELO, utilizando os descritores Insuficiência renal crônica, Hipertensão, Hemodiálise, Doenças cardiovasculares. Resultados: As principais complicações levantadas foram: hipertrofia ventricular esquerda (67,8%), insuficiência cardíaca (20,7%), arritmias cardíacas (36,3%) e doença arterial coronariana (33,4%). Também influenciam nessas complicações anemia, Diabetes Mellitus, dislipidemias e as alterações hidroeletrolíticas. O monitoramento adequado da pressão arterial, o aumento da duração ou frequência das sessões de hemodiálise, o uso de anti-hipertensivos e a intervenção precoce nos fatores de risco são medidas que controlam a evolução dessas complicações. Conclusão: A Hipertensão Arterial é o principal fator de risco para as complicações cardiovasculares e um quadro crônico nos pacientes em hemodiálise. Descritores: Insuficiência renal crônica, Hipertensão, Diálise renal, Complicações, Doenças cardiovasculares.