Doutorado em Enfermagem e Saúde (FEN)

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Avaliação da funcionalidade familiar por idosos
(Universidade Federal de Goiás, 2013-03-11) Vera, Ivana; Lucchese, Roselma; http://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4769849E6; Nakatani, Adélia Yaeko Kyosen; http://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4794709T6; Nakatani, Adélia Yaeko Kyosen; Alvarenga, Márcia Regina; Vila, Vanessa da Silva Carvalho; Munari, Denize Bouttelet; Sadoyama, Geraldo
Demographic and epidemiologic transitions influence the Family arrangements, making the course of life of the families dynamic and leading to intergenerationality. These factors influence several aspects of the life of the elderly, especially their family relations. To assess the family dynamic of the elderly is associated to the lack of studies on the family function in this context. Thus, the objective was to assess the family relationship of the elderly using the family APGAR and the associated factors in a capital city in the Brazilian Mid-West region. This is a cross-sectional, populationbased, epidemiological study which is part of the matrix study carried out by the Rede de Vigilância a Saúde do Idoso (REVISI -Network for Elderly Health Surveillance). The probability sample was formed by 934 elderly living in the urban area of Goiânia, Goiás, Brazil. Data were collected from November 2009 to April 2010. A standardized questionnaire was applied including socioeconomic and demographic variables, self-referred health conditions, pain, falls, and access to health services. Scales to measure functional and cognitive capacities were applied. Family APGAR index assessed the family dynamics. Scores 7 refer to Good Family Function (GFF) and scores <7 refer to Family Dysfunction (FD). The outcome variables considered were the family relations and all the other relations considered as predictor variables in the instrument. For univariate association analysis, Chisquare (c)2, or Fischer’s Exact test was used at a 5% significance level. The association magnitude was expressed by Prevalence Ratio (PR) and their respective confidence intervals (CI95%). Multiple logistic regressions were used to identify factors associated to the outcome by building the model with the predictor variables whose p values were 0.20 in the univariate analysis. When we inquired the total sample that answered the index, GFF was associated to age, education, having an income, self-refer health as bad /terrible, pain complaint osteoporosis and cancer. As for the elderly who referred family dysfunction, high dysfunction was associated to falls, and a previous episode of AMI. When the population aged 80 was assessed, GFF was associated to variables of referring bad /terrible health, osteoporosis and falls. These results characterize the family dynamics of non-institutionalized elderly regarding GFF prevalence and they point to the need to adjust the current State policies to focus on the real needs of this population stratum so that professionals understand and can help balance the family dynamics and that it can strengthen the health team that works on strategies for Family health.
Efeito da lanolina anidra comparado ao leite materno combinado à concha de proteção para tratamento da dor e do trauma mamilar em lactantes: ensaio clínico randomizado
(Universidade Federal de Goiás, 2013-04-30) Vieira, Flaviana Vely Mendonça; Mota, Dálete Delalibera Correa de Faria; http://lattes.cnpq.br/1684517331855276; Bachion, Maria Márcia; http://lattes.cnpq.br/8503907944360635; Bachion, Maria Márcia; Abrão, Ana Cristina Freitas Vilhena; Almeida, Ana Maria de; Costa, Paulo Sérgio Sucasas da; Guimarães, Janaína Valadares
INTRODUCTION: Women often experience nipple trauma when they start breastfeeding, and this is one of the predictive factors of early weaning. There is no sufficient evidence to date supporting one best treatment for nipple trauma. OBJECTIVE: Assess the effect of lanolin anhydrous in the treatment of nipple pain, compared to mother’s breast milk combined with nipple protection shells during breastfeeding. METHOD: Randomized clinical trial, controlled with 100 puerperal women with nipple trauma, who had delivered at a public maternity hospital of Goiânia, Goiás, Brazil. Fifty women were randomized to group 1 and 50 to group 2. In group 1, a total of 97 breasts with nipple trauma were treated with lanolin anhydrous, and in group 2, 95 breasts with nipple trauma were treated with breast milk combined with nipple protection shells, and followed for up to 10 days. Both groups received educational instructions regarding breastfeeding. The outcome variables were: nipple trauma healing – determined by the Nipple Trauma Score (NTS) and pain in the nipple-areolar region – determined by a numerical pain scale. The research proposal was approved by the Research Ethics Committee of the University Hospital at Federal University of Goiás, and was recorded on the Brazilian Record System of Clinical Trials. Data analysis was performed using chi-square test, Fisher’s Exact Test and ANOVA MR, with significance at p<0.05. RESULTS: In the baseline assessment, the groups were homogenous in terms of sociodemographic, obstetrical and neonatal characteristics. The onset of nipple trauma was on the 2nd day postpartum, in average. Intervention was initiated on the 2nd day of nipple trauma. There was a variation of traumas, with the crust being the most frequent. Nipple depigmentation improved with time, with a difference between the groups on day 7 (p=0.013) and 10 (p=0.001). There was no difference between groups for the NTS before the intervention (p=0.642). The analysis of variance over time (ANOVA MR) indicated lower NTS in group 2 with a difference between the groups on days 3 (p=0.026), 5 (p=0.004), 7 (p<0.001) and 10 (p<0.001) of follow-up. Regarding the intensity of pain in the nipple-areolar region, a 5.5 mean was found for group 1 and 5.8 for group 2, on day 1, with no difference between the groups. The intensity of pain was smaller in group 2 compared to group 1 on days 5 (p=0.001), 7 (p<0.001) and 10 (p<0.001). CONCLUSION: Compared to lanolin anhydrous, breast milk combined with nipple protection shells proved more effective in reducing pain and healing nipple trauma in breastfeeding puerperal women.
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 e
INTRODUCTION: 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.
Epidemiologia da Infecção pelo Vírus da Hepatite B em Assentamento Rural em Mato Grosso do Sul, Brasil Central
(Universidade Federal de Goiás, 2013-12-09) Rodrigues, Fabiana Perez; Teles, Sheila Araujo; http://lattes.cnpq.br/4975298732179917; Teles, Sheila Araujo; Castro, Ana Rita Coimbra Motta de; Martins, Regina Maria Bringel; Matos, Márcia Alves Dias de; Tipple, Anaclara Ferreira Veiga
Hepatitis B virus (HBV) infection has been responsible for the largest number of chronic hepatitis illness throughout the world as well as its sequelae: cirrhosis and hepatocellular carcinoma. In Brazil, a low endemic country for hepatitis B, the most of the information on this infection has been limited to urban populations. Data about hepatitis B epidemiology in rural settlement are rare. Thus, the aim of this study was to investigate the epidemiological profile of hepatitis B virus infection in individuals living in a rural settlement (Itamarati I) from Mato Grosso do Sul, Brazil. Initially a cross-sectional study was carried out. Then HBV susceptible individuals were vaccinated against HBV and their vaccine response were evaluated. Participants were recruited following a random selection of their families. All family member aged ≥ 2 years who agreed to take part into the study was recruited by signing an Informed Consent Form. Then, 10-ml-blood sample was taken for detecting HBV markers: HBsAg, anti-HBs and total anti-HBc by using commercial kits. HBsAg positive samples were retested for HBeAg and anti-Hbe markers. Hepatitis B vaccine was offered to all individuals who were identified as susceptible to infection, and quantitative detection of anti-HBs was measured after the third vaccine dose. Statistical Package for the Social Sciences – SPSS for Window 15.0 was used for processing and analyzing data. The present project was approved by the Ethics Committee from Universidade Federal de Mato Grosso do Sul – UFMS. Of all participants, 54.4% were female. The majority (59.7%) were up to 40 years old, 62.7% were married and 78.3% self-declared white. Serological markers of HBV infection were identified in 110 settlers, resulting in an overall prevalence of 24.1% (95% CI: 20.4 to 28.2). Twelve subjects (2.6%) were HBsAg-positive. In 139 (30.5%) individuals were detected only anti-HBs, suggesting previous vaccination. Multiple regression analysis showed that age, social movements and sharing personal hygiene objects were independently associated to HBV. HBV DNA was found in four samples, being classified as genotypes D (3/4) and A (1/4). From those 207 individuals identified as susceptible to HBV infection, 84 received the first vaccine dose, but only 44 complied with the full vaccine regimen. In 28 of them (63.6%) vaccine response was evaluated, and 57.1% showed protective anti-HBs titers. The results of the present study show a high prevalence of hepatitis B in the settlers studied, compared to the urban population in the Midwest Region, and difficulties for vaccination against hepatitis B in this population. These findings ratify the need of the relationship between agricultural and health services and leaders of social movements of settlers for the creation and implementation of health strategies specific to this slice of rural Brazil.
Implicações pessoais e profissionais do acidente com material biológico para o trabalhador da saúde
(Universidade Federal de Goiás, 2014-01-31) Melo, Dulcelene de Sousa; Souza, Adenícia Custódia Silva e; http://lattes.cnpq.br/5966034868102264; Souza, Adenícia Custódia Silva e; Tipple, Anaclara Ferreira Veiga; Lemes, Lila Maria Spadoni; Pereira, Milca Severino; Vila, Vanessa da Silva Carvalho
INTRODUCTION: The health of workers, in their everyday work, are exposed to various risks, among which, biological. This represents a danger important to public health, which may, in addition to physical injury, have broader implications, and impact various aspects of their lives. OBJECTIVE: To analyze the personal and professional implications of exposure to biological material for healthcare workers. METHODOLOGY: A qualitative study conducted with ten workers in the healthcare field who experienced accidents with biological material and who were treated by a reference healthcare service in Goiania, Brazil. Data were collected between October and November 2012, through interviews using the critical incident technique. Data processing used the content analysis methods proposed by Bardin, with the additional aid of Atlas ti 6.0 software. The discussion of findings was presented using theoretical frameworks of complex thinking from the perspective of Edgar Morin, as well as cultural theory of risk by Douglas. RESULTS: From the narratives of those experiences, for ten healthcare workers treated by three units of reference specializing in situations of exposure to biological material, four categories of analysis emerged: personal implications; professional implications, the workplace and risk management, and reference service and risk management. The results showed great psychological distress expressed through feelings of fear of contamination of self and family, worry, despair, lack of protection, guilt, anger, insecurity, introspection, helplessness, uncertainty, and awkwardness, among others. This suffering was reflected in the three spheres of interaction, as well as relationships between exposed workers. On the other hand, some might experience the solidarity from co-workers, patients, and professionals during service, through gestures and relationships that help in coping with tensions when such a situation arises. The structures in place at work and in referral services showed contradictions in such situations: support / helplessness; commitment / disengagement; climate of security / insecurity; careful / careless; organization / disorganization, respect / disrespect; acceptance / leaving at the mercy of fate. The accident was established as the driving force for workers to pay attention to their own safety and change their routines in this context, extending this reflection not only to themselves, but for those who they interact with professionally interaction. CONCLUSION: The experiences of these workers shows antagonistic, contradictory, and complementary aspects of complex systems for the health services worker. It suggests the need for a greater appreciation and consideration of the psycho-emotional consequences experienced by workers, along with review of treatment procedures as to their effectiveness and problem solving that improve quality of life to the healthcare worker.
A essência do cuidado à criança com asma
(Universidade Federal de Goiás, 2014-07-02) Siqueira, Karina Machado; Barbosa, Maria Alves; http://lattes.cnpq.br/5025797873585225; Barbosa, Maria Alves; Teixeira, M. F.; Castral, Thaíla Corrêa; Salge, Ana Karina Marques; Andraus, L. M. S.
Among the chronic diseases that affect children's health, asthma deserves special mention because of its high prevalence and the impact it can have on a child's life. Given its complexity, the care of children with asthma should be shared between the family and a team of health professionals trained for this purpose. This study aimed to unveil facets of the essence of this care, according to the perceptions and experiences of children and their families. For value conscious experience of people, the phenomenology was chosen as theoretical and methodological referential. Through this approach, was possible to shed light to what is essential in the care of these children and advance in the elucidation of this phenomenon, from its intentional structure. The care was taken as the centerpiece of discussions and, accordingly, became appropriate appeal to think of Martin Heidegger, in order to enlarge the possibilities of understanding and discuss some issues that converge to the phenomenology of care. Participated in the survey five families of children with moderate or severe asthma, aged between seven and ten years, attending in a outpatient clinic specializing in childhood asthma, located in Goiânia-GO. Data collection occurred during home visits between September 2013 and January 2014. Initially were elaborated genograms and ecomaps representing families and, then, were made interviews with children and family, mentioned as participants in care. Descriptions expressed were analyzed according to the Method of Qualitative Analysis of Situated Phenomenon. The invariant structure of the phenomenon directed to three major themes: Being with a child with asthma; The family care to children with asthma; Be children with asthma: particularities and restrictions. Data analysis aggregated relevant aspects for the understanding of the essence of the care of children with asthma and were presented in the form of articles. The joint construction of genograms and ecomaps favored the approximation with families and facilitated the conduct of interviews according to the phenomenological method. The results enabled us to understand that the established relationships with the child, the members of the family unit, health services and religious institutions stood out as sources of support for care. The school was presented as a space of relevance, which found support, but also experienced situations of embarrassment and exclusion. Family members described their anxieties, fears and difficulties, especially during asthma attacks. Highlighted particularities and restrictions in the lives of children and in family environment, and described attitudes of protection. Emerged the difficulty of children in dealing with some fears, frustrations and constraints related to the disease and treatment, but also became clear their strengths and their families’ strengths to take care of more autonomous and effectively way. The study revealed that knowledge about the experiences of families provides important information for health professionals that work within the context of childhood asthma and may contribute to better understanding of the proposed interventions, promoting new strategies of attention.
A dimensão social do trabalho do enfermeiro na estratégia de saúde da família
(Universidade Federal de Goiás, 2014-09-12) Reis, Mary Lopes; Medeiros, Marcelo; Medeiros, Marcelo; Gottems, Leila Bernarda Donato; Munari, Denize Bouttelet; Caixeta, Camila Cardoso; Sousa, Ana Luiza Lima
The nurses’ work at primary health care requires larger view of the health-disease process considering the social health determinants. Nursing has historically recognized two dimensions of its work, the theoretical (scientific) and the practical (technical). The objectives of this research were to identify and analyze the social dimension of actions performed by nurses in the Family Health Strategy; to analyze the nurses’ understandings about the Family Health Program on the social dimension of their work; and to analyze the interdisciplinary contributions under the Family Health Strategy in the actions of the social dimension of the work of nurses. Descriptive study on qualitative approach developed in a capital of central-western Brazilian region. Data were collected with 12 nurses of the Family Health Strategy through semi-structured interviews and participant observation. Once transcribed, the interviews were subjected to thematic content analysis and discussed based on the framework of Health Promotion and Social Action Theory of Max Weber and on the observation field notes. The results were organized and discussed into five categories, as known, "rational social actions related to purpose", "social actions in the traditional way", "rational actions regarding values and affective way," "overhead and hands tied" and "demands for work in the social dimension”. Generally it shows that nurses carry out actions aimed at social field, but does not identify or systematize the social dimension of their own work. The Max Weber’s Theory of Social Action becomes possible to understand the actions performed by nurses, its impacts, limitations, misconceptions and principles that guide their practice. These allow us to conclude that there is need for development of the social dimension of nurses' work, through the insertion of this discussion from initial training to the postgraduate level in order to meet the demands of such a size in the Family Health Strategy.
Desenvolvimento de liderança para enfermeiros da saúde da família com o uso da estratégia coaching em grupo
(Universidade Federal de Goiás, 2014-12-02) Rocha, Bárbara Souza; Munari, Denize Bouttelet; http://lattes.cnpq.br/8409035360598716; Munari, Denize Bouttelet; Fortuna, Cinira Magali; Bezerra, Ana Lúcia Queiroz; Medeiros, Marcelo; Motta, Kátya Alexandrina Matos Barreto
The Family Health Strategy, reorienting considered practices in health care model, in its complexity brings an action that emphasizes teamwork, participation and social mobilization, professional autonomy and complementarity of practice and care management. In this context, the nurse has been recognized as a professional who works in leadership at all levels of management. Aware of the presence of weaknesses in academic training to develop skills essential to this task and the lack of investment in improvement programs that emphasize this theme, we aimed to analyze and implement a process of leadership development for nurses using the Family Health coaching group as a guiding tool. Action research was methodological option in the conduct of research by enabling the interaction between researcher and participants at the time of production of the survey results and focus on the change of the reality. We opted for the intervention group by enabling the exchange and learning through living with others, and the use of coaching, for goals to give the change process, defining steps. Following phases of coaching, nurses experienced the stage of the evaluation, which built a picture of the current situation experienced in leadership, pointing out difficulties in professional identity and occupation of spaces in this sphere of activity. In the grounds of personal issues and how these characteristics influence the leadership and in the formulation, the group was led to develop their leadership skills, particularly communication, feedback, and the act of delegating were discussed. Implementation concept, skills and attitudes for good leadership practices, as well as potential resources for their development have been deepened. The phase transformation nurses pointed out the changes made after the intervention and consolidation, there was strengthening of experienced change and identifying the effects of the intervention. We conclude that the qualification should focus more meaningful learning practices involving participants in the change process. Likewise, it is necessary to use innovative tools to deepen their understanding of themselves and the situation through experimentation and experience, aiming to change attitudes and behaviors in managerial practice.
Fatores associados à qualidade de vida relacionada à saúde do portador de doença renal crônica em tratamento pré-dialítico
(Universidade Federal de Goiás, 2014-12-19) Cordeiro, Jacqueline Andréia Bernardes Leão; Brasil, Virginia Visconde; http://lattes.cnpq.br/1940761888797180; Brasil, Virginia Visconde; Canhestro, Mônica Ribeiro; Barbosa, Maria Alves; Vila, Vanessa da Silva Carvalho; Freitas, Ana Tereza Vaz de Souza
Chronic kidney disease is considered a worldwide public health problem because of the high mortality rates and the physical, social and emotional limitations that interfere significantly in quality of life. The evaluation of the quality of life of chronic kidney disease carrier has demonstrated commitment to many aspects of life of these individuals and it was directed mainly to patients on dialysis. The number of referrals for pre - dialysis monitoring, resulting from complications due to comorbidities such as hypertension and diabetes mellitus is growing, and it requires that the focus of assistance is not only early diagnosis and treatment of disease, but also, aspects related to subjectivity, the perceptions of individuals in relation to their well - being and quality of life (QOL). At present there is no specific instrument to assess QOL of individuals in pre- dialysis treatment. This study aimed to analyze the factors associated with QOL related to the health of the chronic kidney disease carrier in pre- dialysis treatment. An analytical cross-sectional study was developed in three nephrology clinics of large hospitals in the city of Goiânia/Goiás, with 130 patients in stage IV and V of chronic kidney disease. Data collection was done through the application of socio - demographic - clinical - laboratory questionnaire and the specific QOL instrument for kidney disease, KDQOL -SF. A total of 57.7% of patients were male and the group average age was approximately 64 years old. Most patients were classified as stage 4 (69.2%) and some had no schooling (54.6 %). Among the comorbidities detected hypertension was more prevalent, followed by diabetes mellitus and 28.5% of patients had hemoglobin levels lower than expected. The dimensions of quality of life "the professional role" (25.38) and "the physical function" (28.08) showed lower values while "the stimulus by the clinic staff" (88.37) and "the cognitive function" (86.00) had the highest average. QOL is more compromised in women and in patients with five or more children who do not work and have no income, who are obese, hypertensive and show alterations especially in urea and creatinine. It was shown that QOL is influenced by chronic kidney disease, especially when there is change in laboratory parameters which control may extend the start of dialysis therapy or even minimize possible organic misfits. The KDQOL -SF was adequate to evaluate the QOL of individuals in pre- dialysis treatment. The gaps shown by the assessment of QOL in this study showed the importance of care to the kidney patient in the pre- dialysis phase, requiring more effective attention to the subjective demands. This could be achieved if the individual is taught to manage his condition, and it is essential a multidisciplinary monitoring to consider the level of patient understanding, so he can transform the information provided in benefits for his own health.
Segurança do paciente na atenção primária: conhecimento dos profissionais de saúde
(Universidade Federal de Goiás, 2015-02-18) Paranaguá, Thatianny Tanferri de Brito; Bezerra, Ana Lúcia Queiroz; http://lattes.cnpq.br/0088227879433410; Bezerra, Ana Lúcia Queiroz; Rosso, Claci Fátima Weirich; Minavisava, Ruth; Vieira, Maria Aparecida Da Silva; Coelho, Maria Alice
The general objective was to analyze the effect of an educational program on patient safety, developed by Tele-education, in the knowledge of professionals working in primary care. Study type intervention before and after, conducted with registered health professionals in Telehealth Network of Goiás. Were used self-report instruments, via web and carried out a descriptive statistical analysis. The results showed weaknesses in the knowledge of health professionals on patient safety, in the context of the practice, which subsidized the construction of an educational program which proved satisfactory to the expansion of knowledge about the studied subject. The reports of the incidents revealed the importance of acquiring knowledge on patient safety, to identify occurrences of the various incidents in primary care and highlighted the need to work conceptual aspects with greater depth in order to increase the accuracy of these professionals for the identification and monitoring of incidents arising from care. The study can be used globally, contributing to the diagnosis of knowledge about patient safety, to identify gaps that need to be worked for the management of health services, and the elaboration of educational policies that support the formation of a safety culture and quality in health services, in order to reduce the occurrence of incidents and prevent harm to patients who weeks care in primary care.
O impacto do planejamento estratégico na elaboração e implementação do plano de gerenciamento de resíduos de serviços de saúde na atenção básica
(Universidade Federal de Goiás, 2015-03-13) Alves, Sergiane Bisinoto; Tipple, Anaclara Ferreira Veiga; Souza, Adenícia Custódia Silva e; http://lattes.cnpq.br/5966034868102264; Souza, Adenícia Custódia Silva e; Takayanagui, Angela Maria Magosso; Pereira, Milca Severino; Rosso, Claci Fátima Weirich; Prado, Marinésia Aparecida do
The waste management is still deficient in many healthcare services. Those healthcare services smaller, as the primary healthcare offices, this problem becomes greater. Also important the destination for healthcare waste management generated by professionals and users in households. Faced with the expansion of the number and specificities of units in primary healthcare of occupational, environmental and social risks represent by healthcare waste generated in these environments, if not correctly managed, interventions in these realities are necessary and urgent. The objective was to evaluate the impact of the implementation of a healthcare waste management plan in primary healthcare unit and to check the approaches adopted by healthcare workers on the management of piercing and cutting waste generated by insulin users at households. This is a comparative and intervention study, pre and post, in a non-hospital unit to emergency care and also in a family healthcare unit, in the period from 2011 to 2014. The intervention performed consisted of: design and implementation of healthcare waste management plan using the situational strategic planning, educational and illustrative activities for users and multimodal permanent education, collective and individualized, for professionals for both healthcare units. A year after the intervention, all waste generated during a week in each healthcare unit were weighed and analyzed about the segregation. The values obtained were compared to those in the pre-intervention phase (Alves, 2010) that made the diagnosis in the same units and used the same methodology for the quantification and segregation analysis of the healthcare waste. The results show that the development and implementation of the waste management plan, using the situational strategic planning reduced healthcare waste generation and the inadequacies found about segregation in both units studied. It was also observed that there isn´t a management plan about management of piercing and cutting waste generated by users in households and that management is not assimilated in professional practice or in institutional procedures. The proposed intervention proved to be easy to apply and to involve all professionals and managers in prepare and implementation of a healthcare waste management plan in primary healthcare unit. The professionals and managers actively participated since the diagnosis of the healthcare waste management situation, discussion of alternatives to solve the problems listed until the decision making, resulting in a collective commitment to implement the healthcare waste management plan of healthcare services.
Rastreamento da infecção pelo vírus da Hepatite B em indivíduos portadores de doenças onco-hematológicas em goiás: subsídios para prevenção e controle
(Universidade Federal de Goiás, 2015-05-05) Pessoni, Grécia Carolina; Carneiro, Megmar Aparecida dos Santos; http://lattes.cnpq.br/8398563469665169; Teles, Sheila Araujo; http://lattes.cnpq.br/4975298732179917; Teles, Sheila Araujo; Soares, Caroline Cordeiro; Arantes, Adriano de Moraes; Minamisava, Ruth; Tipple, Anaclara Ferreira Veiga
This is an observational, cross-sectional, analytical study of 348 individuals with onco-hematological diseases (OD), ie leukemia, Hodgkin's and non-Hodgkin’s lymphoma, conducted in two hospitals in Goiania, Goias. The objective was to track hepatitis B (HBV) infections in the area. Data were obtained through interviews and collecting blood samples from July 2011 to August 2012 and a survey of hospital records from June to October 2014. Initially, all samples were tested for HBsAg, anti-HBs and total anti-HBc. HBsAg and anti-HBc samples with isolated reagents were tested for HBeAg and anti-HBe, subjected to extraction and partial amplification of the pre-S / S region of HBV-DNA by polymerase chain reaction (PCR). Samples positive for viral DNA were also sequenced and genotyped. Most participants were aged between 36 and 65 years (55.4%) and were male (54.3%). The most frequent OD were chronic myeloid leukemia (33.5%), and non-Hodgkin’s lymphoma (32.2%). The overall prevalence of HBV was 14.9% (95% CI, 11.58 to 19.07), being 1.1% (95% CI: 0.45 to 2.92) for HBsAg, 9.5% (95% CI: 6.83 to 13.0) for anti-HBc and anti-HBs, and 4.3% (95% CI: 2.63 to 6.99) for anti-HBc. Of the total participants, 8.6% (95% CI 6.10 to 12.2) tested positive for anti-HBs, suggesting low vaccination coverage. Viral DNA was detected in four samples, three of them non-reactive for HBsAg, showing hidden HBV infection. All samples were identified as genotypes A / A1. The records of eight patients suggested seroconversion for anti-HBc during the treatment period for OD. Only history of acupuncture (RP: 2.07; p = 0.035) was predictive of exposure to HBV. The low frequency of individuals immunized against hepatitis B, detection of HBV DNA in HBsAg negative samples, and the suggestion of exposure to HBV during treatment show the potential to spread this virus in this population, reinforcing the importance of serological monitoring, vaccination against hepatitis B and adoption of precautionary measures in patients with OD.
A prática assistencial na rede de enfrentamento da violência contra as mulheres em Palmas/TO
(Universidade Federal de Goiás, 2015-06-30) Pacheco, Leonora Rezende; Medeiros, Marcelo; http://lattes.cnpq.br/3009722217245952; Medeiros, Marcelo; Guilhem, Dirce; Bezerra, Ana Lúcia Queiroz; Caixeta, Camila Cardoso; Brasil, Virginia Visconde
The combating of violence against women must be done by the work that involves the health, legal, police and psychosocial areas in an intersectoral network, because it is a complex and multifactorial phenomenon. The nurse belongs to the health area and the care practice is essential in the confronting of violence.This study aims to: analyze the meanings of violence against women by professionals of Network of Violence Against Women Combat, Understand the operations of the Network of Violence Against Women Combat according to its professionals, analyze the nurse assistance in Network of Violence Against Women Combat by the professionals and nurses from the network. The theoretical categories for data analysis contemplated the concepts of violence against women, the practice of the nurse, the historic route of the nursing work in Brazil and the operationalization of Network of Violence Against Women Combat; passing by authors like: Lenore Walker, Hannah Arendt and Karl Marx. It is a Social Research in Strategic Mode on a qualitative form. The data were collected through semi-structured interview with 21 professionals from 15 institutions that composed the Network of Violence Against Women Combat of Palmas/TO, and by observation of the field. Data analysis was based on thematic content analysis, emerging three thematic categories: "Meanings of violence against women", treating about the meanings, concepts and forms of violence for the participants; "Understanding the Network of Violence Against Women Combat" describing the operation of the network, its barriers and solutions; "The meanings of nurse's practice assistance in the Network of Violence Against Women Combat", participants showed how nurses were performing their practice assistance in the fighting of violence against women. After analyzing the barriers in the functioning of Network of Violence Against Women Combat and the aspects recommended by the literature and public political, a model/flowchart of network operating was proposed in a integrate and cross-sectoral way. The research concluded that for the implementation of networking is necessary to sensitize professionals and nurses about his role in the fighting of violence against women, making them recognize that the network service depends on the co-responsibility, initiative, communication and partnership of each of them. The network consists of institutions, and these by their professionals that should act effectively. Also offered subsidies for nurses practice, as well for other professionals from several sectors, in the establishment of coherent, solving and transforming actions for the prevention, detection and care of women in situations of violence. The training and inclusion of the issue of violence in the formation of professionals are very important. This research contributed to the Network of Violence Against Women Combat of Palmas, in the sensitize of professionals, recognition of partners and communication between them.
Uso e manuseio do jaleco: uma análise das condutas dos trabalhadores da saúde na prática clínica
(Universidade Federal de Goiás, 2015-09-15) Neves, Heliny Carneiro Cunha; Santos, Silvana de Lima Vieira dos; http://lattes.cnpq.br/2461784381351166; Souza, Adenícia Custódia Silva e; http://lattes.cnpq.br/5966034868102264; Souza, Adenícia Custódia Silva e; Pereira, Milca Severino; Souza, Sandra Brunini de; Silva, Ana Elisa Bauer de Camargo; Melo, Dulcelene de Sousa
Inappropriate behaviors of healthcare workers about the use and the handling lab coat represent a risk to the patient and the professional, family and community. The recommendations in this area are guided on limited evidences and the specific norms for the standardization of practices for use and handling is fragile. OBJECTIVE: To analyze the use and handling of lab coats by healthcare workers. METHODS: Cross-sectional, observational and analytical study conducted with 103 healthcare workers in a public teaching hospital, located in the Center-West of Brazil. The characteristics of the lab coats, the data regarding the transport and the handwashing practice before wearing and after removing the lab coat were observed at the arrival timing and exit of the unit and registered in check list. The use of clothes and larger contact areas with surfaces and patients were observed at the time of procedures execution. Sociodemographic and occupational data and the worker's conduct about lab coat handling were collected through interview after the observation period of each professional. To estimate the factors associated with misconduct of healthcare workers as hand hygiene, transportation and exchange frequency of lab coat the univariate analysis was performed. Then variables with p <0.10 were included in the Poisson regression model. The chi-square test was used to verify the differences between the ratios and p values <0.05 were considered statistically significant. RESULTS: The workers used the lab coat and the gown to the different clinical situations observed, without clarity when to use each clothes. Fists and abdominal region of lab coats and gown were areas that had higher patient contact and higher environmental surfaces contact. Workers had inappropriate handling about the lab coats transport, exchange frequency, washing process and hand hygiene. Were predictors for misconduct about the exchange frequency of lab coat, to be physicians and other healthcare workers male, with shorter professional practice and reporting inadequate practice to transport lab coats. Were associated with inadequate practices of lab coats transport, have misconduct about the exchange frequency and the physicians workers. CONCLUSIONS: The conduct of workers using their own lab coat like a protective equipment and transports to process at home are inadequate and can endanger the health and safety of workers, their families and patients. These findings show that the lab coat worker must not be used as personal protective equipment in clinical practice.
Diagnósticos, intervenções e resultados de enfermagem à pessoas em tratamento hemodialítico: validação de consenso por especialistas
(Universidade Federal de Goiás, 2015-10-20) Lemes, Maria Madalena Del Duqui; Bachion, Maria Márcia; http://lattes.cnpq.br/8503907944360635; Lemes, Maria Madalena Del Duqui; http://lattes.cnpq.br/8503907944360635; Barbosa, Dulce Aparecida; Brasil, Virgínia Visconde; Munari, Denize Bouttelet; Almeida, Miriam de Abreu
INTRODUCTION: Among the health problems experienced by adult and elderly people, who have a strong impact on the quality of life, stands out chronic kidney disease (CKD). The nursing process improves the clinical practice of care in hemodialysis, however, is still in its infancy and the scope of the phenomenas described in the taxonomies of diagnoses, interventions and nursing results, as the focus on hemodialysis scenario has not yet been described. OBJECTIVES: To validate nursing diagnoses as priorities by expert nurses; Validate interventions for diagnosis identified as priority by expert nurses; Validate relevant nursing results for diagnoses identified as priority by expert nurses. METHODOLOGY: A descriptive, cross-sectional study, validation of nursing diagnoses, interventions and priority outcomes for patients with chronic kidney disease on hemodialysis people, from the NANDA-I Terminology / NIC / NOC. Participated 12 hemodialysis units that served 1788 patients and 55 nurses working. From the occupational profile of these nurses was identified 21 experts. Of these, nine validated diagnoses, interventions and nursing outcomes, through a focus group, for people with chronic kidney disease. RESULTS: There were 36 validated diagnostic, 124 interventions and 119 nursing results. Of validated nursing diagnoses, 13 are recognized more often in literature and 23, little mentioned or not mentioned. CONCLUSION: The diagnoses, interventions and nursing outcomes validated by experts in hemodialysis give visibility to a qualified clinical practice proposal for systematization of nursing care in accordance with the reality of unity.
Mudança organizacional planejada para gestão do atendimento ao acidentado com material biológico
(Universidade Federal de Goiás, 2016-03-29) Ribeiro, Luana Cássia Miranda; Munari, Denize Bouttelet; http://lattes.cnpq.br/8409035360598716; Munari, Denize Bouttelet; Souza , Adenicia Custodia Silva e; Mendonça , Katiane Martins; Chaves , Lucieli Dias Pedreschi; Bezerra , Ana Lucia Queiroz
Introduction: Accidents with biological material represent an important issue for workers because of the consequences involved. Therefore, qualified care of these workers is required, despite representing a management challenge for institutions and professionals involved in its monitoring and development. Several variables should be analyzed and provided so that care occurs in a qualified and effective way, according to the current regulations. Objective: To demonstrate the development and implementation process of the organizational change planned for managing the care of victims of accidents with biological material. Methodology: An intervention study was developed based on action research, organized in three stages. The first stage consisted of a pre-intervention evaluation of the care provided to victims of accidents with biological material conducted with patients, based on the clinical incident technique (CIT). The second was the intervention itself, by means of the action research and planned organizational change (POC), conducted with workers involved in the care. The third stage was a post-intervention evaluation with patients based on the CIT as described in the first stage. Data analysis was conducted based on the principles of content analysis. Results: The main changes verified were associated with the drawing of a flowchart of care provided to victims of accidents with biological material, focused on the reality and adapted to the institution, made by the professionals involved, as well as its use during practice, the development of a guideline form regarding the issue and its implementation in service, changes in standardized printed materials for the organization of care, development of systematized guidelines and in line with regulations, commitment of the whole team regarding the issue and organizational matters associated with the delivery of exams and other aspects that made care difficult. The evaluation of patients conducted in the pre- and post-intervention stages after five months showed improvements in care regarding the guidelines received, organization and agility for medical appointments, as well as changes in professionals’ attitude in the whole care process, identified as becoming more suitable and human. The changes regarding the management of care provided to victims of accidents with biological material in a sentinel healthcare unit based on the intervention developed, by means of the POC, were possible because of the adopted method and theoretical perspective based on participatory management. Because of the participants’ involvement since its conception, the POC encouraged a collective and cooperative learning environment, which is the reason it proved to be effective for the desired consolidation of changes. Final Considerations: This coordination favored not only the institution, for promoting desired organizational changes, but also those involved, by fostering awareness and shared knowledge and for encouraging a cultural change, providing the development of characteristics that make organizations evolve. The improvement of quality in the care offered to victims of accidents with biological material in sentinel care, reported by those involved, strengthen and legitimize the success of the intervention.
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 Veiga
Accidents 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.
Reanimador manual: quando trocar no mesmo paciente
(Universidade Federal de Goiás, 2016-03-31) Gomes, Giselle Pinheiro Lima Aires; Pereira, Milca Severino; http://lattes.cnpq.br/9304767101674108; Souza, Adenícia Custódia Silva; http://lattes.cnpq.br/5966034868102264; Souza, Adenícia Custódia Silva; http://lattes.cnpq.br/5966034868102264; Oliveira, Adriana Cristina; Tipple, Anaclara Ferreira Veiga; Leão, Lara Stefânia Netto de Oliveira; Brasil, Virginia Visconde
INTRODUCTION: The manual resuscitator is a widely used respiratory assist device that has been reported to be a reservoir and a source of contamination from various microorganisms. At present, there is no criteria to replacement of manual resuscitator when it is in successive use in the same patient. AIM: To evaluate the safest amount of time the manual resuscitator can be successively used in the same patient. METHODS: An open, prospective cohort study was conducted from October to November, 2014 using 30 patient connector valves from manual resuscitator devices obtained from Intensive Care Units of a general hospital located in a region north of Brazil. The samples were collected through swab friction on the manual resuscitator that was used by the same patient, at zero (ready use), 24 and 48 hours. Bacterial identification and antibiotic susceptibility were performed automatically (Vitek 2 Compact®). RESULTS: Of the 30 resuscitators evaluated, 20 (66.6%) were found to be contaminated. There was a significant difference between the microbial load on the manual resuscitators in use at zero and 24 hours (p = 0.03). Associated risk factors for the contamination of manual resuscitators identified were frequency and time of use. The presence of visible soil was not detected on 19 manual resuscitators in use, however, 95.0% were contaminated. The number of microorganisms isolated at zero, 24 and 48 hours were five, 11 and 24, respectively. Thirteen devices were contaminated with two or more bacterial species. Of the Gram-positive cocci, 38.9% (n = 18) were methicillin-resistant Staphylococcus aureus and 11.1% were methicillin-resistant coagulase-negative Staphylococcus, all were constitutive MLSB resistant. Of the Gram-negative rods (n = 36), Acinetobacter baumannii (36.1%), Pseudomonas aeruginosa (19.4%), Serratia marcescens (22.2%) and Proteus spp. (8.3%) dominated. Over 50% of these were resistant to carbapenems, second, third and fourth cephalosporins generations, and ampicillin/sulbactam. CONCLUSION: Manual resuscitators in successive use in the same patient were contaminated even in the absence of visible dirt. Multi- and extensively-resistant bacteria of clinical importance were also detected. Frequency and time of use were identified as risk factors in the contamination of manual resuscitators. The longer the time of use, the greater the number of contaminated resuscitators and bacterial species isolated. These results point to failures in reprocessing, and therefore highlights the importance of having thorough discussions among regulators about the recommendations for the reprocessing of semi-critical medical devices, especially, those for ventilatory assistance. Furthermore, the results highlight the need to replace manual resuscitators every 24 hours after use as a strategy for infection control and to minimize the risk of re-colonization or -infection of the respiratory tract.
Análise dos registros de curativos em prontuários de um hospital de ensino do Estado de Goiás
(Universidade Federal de Goiás, 2016-06-21) Lemos, Lucimeire Fermino; Barbosa, Maria Alves; http://lattes.cnpq.br/5025797873585225; Almeida, Alessandra Rodrigues de; Barbosa, Nelson Bezerra; Bezerra, Ana Lúcia Queiroz; Prado, Marinésia Aparecida do; Barreto, Regiane Aparecida dos Santos Soares
Health records are important for keeping effective communication among all professionals involved in the process of taking care as well as for legitimating the team actions in the face of patients and families. The records must be clear and objective because they are sources of information for judicial, research, teaching, billing and auditing issues. This study has an objective to analyze the records of procedures of Level II Curative in medical records of hospitalized patients, from the nurses’ perspective, before and after the pedagogical intervention, in a Brazilian teaching hospital in the Midwest region. It was a descriptive study with both qualitative and quantitative research and was developed in many stages. The first stage included the nurses’ profiles and the identification of the main reasons why the nursing actions were not recorded. The second stage was the analysis of the records before and after the pedagogical action, which was the third stage. At last, the nurses were interviewed about their perception of the importance of the records for billing. It was observed among the sample of nurses the predominance of women (87,2%), post-graduated (82,1%) and statuary civil servants (80,4%). Even though 53,6% of the nurses said that they do not have double employment relationships, 46,4% said they do. The nurses said that it was not possible to record the procedures due to lack of time (50%), work overload (20%), lack of human resources and access to the records (12,5%), interruptions and lack of guidance (2,5%). The objective of the intervention was to discuss the importance of health records, and specially, in relation to the level II curative. 45,2% of the nurses of this institution took part in this event. In the analysis of the records, before and after the intervention, it was possible to observe the increase of the records of the curatives (82,3%), the detailing of the quantity of curatives per patient (69,9%), the classification of the wounds (63,5%), the description of the materials used in the procedures (67,3%), and also the scheduling (74%) and the checking (71,4%). The data shows that the quantity of material used maintained still. However, there was a rise of curative prescription by the nurses (79,4%) and a fall of curative prescription by the doctors (18,3%). It was also possible to observe that the performed and not prescribed procedures or prescribed and not verified procedures, in both cases, were not billed. Nevertheless, the hospital overturn related to this procedure has an increase, from July 2015. The interviews with the nurses showed that they take the responsibility in the treatment of wounds for themselves. However, it is necessary to standardize the prescriptions and the evolutions of the procedure. The complete record of this intervention is important to safeguard the institution in case of auditing. In conclusion, nurses have an important role in recording the wound treatment. The obligation of recording should be reinforced due to the quality of the service and the profession´s visibility as well as for a better material and input control and billing.
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 Amorim
INTRODUCTION: 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.

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