GESTÃO DE SUPRIMENTOS DE UMA UNIDADE DE TERAPIA INTENSIVA: PERCEPÇÃO DOS PROFISSIONAIS DE SAÚDE SOBRE A OCORRÊNCIA DE INFECÇÕES HOSPITALARES ASSOCIADAS ÀS FALHAS DE ABASTECIMENTO / SUPPLY MANAGEMENT OF AN INTENSIVE CARE UNIT: PERCEPTION OF HEALTH PROFESSIONALS ABOUT THE OCCURRENCE OF NOSOCOMIAL INFECTIONS RELATED TO SUPPLY FAILURE

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

Nursing Workload as a Risk Factor for Healthcare Associated Infections in ICU: A Prospective Study

Introduction: Nurse 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). Methods: This 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. Results: 195 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. Conclusions: Excessive 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.Foundation for Research of the State of Sao Paulo (FAPESP- Fundacao de Amparo a Pesquisa do Estado de Sao Paulo) [2008/00955-2

Validity, reliability and applicability of Portuguese versions of sedation-agitation scales among critically ill patients

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

Nursing Activities Score and the cost of nursing care required and available

ABSTRACT 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