Doutorado em Enfermagem e Saúde (FEN)
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Navegando Doutorado em Enfermagem e Saúde (FEN) por Por Orientador "Tipple, Anaclara Ferreira Veiga"
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Item Instrumental ortopédico de conformação complexa: avaliação do processamento, formação de biofilme e suas implicações(Universidade Federal de Goiás, 2016-12-20) Lopes, Lillian Kelly de Oliveira; Watanabe, Evandro; http://lattes.cnpq.br/6142675059689994; Tipple, Anaclara Ferreira Veiga; http://lattes.cnpq.br/4288704233343920; Tipple, Anaclara Ferreira Veiga; http://lattes.cnpq.br/4288704233343920; Hunt, Alessandra Marçal Agostinho; Lima, Ana Beatriz Mori; Melo, Dulcelene de Sousa; Caetano, Karlla Antonieta AmorimINTRODUCTION: Depth gauge and flexible drill bite cutter are orthopedic surgical instruments of complex conformation and they are into loanered instrumentation box to different healthcare facilites. The challenge is to ensure that appropriatly cleaning was done to prevent the formation of biofilm in these instruments´models. There are no experimental or clinical studies analyzing the impact of different cleaning protocols on formation of biofilm on surfaces those two surgical instruments. OBJECTIVES: To validate and to evaluate laboratory method to formation of biofilms in stainless steel. To evaluate microbial load and to determine formation of biofilms after laboratory contamination and processing for several cycles in surgical instruments of complex conformation used in surgeries of orthopedic implants. METHOD: Experimental study was developed from November/2014 to March/2016, at the Laboratory of Macquarie University, Sydney (AU). Method´s validation: new forceps halsted hemostatic mosquito were contaminated within contaminant solution containing S. aureus (ATCC 25923) and sterilized in saturated steam. Forceps were divided into three groups according to cleaning: 1) rinsing, 2) manual cleaning and 3) manual cleaning followed by automated cleaning. After 6th, 13th and 20th three forceps from each protocol were analised for microbial load and protein amount (Bicinchoninic Acid Assay) and visual analysis by scanning electronic microscopy. The same method was used on new flexible drill bite cutters and depth gauges, and analised after 10th and 20th reprocessing. RESULTS: Method´s validation: forceps submitted to protocols 1 (positive control of cleaning) and 2 showed coccus in biofilms and forceps sumitted to protocol 3 showed organics residues after 20 reprocessing. No microbial load or residual protein was found. Complex instruments: flexible drill bite cutters submitted to rinsing presented high amount of protein with increase of 1699μg of protein from 10th to 20th reprocessing (P = 0.03). Depth gauge submitted protocol 1 presented high amount of protein, however there was no statistically significant difference from 10th to 20th processing (P = 0.60). All instruments submitted to manual and/or automated cleaning did not present residual protein. It was possible to identify residue and biofilm into lumen of surgical instruments after 20 reprocessing. CONCLUSION: Experimental techniques to formation and evaluation of biofilm in surgical instruments manufactures in stainless steel were validated and 20 inappropriated cleaning processing were enough to buildup biofilm. Biofilm was formed within lumens of flexible drill bite cutter and depth gauge, after 20 processing despite the instruments were submitted to “gold standard” cleaning, also accumulation of protein on flexible drill bite cutters. Depth gauge lumen allowed accumulation of waste using manual cleaning followed by automation cleaning and manual cleaning allowed buildup residue on its external surface. Manual cleaning allowed accumulation residue on deep gauge. It was not possible to recover viable S. aureus in biofilm on instrumental surface, but it indicates that design of instruments evaluated is not safe to processing. It is presumed have risk ratio for aseptic loss of prostheses and infection related to healthcare, since they are instruments of difficult cleaning control and circulate in numerous healthcare facilites using different cleaning protocols.Item Ação de detergentes e desinfetantes em biofilme tradicional e buildup no modelo MBEC(Universidade Federal de Goiás, 2016-12-20) Luciano, Cristiana da Costa; Alfa, Michelle J.; Tipple, Anaclara Ferreira Veiga; http://lattes.cnpq.br/4288704233343920; Hunt, Alessandra Marçal Agostinho; Watanabe, Evandro; Melo, Dulcelene de Souza; Teles, Sheila Araújo; Tipple, Anaclara Ferreira VeigaINTRODUCTION: Flexible Gastrointestinal Endoscopes (FGE) are used for diagnostic and therapeutic procedures, classified as semicritical health products (HP), requiring High-Level Disinfection (HLD) processing among users. The FGE designs are complex, making it difficult to process and favor the occurrence of faults that contribute to the accumulation of organic matter on the surface of the internal channels of the endoscopes, contributing to the formation of the biofilm. OBJECTIVE: To develop a Biofilm Buildup (BBF) accumulation model, based on repeated exposure of test soil containing Entercoccus faecalis and Pseudomonas aeruginosa by means of repeated cycles of fixation and to evaluate the ability of detergents and disinfectants to destroy and remove bacteria in the Traditional Biofilm (TBF) and Buildup. MATERIALS AND METHODS: TBF was developed in MBEC ™ peg, without hydroxyapatite, and BBF, with hydroxyapatite, over a period of eight days. For the development of both biofilms, E. faecalis and P. aeruginosa, containing 8 log10, colony forming units per cubic centimeters (CFU/cm2) were used. Prolystica Enzymatic (D1), Prolystica Neutral (D2), Neodisher (D3) and Endozime (D4) were tested alone and in combination with Glutaraldehyde (GLUT), Orthophthaldehyde (OPA) and Hydrogen Peroxide Accelerator (APH) to determine if both biofilms could be removed. The removal of the traditional biofilm and buidulp, using viable bacteria count, quantification of protein and carbohydrates and by means of scanning electron microscopy (SEM) was evaluated. RESULTS: After eight days of BBF development, 6.14 log10 CFU/cm2 of E. faecalis and 7.71 log10 CFU/cm2 of P. aeruginosa were reached. None of the detergents and disinfectants have been able to remove the traditional biofilms and buildup or reduce the level of bacteria. The combination of detergents and disinfectants tested in BBF provided a reduction of 3 to 5 log10 in viable bacteria, but no combination could provide the expected reduction of l log10. Only enzyme Prolystica and Endozime removed both E. faecalis (3.90 log10 colony forming units per milliliter (CFU/mL)) and P. aeruginosa (3.96 log10 CFU/mL) in suspension bacteria. None of the detergents tested removed > 1 log10 CFU/cm2 from the bacteria within the traditional biofilm. No combination of high-level disinfectant and detergent reduced the level of both E. faecalis and P. aeruginosa from the traditional biofilm interior (3 to 5 log10 CFU/cm2). Although the combination of Endozyme and Glutaraldehyde reduced 6 log10, it did not eliminate both bacteria in the traditional biofilm. CONCLUSION: Data indicate that if TBF and BBF accumulate in the EGF channels during repeated processing cycles, neither detergents nor high level disinfectants will provide the expected level of bacterial removal or destruction. Future research using the buildup model can help develop new cleaning and disinfection methods that can prevent or eliminate the BBF within the endoscope channels.Item Risco biológico nas etapas finais do sistema de medicação em serviços de urgência e emergência e a implementação de uma estratégica educativa pautada no Arco de Maguerez(Universidade Federal de Goiás, 2013-11-04) Mendonça, Katiane Martins; Tipple, Anaclara Ferreira Veiga; http://lattes.cnpq.br/4288704233343920; Tipple, Anaclara Ferreira Veiga; Pereira, Milca Severino; Vila, Vanessa da Silva Carvalho; Queiroz, Maria Goretti; Souza, Adenícia Custódia Silva eINTRODUCTION: the prepare and the administration medications´s are activities performed by nursing staff and involve the biological risk to users and to professionals. This risk may be exacerbated when work activities are developed in areas such as emergency care that require immediate decisions. For intervention in this reality is necessary be based on situational analysis and involve all staff in the change process. OBJECTIVES: the general was to analyze the biological risk in the final stages of the medication system in the context of emergency services. And the specifics were to identify the recognition by nursing staff on the occurrence of behaviors that are characterized as biological risk in the final stages of the medication system, in the context of emergency services; characterize cases of accidents with biological material during the administration of medication in emergency services; describe ways to reduce the occurrence of accidents, indicated by the victims during the administration of medications in emergency services and describe the process of implementing an educational intervention on the biological risk in the prepare and the administration medications´s based on Problematization Methodology with Maguerez´s Arch. METHOD: The study was divided into two stages. The first presented an analytical design. Data collection occurred from October/2011 to April/2012, using a questionnaire, with demographic data and related accidents with biological material and Likert scale, with 44 items about risk behaviors previously observed among the study participants. The instruments were subjected to pilot testing. The data were processed by SPSS / IBM 20.0. In the second stage there was a descriptive exploratory study with a qualitative approach. The sources of information were recordings of the group discussions, field notes and record the speeches in the posters. The data´s collection, analysis and presentation were guided by the stages of the Arch and the guidelines of Bogdan and Biklen (2010). The educational intervention was performed in 44 meetings 34 professionals, in small groups, from August to December 2012. All went through by the stages of Maguerez´s Arch (reality observation, problem definition, key points, theorizing, possible solutions and application to reality). The project was approved by the Ethics Committee number 065/08 and 118/08 and all participants signed the informed consent. RESULTS: The scale showed the recognition by professionals of the existence of conduct that characterized the biological risk. The scale showed satisfactory reliability (Cronbach's alpha of 0.75 overall) and showed the recognition by professionals of the existence of conduct that characterized the biological risk. The conducts were related to the practice of hand washing, protective equipment, maintenance of aseptic chain, waste of health services and occupational accidents. The accident rate was 41.7% and most of the victims worked at night and said it had not received training to work in the emergency department. The protection items were neglected. Individual and organizational issues were identified as ways to reduce accidents. The educational intervention in these departments required adaptations. Were held 44 meetings with the participation of 34 professionals (87.2% of the population), six nurses and 28 nursing technicians, divided into small groups, from August to December/2012. All went through the steps of the Maguerez´s Arch (observation of reality, problem definition, key points, theorizing, possible solutions and application to reality). From the proposal for discussion of the problem related to the practice of preparation and administration of medications in emergency care unit, the key points prioritized contemplated infrastructure, human and material resources and staff qualification. Theorizing complemented the stage of the search for possible solutions, among which could be implemented in the short, medium and long term. The evaluation of the implementation of this strategy showed the commitment of professionals with field experience and successful methodology. CONCLUSION: all accidents reflected the configuration of risk behaviors recognized. The essence of this study was to understand the practice where it gives, with our own eyes, the eyes of the other and together seek a path to transformation. We found that the route chosen for the study provided us subsidies to analyze and reflect on the process of intervening in questions about the biological risk units with the wealth of specifics, such as emergency departments and direct strategies for use in units with characteristics like.Item Acidentes com material biológico entre trabalhadores da área da saúde da região metropolitana de Goiânia-GO: uma análise de 25 anos de registros(Universidade Federal de Goiás, 2016-03-30) Neves, Zilah Cândida Pereira das; Tipple, Anaclara Ferreira Veiga; http://lattes.cnpq.br/4288704233343920; Oliveira, Adriana Cristina de; Souza, Adenícia Custódia Silva e; Pereira, Milca Severino; Mendonça, Katiane Martins; Tipple, Anaclara Ferreira VeigaAccidents with biological material are reportable events, health care workers (TAS), victims of these accidents may be exposed to the hepatitis B and C and HIV, among others. The aims of this study were: to analyze the epidemiology of occupational accidents with biological material among health care workers of the metropolitan area of Goiania-GO (general); describe the socio-demographic and occupational profile of health care workers, victims of occupational accidents with biological material; describe the profile of accidents with biological material among health care workers; characterize the adoption of pre-exposure behaviours related to the latest accident; identify the serological status related to hepatitis B, C and HIV in victims of occupational accidents involving biological material and source patients, and establish the demographic and employment factors associated with the occurrence of multiple accidents among health care workers of the metropolitan area of Goiania-GO. Epidemiological Cross and analytical study which included all registration records of accidents involving biological material of HCW from two sources: A - records of injured HCW in a reference hospital for notification in Goiania, from the first record in 1989 to 2010, and B - records of Sinan, including the first record in 2006 until those available at 31/12/2014. Linkage of databases was performed and data analyzed using the Statistical Package for Social Sciences (SPSS). Socio-demographic and employment variables were the predictor variables and have suffered more than one accident, the outcome. Univariate analysis was performed and variables with P<0.10 were included in a logistic regression model. Ethical precepts were followed (Approval Ethics Committees: 033/2010 and 414.258/2013). A total of 11,536 accidents were recorded from 1989 to December 2014. Of these, 9,575 (83.0%) occurred among HCW and the majority was female. It was found that 665 (7.5%) of the HCW experienced more than one accident, while 70 (0.8%) experienced three or more accidents, totaling 8,825 victims. Nursing staff, auxiliary cleaning, physician, and dental and laboratory teams were the ones who were more frequently hurted, respectively. Most of the victims had completed high school (3,719 (48.0%). Blood/serum/plasma were the biological materials found to be the most involved (6,480/67.7%), at the time of administering medications/vascular access puncture occurring in 2.759 (28.9%), and involving needles with and without lumen in 6,097 (63.7%). A total of 6,653 (75.4%) HCW were vaccinated for hepatitis B. Incomplete information on Sinan records such as, use of PPE (gloves, masks, boots and safety glasses) and serological markers (HBsAg; Anti-HBs, Anti-HCV and Anti-HIV) was found to be the major factor that hampered data analysis. Age, type of material, and organic fluid were predictors risk factor for multiple accidents involving biological material among health care workers.