EFICÁCIA DE DOIS MÉTODOS DE DEGERMAÇÃO, UTILIZANDO POLIVINILPIRROLIDONA-IODO À 10% / EFFICACY OF TWO-DEGERMATION METHOD, USING POLYVYNYLPIRROLYDONE-IODINE 10%

Introdução: O procedimento de degermação cirúrgica das mãos e antebraço está incluído no processo de paramentação cirúrgica como medida de prevenção de infecções hospitalares. Com a modernização e maiores estudos, após o advento dos princípios antissépticos degermantes, a necessidade da utilização de escovas vem sendo questionada, devido às lesões que as mesmas podem ocasionar com posterior favorecimento de colonização. Objetivo: Verificar a eficácia de dois métodos de degermação cirúrgica das mãos utilizando polivinilpirrolidona iodo (PVPI à 10%): com escova e sem artefato. Métodos: Trata-se de um estudo experimental. A coleta foi realizada no período de junho a agosto de 2012 no Centro Cirúrgico de um Hospital Universitário em São Luís – MA e analisada no Laboratório de Microbiologia do referido Hospital. A amostra foi de 10 participantes que realizaram as técnicas após explicação e observação do folder ilustrativo. Resultados: Verificou-se que os dois procedimentos de degermação cirúrgica foram eficazes e não houve diferença estatisticamente significante entre os mesmos. Os microrganismos mais frequentes isolados na pele antes e após degermação foram Serratiamarcescens, Staphylococcus aureus, Staphylococcus spp. coagulase negativa. Em menor ocorrência encontrou-se Acinetobacter ursingii e Acinetobacter baumannii. Conclusão:Conclui-se que a redução de microrganismos da pele não está ligada ao uso de artefatos, mas ao tempo que o degermante permanece em contato com a pele associada à fricção utilizando ou não artefatos.Palavras-chave: Lavagem de mãos. Antissépticos. Infecção Hospitalar.AbstractIntroduction: The procedure for surgical hand and forearm antisepsis is included in the process of surgical scrub as a measure to prevent nosocomial infections. With the modernization and further studies after the advent of antiseptic principles, the need for the use of brushes has been questioned, due to the injuries they can cause later with favoring colonization. Objective: To determine the effectiveness of two methods of surgical hand antisepsis using polyvinylpyrrolidone iodine (10% PVP): with brush and without artifact. Methods: This is an experimental study. The collection was performed at the Surgery Center of University Hospital in São Luís - MA and analyzed in the Microbiology Laboratory of the aforementioned Hospital. The sample consisted of 10 participants who performed the technical explanation and observation after the illustrative folder. Results: It was demonstrated the efficacy of the two surgical antiseptic procedures and that there was no statistically significant difference between them. The microorganisms most frequent on the skin before and after antisepsis were Serratiamarcescens, Staphylococcus aureus, Staphylococcus spp. coagulase negative. In lower occurrence there were Acinetobacter ursingii and Acinetobacter baumannii. Conclusion: It is concluded that the reduction of microorganisms from the skin is not related to the use of artifacts, but at the time the antiseptics remains in contact with the skin associated with friction using or not artifacts.Keywords: Hand washing. Antiseptics. Infection

Ants in a hospital environment and their potential as mechanical bacterial vectors

Introduction We studied the richness and abundance of ant species, their bacteria and the bacteria isolated from patient clinical samples. Methods Ants were collected with baited traps at 64 sites in a public hospital in São Luis, State of Maranhão, Brazil. Results In total, 1,659 ants from 14 species were captured. The most frequent species were Crematogaster victima, Solenopsis saevissima, Tapinoma melanocephalum, Camponotus vittatus and Paratrechina fulva. Forty-one species of bacteria were isolated from the ants and 18 from patients. Conclusions Ants are potential vehicles for pathogenic and opportunistic bacteria, and they can represent a risk factor in nosocomial infections

Uma história de conceitos na saúde pública: integralidade, coordenação, descentralização, regionalização e universalidade A history of public health concepts: integrity, coordination, decentralization, regionalization, and universality

O Sistema Único de Saúde conferiu visibilidade a uma série de conceitos próprios da organização de sistemas de saúde. Entre eles a integralidade, que delimita fronteiras comuns com quase todos os demais princípios do Sistema, tem sido objeto de ampla literatura no Brasil. Com base em extensa revisão de fontes primárias e secundárias, este artigo apresenta uma recuperação histórica dos conceitos de integralidade, descentralização, regionalização e universalidade - ideias e conceitos que em grande parte se conformam e se interligam no ideário da organização dos serviços sanitários pelo modelo dos Centros de Saúde distritais.<br>Brazil's Unified Health System (Sistema Único de Saúde) has highlighted a series of concepts specific to the organization of healthcare systems. Among these, integrity - which shares boundaries with almost all other System principles - has been the object of much academic production in Brazil. Based on an extensive review of primary and secondary sources, the article offers a historical recovery of the concepts of integrity, decentralization, regionalization, and universality - ideas and concepts that in good measure are shaped by and interlinked with the set of ideals of the organization of sanitary services according to the district health centers model

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline

Initial invasive or conservative strategy for stable coronary disease

BACKGROUND Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, 121.8 percentage points; 95% CI, 124.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used

Search for neutral MSSM Higgs bosons decaying into a pair of bottom quarks

A search for neutral Higgs bosons decaying into a b-bbar quark pair and produced in association with at least one additional b quark is presented. This signature is sensitive to the Higgs sector of the minimal supersymmetric standard model (MSSM) with large values of the parameter tan(beta). The analysis is based on data from proton-proton collisions at a center-of-mass energy of 8 TeV collected with the CMS detector at the LHC, corresponding to an integrated luminosity of 19.7 inverse femtobarns. The results are combined with a previous analysis based on 7 TeV data. No signal is observed. Stringent upper limits on the cross section times branching fraction are derived for Higgs bosons with masses up to 900 GeV, and the results are interpreted within different MSSM benchmark scenarios, m[h,max], m[h,mod+], m[h,mod-], light-stau and light-stop. Observed 95% confidence level upper limits on tan(beta), ranging from 14 to 50, are obtained in the m[h,mod+] benchmark scenario

Search for Pair Production of First and Second Generation Leptoquarks in Proton-Proton Collisions at s\sqrt{s} = 8 TeV

A search for pair production of first and second generation leptoquarks is performed in final states containing either two charged leptons and two jets, or one charged lepton, one neutrino and two jets, using proton-proton collision data at $\sqrt{s} =$8TeV. The data, corresponding to an integrated luminosity of 19.7 fb$^{-1}$, were recorded with the CMS detector at the LHC. First-generation scalar leptoquarks with masses less than 1010 (850) GeV are excluded for $\beta =$ 1.0 (0.5), where $\beta$ is the branching fraction of a leptoquark decaying to a charged lepton and a quark. Similarly, second-generation scalar leptoquarks with masses less than 1080 (760) GeV are excluded for $\beta =$ 1.0 (0.5). Mass limits are also set for vector leptoquark production scenarios with anomalous vector couplings, and for R-parity violating supersymmetric scenarios of top squark pair production resulting in similar final-state signatures. These are the most stringent limits placed on the masses of leptoquarks and RPV top squarks to date