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Resumen: Introducción: la Agenda Global de Seguridad Sanitaria indicó la necesidad de asegurar la capacitación de los trabajadores de la salud en el control y prevención de infecciones. Materiales y métodos: se propuso un estudio de tipo ecológico. Se compararon los programas de instrumentación quirúrgica en Colombia, de manera agregada, y se contrastaron con las competencias transversales y específicas del instrumentador quirúrgico y las competencias propuestas para prevención y control de infecciones y bioseguridad por los organismos internacionales. Resultados: se observó que las competencias de prevención y control de infecciones y bioseguridad se incluyen en las competencias específicas de los planes de estudios de los 13 programas de instrumentación quirúrgica en el país. Estas se abordan con mayor dedicación en horas en las asignaturas teórico-prácticas en los primeros semestres, en tanto que en las competencias transversales se ubican asignaturas prácticas a lo largo de la malla curricular con mayor intensidad en los últimos semestres. Conclusión: para las profesiones de la salud, el programa de instrumentación quirúrgica desarrolla competencias específicas y transversales afines con competencias en prevención y control de infecciones y bioseguridad. Esto permite considerar los planes de estudios de instrumentación quirúrgica como línea de base para cimentar la oferta académica para las profesiones de las ciencias de la salud, en pre y postgrado. Abstract: Introduction: The Global Health Security Agenda have indicated the need to ensure the training of health care workers in infection control and prevention. Materials and methods: An ecological study was proposed. An aggregate comparison of surgical instrumentation programmes in Colombia was made and contrasted with the cross-cutting and specific competencies of the surgical technician and the infection prevention and control, and biosafety competencies proposed by international organisations. Results: It was observed that infection prevention and control and biosafety competences are included in the specific competencies of the curricula of the country’s 13 surgical instrumentation programmes. More hours are addressed to these competencies in theoretical-practical subjects in the first semesters, whereas cross-cutting competencies were found in practical subjects across the curriculum with greater intensity in the last semesters. Conclusion: For the health professions, the surgical instrumentation programme develops specific and cross-cutting competencies related to infection prevention and control, and biosafety. This means surgical instrumentation curricula can be considered a baseline for cementing the academic offer for health sciences professions at undergraduate and postgraduate levels.

Abstract Objective: to assess the effectiveness of supplemental oxygenation with high FiO2 when compared to conventional FiO2 in the prevention of surgical site infection. Method: an effectiveness systematic review with meta-analysis conducted in five international databases and portals. The research was guided by the following question: Which is the effectiveness of supplemental oxygenation with high FiO2 (greater than 80%) when compared to conventional FiO2 (from 30% to 35%) in the prevention of surgical site infections in adults? Results: fifteen randomized clinical trials were included. Although all the subgroups presented a general effect in favor of the intervention, colorectal surgeries had this relationship evidenced with statistical significance (I2=10%;X2=4.42; p=0.352). Conclusion: inspired oxygen fractions greater than 80% during the perioperative period in colorectal surgeries have proved to be effective to prevent surgical site infections, reducing their incidence by up to 27% (p=0.006). It is suggested to conduct new studies in groups of patients subjected to surgeries from other specialties, such as cardiac and vascular. PROSPERO registration No.: 178,453.

ABSTRACT Objective: To know the conceptions regarding patient safety during their surgical positioning from the perspective of nurses in a Surgical Center. Method: Qualitative descriptive exploratory study, with seven nurses from private hospital in southern Brazil in August 2018. Data generation using the Focus Group technique, with content analysis by Bardin. Results: From the data analysis, six categories emerged: “patient safety”, “surgical patient risks”, “nurses in the operating room”, “training”, “involvement of the interprofessional” team and application of the risk assessment scale. The development of injuries resulting from positioning was identified as the greatest risk for the surgical patient, highlighting the presence of the nurse in the operating room as essential for the prevention of this risk, through patient assessment and staff training. Final considerations: Nurses identified risk to patient safety in relation to surgical positioning and considered they presence in the operating room to be indispensable.

Abstract Objectives: To assess the actions performed by the operating room nurse during anesthesia and their behavior for patient safety regarding the reporting on adverse events, and to analyze their knowledge about anesthetic practices. Method: This is a cross-sectional study carried out using an electronic questionnaire consisting of socio-demographic, professional practice, knowledge in anesthesia, patient safety, and professional practice questions, conducted from January to March 2019 with operating room nurses. Results: One hundred nurses participated, 89 (89%) being women, with a mean age of 41.09 years (SD = 9.36), time of undergraduate completion of 14.33 years (SD = 8.34). The average attendance was 4.69 operating rooms (SD = 2.07) per nurse, with an emphasis on action before induction (49; 49%). Professionals reported performance of simultaneous activities (72; 72%) and insufficient number of employees (57; 57%) as difficulties of their daily practice. Among the participants, 77 (77%) correctly cited the periods of general anesthesia and 80.4% always reported the occurrence of an adverse event. Conclusion: Nurses identified their role in anesthesia, with limitations for assistance from multiple activities and lack of professionals.

ABSTRACT Objectives: to analyze the work of the nursing team in the operating room and the physical, psychological, and social damage related to occupational health. Methods: quantitative study conducted from November 2017 to January 2018 in the operating room of a university hospital. The sample consisted of 160 nursing workers who responded to the Work-Related Damage Assessment Scale. Data were analyzed using the Student’s t test, One-Way analysis of variance (ANOVA) followed by Pearson’s chi-square test. Results: psychological and social damage were assessed by workers as low risk by 86.8% (139) and 87.4% (140), respectively. Physical damage was considered a medium risk by 57.9% (93) of the sample. Conclusions: the results direct the attention of managers and the occupational medicine service to physical damage, preventing them from getting worse and thus promoting improvements in working conditions and occupational health.

ABSTRACT Objectives: to report the construction of a process model to support the decision making of operating room nurses to control the risk for perioperative positioning injury. Methods: experience report on a process model that helps nurses with decision making regarding clients at risk for perioperative positioning injury. By following the steps, it was possible to identify intrinsic and extrinsic variables of the literature and of the workflows of teams involved in the positioning of the client for surgery. The Business Process Model and Notation, the Bizagi Modeler software and terms from the International Classification for Nursing Practice were used in the model. Results: the experience allowed the observation of the knowledge integration between different areas, which enabled the process modeling and its validation. Conclusions: process modeling is an innovative option for the development of support systems for clinical nursing decisions.

ABSTRACT Objective: To analyze the indicators of surgical patients after the implementation of an Internal Bed Regulation Committee in a university hospital. Method: Longitudinal, quantitative, and retrospective study. The data collection was conducted in the Hospital Management Information institutional system, from which the information of patients submitted to surgical procedures from January 2015 to June 2018 were obtained. To verify the data trends, a simple linear regression model was used. Results: The predominance of patients aged 20 to 39 and hospitalized on an emergency basis was observed. An ascending trend for structure indicators was verified regarding the number of surgical procedures and patients per surgical room. The process indicators were stagnant. An ascending trend was presented by the result indicators related to the number of surgical patients, hospitalized surgical patients, surgical procedures, and patients with Hospitalization Authorization. Conclusion: A change in the mean values of the process indicators was observed, showing the performance of this service. Organizational changes were also observed regarding the establishment of norms, processes, and flows.

ABSTRACT Objective: Identify workflow factors in the operating room and their implications, which influence nurses' decision making. Method: Integrative review of the literature conducted through searches in the databases: Latin American and Caribbean Literature in Health Sciences; Nursing Database; Pubmed; Scopus and Cumulative Index to Nursing and Allied Health Literature. The results were organized into factors related to positive, negative and positive and negative implications. Results: The sample of 18 articles included examples of factors with positive implications, such as preoperative data collection, negative outcomes, such as lack of human, material and structural resources, and positive and negative outcomes, as preparation for certification. Conclusions: Factors that influence the decision-making process of nurses are associated to different conditions: client- related conditions and those conditions that go beyond the domain and organization of the surgical environment.

Objective: to determine the microbiological characteristics of the red blood cells obtained with the cell saver in heart surgery patients on an extra-body circuit. Method: a cross-sectional and descriptive study conducted with 358 patients scheduled for heart surgery where the saver was used. Sociodemographic variables were collected, as well as from the saver and of the microbial identification in the re-infusion bag proceeding from the cell saver. Informed consent performed. Results: of the 170 GRAM+ bacteria isolations, the most frequent species were Staphylococcus epidermidis in 69% (n=138) of the cases and Streptococcus sanguinis with a report of 10% (n=20). Significant differences were found in the Staphylococcus epidermidis strain in patients with a Body Mass Index ≥25 (p=0.002) submitted to valve surgery (p=0.001). Vancomycin was the antimicrobial which resisted the Staphylococcus epidermidis strain with a minimum inhibitory concentration of >16 µg/ml. Conclusion: the microbiological characteristics of the red blood cells obtained after processing autologic blood recovered with the cell saver during heart surgery are of GRAM+ bacterial origin, the most isolated species being Staphylococcus epidermidis. Consequently, in order to reduce the presence of these GRAM+ cocci, an antibiotic should be added to the cell saver reservoir, according to a previously established protocol.

Objective: to elaborate, validate and evaluate the reliability of the Safety Protocol for Pediatric Thirst Management in the immediate postoperative period. Method: methodological quantitative research, based on the assumptions on measurement instrument development. The protocol was elaborated after literature review, interview with specialists and observation of the child’s anesthetic recovery. The judges performed theoretical validation through apparent, semantic and content analysis. Content Validity Index was calculated for content validation, whose minimum established concordance was 0.80. Protocol’s reliability was evaluated in children between three and 12 years old in the Post Anesthesia Care Unit. Results: in its final version, the protocol consisted of five evaluation criteria: level of consciousness, movement, airway protection, breathing pattern and nausea and vomiting. It presented easy comprehension and relevant content, and all indexes exceeded the minimum agreement of 0.80. Pairs of nurses applied the protocol 116 times to 58 children, resulting in a high reliability index (kappa general = 0.98) Conclusion: the unprecedented protocol developed is valid and is a useful tool for use in anesthetic recovery, aiming to assess safety for reducing the thirst of infant patients.

ABSTRACT Objective: to measure the adherence to the objectives of the Safe Surgery Saves Lives Initiative in surgical centers from the perspective of nurses. Method: cross-sectional study, developed through an online survey via the Google Forms® platform. The study participants were 220 nurses from surgical centers in different regions of Brazil. The data were collected through a socio-professional characterization form and a questionnaire in which the participants indicated their level of agreement in relation to the fulfillment of the objectives of the Safe Surgery Saves Lives Initiative. Data analysis was performed using descriptive statistics. Results: objective 1, The team will operate on the correct patient at the correct site, presented the highest levels of total agreement (n = 144; 65.5%) and partial agreement (n = 52; 23.6%). Objective 10, Hospitals and the public health systems will establish routine surveillance of surgical capacity, volume and results, obtained the lowest percentages of total (n = 69, 31.4%) and partial agreement (n = 81, 36.8%). Conclusion: adherence to the objectives of the Initiative is adequate, but there are weaknesses, especially in relation to the prevention of never events.

Introduction: Surgical safety is a global public health concern. The attitudes and perceptions of the surgical team regarding to the patient safety are associated to the safety climate and the prevalence of adverse events. Objective: To describe the safety climate according to sociodemographic characteristics and work professional conditions of operating room nurses from three Hospitals in Canary Islands, Spain. Method: This work presents a multicentre cross-sectional study. Data collection was obtained by means of The Safety Attitudes Questionnaire (SAQ), a self-completed questionnaire translated to the Spanish. A convenience sample with voluntary participation was selected. The safety climate was determined through six factors: Teamwork climate, Safety climate, Job satisfaction, Perception of the Unit and Hospital Management, Working conditions and Stress recognition. Results: The SAQ domains show variability in relation to sociodemographic characteristics and work professional conditions. Perception of the management and Working conditions are the domains lower valued in every sociodemographic characteristics studied. The size of the hospitals and Years of professional experience showed statistical differences in several domains. Conclusions: The age, years of profession, years of experience and type of hospital present strong relationship among patient safety perception.

RESUMO Objetivo Verificar a efetividade do uso da aromaterapia com óleos essenciais de lavanda (Lavandula angustifolia) e gerânio (Pelargonium graveolens) associado à massagem para alívio do estresse de uma equipe de Enfermagem do centro cirúrgico por meio da avaliação de parâmetros biofisiológicos e psicológicos. Método Estudo-piloto do tipo ensaio clínico controlado e randomizado, realizado com a equipe de enfermagem de um centro cirúrgico de um hospital escola do interior do estado de São Paulo. A intervenção foi composta de seis massagens com aromaterapia com os óleos essenciais diluídos em creme neutro na concentração de 1% cada. A frequência cardíaca e a pressão arterial foram verificadas antes e após cada massagem e a Escala de Estresse no Trabalho e a Lista de Sintomas de Stress foram aplicadas antes e ao final da intervenção. A análise estatística foi realizada com o teste t pareado e qui-quadrado, intervalo de confiança de 95% e p

ABSTRACT Objective: To construct and validate a nursing care protocol in anesthesia. Method: methodological study of face and content validation, judging clarity, relevance, pertinence and comprehensiveness of a care protocol, elaborated from the integrative review of previous literature and based on the conceptual model of assistance perioperative nursing of Castellanos and Jouclas. The protocol was evaluated by five anesthesiologists and nurses from the surgical center. The results were analyzed through the content validity index. Results: among the 119 items assessed by experts, 11 (9.2%) instrument items presented content validity index of

O presente trabalho trata-se de pesquisa quase experimental para avaliar o impacto na redução do absenteísmo de usuários agendados para cirurgia eletiva, quando submetidos à confirmação de presença por telefone. O estudo foi conduzido no Centro Cirúrgico do Hospital das Clínicas da Faculdade de Medicina de Botucatu, durante trinta dias, perfazendo 89 usuários. Os resultados indicaram a efetividade da intervenção, que reduziu o absenteísmo em 30%. Recomenda-se sua implementação na antevéspera da cirurgia, possibilitando novas tentativas para encontrar o usuário no domicílio e convocação de outro. A criação de um núcleo de atendimento poderia constituir um canal de comunicação entre instituição e usuário, permitindo a confirmação da presença da pessoa e a oportunidade de sanar dúvidas sobre o tratamento e comunicar eventuais impedimentos à cirurgia. O núcleo demandaria um profissional com habilidade e conhecimento do serviço, uma vez que os usuários requerem orientações sobre o tratamento durante o contato telefônico.Investigación cuasi experimental evaluando el impacto en la reducción del ausentismo de pacientes agendados para cirugía electiva, confirmando su presentación por vía telefónica. Estudio realizado en el Centro Quirúrgico del Hospital de Clínicas de la Facultad de Medicina de Botucatu, durante 30 días, involucrando a 89 pacientes. Los resultados indican la efectividad de la acción, que redujo el ausentismo en 30%. Se recomienda implementarla en la antevíspera de la cirugía, con tiempo para nuevos intentos de encontrar al paciente en domicilio o de convocar a otro. La creación de un centro de atención podría constituirse en un canal de comunicación institución-paciente, permitiendo la confirmación de la presencia, la oportunidad de subsanar dudas acerca del tratamiento y comunicar eventuales impedimentos para la cirugía. El centro demandaría de un profesional con habilidad y conocimiento del servicio, dado que los pacientes habitualmente solicitan orientaciones sobre el tratamiento durante el contacto telefónico.The objective of this quasi-experimental study was to evaluate the impact of telephone confirmation of attendance on the reduction of absenteeism of patients scheduled for elective surgery. The study was conducted at the Surgical Department of the Botucatu School of Medicine for 30 days and included 89 patients. Results showed the effectiveness of the intervention, which reduced absenteeism by 30.0%. Telephone confirmation two days prior to surgery is recommended, thus allowing enough time to place new calls to find patients at home, or schedule another patient in the event the patient cannot be reached. The creation of a service center could provide a communication channel between the institution and patients, and would enable the confirmation of patients' attendance, provide them with the opportunity to ask questions concerning the procedure and provide information regarding impediments to the surgery or preparations needed. The center would require a professional skilled and knowledgeable regarding the service, as it involves providing patients with information about their upcoming surgery during the telephone contact.

A antissepsia cirúrgica das mãos visa à prevenção de infecções do sítio cirúrgico, importante causa de morbimortalidade pós-operatória e aumento dos custos hospitalares. Este estudo teve como objetivo comparar a eficácia de preparações alcoólicas com os produtos tradicionais na antissepsia cirúrgica das mãos por meio de uma revisão sistemática da literatura. Foram considerados estudos primários ou secundários, tendo como desfecho a contagem microbiana das mãos ou taxas de infecções do sítio cirúrgico. A busca foi realizada no Portal BVS, PubMed, Ask e MEDLINE. Foram selecionados 25 estudos (2 revisões sistemáticas, 19 experimentais e 4 de coorte). As preparações alcoólicas tiveram uma redução microbiana igual e/ou maior aos produtos tradicionais em 17 estudos e inferior em 4; as taxas de infecções do sítio cirúrgico foram similares. Portanto, existem evidências científicas que suportam a segurança das preparações alcoólicas para antissepsia cirúrgica das mãos.La antisepsia quirúrgica de manos apunta a prevenir infecciones en el sitio quirúrgico, causa importante de morbi-mortalidad postoperatoria y aumento de costos hospitalarios. El estudio objetivó comparar la eficacia de preparaciones alcohólicas con los productos tradicionales de la antisepsia quirúrgica de manos, mediante revisión sistemática de la literatura. Fueron considerados estudios primarios o secundarios, teniendo como objetivo el recuento microbiano en manos o tasas de infecciones del sitio quirúrgico. La búsqueda fue realizada en las bases BVS, PubMed, Ask y MEDLINE. Fueron seleccionados 25 estudios (2 revisiones sistemáticas, 19 experimentales y 4 de cohorte). Las preparaciones alcohólicas consiguieron una reducción microbiana igual y/o mayor que los productos tradicionales en 17 estudios, e inferior en 4; las tasas de infección del sitio quirúrgico fueron equivalentes. Por lo tanto, existen evidencias científicas que dan soporte a la seguridad de las preparaciones alcohólicas para la antisepsia quirúrgica de las manos.Surgical hand antisepsis aims at preventing surgical site infections, an important cause of postoperative morbidity and mortality and escalating hospital costs. The objectives of this study were to compare the efficacy of alcohol preparations with traditional surgical hand antisepsis products by means of a systematic review of the literature. Primary and secondary studies were included, considering the microbial count or surgical site infection rates as outcomes. The search was performed on the BVS Portal, PubMed, Ask and MEDLINE. Twenty-five studies were selected (two systematic reviews, nineteen experimental and four cohort studies). The alcohol preparations promoted a microbial reduction equal to and/or greater than traditional products in 17 studies, and a lesser reduction in four studies; similar surgical site infection rates were identified. Therefore, there is scientific evidence that support the safety of alcohol preparations for surgical hand antisepsis.

Objective. To interpret the experience of being unconscious or alert from a group of patients during the surgical act and appreciations from the members of the nursing team on the same context. Methodology. Qualitative study focusing on grounded theory. Information was collected through a) observation and b) interviews to 20 patients, 19 nursing aides, and 8 nursing professionals who work in level II surgical centers in Valle de Aburrá, Colombia. Results. From being aware of everything to being at the mercy of another, during el intraoperative, the patient goes through different states of conscience, which means being subjected to total care. Instead, for the nursing personnel the same context implies different behavior going between two environments: the 'scenario' -when in front of the patient awake, which involves measured and diplomatic behavior; or, 'behind the scenes' - with the person under the effects of anesthesia - the behavior is more free and uninhibited. Conclusion. The intraoperative surgical context is different for patients and for the nursing team. However, it is necessary to bear in mind that they are caring for a human being who requires respect, dignified treatment, and that care must be promoted under an ethical perspective.Objetivo. Interpretar la experiencia de un grupo de pacientes con respecto al estar inconsciente o alerta durante el acto quirúrgico y las apreciaciones de los miembros del equipo de enfermería sobre el mismo contexto. Metodología. Estudio cualitativo con enfoque en la teoría fundamentada. La información se recolectó mediante a) observación y, b) entrevistas a 20 pacientes, 19 auxiliares de enfermería y 8 enfermeras, quienes laboran en centros quirúrgicos de segundo nivel del valle de Aburrá, Antioquia (Colombia). Resultados. Desde dándome cuenta de todo hasta estando a merced del otro, durante el transoperatorio, el paciente transita por diferentes estados de consciencia que le significa sujetetarse al cuidado total. En cambio, para el personal de enfermería el mismo contexto le implica un comportamiento diferente que se mueve entre dos ambientes: por una parte, el 'escenario' -cuando se está en frente del paciente despierto-, que involucra un comportamiento mesurado y diplomático; por otra, 'tras bastidores'-con la persona bajo los efectos de la anestesia- por el contrario, el comportamiento es más libre y desinhibido. Conclusión. El contexto quirúrgico transoperatorio es diferente tanto para los pacientes como para el equipo de enfermería. Sin embargo, es necesario tener presente que están al cuidado de un ser humano que requiere respeto y un trato digno. Por consiguiente, se debe promover un cuidado bajo una perspectiva ética.Objetivo. Interpretar a experiência de estar inconsciente ou alerta de um grupo de pacientes durante o ato cirúrgico e as apreciações dos membros da equipe de enfermaria sobre o mesmo contexto. Metodologia. Estudo qualitativo com enfoque na teoria fundamentada. A informação se coletou mediante a) observação e, b) entrevistas a 20 pacientes, 19 auxiliares de enfermaria e 8 enfermeiras que laboram em centros cirúrgicos de segundo nível do Vale de Aburrá, Colômbia. Resultados. Desde dando-me conta de tudo até estando a graça do outro, durante o transoperatório, o paciente transita por diferentes estados de consciência que lhe significa estar sujeito ao cuidado total. Em mudança, para o pessoal de enfermaria o mesmo contexto lhe implica um comportamento diferente que se move entre dois ambientes: o 'palco' -quando se está em frente do paciente desperto-, que envolve um comportamento mesurado e diplomático; em mudança, 'depois de bastidores'-com a pessoa sob os efeitos da anestesia- o comportamento é mais livre e desinibido. Conclusão. O contexto cirúrgico transoperatório é diferente para os pacientes e para a equipe de enfermaria. No entanto, é necessário ter presente que estão cuidando a um ser humano que requer respeito, trato digno e se deve promover um cuidado sob uma perspectiva ética.

This exploratory-descriptive study was carried out in the Surgical Center Unit of a university hospital aiming to measure time spent with concurrent cleaning performed by the cleaning service and turnover time and also investigated potential associations between cleaning time and the surgery's magnitude and specialty, period of the day and the room's size. The sample consisted of 101 surgeries, computing cleaning time and 60 surgeries, computing turnover time. The Kaplan-Meier method was used to analyze time and Pearson's correlation to study potential correlations. The time spent in concurrent cleaning was 7.1 minutes and turnover time was 35.6 minutes. No association between cleaning time and the other variables was found. These findings can support nurses in the efficient use of resources thereby speeding up the work process in the operating room.Este estudio exploratorio y descriptivo fue conducido en la Unidad de Centro Quirúrgico de un hospital de enseñanza teniendo por objetivos mensurar el tiempo utilizado para limpieza concurrente en sala de operación (por el Servicio de Higiene y Limpieza) y el intervalo entre las cirugías; e, investigar las asociaciones entre: tiempo de limpieza, porte de la cirugía, especialidad de la cirugía, período de ocurrencia y tamaño de la sala. El estudio fue constituido de 101 casos de limpieza (estudio de tiempo de limpieza) y 60 cirugías (estudio de intervalo entre cirugías). El método de Kaplan-Meier fue utilizado para el análisis del tiempo y la correlación de Pearson para el estudio de las asociaciones. El tiempo promedio de limpieza concurrente de la sala fue de 7,1 minutos y el del intervalo entre cirugías de 35,6 minutos. No fue encontrada correlación entre el tiempo de limpieza y las demás variables. Estos hallazgos instrumentalizan a los enfermeros en el uso eficiente de recursos, agilizando el proceso de trabajo en el Centro Quirúrgico.Este estudo exploratório-descritivo foi conduzido na unidade de centro cirúrgico de um hospital de ensino, tendo por objetivos: mensurar o tempo despendido para limpeza concorrente pelo Serviço de Higiene e Limpeza, em sala de operação, e o intervalo entre as cirurgias, e investigar a associação entre o tempo de limpeza e porte e especialidade da cirurgia, período de ocorrência e tamanho da sala. A amostra foi constituída por 101 (estudo tempo de limpeza) e 60 cirurgias (estudo intervalo entre cirurgias). O método de Kaplan-Meier foi utilizado para análise do tempo e a correlação de Pearson para o estudo das associações. O tempo da limpeza concorrente da sala foi de 7,1 minutos e o do intervalo entre cirurgias de 35,6 minutos. Não se encontrou correlação entre tempo de limpeza e demais variáveis. Esses achados instrumentalizam os enfermeiros no uso eficiente de recursos, agilizando o processo de trabalho em centro cirúrgico.

A hospitalização é uma experiência complexa, sendo agravada no caso de necessidade de intervenção cirúrgica, principalmente quando o paciente é criança. Quando a cirurgia é suspensa, paciente e seus familiares podem apresentar sentimentos de insegurança, angústia e ansiedade. Este estudo teve como objetivo identificar e descrever a percepção de quinze mães e/ou responsáveis por crianças de 0 a 18 anos, internadas em um hospital, após receberem a notícia de que a cirurgia de seu filho foi suspensa. É um estudo descritivo, qualitativo, que utilizou o referencial teórico da Comunicação Interpessoal e o metodológico da Análise de Conteúdo. Os resultados evidenciaram que as suspensões de cirurgias pediátricas são fatos presentes na instituição, que trazem repercussões ao paciente e familiares, e à organização institucional; que a comunicação entre profissionais da saúde, pacientes e familiares é inadequada; que a atuação do enfermeiro na notícia da suspensão da cirurgia precisa ser efetiva.La hospitalización es una experiencia compleja, agravada en el caso de ser necesaria una intervención quirúrgica, en particular cuando el enfermo es un niño. Cuando la cirugía es suspendida, el enfermo y sus familiares pueden manifestar sentimientos de inseguridad, angustia y ansiedad. Este estudio tuve como objetivo identificar e describir la percepción de quince madres y/o responsables por niños con edades entre 0 y 18 años internados en un hospital después de recibir la noticia de que la cirugía de su hijo fue suspendida. Se trata de un estudio descriptivo cualitativo que utilizó el referencial teórico de la Comunicación Interpersonal y la metodología del Análisis de Contenido. Los resultados evidenciaron que las suspensiones de cirugías pediátricas son hechos presentes en la institución, que traen repercusiones al enfermo y familiares y en la propia organización institucional, que la comunicación entre profesionales de la salud, enfermos y familiares es inadecuada y que la actuación del enfermero en la noticia de la suspensión de la cirugía debe ser necesariamente efectiva.Hospitalization is a complex experience; this can be made worse if surgical intervention is required, especially when the patient is a child. When surgery is suspended, patient and family can experience feelings of insecurity, distress, and anxiety. The objective of this study was to identify and describe the perceptions of fifteen mothers or guardians of children between 0 and 18 years old admitted in a teaching hospital, after receiving news that surgery for their child was suspended. This was a descriptive qualitative study which used Interpersonal Communication as theoretical reference and Analysis of Content as the methodology. Results showed that suspension of pediatric surgery in our institution causes repercussions to patients, their families, and institution organisation; that communication between health team professionals, patients and families is inadequate; and that the nurses' participation in informing surgery suspension must be effective.

Pesquisa qualitativa que objetivou caracterizar os elementos que integram o ambiente do Centro Cirúrgico e analisar suas implicações para a dinâmica de cuidar e de cuidados de enfermagem. Ancorou-se nos princípios da Teoria Ambientalista. Participaram 12 enfermeiras do centro cirúrgico de um Hospital Universitário do Rio de Janeiro. Os dados foram produzidos pela técnica de criatividade e sensibilidade "Mapa-Falante", entrevista semi-estruturada e observação participante; e analisados por categorias temáticas. Os resultados apontam que o cuidado ocorre direta e indiretamente, em prol da plena restauração do cliente, incluindo o ambiente que o integra, de modo a manter-se harmônico e equilibrado. As intervenções da enfermeira são no sentido de manter o ambiente em condições favoráveis de modo a torná-lo promotor de cuidados.Investigación cualitativa que objetivó caracterizar los elementos que integran el ambiente del quirófano y analizar sus implicaciones para la dinamica del cuidar y del cuidado de enfermería. Basada en los principios de la Teoría Ambientalista. Participaran 12 enfermeras del quirófano de un Hospital Universitario del Río de Janeiro. Los datos foran producidos por la técnica de creatividad y sensibilidad "Mapa-Hablante", entrevista semi estructurada y observación participante; y analizados por categorías temáticas. Los resultados apuntan que el cuidado ocurre directa e indirectamente, a favor de la plena restauración del cliente, incluyendo el ambiente que lo integra, de modo a mantenerse harmónico y equilibrado. Las intervenciones de la enfermera son en el sentido de mantener el ambiente en condiciones favorables de modo a tornalo promotor de los cuidados.The purpose of this qualitative research was to characterize the elements that constitute the environment of the Surgical Center and to analyze its implications for dynamic of care and nursing care. Based on the Environmental Theory's principals. Participated twelve nurses from the Surgical Center of a College Hospital in Rio de Janeiro. Data were gathered through the creativity and sensitivity technique "Map-Speaker", semi-structered interviews and participant observation, and were analyzed by thematic categories. The results showed that care can happen directly and indirectly in favor of full client recovery, counting the environment that the integrate in purpose to maintain harmonic and balanced. The nurse interventions aim to maintain the environment in favorable conditions so that a higher standard of care can be promoted.

This is a prospective study that focused on the dynamics of operating rooms using operational indexes that measure optimization, resistance, overload and utilization of the surgical unit, and also identified the factors most associated with these indexes. A total of 1,908 surgeries were analyzed over a period of two months in 2007. The average rates of utilization, optimization and resistance indexes were 80.41%, 65.35% and 34.65% respectively. The difference between the positive and negative overload index was low (5.42%). Operating room rescheduling and delays were the variables that contributed the most to the increase in these indexes. In the linear regression statistical model, the utilization rate was found to be the first common variable selected in the overload, resistance and optimization indexes. It is essential to work on these operational indexes with a view to obtain satisfactory results in the management of the surgical center, with well-defined work processes and teamwork.Se trata de un estudio prospectivo que analizó la dinámica de las salas quirúrgicas a través de índices operacionales que miden la optimización, resistencia, sobrecarga y ocupación del centro quirúrgico, y también identificó los factores que más se asociaron a esos índices. Fueron analizadas 1.908 cirugías, durante dos meses en el año de .2007. La tasa de ocupación y los índices de optimización y resistencia promedios encontrados fueron 80,41, 65,35 y 34,65%, respectivamente. La diferencia entre el índice de sobrecarga positivo y negativo fue bajo (5,42%). El cambio de sala y el atraso, respectivamente, fueron las variables que más contribuyeron para la elevación de esos índices. En la prueba estadística de regresión linear se observó que la tasa de ocupación fue la primera variable común seleccionada tanto en los índices de sobrecarga, resistencia y optimización. Es fundamental la actuación sobre eses índices operacionales para obtener resultados satisfactorios en la administración del centro quirúrgico, con procesos bien definidos y trabajo en equipo.Estudo prospectivo que analisou a dinâmica das salas cirúrgicas através de índices operacionais que medem a otimização, resistência, sobrecarga e ocupação do centro cirúrgico, e também identificou os fatores que mais se associaram a esses índices. Foram analisadas 1908 cirurgias, durante dois meses de 2007. A taxa de ocupação e os índices de otimização e resistência médios encontrados foram 80,41, 65,35 e 34,65%, respectivamente. A diferença entre o índice de sobrecarga positivo e negativo foi baixo (5,42%). O remanejamento de sala e o atraso, respectivamente, foram as variáveis que mais contribuíram para a elevação desses índices. No teste estatístico de regressão linear observou-se que a taxa de ocupação foi a primeira variável comum selecionada tanto nos índices de sobrecarga, resistência como otimização. É fundamental a atuação sobre esses índices operacionais para se obter resultados satisfatórios no gerenciamento do centro cirúrgico, com processos bem definidos e trabalho em equipe.

This study to do an analysis of the PONV`s importance, by nurses from the Dailys SurgeryRoom of an University Hospital, through forms distributed to them and to apply the written communicationinstrument on the PONV,proposed by NORONHA & ARAÚJO (1995). The results this research were: 92,9% ofthe nurses from the Dailys Surgery Room think that it is important the performance of the PONV to the patientand Nursing aid, and 85,7% think the PONV is important for the nurse who works in a Surgery Room. Thewritten communication instrument on the PONV was applied with success, being really easy to fill it in with clearquestions , showing so to be a lot of viable but some items of the instrument like blood group and FATOR RHcouldnt be filled even after the records check. In this way, I think it is worth the suggestion o9f sitting the writtencommunication instrument proposed by ARAÚJO AND NORONHA (1995) at this State University, proposinghowever, inclusion on the patients records data about blood group and FATOR RH.

O estudo identificou e descreveu os critérios adotados pelas enfermeiras na seleção dos fios de sutura cirúrgica para a elaboração da sua previsão e posterior provisão das Unidades de Centro Cirúrgico, segundo a natureza pública ou privada das instituições hospitalares. Os dados foram coletados por meio de entrevista estruturada e participaram do estudo 74 hospitais do município de São Paulo. A maioria dos hospitais pertence à rede privada e de porte médio, com Centro Cirúrgico geral e até 500 procedimentos/mês. A natureza determina a modalidade de aquisição, tipos de procedimentos cirúrgicos e a variedade de fios adquiridos. As enfermeiras participam dos processos de aquisição, distribuição e utilização de fios de sutura.El estudio identificó y describió los criterios adoptados por las enfermeras al seleccionar los hilos de sutura quirúrgica para hacer la planificación y posterior adquisición de los mismos para cada unidad de Cirugía, con variables según el tipo de institución hospitalaria, ya sea pública o privada. Los datos fueron obtenidos por medio de entrevistas estructuradas realizadas en 74 hospitales del municipio del Estado de São Paulo, Brasil. La mayoría de los hospitales de la red privada se clasifican como de porte medio, con una unidad de Cirugía General y hasta 500 procedimientos por mes. La naturaleza de la Institución determina la modalidad de adquisición, tipos de procedimientos quirúrgicos y la variedad de hilos de sutura adquiridos. Las enfermeras participan de los procesos de adquisición, distribución y uso de los hilos de sutura.The study has identified and described criteria adopted by the nurses in selecting and calculating quantities of surgical sutures to supply the Surgical Center, according to the public or private nature of the surgical centers. The data were collected using structured questionnaires in 74 hospitals within the municipality of São Paulo. The majority of hospitals are medium in size and privately owned with a general Operation Room and up to 500 surgical procedures performed per month. The procedures, the type and the variety of surgical sutures are related to the nature of hospital management. However, there are no criteria to select surgical sutures and their distribution in the operation rooms. The nurses participate on the procedures for purchasing, distribution and use of the surgical sutures.

O presente trabalho faz considerações sobre a representação social dos enfermeiros acerca da suspensão de cirurgias e suas atitudes diante do problema. Os dados foram coletados através de entrevistas com roteiro temático e posterior categorização das atitudes verbalizadas. Para a análise do conteúdo utilizou-se o referencial teórico das "Representações Sociais". Os resultados foram sistematizados obedecendo a uma Escala de Atitudes que variou desde a Passividade, com persistência de traços culturais de submissão, ligados a uma forma tradicional de exercício, até Ações ativas, autônomas, de enfrentamento, destinadas a resolver o problema da suspensão de cirurgias e/ou minimizar suas conseqüências.The present work make considerations about the nurses social representation of surgery suspension and their attitudes in front of the problem. The dates was collected through interviews whit thematic guide and later categorization of attitudes in front of the problem. By the analysis of the contents verbalized by nurses it was used the theoretical background of the Social Representations. The results was systematized in a Attitude Scale that varied from Passivity with persistence of cultural traces of submission, like a traditional form of working, to Active Actions, with autonomy, destined to resolve the problem of surgery suspension or reduced its consequences.

A partir da visão materialista-histórico e dialética do trabalho da Enfermagem como uma prática social inserida no modo de produção y capitalista brasileiro desta década de 80, este estudo, pela decomposição do trabalho do enfermeiro de centro cirúrgico em seus três elementos essenciais procurou apontar para a necessidade da compreensão não somente destes três elementos mas, principalmente, para o entendimento de suas relações super-estruturais mediadas pelo modo de produção brasileiro no sentido de, por meio desta praxis reflexiva, buscar uma síntese, entre o que tenho (o que é o trabalho do enfermeiro de centro cirúrgico) e o que quero, síntese esta que possibilite uma nova prática.

Este trabalho teve por finalidade verificar o número de hospitais com enfermeiras de centro cirúrgico, em São Paulo, que realizam a visita pré-operatória de enfermagem, procedimento este indispensável para assegurar ao paciente assistência contínua e centrada em suas necessidades. Os resultados mostraram que a maioria das enfermeiras, embora tendo conhecimento da importância desse procedimento, não o realizam.

Este trabalho apresenta uma proposta de modelo conceituai de assistência de enfermagem perioperatória, modelo este utilizado no desenvolvimento do processo ensino-aprendizagem da disciplina Enfermagem em Centro Cirúrgico da Escola de Enfermagem da USP, em fase de operacionalização dentro do Programa de Integração Docente-Assistencial no Hospital Universitário da USP. O modelo é descrito a partir de suas bases filosóficas, as finalidades, os objetivos e sua operacionalização.

ABSTRACT Aim: To evaluate the management modes in the workplace of the nursing staff of the surgical ward of a university hospital. Methods: Cross-sectional, descriptive, quantitative and analytical study performed in the Surgical Ward of a university hospital in southern Brazil. Sample consisted of 160 nursing workers who answered the Management Styles Assessment Scale. Comparisons were made using Student's t-test and One-Way analysis of variance (ANOVA), Pearson's chi-square test, multiple comparisons test and multiple linear regression analyzes. Results: The Collectivist style was classified as “Predominant” by 46.2% (72) of the workers. The Normative and Directive styles were rated as “Moderate Presence” by 53.2% (84) and 50.3% (77), respectively. The Individualist style was rated as “Unremarkable” by 60.6% (94) of the sample. Conclusions: The presence of collectivist management meets the characteristics of nursing work, which is patient care, planned and performed jointly and in line with the multiprofessional team in the pursuit of comprehensive care.

Objectives: To determine the level of occupational exposure to anesthetic gases in the absence of an extractor during pediatric anesthesia and to assess the efficacy of a purpose-built extraction system., Methods: The patients were 24 children undergoing tonsillectomy and adenoidectomy. Gases were extracted from the room for 1 group and were not extracted for the other group (n=12 in each group). Induction was with 8% sevoflurane, 60% nitrous oxide (N2O), 40% oxygen at a flow rate of 8 L x min(-1) through a Mapleson C circuit. Maintenance was with 2% sevoflurane at the same flow rate and gas mixture under spontaneous ventilation with an endotracheal tube and a Mapleson D circuit. The circuits were equipped with an airway pressure-limiting valve to allow connection to an anesthetic gas extractor. Ambient levels of sevoflurane and N2O were measured in the breathing area around the anesthesiologist. The surgeon and the nurse were asked about symptoms related to occupational exposure., Results: The mean (SD) exposure to N2O and sevoflurane in the group without an extractor was 423 (290) and 12 (10.9) parts per million (ppm), respectively. In the group working with the extractor, exposure was 94% and 91% lower: 24.7 (26) and 1.1 (1) ppm (P<.001). A higher incidence of noticing a "smell of gas" was registered for the group without an extractor (87% vs 11% in the extractor group, P=.003). Higher rates were also found for general discomfort (62% vs 11%, P=.05), nausea (62% vs 0%, P=.009), and headache (62% vs 0%, P=.009) in the absence of the extractor., Conclusions: Gas extraction decreased the level of exposure by up to 94%, achieving levels that were below the recommended limits and greatly reducing occupational risk.

Latest statistics show worrying figures about labour accidents and illnesses in surgical nursery, due to the lack of preventing measures or unsuitable working conditions. Actually the duties of a scrub nurse bring an important static physical burden and the fulfilment of reiterative movements, as well as environmental conditions that may raise the provability of the development of skeletal muscular diseases in a medium-long time. In order to monitor the correct accomplishment of preventing rules related to working postures and the handling of heavy loads and identify risk factors that may lead to these disorders and asses symptoms related to inadequate positions and/or heavy efforts, a descriptive quantitative study was carried out over 24 theatre nurses from 2 hospitals in Murcia. According to the gathered information, analysed with the statistic program SPSS, the adopted measures to avoid risks are inadequate and insufficient. The inquired population adopt unsuitable postures in a high proportion moreover, what let us establish a significant correlation with the obtained information referred to the posture adopted. As a result, we cannot any longer state that scrub nurses are undergoing the established preventive rules in order to avoid those symptoms associated to the kind of job they carry out. To sum up we believe as very necessary to improve the scrub nurses' quality of work life, the removal of risk factors and the supply of suitable instrumental, drawing up a protocol of safety and working behaviours as well as offering seminars to teach that protocol.