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Background:Central venous catheter–related bloodstream infection is an important adverse event in health care. Molecular methods are not yet substitutive of microbiological in the detection of the pathogens responsible for the infection, but they can help in the epidemiological characterization.Aim:To detect bacteria by polymerase chain reaction, from material extracted from the tip of central catheters of patients suspected of infection at the intensive care unit.Methods:Catheters (n = 34) of patients suspected of central venous catheter–related infection were analyzed by polymerase chain reaction. The findings were compared with culture of catheter tip and blood cultures performed by the hospital.Findings:The prevalence of bacteria was Staphylococcus aureus (50%), Enterococcus faecalis (41.2%), Klebsiella pneumoniae (32.4), Pseudomonas aeruginosa (20.6%), Acinetobacter baumannii (38.2%), Escherichia coli (2.9%), and Enterobacter cloacae (0%). No blood culture showed bacterial growth, the culture of catheter tip revealed bacteria in 21 (61.8%) and the polymerase chain reaction had positivity in 31 (91.2%) of the catheters. The mean central venous catheter time was 11 days, and the jugular vein was the site of insertion.Conclusion:The molecular method identified more bacteria than microbiological methods and revealed colonization of the catheters. The most commonly found bacteria are in the environment and in the microbiota of the skin, which suggests contamination by the hands of health professionals and points out the need for more efforts in preventive strategies.

The central venous catheter that is inserted in patients undergoing hemodialysis can cause hemodynamic instability and trigger complications such as thrombus formation. The objective of this study was to investigate hemostatic and numerical influences on thrombus formation in patients undergoing hemodialysis with a central venous catheter. Participants were assigned to three groups: I: clinical and laboratorial healthy individuals matched by sex and age (controls); II: participants after one month of insertion of the catheter and III: participants after 4 months of insertion of the catheter. Platelet activation was investigated by GPIIb/IIIa and p-selectin expressions using flow cytometry. A three-dimensional model of the catheter was constructed in the numerical simulation for the calculation of partial differential equation of a platelet activation model. A significant difference was detected by the expression of p-selectin comparing the group I (33.42 ± 4.74), group II (40.79 ± 5.54) and group III(51.00 ± 7.21) (p < 0.0001). The median values for GPIIb/IIIa were 10426 (10029-10721), 13921 (13412-15652) and 19946 (18714-21815) after catheter insertion (p < 0.0001), for groups I, II and III, respectively. Excluding the first arterial orifice, venous orifices tend to have greater platelet activation when compared to the other arterial orifices. The results of this study showed the influence of arterial and venous lateral orifices in stimulating the development of thrombi associated with the activation of platelet markers the longer the catheter was used

RESUMO Objetivo: determinar a incidência e os fatores associados da infecção de sítio cirúrgico em osteossíntese de fêmur em uma unidade hospitalar filantrópica no interior de Minas Gerais - Brasil. Método: estudo transversal, descritivo e retrospectivo conduzido no período de 2 de fevereiro de 2017 a 31 de março de 2019. Os dados foram extraídos dos prontuários e das fichas de notificação das infecções relacionadas à assistência à saúde. Resultados: a incidência de infecções de sítio cirúrgico foi de 5,5%. 46,7% dos pacientes foram reinternados, 26,7% fizeram desbridamento cirúrgico e o tempo médio da internação foi de 13,5±6,2 dias. Não houve registro de óbitos. A profilaxia antimicrobiana foi observada em 80% dos pacientes. Resultados: reporte de experiencia de los diez años de implementación del programa de residencia. Los datos se obtuvieron de documentos internos e informes de coordinadores y tutores. Se capacitó a trescientos setenta y dos profesionales. Entre los avances del programa, cabe destacar el incremento en el número de vacantes y especialidades, la consolidación del Reglamento Interno, la gestión computarizada de la información académica, el incentivo a la investigación y el mejoramiento de la asistencia en el ámbito hospitalario. Conclusão: o estudo contribuiu para a geração de indicadores de saúde e de avaliação que proporcionaram o rastreamento das infecções de sítio cirúrgico e vigilância ativa para a construção de estratégias de prevenção de eventos adversos institucionais. RESUMEN Objetivo: determinar la incidencia y los factores asociados a la infección del sitio quirúrgico en osteosíntesis femoral en una unidad hospitalaria filantrópica del interior de Minas Gerais - Brasil. Método: estudio transversal, descriptivo y retrospectivo realizado en el periodo comprendido entre el 2 de febrero de 2017 y el 31 de marzo de 2019. Los datos se extrajeron de las historias clínicas y de los formularios de notificación de infecciones relacionadas con la atención sanitaria. Resultados: la incidencia de infecciones del sitio quirúrgico fue del 5,5%. El 46,7% de los pacientes reingresaron, el 26,7% fueron sometidos a desbridamiento quirúrgico y la duración media de la estancia fue de 13,5±6,2 días. No había registro de muertes. La profilaxis antimicrobiana se observó en el 80% de los pacientes. Conclusión: el estudio contribuyó a la generación de indicadores de salud y evaluación que proporcionaron el seguimiento de las infecciones del sitio quirúrgico y la vigilancia activa para la construcción de estrategias de prevención de eventos adversos institucionales. ABSTRACT Objective: to determine the incidence and associated factors of surgical site infection in femoral osteosynthesis in a philanthropic hospital unit in the interior of Minas Gerais - Brazil. Method: cross-sectional, descriptive, retrospective study conducted from February 2, 2017, to March 31, 2019. Data were extracted from medical records and health care-related infection notification forms. Results: the incidence of surgical site infections was 5.5%. 46.7% of the patients were readmitted, 26.7% had surgical debridement and the mean length of stay was 13.5±6.2 days. No deaths were reported. Antimicrobial prophylaxis was observed in 80% of the patients. Conclusion: the study contributed to the generation of health and evaluation indicators that provided the tracking of surgical site infections and active surveillance for the construction of strategies to prevent institutional adverse events.

Objetivo: Avaliar, na literatura, os protocolos disponiveis sobre descontaminacao/reutilizacao das mascaras N95 em tempos de pandemia da Covid-19. Metodo: Revisao integrativa, no periodo de 2010 a 2020 nas bases de dados MEDLINE/PubMed, Science Direct, Cochrane, SAGE journals,Web of Science, Scopus, Embase e Wiley, com os descritores Masks AND Respiratory protective devices; Mask OR N95 AND Covid-19; N95 AND Respirators; Decontamination AND N95 AND Coronavirus; Facemask OR Pandemic. Resultados: Incluiram-se 12 estudos, dos quais 3 (30,0%) utilizaram irradiacao germicida ultravioleta e indicaram deterioracao da mascara entre 2 a 10 ciclos, 4 (40,0%) utilizaram o vapor de peroxido de hidrogenio e a perda da vedacao variou de 5 a 20 ciclos, 4 (33,3%) avaliaram a integridade estrutural por meio de inspecao visual e 6 (54,4%), a eficiencia da filtracao da mascara N95. Conclusao: Estrategias de reutilizacao para suprir a escassez de dispositivos diante da pandemia desafiam o conceito vigente para as boas praticas do processamento de produtos para saude. Palavras-chave: Mascaras. Dispositivos de protecao respiratoria. Descontaminacao. Coronavirus. Infeccoes por coronavirus. Pandemias

The therapeutic benefits of LED in wound care have been reported since the 1990s. Nevertheless, studies directly related to the effects of LED phototherapy on the venous and arterial circulation and the healing process of pressure injuries are scarce in literature. Thus, the aim of this study was to evaluate the efficacy of a LED phototherapy prototype in participants with pressure injuries. In this pilot study 15 participants were randomized into three therapeutic groups. The experimental groups received applications of 630 and 940 nm LED three times a week for 8 weeks, with a dose of 6 J/cm2 in Group I. In group II, a dose of 8 J/cm2 in addition to the standard treatment. Group III (control group) received only daily standard treatment which consisted of cleaning the lesioned area with physiological solution, followed by application of an alginate hydrogel dressing over a period of 8 weeks. Pressure injuries were photographed and the area was measured by the Quantikov® image analyzer software. There was no statistically significant difference (p > 0.05) between the three groups when assessing the initial lesion area. At the end of 2 months, the median and interquartile ranges of the injuries were 5.90 (0.79–9.5) cm2 for group I, 0.54 (0.47–1.16) cm2 for group II and 26.76 (17.25–41.05) for group III. There was a statistically significant difference between treatment types (I x III and II x III) for pressure injuries over the 21 sessions. However, there was no significant difference between groups I x II that received different doses of LED phototherapy. The initial hypothesis was supported given that the combination of two wavelengths in the LED phototherapy with different doses may be helpful in accelerating the healing of pressure injuries.

Objective: to analyze the COVID-19 pandemic and what we have (re)learned from the world experience of adopting prevention measures recommended by the World Health Organization as well as the epidemiological overview in the world, in Latin America and in Brazil. Results: the World Health Organization has pointed out that the path to reduce the speed of circulation of the virus, control and decrease in the number of cases and deaths resulting from this pandemic can only be accomplished with mass adoption of fundamental measures that include hand hygiene, alcohol gel use, cough etiquette, cleaning surfaces, avoiding agglomerations and social distancing. The epidemiological curve of the disease clearly shows the devastating proportions in Italy, Spain and the United States, surpassing China in death records, due to the delay in adopting the aforementioned measures. In Brazil, the rapid progression in relation to the world and Latin America points to an important increase in the number of cases. Conclusion: this is possibly the most serious pandemic in recent human history, and its course can be influenced by the rigor in adopting individual and collective behavioral measures.

Objetivo: caracterizar as internações por condições sensíveis à atenção primária de um município do interior de Minas Gerais, Brasil. Método: estudo transversal, descritivo, com coleta de dados secundários de prontuários, provenientes de internações hospitalares. Foi elaborado um formulário de coleta estruturado em três blocos: sociodemográficos; relacionados à anamnese; e relacionados a internação. Foram realizadas as frequências absolutas e relativas das variáveis e utilização do Qui-quadrado de Pearson e o Exato de Fisher, considerando o nível de significância de 5%. Resultados: Foram identificados 663 prontuários, com predomínio de pacientes ≥ 60 anos (70.7%), sexo feminino (54,1%), raça/cor parda e preta (69,5%) e sem registro referente a presença ou ausência de fatores de risco (28,5%). Predominaram os diagnósticos de acidentes vasculares e insuficiência cardíaca congestiva ambos com 13,3%, pneumonia (11,0%), angina (9,5%) e doença bronco pulmonar obstrutiva crônica com 8,4% dos casos. Entre os 45 casos (6,8%) de óbito, 19 (42,2%) foram pacientes que não pertenciam à área com cobertura da equipe de Estratégia de Saúde da Família do município. Conclusão: Os resultados contribuirão para uma adequação e qualificação da gestão dos serviços de saúde e melhor planejamento dos cuidados prestados, assim como, a definição de indicadores de desempenho para atenção primária à saúde da região para que sejam controladas e reduzidas as taxas de hospitalizações evitáveis.

Background and objectives: In the prevention of adverse events associated with bloodstream infections, the hand Hygiene (HM) is one of the priority measures in actions aimed at patient safety. The objective was to verify the challenge for the implementation of bundles for the prevention of blood infection associated with the central venous catheter. Methods:Exploratory-descriptive quantitative cross-sectional study, performed at the intensive care unit of a philanthropic hospital in the interior of Minas Gerais. A multiprofessional team was directly observed by means of a data collection instrument that contained variables such as HM in medication administration, exchange of dressings and insertion of the catheter. Pearson's chi-square test was used when the expected value was> 5 and Fisher's exact test for the expected value

The present study aimed to numerically simulate blood flow within central venous catheters of hemodialysis and its thrombogenic potential. Numerical simulation research performed through the dynamic computational program of fluids. A three-dimensional geometry of right and left internal jugular veins were built, taken from the Visible Human Project®. Catheters with obstructed and unobstructed lateral holes were constructed. For the simulation, we considered the duration of the cardiac cycle of 0.8 s with pulsatile cycle of 75 beats per minute. Shear stress, velocity and pressure increased when the catheter was within the vein and when they were obstructed. At the venous orifice of the catheter that was unobstructed, the velocity increased from 0.99 ± 0.02 m s-1 to 1.79 ± 0.009 m s-1 and the pressure from 1487 ± 0.8 Pa to 3215 ± 0.7 Pa. Blood re-circulation areas have created areas of stagnation of blood flow, making it more susceptible to the development of venous thrombi. This study may contribute to the expansion of multiprofessional partnerships between health professionals and Bioengineering fields in order to study health problems that can be verified through advanced technologies. Such technologies, such as simulation programs, detail possible adverse events based on scientific evidences which often occur silently in patients.

Objetivo: o objetivo deste estudo foi avaliar as medidas de vigilância e prevenção de infecções deferidas cirúrgicas em um hospital filantrópico no interior de Minas Gerais.Método: estudo quase-experimental realizado nas fases pré-intervenção, intervenção e pósintervenção.O teste qui-quadrado de Pearson foi utilizado quando o valor esperado era >5 e oteste exato de Fisher para o valore previsto 5y el test exacto de Fisher para valor previsto 5 and Fisher’sexact test for the expected value

This paper presents for the first time a numerical prediction of the thrombogenic potential by means of partial differential equation in computational fluid dynamics for cardiovascular devices. To quantify the thrombogenic potential was developed the Platelet Lysis Index equation in an Eulerian model. Six different catheter tip models with the results obtained from the literature, however, with Lagrangian approach were compared. Three-dimensional computational fluid dynamics was done with a realistic central venous catheter model. The partial differential equation covers the entire computational domain, allowing the visualization of the regions with the highest platelet activation. In the realistic catheter, the first arterial proximal hole was the region with the highest Platelet Lysis Index and shear rate. Despite all limitations and considerations, the use of the Eulerian model allows a quick numerical comparison of the thrombogenic potential of cardiovascular device, being a useful tool in its design.

The formation of thrombi in medical devices that come into contact with blood is a common cause of increased morbidity and mortality. Prolonged use of central venous catheters (CVCs) may cause high infection rates or compromise CVC patency due to thrombus development. In this study, we sought insights into possible changes in the hemostatic system during prolonged use of inserted CVCs for hemodialysis by assessing platelets by CD62P and CD41a expression and the potential for thrombin generation (TG). This study included patients with chronic renal failure who were undergoing hemodialysis three times a week using a CVC, and healthy subjects as controls. The participants were distributed into three groups: Group 1: clinically and laboratorially healthy individuals matched by sex and age to the patients (controls); Group II: patients who had completed 1 month of CVC insertion; and Group III: the same patients after they had completed 4 months of CVC insertion. Platelet activation analysis and TG evaluation were performed using blood samples obtained through two different accesses, that is, through a peripheral vein and directly from the CVC lumen. The data showed platelet activation and an increase in the generation of thrombin, particularly after 4 months of CVC use. The results also indicated that insertion of the catheter into the blood stream stimulated the intrinsic rather than the extrinsic pathway. Taken together, the data showed a direct relationship between the use of CVCs in hemodialysis patients and a state of hypercoagulability, most likely associated with endothelial damage and the contact of the medical device with blood components such as platelets and coagulation factors.

OBJECTIVE Evaluating thrombi microstructure developed in central venous catheters using confocal and electron microscopy. METHOD An experimental, descriptive study carrying out a microstructural evaluation of venous thrombi developed in central venous catheters using Scanning Electron Microscopy and Confocal Laser Scanning Microscopy. RESULTS A total of 78 venous catheters were collected over a period of three months. Different fibrin structures were distinguished: fibrin plates, fibrin network, and fibrin fibers. It was observed that the thrombus had thick fibrin plates adhered to the catheter wall openings in both a catheter with three days of permanence as well as in a catheter with 20 days of insertion in the patient. However, a greater amount of erythrocytes and fibrin fibers were found in the central region of the thrombus. CONCLUSION This study contributes to improving health care and can have a positive impact on clinical practice, as easy adherence of platelets and fibrins to the catheter wall demonstrated in this study makes it possible to adopt thrombus prevention strategies such as therapy discontinuation for an extended period, blood reflux by a catheter, slow infusion rate and hypercoagulo pathyclinical conditions. Resumen OBJETIVO Evaluar la microestructura por microscopia confocal y electrónica en trombos desarrollados en catéteres venosos centrales. MÉTODO Investigación experimental, descriptiva en que se hizo una evaluación microestructural de trombos venosos desarrollados en catéteres venosos centrales por Microscopia Electrónica de Barrido y Microscopia Confocal de Barrido con Láser. RESULTADOS Fueron recolectados 78 catéteres venosos centrales en un período de tres meses. Se distinguieron distintas estructuras de fibrina: la placa de fibrina, la red de fibrina y las fibras de fibrina. Se observó que, tanto en un catéter con tres días de permanencia como en un catéter con 20 días insertado en el paciente, el trombo presentó placas de fibrina espesas adheridas a las paredes de los orificios de los catéteres. En la región central del trombo, no obstante, se observó mayor cantidad de eritrocitos y fibras de fibrina. CONCLUSIÓN El trabajo contribuyó para una mejoría de la asistencia sanitaria y puede generar un impacto positivo en la práctica clínica, toda vez que la facilidad de adherencia de plaquetas y fibrinas a la pared del catéter demostrada en este estudio posibilita la adopción de estrategias de prevención del trombo, tales como la interrupción de terapia por tiempo prolongado, el reflujo de sangre por el catéter, la velocidad lenta de infusión y los estados clínicos de hipercoagulopatía. Resumo OBJETIVO Avaliar a microestrutura por microscopia confocal e eletrônica em trombos desenvolvidos em cateteres venosos centrais. MÉTODO Pesquisa experimental, descritiva, em que foi feita uma avaliação microestrutural de trombos venosos desenvolvidos em cateteres venosos centrais por Microscopia Eletrônica de Varredura e Microscopia Confocal de Varredura a Laser. RESULTADOS Foram coletados 78 cateteres venosos centrais num período de três meses. Distinguiram-se diferentes estruturas de fibrina: a placa de fibrina, a rede de fibrina e as fibras de fibrina. Observou-se que tanto em um cateter com três dias de permanência quanto em um cateter com 20 dias inserido no paciente o trombo apresentou placas de fibrina espessas aderidas às paredes dos orifícios dos cateteres. Na região central do trombo, no entanto, observou-se maior quantidade de eritrócitos e fibras de fibrina. CONCLUSÃO O trabalho contribui para uma melhoria da assistência à saúde e pode gerar um impacto positivo na prática clínica, uma vez que a facilidade de aderência de plaquetas e fibrinas à parede do cateter demonstrada neste estudo possibilita a adoção de estratégias de prevenção do trombo, tais como a interrupção de terapia por tempo prolongado, o refluxo de sangue pelo cateter, a velocidade lenta de infusão e os estados clínicos de hipercoagulopatia.

Although catheters with side holes allow high flow rate during hemodialysis, they also induce flow disturbances and create a critical hemodynamic environment that can favor fibrin deposition and thrombus formation. This study compared the blood flow and analyzed the influence of shear stress and shear rate in fibrin deposition and thrombus formation in nontunneled hemodialysis catheters with unobstructed side holes (unobstructed device) or with some side holes obstructed by blood thrombi (obstructed device). Computational fluid dynamics (CFD) was performed to simulate realistic blood flow under laminar and turbulent conditions. The results from the numerical simulations were compared with the fibrin distribution and thrombus architecture data obtained from scanning electron microscopy (SEM) and two photons laser scanning microscopy (TPLSM) on human thrombus formed in catheters removed from patients. CFD showed that regions of flow eddies and separation were mainly found in the venous holes region. TPLSM characterization of thrombi and fibrin structure in patient samples showed fibrin formations in accordance with simulated flux dynamics. Under laminar flow conditions, the wall shear stress close to border holes increased from 87.3 ± 0.2 Pa in the unobstructed device to 176.2 ± 0.5 Pa in the obstructed one. Under turbulent flow conditions, the shear stress increased by 47% when comparing the obstructed to the unobstructed catheter. The shear rates were generally higher than 5000/s and therefore sufficient to induce fibrin deposition. This findings were supported by SEM data documenting a preferential fibrin arrangement on side hole walls.

Purpose Despite the increasing use of central venous catheters (CVC) for hemodialysis in clinical practice, the role of CVC in thrombus development is poorly understood. This work aims at defining new methods and protocols for assessing the micromorphology and composition of thrombi formed into tunneled and non-tunneled hemodialysis CVC removed from patients. Methods Twenty-nine CVCs were collected and the microscopic features of intra-luminal thrombi were quantified by scanning electron microscopy (SEM) and visualized by two photon laser scanning microscopy (TPLSM). Results SEM quantification showed that fibrin was the most abundant structure in CVC thrombi. Specifically, the median micromorphologic composition of the surface layer resulted in: 42.6% of fibrin plaque, 16.3% of fibrin network, 0.4% of fibrin fibers, 9.3% of platelets, 10.3% of erythrocytes and 1.7% of white blood cells. TPLSM showed that sub-surface layers were instead composed by smaller amounts of fibrin and platelets and higher amounts of blood cells. Conclusions Integration of SEM and TPLSM was found to be an excellent tool for characterizing thrombi in hemodialysis CVC removed from patients. Protocols and techniques presented here may be useful in the development and testing of new strategies for limiting thrombus formation on vascular access because of CVC.

Purpose Fibrin deposition and thrombotic occlusion represent a serious cause of access dysfunction in hemodialysis central venous catheters (CVCs). The aim of this work was to define and apply a method for imaging and quantifying fibrin in thrombi formed into the side holes of CVCs. Methods Forty-three CVCs removed from a cohort of dialyzed patients were analyzed in this pilot study. Hematoxylin and eosin and a modified Carstair's staining were applied on permanent thrombus sections. Fluorescence microscopy and image analysis were performed to quantify the fibrin amount. Results Highly fluorescent areas were invariably associated with fibrin by Carstair's method. The deposition of concentric layers of fibrin and erythrocytes was easily identified by fluorescence microscopy, showing growth features of the thrombus. Fibrin amount in diabetic patients was significantly higher than that in nondiabetic patients with median (interquartile range) values of 51% (47-68%) and 44% (30-54%), respectively (p=0.032). No significant difference in fibrin content was found by grouping data according to catheter type, permanence time, insertion site and dialysis vintage. Higher variability in fibrin values was found in thrombi from CVCs removed after 1-15 days compared with 16-60 days. A trend of an increase in fibrin amount in thrombi was noted according to blood platelet count at CVC insertion. Conclusions The analytical method presented here proved to be a rapid and effective way for quantifying fibrin content in thrombi formed on CVCs with potential application in future clinical studies.

It was aimed at knowing the participation of the professionals in training about infections hospitals, cognitives and behavior aspects to adoption of the precaution and a perception regarding the activities that designates the CCIH. It was a descriptive study carried out in a public hospital in the period from july to November 2006. 159 health care workers took part of the study: 59,1% nursing technicians, 18,9% physicians,13,8% nurses, 5,0% nursing auxiliaries and 3,1% physiotherapeutics. It was verified that for 37,7% of the professionals the CCIH promotes training, but 56,6% never took part on them; 90,6% admitted the indication of the handwashing, however only 46,5% had known the type of the EPI to be used in the colonized patient healthcare and just 17% the type of the precaution to be established for this patient. Concerning the activities that designates the CCIH it was distinguished the training of the professionals and the infections control; the non-adoption of precautions among the professional was justified by inadequate training and knowledge lack. This study contributes for redefinition of the training strategies together the healthcare workers team, favouring the attention for precautions recommendations during the care.