IntroductionNurse understaffing is frequently hypothesized as a potential risk factor for healthcare-associated infections (HAI). This study aimed to evaluate the role of nursing workload in the occurrence of HAI, using Nursing Activities Score (NAS).MethodsThis prospective cohort study enrolled all patients admitted to 3 Medical ICUs and one step-down unit during 3 months (2009). Patients were followed-up until HAI, discharge or death. Information was obtained from direct daily observation of medical and nursing rounds, chart review and monitoring of laboratory system. Nursing workload was determined using NAS. Non-compliance to the nurses’ patient care plans (NPC) was identified. Demographic data, clinical severity, invasive procedures, hospital interventions, and the occurrence of other adverse events were also recorded. Patients who developed HAI were compared with those who did not.Results195 patients were included and 43 (22%) developed HAI: 16 pneumonia, 12 urinary-tract, 8 bloodstream, 2 surgical site, 2 other respiratory infections and 3 other. Average NAS and average proportion of non compliance with NPC were significantly higher in HAI patients. They were also more likely to suffer other adverse events. Only excessive nursing workload (OR: 11.41; p: 0.019) and severity of patient’s clinical condition (OR: 1.13; p: 0.015) remained as risk factors to HAI.ConclusionsExcessive nursing workload was the main risk factor for HAI, when evaluated together with other invasive devices except mechanical ventilation. To our knowledge, this study is the first to evaluate prospectively the nursing workload as a potential risk factor for HAI, using NAS.

CONTEXT AND OBJECTIVE: Sedation scales are used to guide sedation protocols in intensive care units (ICUs). However, no sedation scale in Portuguese has ever been evaluated. The aim of this study was to evaluate the validity and reliability of Portuguese translations of four sedation-agitation scales, among critically ill patients: Glasgow Coma Score, Ramsay, Richmond Agitation-Sedation Scale (RASS) and Sedation-Agitation Scale (SAS). DESIGN AND SETTING: Validation study in two mixed ICUs of a university hospital. METHODS: All scales were applied to 29 patients by four different critical care team members (nurse, physiotherapist, senior critical care physician and critical care resident). We tested each scale for interrater reliability and for validity, by correlations between them. Interrater agreement was measured using weighted kappa (k) and correlations used Spearman's test. RESULTS: 136 observations were made on 29 patients. All scales had at least substantial agreement (weighted k 0.68-0.90). RASS (weighted k 0.82-0.87) and SAS (weighted k 0.83-0.90) had the best agreement. All scales had a good and significant correlation with each other. CONCLUSIONS: All scales demonstrated good interrater reliability and were comparable. RASS and SAS showed the best correlations and the best agreement results in all professional categories. All these characteristics make RASS and SAS good scales for use at the bedside, to evaluate sedation-agitation among critically ill patients in terms of validity, reliability and applicability.

Objective: To estimate the cost of nursing care required and available through the use of the Nursing Activities Score. Method: Quantitative study, direct costing of nursing care required and available in the Intensive Care Units. Data collection included variables of the patients, nursing professionals and nursing workload measured by the Nursing Activities Score. The cost of nursing care was estimated by multiplying the cost of each hour with the total number of hours of care per category. Results: The negative difference of R$ 94,791.5 between the cost of available and required nursing care indicated an increase of 3.2 nurses and 7.0 nursing technicians. Conclusion: The cost of nursing care required identified through the application of the Nursing Activities Score, which is higher than the cost of available care, indicates the need to adjust the number of professionals to meet patients' demands.

OBJECTIVE To reduce transmission of carbapenem-resistant Enterobacteriaceae (CRE) in an intensive care unit with interventions based on simulations by a developed mathematical model. DESIGN Before-after trial with a 44-week baseline period and 24-week intervention period. SETTING Medical intensive care unit of a tertiary care teaching hospital. PARTICIPANTS All patients admitted to the unit. METHODS We developed a model of transmission of CRE in an intensive care unit and measured all necessary parameters for the model input. Goals of compliance with hand hygiene and with isolation precautions were established on the basis of the simulations and an intervention was focused on reaching those metrics as goals. Weekly auditing and giving feedback were conducted. RESULTS The goals for compliance with hand hygiene and contact precautions were reached on the third week of the intervention period. During the baseline period, the calculated R0 was 11; the median prevalence of patients colonized by CRE in the unit was 33%, and 3 times it exceeded 50%. In the intervention period, the median prevalence of colonized CRE patients went to 21%, with a median weekly Rn of 0.42 (range, 0-2.1). CONCLUSIONS The simulations helped establish and achieve specific goals to control the high prevalence rates of CRE and reduce CRE transmission within the unit. The model was able to predict the observed outcomes. To our knowledge, this is the first study in infection control to measure most variables of a model in real life and to apply the model as a decision support tool for intervention. Infect Control Hosp Epidemiol 2016;1-8.

RESUMOGerenciar recursos em estoques evitando a falta de materiais médico-hospitalares e medicamentos são, sem dúvida, o principal desafio em instituições hospitalares. A falta de materiais seja por falta de recursos financeiros, falhas na previsão de pedidos, atenção gerencial, falha de fornecedores, dentre outras, pode acarretar consequencias graves aos pacientes em Unidades de Terapia Intensiva (UTI), aumentando os riscos associados à falta de materiais essenciais na assistência ao paciente e na ocorrência de infecções relacionadas à saúde (IRAS). O presente estudo de caso objetivou analisar o fluxo de solicitações de materiais em diferentes esferas administrativas e as falhas de abastecimento dos insumos de uma Unidade de Terapia Intensiva (UTI) de um hospital público terciário, em períodos de ocorrência de IRAS, por meio de levantamentos e análise documental dos casos registrados na unidade em 2014. De acordo com a criticidade do material em falta a ser utilizado no setor, foi possível gerar um relatório à Subcomissão de Controle de Infecção Hospitalar e ao setor administrativo, para auxiliar na aquisição emergencial e distribuição dos materiais básicos para a assistência, e desta forma minimizar a ocorrência de eventos adversos e aumentar, consequentemente, a satisfação dos profissionais e segurança dos pacientes. Após a análise da distribuição de 164 itens, estes foram reagrupados segundo um escore baseado no sistema de classificação em categorias ABC e XYZ. Não foram encontrados insumos na categorizados AX (caros e de baixa criticidade), enquanto que as falhas de abastecimento envolveram cerca de 50% de insumos classificados em CZ (baratos e de alta criticidade).

O gerenciamento de suprimentos hospitalares em uma Unidade de Terapia Intensiva (UTI) deve suprir às boas condições durante o trabalho. O presente estudo objetivou compreender a percepção de profissionais da área de saúde de um hospital público terciário, identificando os riscos associados à falta de materiais essenciais na assistência ao paciente e ocorrência de infecções hospitalares ou infecções relacionadas à saúde. Um questionário semiestruturado foi elaborado para a equipe da unidade estudada, composta por médicos, enfermeiros, técnicos de enfermagem, auxiliares de enfermagem e fisioterapeutas. Foi realizado um levantamento e análise documental dos casos registrados de infecções relacionadas à saúde na unidade entre 2012 e 2013, análise das informações contidas nas planilhas de fornecimento de medicamentos, insumos e equipamentos de proteção individual. Os resultados demonstraram que 69% dos profissionais associam o risco de infecções hospitalares à falta de aventais descartáveis e luvas em uma UTI, gerando sofrimento e insatisfação no desempenho da assistência ao paciente. A gestão de compras e abastecimento de insumos para a UTI deve ser um foco de controle das Comissões de Controle de Infecção Hospitalar para criar estratégias na prevenção da ocorrência de eventos adversos, aumentar a satisfação dos profissionais e garantir a biossegurança dos pacientes e colaboradores.

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