Objective: Assess the accumulation of protein and biofilm on the inner surfaces of new flexible gastroscope (FG) channels after 30 and 60 days of patient use and full reprocessing.Design: Clinical use study of biofilm accumulation in FG channels.Setting: Endoscopy service of a public hospital.Methods: First, we tested an FG in clinical use before the implementation of a revised reprocessing protocol (phase 1 baseline; n = 1). After replacement of the channels by new ones and the implementation of the protocol, 3 FGs were tested after 30 days of clinical use (phase 2; n = 3) and 3 FGs were tested after 60 days of clinical use (phase 3; n = 3), and the same FGs were tested in phase 2 and 3. Their biopsy, air, water, and air/water junction channels were removed and subjected to protein testing (n = 21), bacteriological culture (n = 21), and scanning electron microscopy (SEM) (n = 28). Air–water junction channels fragments were subjected to SEM only.Results: For the FGs, the average number of uses and reprocessing cycles was 60 times. Extensive biofilm was detected in air, water, and air–water junction channels (n = 18 of 28). All channels (28 of 28) showed residual matter, and structural damage was identified in most of them (20 of 28). Residual protein was detected in the air and water channels of all FG evaluated (phases 1–3), except for 1 air channel from phase 2. Bacteria were recovered from 8 of 21 channels, most air or water channels.Conclusions: The short time before damage and biofilm accumulation in the channels was evident and suggests that improving the endoscope design is necessary. Better reprocessing methods and channel maintenance are needed.

RESUMO Objetivo: Analisar a epidemiologia do abandono do acompanhamento clínico-laboratorial entre os trabalhadores da área da saúde que sofreram acidente com material biológico. Método: Estudo de coorte realizado a partir dos acidentes de trabalho com material biológico notificados em Goiânia/Goiás. Os dados foram analisados no Stata com estatística descritiva e analítica. Resultados: Dos 8.596 acidentes notificados, foram analisadas 2.104 exposições, a maioria no sexo feminino, com ensino médio completo e pertencente à equipe de enfermagem. Os acidentes ocorreram, predominantemente, por lesão percutânea, envolvendo agulha com lúmen, durante administração de medicamentos ou acesso vascular. A taxa de abandono do acompanhamento foi de 41,5%. Os fatores preditores para a interrupção do seguimento clínico-laboratorial foram idade, ocupação, uso de equipamento de proteção individual (avental), objeto envolvido no acidente, situação no mercado de trabalho, circunstância da exposição e condutas profiláticas recomendadas. Conclusão: Frente à elevada taxa de abandono encontrada, sugere-se a implementação de estratégias para garantir o seguimento e reduzir os riscos para o trabalhador.

Objetivo definir as competências para a prevenção e o controle de infecções relacionadas à assistência à saúde que devem ser desenvolvidas pelo enfermeiro generalista e pelo enfermeiro especialista em controle de infecções no Brasil. Método empregou-se a técnica Delphi, desenvolvida em quatro rodadas. Participaram do estudo 31 enfermeiros e oito médicos com expertise em prevenção e controle de infecções. Para a coleta de dados, utilizaram-se instrumentos com perguntas abertas cujas respostas foram tratadas por meio da técnica de análise de conteúdo e instrumentos estruturados para avaliar a importância de cada competência por meio de escala Likert, sendo os dados analisados e apresentados de forma descritiva, uso de mediana e de coeficiente de variação. Resultados as competências foram organizadas em 04 centrais, 14 genéricas e 17 específicas, com nome e a descrição de cada competência. Conclusão a definição das competências para a prevenção e o controle de Infecções Relacionadas à Assistência à Saúde é o primeiro passo para se iniciar o repensar acerca do processo de ensino e aprendizagem na formação inicial dos enfermeiros. Os dados encontrados auxiliam na reestruturação do ensino, além de fundamentar programas de educação permanente em saúde.

Background: Timely detection of cleaning failure is critical for quality assurance within Sterilising Service Units (SSUs). Rapid Adenosine Triphosphate (ATP) testing provides a real time and quantitative indication of cellular contaminants, when used to measure surface or device cleanliness. The aim of this study was to investigate the use of an ATP algorithm and to whether it could be used as a routine quality assurance step, to monitor surgical instruments cleanliness in SSUs prior to sterilisation. Methods: Cleanliness monitoring using rapid ATP testing was undertaken in the SSUs of four hospitals located in the western (Amazonia) region of Brazil. ATP testing was conducted (Clean Trace, 3M) on 163 surgical instruments, following manual cleaning. A sampling algorithm using a duplicate swab approach was applied to indicate surgical instruments as (i) very clean, (ii) clean, (iii) equivocal or (iv) fail, based around a ‘clean’ cut-off of 250 Relative Light Units (RLU) and a ‘very clean’ <100 RLU. Results: The four cleanliness categories were significantly differentiated (P≤0.001). The worst performing locations (hospitals A & C) had failure rates of 39.2% and 32.4%, respectively, and were distinctly different from hospitals B & D (P≤0.001). The best performing hospitals (B & D) had failure rates of 7.7% and 2.8%, respectively. Conclusion: The ATP testing algorithm provides a simple to use method within SSUs. The measurements are in real time, quantitative and useful for risk-based quality assurance monitoring, and the tool can be used for staff training. The four-tiered approach to the grading of surgical instrument cleanliness provides a nuanced approach for continuous quality improvement within SSU than does a simple pass/fail methodology.

Objective: to identify whether nursing professionals carry out hand hygiene, how they do it, and what resources are available for this practice during home visits. Method: cross-sectional study conducted in a public Home Care service. The World Health Organization instrument was used to observe the hand hygiene technique, the time of performance, and the product used. Results: a total of 940 hand hygiene opportunities taking place in 231 home visits were observed. Overall adherence was 14.4%, with the practice of hand hygiene being higher after contact with the patient (53.7%). Before aseptic procedures, after risk/exposure to body fluids, after contact with the patient’s environment, and before contact with the patient, adherence was 0.4%. Regarding the quality of the technique, in none of the 135 practices the recommended steps were followed. As for the structure available in the households, 35 (15.2%) had accessible sinks and none had liquid soap and alcohol-based formulation. Conclusion: adherence to hand hygiene by nursing professionals in home care was low, the technique was not performed, and households did not have resources for the practice.