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Despite a great number of studies regarding the favorable correlation between higher dialysis dose and the clinical efficiency of the hemodialysis treatment, the effect dialyses flow rate inside the catheter has been few investigated in the perspective of the hemodynamics modifications in central venous access for hemodialysis. This study proposes the numerical simulation and na in-vitro experimental validation of this model to assess the hemodynamic behavior and the thrombogenic potential in central venous access for hemodialysis, using different flow rates values in the central venous catheter (200, 250, 300, 350 and 400 mL/min). A mathematical model based in the Eulerian formulation was implemented in the solver subroutine to calculate the platelet lysis index (PLI). The pressure drop values obtained by numerical and experimental models were compered in order to validate the numerical model. The maximum percentage difference between those models was less than 13%. The flow rates values of 250, 300 and 350 mL/min resulted in larger recirculation zones in the flow field. It was possible to conclude that, in general, shear stresses and turbulence intensity increased in a quadratic manner with dialysis dose. The platelet lysis index increased with the dialysis flow rate and showed higher values in instants of time associated with major recirculation zones.

Introduction Understanding the different transmission routes of SARS-CoV-2 is crucial in planning effective interventions in healthcare institutions. This study aimed to evaluate the presence of SARS-Cov-2 genome on inanimate surfaces in COVID-19 intensive care unit and emergency care cohorts. Methods This is a prospective cross-sectional study. Samples of the environmental surface of objects and furniture were collected between July 15 and October 15, 2020, at COVID-19 intensive and emergency care units. The presence of SARS-CoV-2 genome was determined by quantitative RT-qPCR. The positivity rate for SARS-Cov-2 genome is presented as the arithmetic mean of the sum of the values obtained in each collection. Values of 1.0, 0.5, and 0.0 were assigned for positive, indeterminate, and negative events, respectively. Results In the intensive care unit, 86% of samples collected at the stethoscope and bed rail surfaces were positive. In the emergency care unit, 43% of bathroom tap, bed rails, and bedside table samples were positive. SARS-CoV-2 genome was not detected at the computer mouse and keyboard. At the emergency care unit, 14.3% of the samples from the collection room armchair were positive. Conclusions SARS-CoV-2 genome can be found at the environmental surface of objects and furniture at COVID-19 care units. They can represent a potential source of indirect transmission pathway for COVID-19, especially within health service institutions.

Objetivo: avaliar o conhecimento dos pacientes com doença renal crônica terminal quanto aos fatores de risco e complicações associadas antes e após uma intervenção educativa. Método: estudo de intervenção, randomizado com 101 participantes subdivididos em dois grupos de um setor de hemodiálise entre 2019 a julho de 2020. Para as análises fizeram-se testes McNemar, t-Student pareado, Qui-Quadrado de Pearson e Exato de Fisher, com nível de significância de 5%. Resultados: após intervenção, houve diminuição significativa (p

Failure to mature the fistula in patients undergoing hemodialysis leads to prolonged use of the central venous catheter (CVC) and can compromise the patency of the catheter and the arteriovenous fistula (AVF) due to thrombus development.To evaluate hemostatic changes in patients undergoing hemodialysis with prolonged use of CVC or AVF.Cross-sectional study with a total of 200 adult participants who were divided into the following groups: I:control; II: patients who had 5-8 months of CVC insertion; III: patients who had 9-36 months of insertion; IV patients who had 5-8 months of AVF; and V: patients who had 9-36 months of AVF. Platelet activation was investigated by expressions of GPIIb/IIIa and p-selectin using flow cytometry. The Elisa-thrombomodulin (TM) test was used to compare groups III and V.The p-selectin percentage expression of group I was 15.30 (12.30-16.80), II 23.25 (20.75-30.55); and III 54.00 (44.75-59.29) were significant (p 0.001). Groups I, IV, and V were also significant (p 0.001). The median fluorescence for GPIIb/IIIa for groups I, II, and III were significant (p 0.0001). As for the Elisa test, an increased absorbance of TM was verified in patients who used the CVC 4372 (3951-4733) compared with those patients who used the AVF 2162 (1932-2485) (p 0.0001).It can be concluded that CVC patients had a larger platelet expression of GPIIb/IIIa and p-selectin than AVF patients. The high concentration of TM in CVC patients may suggest a greater stimulation of the intrinsic than extrinsic coagulation pathways.

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.

Objective: to know the factors that exert an influence on the health professionals’ perception of the risk of becoming contaminated with COVID-19 in Brazil. Methods: a survey conducted from May to October 2020 with 436 active health professionals working in the front line against COVID-19. Descriptive analyses were used and a structural equation model from an exploratory factor analysis was estimated. Results: the health professionals’ perception on contracting COVID-19 was considered as medium to very high for 72% of the respondents. In the structural equation model, knowledge of the treatment for COVID-19, preparation of the health professionals to work, and safety in the institutional protocol together with confidence in official protocols and disclosures through social, printed and television media exerted an influence on confidence to face the pandemic (P

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

Objective: to verify the impact of the bundles and the interprofessional learning for the prevention of mechanical ventilation-associated pneumonia of an intensive care unit (ICU). Methodology: This was a quasi-experimental study performed in an ICU of a public hospital in Diamantina, Minas Gerais. Were included in this study 56 professionals who provided direct assistance to patients in mechanical ventilation. The data collection took place in three phases: pre-intervention, which consisted of direct observation and interview; intervention, in which training was performed through clinical simulations; and post-intervention, in which the impact of the strategies implemented through direct observation, was evaluated. Differences between pre and post groups were assessed using McNemar’s test. An alpha level of 0.05 set a priori was used, and a Bonferroni correction determined statistical significance for the case of multiple comparisons. Results: After the intervention, there was increased adherence to endotracheal cuff pressure (8.10%), daily interruption of sedation (16.67%) and subglottic aspiration (18.75%). It was significant (p < 0,0083) in the associations between the professional category versus non-aspiration, bed head positioning, oral hygiene frequency and the type of hand hygiene after intervention. Conclusions: There is still a gap to be detected in the bundle implementation and the positive impact generated by the inter-professional knowledge, mainly because it is not immediate but in the long term to obtain the desired feedback. Descriptors: Pneumonia, Ventilator-Associated; Patient Care Bundles; Infection Control; Quality Improvement; Public Health Surveillance; Intensive Care Units. O IMPACTO DA APRENDIZAGEM INTERPROFISSIONAL NA PNEUMONIA ASSOCIADA A VENTILADORES: IMPLEMENTACAO DE BUNDLES EM UMA UNIDADE DE CUIDADOS INTENSIVOS Objetivo: verificar o impacto dos bundles e o aprendizado interprofissional para a prevencao da pneumonia associada a ventilacao mecânica de uma Unidade de Terapia Intensiva (UTI). Metodo: estudo quase-experimental realizado em uma UTI de um hospital publico de Diamantina, Minas Gerais. Foram incluidos neste estudo 56 profissionais que prestaram assistencia direta aos pacientes em ventilacao mecânica. A coleta de dados ocorreu em tres fases: pre-intervencao, que consistiu em observacao direta e entrevista; intervencao, na qual foi realizado treinamento por meio de simulacoes clinicas; e pos-intervencao, em que foi avaliado o impacto das estrategias de observacao direta. As diferencas entre os grupos pre e pos foram avaliadas pelo teste de McNemar. Um nivel alfa de 0,05 a priori foi usado, e a correcao de Bonferroni determinou significância estatistica para o caso de comparacoes multiplas. Resultados: Apos a intervencao, houve aumento da adesao ao monitoramento da pressao do cuff endotraqueal (8,10%), interrupcao diaria da sedacao (16,67%) e aspiracao subglotica (18,75%). Foi significante (p < 0,0083) as associacoes entre a categoria profissional versus a nao aspiracao, posicionamento da cabeceira da cama, frequencia de higiene bucal e o tipo de higienizacao das maos apos a intervencao. Conclusoes: Ainda existe uma lacuna a ser detectada na implantacao do bundle e o impacto positivo gerado pelo conhecimento interprofissional, principalmente por nao ser imediato, mas a longo prazo, para obtencao do feedback desejado. Palavras-chave: Pneumonia Associada a Ventilacao; Bundles de Assistencia ao Paciente; Controle de infeccao; Melhoria da qualidade; Vigilância em saude publica; Unidades de Terapia Intensiva. EL IMPACTO DEL APRENDIZAJE INTERPROFESIONAL EN LA NEUMONIA ASOCIADA A VENTILADORES: APLICACION DE PAQUETES EN UNA UNIDAD DE ATENCION INTENSIVA Objetivo: verificar el impacto de los bundles y el aprendizaje interprofesional para la prevencion de la neumonia asociada a la ventilacion mecanica de una unidad de cuidados intensivos (UCI). Metodo: Este fue un estudio cuasi experimental realizado en una UCI de un hospital publico en Diamantina, Minas Gerais. Se incluyeron en este estudio 56 profesionales que prestaron asistencia directa a los pacientes en ventilacion mecanica. La recoleccion de datos se realizo en tres fases: pre-intervencion, que consistio en observacion directa y entrevista; intervencion, en la cual se realizo entrenamiento por medio de simulaciones clinicas; y post-intervencion, en que se evaluo el impacto de las estrategias de observacion directa. Las diferencias entre los grupos pre y post se evaluaron mediante la prueba de McNemar. Se uso un nivel alfa de 0,05 a priori, y se uso una correccion de Bonferroni para determinar la significacion estadistica en el caso de comparaciones multiples. Resultados: Despues de la intervencion, hubo aumento de la adhesion al monitoreo de la presion del cuff endotraqueal (8,10%), interrupcion diaria de la sedacion (16,67%) y aspiracion subglotica (18,75%). Fue significativa (p < 0,0083) las asociaciones entre la categoria profesional frente a la no aspiracion, la posicion de la cabecera de la cama, la frecuencia de higiene oral y el tipo de higiene de las manos despues de la intervencion. Conclusiones: Aun existe una laguna a ser detectada en la implantacion del bundle y el impacto positivo generado por el conocimiento interprofesional, principalmente por no ser inmediato, pero a largo plazo, para obtener el feedback deseado. Descriptores: Neumonia Asociada al Ventilador; Paquetes de Atencion al Paciente; Control de Infecciones; Mejoramiento de la Calidad; Vigilancia en Salud Publica; Unidades de Cuidados Intensivos

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.

Justificativa e Objetivo: O vírus da hepatite B tem alta prevalência mundial, com forte impacto na saúde pública, o que justifica as estratégias de vigilância e prevenção dos possíveis agravos. O risco da exposição ao vírus entre os estudantes e profissionais de saúde constitui uma grande preocupação, mostrando-se baixa a adesão desse público às medidas de biossegurança. O objetivo foi avaliar o conhecimento, imunização contra hepatite B e uso das medidas de biossegurança por estudantes da área da saúde em uma universidade no interior de Minas Gerais, Brasil. Métodos: Estudo transversal, descritivo, com aplicação de questionário, de autopreenchimento, a estudantes da área da saúde, composto por variáveis sociodemográficas e referentes ao tema biossegurança. Resultados: Dentre os 540 estudantes que participaram do estudo, 37,2% declararam não ter conhecimento sobre biossegurança, e desse total, 28,9% não foram vacinados contra a hepatite B, 32,4% dos estudantes consideraram que não estavam expostos ao vírus da hepatite B, e desses, 25,7% não eram vacinados. Ainda o estudo mostrou que 13,3% dos estudantes não usavam luvas e, destes, 41,7% não eram vacinados. Conclusão: Verificou-se que existem lacunas em relação ao conhecimento e uso das medidas de biossegurança, entre estas, a falha da imunização contra hepatite B. Neste sentido, faz-se necessária a adoção de políticas de educação permanente com inclusão sistemática do tema biossegurança e adoção de mecanismos que garantirão a imunização desses estudantes.

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: investigar a prevalencia clinica-epidemiologica dos pacientes submetidos a cirurgia de varizes dos membros inferiores. Metodo: estudo prospectivo e transversal. Aplicou-se um questionario de qualidade de vida semiestruturado adaptado do Venous Insufficiency Epidemiological and Economic Study previamente a cirurgia e apos 40 dias da cirurgia. Utilizou-se Teste de Qui-quadrado de Pearson para o valor esperado >5 e teste exato de Fisher para o valor

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.

INTRODUCTION Molecular techniques for the detection of pathogens have been shown to be effective diagnostic tools with high sensitivity and short turnaround times. METHODS This study compared five Staphylococcus aureus DNA extraction methods for detection by the polymerase chain reaction. RESULTS: The concentration and purity of the extracted DNA showed that the methods did not yield DNA of significant quality. However, most protocols yielded 100% positivity, even with low DNA concentrations. CONCLUSIONS: Although one protocol seemed more efficient than the others, PCR was sensitive enough to allow for detection of S. aureus with all the protocols.

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.

Objetivo: avaliar a equipe de enfermagem quanto as condutas de puncao e manutencao do cateter intravenoso periferico. Metodo: estudo transversal, realizado entre os meses de setembro e dezembro de 2017, em uma instituicao filantropica no interior de Minas Gerais, nas clinicas cirurgica, pediatrica e maternidade. Utilizou-se o indice de concordância de Kappa, nao ponderado, com intervalo de confianca de 95% e nivel de significância p

Objetivo: identificar as deteriora��es f�sicas e qu�micas apresentadas nos instrumentais cir�rgicos ap�s reprocessamentos. M�todo: estudo transversal e quantitativo. Foram analisados 552 instrumentais cir�rgicos, com uso de lupa de aumento de 10 vezes e classificados como deteriora��es f�sicas e qu�micas Resultados: todos os instrumentais cir�rgicos avaliados apresentaram algum tipo de altera��o. Dessas, o maior percentual de danos foi encontrado da seguinte forma: 440 (79,71%) instrumentais cir�rgicos apresentaram manchas; 349 (63,0%) apresentaram perda do filme protetor; 265 (48,07%) apresentaram riscos; 253 (45,83%) apresentaram corros�o. Conclus�o: por meio deste estudo foi poss�vel a cria��o de indicadores de avalia��o de qualidade dos instrumentais cir�rgicos, levando a institui��o a criar novos espa�os de atua��o do enfermeiro e aumento de seguran�a nas cirurgias.

Objetivo: identificar quais os tipos de cren�as, segundo o referencial de Rokeach, relacionadas � Insufici�ncia Card�aca e os dificultadores da ades�o ao tratamento. M�todo: estudo qualitativo em que entrevistas semiestruturadas foram aplicadas aos participantes. Para an�lise das cren�as, utilizou-se o referencial de Rokeach 1981. Resultados: foram entrevistados 26 pacientes da Estrat�gia de Sa�de da Fam�lia e, dos entrevistados, 88% tinham Hipertens�o Arterial Sist�lica, 35% colesterol elevado e 35% Infarto Agudo do Mioc�rdio pr�vio. As cren�as dos tipos B e A foram as mais predominantes (88%) relacionadas � doen�a, as quais consistiam em cren�as primitivas e de dif�cil modifica��o. Conclus�o: as cren�as dos tipos A e B dificultavam a ades�o ao tratamento. Os fatores dificultadores identificados, como falta de acesso ao servi�o, intera��o m�dico-paciente e mudan�as de h�bitos alimentares e estilo de vida, deveriam ser temas de interven��es efetivas de educa��o e treinamento dos profissionais de sa�de.

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.