Atitudes do enfermeiro face às infecções associadas aos cuidados de saúde

ENQUADRAMENTO: As infecções adquiridas em consequência da prestação de cuidados constitui um problema grave, com morbilidade e mortalidade significativas. Estas infecções são evitáveis em cerca de um terço dos casos, pelo que a capacidade de as prevenir pode constituir um dos indicados de qualidade dos cuidados. É um problema escondido, transversal que nenhuma instituição ou país ainda conseguiu resolver. Em cada ano, centenas de milhares de doentes em todo o mundo são afectados pelas IACS, sendo considerado o evento adverso mais frequente durante a prestação de cuidados, em todo o mundo. OBJECTIVOS: Caracterizar as Atitudes adoptadas pelos Enfermeiros face às IACS; Analisar em que medida as variáveis sócio-profissionais e a formação acerca das IACS influenciam as atitudes do Enfermeiro MÉTODOS: O estudo transversal de natureza observacional assenta numa lógica de análise descritivo – correlaciona e foi realizado numa amostra definida pelo método não probabilístico, de forma acidental, durante um período de tempo, constituída por 142 Enfermeiros prestadores de cuidados na ULS da Guarda. O perfil médio revela enfermeiros do sexo feminino (76,80%), com idade média de 36 anos, a exercer a profissão entre os 10-19 anos (40,80%) com uma média 13,04 anos, licenciados (69,50%), com a categoria profissional de Enfermeiro graduado (50,00%), com horário na instituição de 35h/semana (70,40%), com vínculo à Função pública (61,30%) e sem duplo emprego (77,47%). De forma a caracterizar as atitudes do enfermeiro, utilizou-se um instrumento de colheita de dados constituído por uma caracterização sócio-profissional e formação acerca das IACS, a Escala de Atitudes face às IACS (Barroca, Cruz, Gaspar e Valdemar, 2006) e uma resposta aberta acerca das condições no serviço que favorecem a infecção nosocomial. RESULTADOS: Constatou-se que os enfermeiros adoptam atitudes consideradas adequadas, com uma média de 103 respostas adequadas. Nas variáveis pessoais (sexo e idade) infere-se que não há relação entre o sexo e as atitudes do enfermeiro face às IACS. Das variáveis profissionais dos enfermeiros, apenas o duplo emprego influência as atitudes do enfermeiro face às IACS. Por outro lado inferimos que existe uma relação de dependência entre os enfermeiros com formação acerca das IACS e as atitudes do enfermeiro face às IACS. A idade, o tempo de exercício profissional e o número de horas de formação não se revelam preditoras das atitudes do enfermeiro face às IACS. CONCLUSÕES: As evidências encontradas neste estudo referem que o duplo emprego e a formação dos profissionais acerca das IACS influência as atitudes do enfermeiro face a esta problemática. As soluções para os problemas das IACS baseiam-se em medidas de prevenção e controlo de infecção, que requerem a responsabilização e a mudança de comportamentos por parte dos profissionais de saúde.ABSTRACT FRAMEWORK: Acquired infections as a result of prevision of care remain a serious problem of significant morbidity and mortality. These infections are avoidable by almost a third of the cases thus the preventing capacity could be a quality indication of cares. This is a hidden transversal problem which still has been solved by neither institution nor country. Each year, many hundreds of thousands of patients worldwide are affected by the IACS, it may be viewed as the most frequent adverse event during the prevision of care elsewhere in the world. OBJECTIVES: To characterize the attitude adopted by nurses in the face of IACS; to analyse what extent the socio-professional variables and the formation regarding the IACS influence the nurse´s attitudes. METHODS: The transversal study of the observational nature is based on descriptive analysis defined accidentally not by the provavilistic method– It was made during a certain period of time with a random sample composed of 142 nurses care providers at the ULS in Guarda. The average profile shows nurses of the female sex (76,80%), with average of 36 years of age, practising the profession between 10 to 19 years (40,80%) an average of 13,04 years, graduates (69,50%), with the professional category of graduated nurse (50,00%), with institution's schedule of 35-hour workweek (70,40%), connected with the public service (61,30%) and without double employment (77,47%). In order to characterise the nurse´s attitudes, collection of data was made with an instrument constituted by a socio-professional characterization and formation , the scale of attitudes regarding the IACS (Barroca, Cruz, Gaspar e Valdemar, 2006) as well as an open answer regarding the conditions of the service which can lead to nosocomial infection. RESULTS: It was found the nurses adopt attitudes considered adequate, with an average of 103 adequate answers. In relation to the personal variables (gender and age) we can conclude that there is no relation between the gender of the nurse and his attitude towards the IACS. Relative to the nurse professional variables, only double employment influences his attitude towards the IACS. In other hand, we can conclude that there is a dependent relation between nurses with preparation on IACS and is attitude towards the IACS. Age, professional experience and number of formation hours cannot predict the conduct from nurses towards IACS. CONCLUSIONS: We found evidences in this study that double employment and formation from the professional about the IACS, influences his conduct towards this problem. Solutions to the IACS problem reside in prevention and control of infection which requires responsibility and change in the health professional’s behaviour

A new reporter mouse cytomegalovirus reveals maintained immediate-early gene expression but poor virus replication in cycling liver sinusoidal endothelial cells

Background: The MCMV major immediate early promoter/enhancer (MIEP) is a bidirectional promoter that drives the expression of the three immediate early viral genes, namely ie1, ie2 and ie3. The regulation of their expression is intensively studied, but still incompletely understood. Methods: We constructed a reporter MCMV, (MCMV-MIEPr) expressing YFP and tdTomato under the control of the MIEP as proxies of ie1 and ie2, respectively. Moreover, we generated a liver sinusoidal endothelial cell line (LSEC-uniLT) where cycling is dependent on doxycycline. We used these novel tools to study the kinetics of MIEP-driven gene expression in the context of infection and at the single cell level by flow cytometry and by live imaging of proliferating and G(0)-arrested cells. Results: MCMV replicated to higher titers in G(0)-arrested LSEC, and cycling cells showed less cytopathic effect or YFP and tdTomato expression at 5 days post infection. In the first 24 h post infection, however, there was no difference in MIEP activity in cycling or G(0)-arrested cells, although we could observe different profiles of MIEP gene expression in different cell types, like LSECs, fibroblasts or macrophages. We monitored infected LSEC-uniLT in G(0) by time lapse microscopy over five days and noticed that most cells survived infection for at least 96 h, arguing that quick lysis of infected cells could not account for the spread of the virus. Interestingly, we noticed a strong correlation between the ratio of median YFP and tdTomato expression and length of survival of infected cells. Conclusion: By means of our newly developed genetic tools, we showed that the expression pattern of MCMV IE1 and IE2 genes differs between macrophages, endothelial cells and fibroblasts. Substantial and cell-cycle independent differences in the ie1 and ie2 transcription could also be observed within individual cells of the same population, and marked ie2 gene expression was associated with longer survival of the infected cells

Leishmania Promastigotes Lack Phosphatidylserine but Bind Annexin V upon Permeabilization or Miltefosine Treatment

The protozoan parasite Leishmania is an intracellular pathogen infecting and replicating inside vertebrate host macrophages. A recent model suggests that promastigote and amastigote forms of the parasite mimic mammalian apoptotic cells by exposing phosphatidylserine (PS) at the cell surface to trigger their phagocytic uptake into host macrophages. PS presentation at the cell surface is typically analyzed using fluorescence-labeled annexin V. Here we show that Leishmania promastigotes can be stained by fluorescence-labeled annexin V upon permeabilization or miltefosine treatment. However, combined lipid analysis by thin-layer chromatography, mass spectrometry and 31 P nuclear magnetic resonance (NMR) spectroscopy revealed that Leishmania promastigotes lack any detectable amount of PS. Instead, we identified several other phospholipid classes such phosphatidic acid, phosphatidylethanolamine; phosphatidylglycerol and phosphatidylinositol as candidate lipids enabling annexin V staining.FAZIT (AW)Research Training Group 1121 of the German Research FoundationCarlsberg FoundationCenter for Synthetic Biology at Copenhagen UniversityUNIK research initiative of the Danish Ministry of Science, Technology and Innovatio