BackgroundInfection is the leading cause of morbidity and the second leading cause of mortality in patients on renal replacement therapy. The rates of bloodstream infection in hemodialysis patients vary according to the type of venous access used. Gram-positive bacteria are most frequently isolated in blood cultures of hemodialysis patients. This study evaluated risk factors for the development of bloodstream infections in patients undergoing hemodialysis.MethodsRisk factors associated with bloodstream infections in patients on hemodialysis were investigated using a case–control study conducted between January 2010 and June 2013. Chronic renal disease patients on hemodialysis who presented with positive blood cultures during the study were considered as cases. Controls were hemodialysis patients from the same institution who did not present with positive blood cultures during the study period. Data were collected from medical records. Logistic regression was used for statistical analysis.ResultsThere were 162 patients included in the study (81 cases and 81 controls). Gram-positive bacteria were isolated with the highest frequency (72%). In initial logistic regression analysis, variables were hypertension, peritoneal dialysis with previous treatment, type and time of current venous access, type of previous venous access, previous use of antimicrobials, and previous hospitalization related to bloodstream infections. Multiple regression analysis showed that the patients who had a central venous catheter had an 11.2-fold (CI 95%: 5.17–24.29) increased chance of developing bloodstream infections compared with patients who had an arteriovenous fistula for vascular access. Previous hospitalization increased the chance of developing bloodstream infections 6.6-fold (CI 95%: 1.9–23.09).ConclusionsInfection prevention measures for bloodstream infections related to central venous catheter use should be intensified, as well as judicious use of this route for vascular access for hemodialysis. Reducing exposure to the hospital environment through admission could contribute to a reduction in bloodstream infections in this population.

Objective: to identify studies about strategies for prevention of ventilator-associated pneumonia deployed in health services and classify their level of evidence. Method: integrative review of the literature, in 7 databases, which included the following descriptors: Prevention and Control AND Pneumonia Ventilator-Associated AND Intensive Care Units AND Bundle AND Patient Care. Results: twenty-three scientific productions were included. Of the preventive measures identified, 9 (39.1%) correspond from three to five strategies. The most frequent were: 22 (95.6%) lying with head elevated, 19 (82.6%) oral hygiene with chlorhexidine and 14 (60.8%) reduction of sedation whenever possible. Final Consideration: the application of measures based on scientific evidence is proven to be effective when carried out in conjunction, impacting the reduction of the incidence of ventilator-associated pneumonia.

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Objective: This study's objective was to analyze the effectiveness of educational and support programs for caregivers on reducing their burden. Method: The method used was a systematic review. The following were searched; MEDLINE, LILACS, Embase, Cochrane, Web of Science, SciELO and CINAHL. Results: Seven randomized clinical studies were included. These studies compared an educational program with standard care delivery, assessing the burden of caregivers through the Zarit Burden Interview. After the analysis of sensitivity, four studies were grouped in the meta-analysis showing a statistically significant reduction in caregiver burden among the participants of educational and support programs. Conclusion: The evidence obtained in this study suggests that educational and support programs have a positive impact on the reduction of caregiver burden when compared to standard care. Therefore, the inclusion of these programs in institutions providing care to the elderly is effective and should be encouraged. These programs should also share non-pharmacological management strategies for the behavioral and psychological symptoms of dementia.Descriptors: Dementia; Caregivers; Aged; Geriatric Nursing. Descritores: Demência; Cuidadores; Idoso; Enfermagem Geriátrica. Efectividad de programas educativos en la sobrecarga de cuidadores de pacientes con diagnóstico de demencia: revisión sistemáticaObjetivo: El objetivo de este estudio fue analizar la eficacia de programas de educación y apoyo a cuidadores para reducir su sobrecarga. Método: El método utilizado fue una revisión sistemática. Consultamos el MEDLINE, LILACS, Embase, Cochrane, CINAHL y Web of Science.Resultados: Se incluyeron los ensayos controlados aleatorios que compararon el programa de educación con la atención habitual, con evaluación de la carga del cuidador a través de la Escala de Zarit Burden. Tras el análisis de sensibilidad, cuatro estudios se combinaron en un metaanálisis, que muestra una mayor reducción de la carga del cuidador entre los participantes de los programas educativos y de apoyo, con significación estadística. Conclusión: La evidencia en este estudio indica que los programas educativos y de apoyo son favorables para la reducción de la carga del cuidador. La inclusión de este tipo de programas en las instituciones dedicadas al cuidado de los ancianos es eficaz y debe fomentarse. Se puede inferir que estos programas deben incluir el intercambio de estrategias de manejo no-farmacológico para los síntomas conductuales y psicológicos de la demencia.Descriptores: Demencia; Cuidadores; Anciano; Enfermería Geriátrica. IntroductionPopulation aging in Brazil has been increasingly evident throughout recent decades, i.e. the elderly population has been growing faster than other age groups. According to the census published by the Brazilian Institute of Geography and Statistics (IBGE) in 2002, the population over 60 years-old had increased 35.6% between 1999 and that year, with this age group coming to represent 7.9% of the Brazilian population.The ce...

Resumo Objetivo: Avaliar a adesão dos profissionais de saúde a um conjunto de boas práticas de prevenção de Pneumonia Associada à Ventilação Mecânica, índice de conformidade às medidas individuais e associação de características clínicas dos pacientes e adesão ao conjunto de boas práticas com a pneumonia. Métodos: Estudo de coorte prospectivo realizado em uma Unidade de Terapia Intensiva de um hospital universitário no período de maio de 2017 a outubro de 2017. A amostra foi composta por pacientes internados no período do estudo, que preencheram os critérios de inclusão, a coleta de dados foi realizada por meio de consulta a prontuários. Resultados: O item com maior adesão foi a avaliação diária da sedação e redução sempre que possível, 81 (91,0%), seguido da troca do circuito a cada 7 dias, 76 (82,6). A manutenção da pressão do cuff entre 20 e 30 mm H2O foi o item com menor adesão 22 (23,9%). A adesão ao conjunto completo apresentou conformidade em 20 (21,7%) das oportunidades. O estudo mostrou que quanto maior a adesão às medidas de boas práticas, menor é o risco de Pneumonia Associada à Ventilação Mecânica, porém não foi um dado estatisticamente significante. Os pacientes cirúrgicos e em uso de ventilação mecânica apresentaram maior risco de desenvolver PAV (p= 0,05). Conclusão: A Pneumonia Associada à Ventilação Mecânica pode trazer grave repercussão para o paciente, a aplicação de medidas com embasamento científico é fundamental, a fim de se prevenir a ocorrência deste agravo, que é uma das mais frequentes infecções relacionadas à assistência à saúde dentro das Unidades de Terapia Intensiva brasileiras.

BackgroundThis study was performed to evaluate the effectiveness of surveillance for screening and treatment of patients with chronic kidney disease undergoing hemodialysis and colonized by Staphylococcus aureus.MethodsA systematic review and meta-analysis were performed. The literature search involved the following databases: the Cochrane Controlled Trials Register, Embase, LILACS, CINAHL, SciELO, and PubMed/Medline. The descriptors were “Staphylococcus aureus”, “MRSA”, “MSSA”, “treatment”, “decolonization”, “nasal carrier”, “colonization”, “chronic kidney disease”, “dialysis”, and “haemodialysis” or “hemodialysis”. Five randomized controlled trials that exhibited agreement among reviewers as shown by a kappa value of >0.80 were included in the study; methodological quality was evaluated using the STROBE statement. Patients who received various treatments (various treatments group) or topical mupirocin (mupirocin group) were compared with those who received either no treatment or placebo (control group). The outcomes were skin infection at the central venous catheter insertion site and bacteremia.ResultsIn total, 2374 patients were included in the analysis, 626 (26.4%) of whom were nasal carriers of S. aureus. The probability of S. aureus infection at the catheter site for hemodialysis was 87% lower in the mupirocin group than in the control group (odds ratio [OR], 0.13; 95% confidence interval [CI], 0.05–0.34; p < 0.001). The risk of bacteremia was 82% lower in the mupirocin group than in the control group (OR, 0.18; 95% CI, 0.08–0.42; p < 0.001). No statistically significant difference in bacteremia was observed between the various treatments group (excluding mupirocin) and the control group (OR, 0.77; 95% CI, 0.51–1.15; p = 0.20).ConclusionsTwenty-six percent of patients undergoing hemodialysis were nasal carriers of S. aureus. Of all treatments evaluated, topical mupirocin was the most effective therapy for the reduction of S. aureus catheter site infection and bacteremia in patients undergoing chronic hemodialysis.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2369-15-202) contains supplementary material, which is available to authorized users.

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OBJECTIVES: to assess renal function in elderly patients undergoing contrast-enhanced computed tomography and identify the preventive measures of acute kidney injury in the period before and after the examination. METHOD: longitudinal cohort study conducted at the Federal University of São Paulo Hospital, from March 2011 to March 2013. All hospitalized elderly, of both sexes, aged 60 years and above, who performed the examination, were included (n=93). We collected sociodemographic data, data related to the examination and to the care provided, and creatinine values prior and post exam. RESULTS: an alteration in renal function was observed in 51 patients (54%) with a statistically significant increase of creatinine values (p<0.04), and two patients (4.0%) required hemodialysis. CONCLUSION: There is an urgent need for protocols prior to and post contrast-enhanced examination in the elderly, and other studies to verify the prognosis of this population.