A prevalência de esclerose múltipla (EM) varia consideravelmente no mundo. De acordo com Kurtzke, a América do Sul é considerada região de baixa prevalência (menor que 5 casos:100000 habitantes). OBJETIVO: Descrever a epidemiologia da EM em centro de referência, comparando-a aos achados de oito serviços nacionais. MÉTODO: Através de estudo de incidência, descritivo, prospectivo, longitudinal, foram analisados dados de 118 pacientes, atendidos no Centro de Referência para Atenção ao Paciente Portador de Doença Desmielinizante do Hospital da Restauração - Recife - PE - Brasil (CRAPPDD-HR), entre janeiro de 1987 e março de 2002, com diagnóstico de EM, segundo critérios de Poser. RESULTADOS: Os pacientes foram acompanhados por um a 15 anos. Noventa e cinco (80,5%) pacientes estavam em tratamento específico com imunomoduladores. A prevalência foi igual a 1,36:100000 habitantes. Identificaram-se: predomínio da etnia parda (110 casos, 93,2%); 82 (82,2%) casos clinicamente definidos, 15 (12,7%) laboratorialmente definidos e 6 (5,1%) clinicamente prováveis; número máximo de surtos igual a 46; maior número de casos com EDSS leve, assim como um a 10 anos de doença na forma surto/remissão (SR). A razão de gênero dos 83 casos da forma SR se equivaleu à geral (4,1:1), contudo na forma SR com progressão secundária houve predomínio duas vezes maior para o sexo feminino e na forma primariamente progressiva, 5,5 vezes maior para o sexo masculino. CONCLUSÃO: Apesar da presente pesquisa ter se assemelhado aos oito estudos utilizados para comparação, as diferenças constatadas irão requerer novas pesquisas e novas abordagens.

ABSTRACT. Hand washing: teaching and practice among undergraduate health sector students. This study was undertaken with students during their last year/semester of health sector studies at Higher Education Institutions (HEI), in Goiás State/2005. It aimed to verify the understanding of these students about hands washing (HW), identify the contribution of the HEI to the students' education on this theme, identify factors that favor the practice of HW, and verify the availability of material resources for HW at Health Assistance Establishments (HAE) used as practice scenarios. After observing ethical aspects, the data was obtained through a previously-evaluated questionnaire, and processed using Epi Info software (CDC, 2004), when the chi-square test was applied. 777 students took part (68.0%) in the study, belonging to the following courses: Biomedicine, Nursing, Pharmacy, physiotherapy, phonoaudiology, Medicine, Dentistry and Occupational Therapy. There was a noticeable difference between the understanding on HW and actual practice. Although we evidenced that HEIs have approached this subject during the educational process, this was not enough to modify the practice.

Introduction:In venous ulcers, the presence of Staphylococcus aureus and coagulase-negative staphylococcus resistance phenotypes can aggravate and limit the choices for treatment. Methods: Staphylococcus isolated from 69 patients (98 ulcers) between October of 2009 and October of 2010 were tested. The macrolide, lincosamide, streptogramin B (MLS B ) group resistance phenotype detection was performed using the D-test. Isolates resistant to cefoxitin and/or oxacillin (disk-diffusion) were subjected to the confirmatory test to detect minimum inhibitory concentration (MIC), using oxacillin strips (E-test®). Results: The prevalence of S. aureus was 83%, and 15% of coagulase-negative staphylococcus (CoNS). In addition were detected 28% of methicillin-resistant Staphylococcus aureus (MRSA) and 47% of methicillin-resistant coagulase-negative staphylococcus (MRCoNS). Among the S. aureus, 69.6% were resistant to erythromycin, 69.6% to clindamycin, 69.6% to gentamicin, and 100% to ciprofloxacin. Considering the MRSA, 74% were highly resistant to oxacillin, MIC ≥ 256µg/mL, and the MLS B c constitutive resistance predominated in 65.2%. Among the 20 isolates sensitive to clindamycin, 12 presented an inducible MLS B phenotype. Of the MRCoNS, 71.4%were resistant to erythromycin, ciprofloxacin and gentamicin. Considering the isolates positive for β-lactamases, the MIC breakpoint was between 0.5 and 2µg/mL. Conclusions: The results point to a high occurrence of multi-drug resistant bacteria in venous ulcers in primary healthcare patients, thus evidencing the need for preventive measures to avoid outbreaks caused by multi-drug resistant pathogens, and the importance of healthcare professionals being able to identifying colonized versus infected venous ulcers as an essential criteria to implementing systemic antibacterial therapy.

Bastonetes Gram-negativos em úlceras venosas e implicações para o atendimento de enfermagem na atenção primária*Gram-negative rods in venous ulcers and implications for primary care nursing care Bacilos Gram-negativos en úlceras venosas, implicancias para la atención de enfermería en la atención primaria

No abstract

DOI: http://dx.doi.org/10.31011/1519-339X.2018a18n84.4 Objetiva-se avaliar a adesão da equipe de enfermagem às precauções padrão durante a realização dos curativos deferidas abertas. Estudo transversal descritivo, realizado na clínica cirúrgica de um hospital universitário do Estadode Goiás, no período de dezembro de 2015 a março de 2016. Foram observados 147 procedimentos de curativos.Os dados foram coletados por meio da observação direta com registro em checklist e analisados pelo SoftwareStatistical Package for the Social Sciences, são apresentados as frequências, média e desvio padrão. Os curativos forammajoritariamente realizados pela equipe técnica de enfermagem. Somente 55.8% aderiu a higiene das mãos antesou após o procedimento. Nenhum profi ssional utilizou proteção ocular, e os demais equipamentos de proteçãoindividual foram utilizados pela maioria, entretanto, frequentemente de maneira incorreta. Conclui-se que a equipede enfermagem aderiu parcialmente às precauções padrão para a realização dos curativos, adotaram condutasde risco biológico que podem comprometer a qualidade do cuidado e a saúde do profi ssional. Investimentos naformação e na qualifi cação profi ssional devem ser reforçados para a garantia da segurança e da qualidade desteprocedimento.Palavras-chave: Enfermagem; Precauções Universais; Ferimentos e Lesões. ABSTRACTThe aim is to evaluate the compliance of the nursing team to the standard precautions during the care of openwounds. Descriptive cross-sectional study, performed at the surgical clinic of a university hospital in the Stateof Goiás, from December 2015 to March 2016. A total of 147 dressing procedures were observed. The data werecollected through the direct observation with checklist and analyzed by the Software Statistical Package for theSocial Sciences, the frequencies, mean and standard deviation are presented. Dressings were mostly performedby the technical of nursing. Only 55.8% adhered to the hygiene of the hands before or after the procedure. Noprofessional used goggles, and others personal protective equipment was used by the majority, however, oftenincorrectly. It concludes that the nursing team adhered partially to the standard precautions for wound careprocedure, adopted biological risk behaviors that may compromise the quality of care and the health of theprofessional. Investments in training and professional qualifi cation should be strengthened to ensure the safetyand quality of this procedure.Keywords: Nursing; Universal Precautions; Wounds and Injuries.

Introduction: Central line-associated bloodstream infections are the second most frequent infection in intensive care units. It represents an adverse event of significant magnitude, thus threatening the patient safety. The aim of this study was to analyze the historical trend of central line-associated bloodstream infections in patients in intensive care units, the rate of infection, central venous catheter utilization ratio, type of pathogen and their antimicrobial resistance pattern. Methodology: This ecological study was performed at 42 intensive care units from a state capital of the Midwest region of Brazil. Central line-associated bloodstream infections notifications were collected from two databases, the Municipal Coordination for Patient Safety and Infection Control at Healthcare Services, from 2012-2016, and the FormSUS (National Health System Data Processing Company), from 2014-2016. Results: The incidence of central line-associated bloodstream infections was high and stationary in the period (incidence rate of 2.3 to 3.2 per 1,000 catheter days, central venous catheter utilization ratio average 56,9%). The most frequent microorganisms were coagulase-negative Staphylococcus, Klebsiella pneumoniae, Acinetobacter spp. and Pseudomonas aeruginosa. Resistance to 3rd and 4th generation cephalosporins and carbapenems were detected among Gram-negative bacteria, and resistance to oxacillin among Gram-positive bacteria. Conclusions: Central line-associated bloodstream infections incidence rates were high, however the historical trend remained stationary in adult intensive care units. Infections were mostly caused by coagulase-negative Staphylococcus, K. pneumoniae, Acinetobacter spp. and Pseudomonas aeruginosa, including multi-drug resistant organisms. These findings point to the need of educational strategies addressing the adherence to established preventive measures and to the rational use of antimicrobials.

Estudo objetivou verificar a compreensão dos alunos acerca do uso de Equipamento de proteção individual (EPI) na perspectiva do controle de infecção e identificar a contribuição dos cursos de graduação em enfermagem para a construção do conhecimento dos graduandos sobre esta temática. Realizado com 182 (58,3%) graduandos concluintes dos cursos de enfermagem em Instituições de Ensino Superior do Estado de Goiás no ano de 2005. Os dados foram obtidos por meio de um questionário após aprovação no Comitê de Ética em Pesquisa e analisados por meio de estatística descritiva. Os resultados mostram múltiplas condutas dos alunos no uso e manuseio de jaleco, luvas, máscara, óculos e gorro. Embora relatem fazer uso de EPI, não conhecem suas finalidades de uso, ainda que tenham sido abordadas em disciplina curricular. O conhecimento é inconsistente e sinaliza falha no processo de ensino. Verificamos uma vulnerabilidade dos acadêmicos em relação à prevenção de infecções adquiridas ocupacionalmente.Palavras chave: Equipamentos de proteção; Precauções universais; Educação em Enfermagem.