Academic literature on the topic 'Nursing staff in the material and sterilization center'

This study discusses the problem of surgery cancellation on the economic-financial perspective. It was carried out in the Surgical Center Unit of a school hospital with the objective to identify and analyze the direct costs (human resources, medications and materials) and the opportunity costs that result from the cancellation of elective surgeries. Data were collected during three consecutive months through institutional documents and a form elaborated by the researchers. Only 58 (23.3%) of the 249 cancelled scheduled surgeries represented costs for the institution. The cancellations direct total cost was R$ 1.713.66 (average cost per patient R$ 29.54); distributed as follows: expenses with consumption materials R$ 333.05; sterilization process R$201.22; medications R$149.77 and human resources R$1,029.62. The human resources costs represented the greatest percentile in relation to the total cost (60.40%). It was observed that most of the cancellations could be partially avoided. Planning on management; redesigning work processes, training the staff and making early clinical evaluation can be strategies to minimize this occurrence.

Objetivo: identificar a produção científica em revistas brasileiras com Qualis A1, A2, B1 e B2 sobre Centro de Material e Esterilização. Método: estudo descritivo, retrospectivo e quantitativo, do tipo bibliométrico. Foram selecionados artigos científicos disponíveis no período de 1973 a 2017, publicados em revistas científicas brasileiras, com classificação no Qualis A1, A2, B1 e B2. Resultados: dos 286 artigos identificados, 108 atenderam aos critérios de inclusão. Houve predomínio da investigadora Graziano 20 (18,52%), do objeto de estudo sobre qualidade de esterilização 26 (24,08%), da abordagem metodológica quantitativa 63 (58,33%), e da população-alvo mais estudada foi à equipe de enfermagem 56 (51,85%). Conclusão: a produção científica brasileira em Centro de Material e Esterilização avançou nas últimas décadas, no entanto ainda carece de produção científica, especialmente relacionada às boas práticas e aos avanços tecnológicos disponíveis na área.

BACKGROUND: Operating room nursing professionals are exposed to different workload. It is necessary to recognize which situations resulting from their tasks interfere with the health of the professional. OBJECTIVES: We aimed to identify the physical and physiological loads on operating room nurses and their impact on the health as well as trace ergonomic recommendations based on the literature and performed analysis. METHODS: The is an exploratory, observational, descriptive research conducted in the surgical center of a university hospital between August 2017 and July 2018. Nursing staff of both genders who worked as transport professionals or room circulators were included in the study. Data collection in the OR went through stages of Ergonomic Workplace Analysis (EWA), through semi-structured interviews addressing the physical and physiological work issues and a worksheet of data collected from the observations of the practitioners’ actions. RESULTS: The study included 20 nursing workers of both genders with an average of 17.33±12.58 years of work experience. The most reported problematic factors were: lack of material, staff pressure, patient transporting, employment legal status with the institution, and lack of communication among the practitioners. CONCLUSIONS: There was a physical effort during the activity and a high prevalence of workers with pain complaints, which justifies the investigation.

Este estudo objetivou conhecer a percepção da equipe de enfermagem frente ao processo de trabalho no Centro de Material e Esterilização - CME. Tratou-se de um estudo descritivo-exploratório com abordagem quantitativa, realizado com 18 profissionais de enfermagem do CME de um Hospital Universitário, localizado no interior de São Paulo. A coleta de dados foi realizada entre maio e junho de 2018, através de entrevista semiestruturada e a análise estatística por meio de percentual simples. As dificuldades mais frequentes foram: inadequação de recursos materiais/físicos, sobrecarga de trabalho, falta de treinamento, riscos ocupacionais e a não valorização do trabalho. A contratação de profissionais foi a estratégia de melhoria mais citada. Houve satisfação em relação ao trabalho, porém a falta de valorização e os recursos humanos/materiais inadequados, causam desestímulo. Logo, a importância do reconhecimento das fragilidades do setor e das percepções dos funcionários, visando maior valorização profissional e, consequentemente, uma assistência mais eficaz e segura.Descritores: Esterilização, Segurança do Paciente, Equipe de Enfermagem. The work process in the center of material and sterilization: perception of nursing teamAbstract: This study aimed to know the perception of the nursing team regarding the work process at the Material and Sterilization Center - CME. It was a descriptive-exploratory study with a quantitative approach, carried out with 18 CME nursing professionals from a University Hospital, located in the interior of São Paulo. Data collection was performed between May and June of 2018, through semi-structured interviews and statistical analysis using a simple percentage. The most frequent difficulties were: inadequate material / physical resources, work overload, lack of training, occupational risks and non-valorization of work. The hiring of professionals was the most cited improvement strategy. There was satisfaction with the work, but the lack of valorization and the inadequate human / material resources, cause discouragement. Therefore, the importance of recognizing the fragilities of the sector and the perceptions of the employees, aiming for greater professional valorization and, consequently, a more effective and safe assistance.Descriptors: Sterilization, Patient Safety, Nursing Team. El proceso de trabajo en el centro de material y esterilización: percepción del equipo de enfermeríaResumen: Este estudio objetivó conocer la percepción del equipo de enfermería frente al proceso de trabajo en el Centro de Material y Esterilización - CME. Se desarrolló un estudio descriptivo-exploratorio con abordaje cuantitativo, realizado con 18 profesionales de enfermería del CME de un Hospital Universitario, ubicado en el interior de São Paulo. La recolección de datos fue realizada entre mayo y junio de 2018, a través de entrevista semiestructurada y el análisis estadístico por medio de porcentual simple. Las dificultades más frecuentes fueron: inadecuación de recursos materiales/físicos, sobrecarga de trabajo, falta de entrenamiento, riesgos ocupacionales y la no valorización del trabajo. La contratación de profesionales fue la estrategia de mejora más citada. Hubo satisfacción en relación al trabajo, pero la falta de valorización y los recursos humanos / materiales inadecuados, causan desestímulo. Por lo tanto, la importancia del reconocimiento de las fragilidades del sector y de las percepciones de los funcionarios, buscando mayor valorización profesional y, consecuentemente, una asistencia más eficaz y segura.Descriptores: Esterilización, Seguridad del Paciente, Equipo de Enfermería.

This is a case study with a phenomenological approach on the experience of a woman who works in nursing and suffers from the de Quervain's disease, an osteo-muscular disorder related to working conditions. This study aimed to understand what means to be a woman working in nursing and suffering from an osteo-muscular disorder related to working conditions through a worker of the Material and Sterilization Center of a private hospital. The philosophical referential from Martin Heidegger was used for the comprehensive analysis of the statement in question. The analysis revealed that the physiopathological process of the de Quervain's disease caused changes in the worker's life, characterized by painful manifestations and especially by physical limitations, which generate a multiplicity of feelings. Anguish is present in the process of accepting the disease, when the worker perceives the fragility of her existence and recognizes herself as the one responsible for her own care, reaching authenticity and transcending the disease.

Introduction Catheter-associated urinary tract infections are the most common nosocomial infections of the urinary tract, and among the most common nosocomial infections in general. The major problems of these infections include antibiotic resistance and enormous direct and indirect cost of treatment. Material and methods A retrospective study on major causes of infections and antibiotic resistance was conducted at four clinics of the Clinical Center of Banja Luka. An anonymous questionnaire was distributed to nursing staff dealing with urinary catheters in order to get an overview of their clinical performance. Results The results showed that in 89% of cases (out of 198 patients with developed catheter-associated urinary tract infection) infections were caused by gram-negative bacteria, in 7% by gram-positive bacteria and in 4% by Candida. The most common bacteria were: Escherichia coli (33.6%), Pseudomonas aeruginosa (14.1%), Proteus mirabilis (13.3%), and Enterobacter (10.5%). Majority of bacteria presented with extremely high resistance (72-100%) to ampicillin, gentamycin and cotrimoxazole, and in some cases a significant resistance to ciprofloxacine, nalidixic acid, ceftriaxone and ceftazidime. The questionnaire showed that nursing staff did not follow guidelines for medical care of patients with urinary catheters. Conclusion It can be concluded that poor hygienic and epidemiological conditions, as well as irrational use of antibiotics contribute to uncontrolled development of urinary tract infections in catheterized patients.

Objetivo: identificar os riscos ocupacionais aos quais os profissionais de enfermagem da CME, refletindo sobre a implementação de melhorias das condições de trabalho e qualidade de vida no ambiente laboral. Metodologia: realizou-se uma revisão integrativa da literatura, com caráter descritivo, utilizando as bases de dados LILACS, BDENF e Google Acadêmico, incluindo artigos com texto completo disponível eletronicamente e de forma gratuita, redigidos no idioma português, publicados no recorte temporal entre 2007 a 2018, que abordassem o tema e respondessem à questão norteadora do estudo. Resultados: de acordo com os estudos, o ambiente laboral da CME expõe os profissionais de enfermagem a riscos físicos (85,71%), químicos (42,86%), biológicos (42,86%), ergonômicos (71,43%), de acidentes (71,43%) e psicossociais (42,86%). Conclusão: a sensibilização dos gestores e a implementação de ações preventivas são necessárias para a melhoria das condições laborais e favorecem o bem estar e a satisfação dos profissionais de enfermagem na execução de suas tarefas cotidianas.Descritores: Riscos Ocupacionais. Enfermagem. Esterilização.

Introduction / Innovation Concept: During Emergency Department (ED) resuscitation of critically ill patients, effective teamwork and communication among various healthcare professionals is essential to ensure favorable patient outcomes and to minimize threats to patient safety. However, numerous individual and system factors create barriers to effective team functioning. Simulation center- based training has been used to improve Crisis Resource Management skills among physician and nursing trainees, but in-situ simulation is a relatively new concept in adult Emergency Medicine in North America. Methods: To enhance patient care and team effectiveness, an ED nursing and physician group was created to develop and implement a novel interprofessional in-situ simulation program in two Canadian, academic tertiary-care emergency departments. Departmental approval and financial support was obtained and sessions commenced in January 2015. Curriculum, Tool, or Material: Monthly high-fidelity simulation sessions are held in the ED resuscitation rooms at both campuses of our hospital. Each session is facilitated and debriefed by simulation-trained Emergency Medicine faculty and senior residents, a nurse educator and a research assistant. Technical support is provided by our simulation center staff. Participants are recruited from the physicians, residents, nurses, respiratory therapists and other support staff working in the ED. To minimize the impact on patient care, two additional nurses are scheduled to cover nursing assignments on “sim days”. Simulations are limited to fifteen minutes, followed by a twenty minute debriefing. Conclusion: We have successfully developed and implemented an interprofessional in-situ simulation program in our ED. Participant feedback has been overwhelmingly positive. Lack of financial support, reluctance of staff to participate, and overwhelmed resources are some of the challenges to running a program like this in a busy ED environment. However, there are clear benefits: empowering team members, culture change, identification of latent safety threats, and a perception of improved teamwork and communication.

Abstract Introduction:In country like India, where there is big and complex health care system, mixed economy, private and Government hospitals working together; while providing services generate waste. It is estimated that the quantity of waste generated from hospitals in our country ranges between 0.5 and 2.0 kg/bed/day and annually about 0.33 million tons of waste are generated in India Aim and objectives:To study the awareness of nursing staff about the biomedical waste segregation in a tertiary care center Material and methods:A cross-sectional study was conducted among the nurses of Justice K.S.Hegde Hospital, Derlakatte. Total of 123 nurses who were present at the time were the study subjects. The pre-tested semi-structured questionnaire which was validated by face validation method was distributed. Results:The total of 96.66% of nurses knew the segregation of biomedical waste was the need of the hour. 90% of them felt they have adequate knowledge about segregation. 96% knew the color coding of sharps and human anatomical waste. But 99% knew the colour coding of blood, blood products and microbiological waste. 67% knew the colour coding of pharmacological waste and double glove disposal. Only 89.3% were confident that they followed the correct methods of segregation.

Objective: to review and socialize Standard Operating Procedure (SOP) on the process of disinfecting health products (PPS). Method: An experience report study of an intervention performed in a hospital in the Northwest region of the State of Rio Grande do Sul, in the second semester of 2018, with the participation of the nursing team of the Material and Sterilization Center (CME) and the nurse responsible for the Hospital Infection Control Service (SCIH). The activities took place after contact with the nurse responsible for the unit, who passed on the SOP to be reviewed, there was also the elaboration of a mural on high-level disinfection. Results: five nursing professionals and five academic students who interned at the location participated in the action. It was noticed that two important actions of the PPS disinfection process were not described in the CME POPs, which are: hand hygiene and the use of personal protective equipment (PPE). The team interacted through the exchange of ideas, a principle of permanent health education. Final considerations: The nurse must act as an educator seeking constant updating of his team and solutions for his practice. Finally, the execution of the project made it possible to review the SOPs and discuss with the unit's team and, in addition, it also showed the need for further studies in this area.

O insucesso nos procedimentos cirúrgicos ortopédicos em razão de infecção pode levar a consequências desastrosas como a osteomielite e a perda de próteses implantadas. A infecção hospitalar é um desfecho de causa multifatorial, na qual a esterilização segura do instrumental cirúrgico ocupa uma posição de extrema importância. Não se sabe até o momento quais os reais desafios microbiológicos que a Central de Material e Esterilização (CME) vem enfrentando ao reprocessar a diversidade dos materiais utilizados nos procedimentos cirúrgicos. Micro-organismos com capacidade para esporular estão presentes em quantidade e frequência significativa? Sabe-se que estes se constituem como desafio mensurável na prática da esterilização, fazendo parte de indicadores biológicos. O objetivo desta pesquisa foi determinar e analisar a carga microbiana recuperada do instrumental cirúrgico, após uso em cirurgias ortopédicas, quantificando e identificando o gênero e a espécie do crescimento de bactérias e fungos. A investigação caracterizou-se como uma pesquisa exploratória, de campo e transversal com abordagem quantitativa. As amostras foram coletadas no Instituto de Ortopedia e Traumatologia (IOT) do Hospital das Clínicas (HC) da Faculdade de Medicina da Universidade de São Paulo (FMUSP), com técnica asséptica, depositando-as individualmente em um saco plástico previamente esterilizado, adicionando 500 mL de água de injeção. Para obtenção da carga microbiana, o instrumental foi sonicado em lavadora ultrassônica (US) por três sessões de 5 segundos cada e, consecutivamente, agitado por 5 minutos para complementar a extração da carga microbiana potencialmente presente na superfície dos materiais (externa e internamente). Em seguida, os lavados foram divididos em três partes iguais e submetidos à filtração em filtro Millipore® de 0,45 µm. Cada membrana foi cultivada em meio apropriado para o crescimento aeróbio, anaeróbio e fungos/leveduras. Para a identificação dos micro-organismos, foram utilizados kits e testes de identificação utilizados na rotina laboratorial de microbiologia clínica. Os resultados demonstraram que os três diferentes potenciais de contaminação apresentaram crescimento microbiano. Nas cirurgias limpas, 47% do instrumental estavam contaminados e o micro-organismo mais prevalente foi o Staphylococcus coagulase negativa (28%), seguido do Bacillus subtilis (11%). Nas cirurgias contaminadas e infectadas, houve um crescimento, de aproximadamente, 70% e 80%, respectivamente nos instrumentos, sendo maior o crescimento do Staphylococcus coagulase negativa (respectivamente, 32% e 29%) e Staphylococcus aureus (respectivamente, 28% e 43%). Considerando que os gêneros Bacillus e o Clostridium são capazes de esporularem, concluiu-se que a CME enfrenta um desafio ao precisar eliminar micro-organismos capazes de esporular, em uma densidade 102 UFC, menor que a dos indicadores biológicos e, aproximadamente, 78% dos micro-organismos recuperados foram bactérias vegetativas com sua curva de morte em torno de 80 ºC<br>The failure in orthopedic surgical procedures due to infection can lead to devastating consequences such as the loss of implanted prostheses. Hospital infection is an outcome with a multifactorial cause, in which the safe sterilization of the surgical instruments has an extremely important role. To date, it is not known what microbiological challenges the Material and Sterilization Center (MSC) has been facing when reprocessing the variety of materials used during these surgical procedures. Are microorganisms with the capacity to sporulate present in significant quantity and frequency? It is known that these microorganisms constitute a measurable challenge in sterilization practice and that they are part of the biological indicators. This study aimed at measuring the microbial load recovered from surgical instruments after their use in orthopedic surgeries, quantifying and identifying the genus and species of the bacterial and fungal growth. The study was characterized as an exploratory research, field research and cross-sectional with quantitative approach. The samples were collected at the Institute of Orthopedics and Traumatology (IOT) of Hospital das Clínicas (HC) of the School of Medicine of the University of São Paulo (FMUSP), using an aseptic technique, the samples were then placed in a plastic bag that had been previously sterilized with 500 mL of injection solution. To obtain the microbial load, the instruments were sonicated in an ultrasonic (US) washer for three 5-second sessions each and consecutively agitated for 5 minutes to complement the extraction of the microbial load potentially present on the surface of the materials (external and internally). Subsequently, the washed samples were fragmented in three equal parts and these were submitted to filtration in a 0.45 µm Millipore® filter. Each membrane was cultured in medium adequate for the growth of aerobic and anaerobic organisms, as well as fungi and yeasts. The identification of the microorganisms was carried out with identification kits and tests used in clinical microbiology laboratory routine. The results demonstrated that the three different contamination potentials presented microbial growth. In clean surgeries, 47% of the instruments were contaminated and the most prevalent microorganism was coagulase-negative Staphylococcus (28%) followed by Bacillus subtilis (11%). In contaminated and infected surgeries, a growth of approximately 70% and 80%, respectively, was identified in the instruments, with the higher growth being that of coagulase-negative Staphylococcus (respectively, 32% and 29%) and Staphylococcus aureus (respectively, 28% and 43%). Considering that the Bacillus and the Clostridium genera are capable of sporulating, we concluded that the MSC faces a challenge in having to eliminate microorganisms capable of sporulating, although in a lower density than that of biological indicators (102 UFC) and, approximately, 78% of the recovered microorganisms were vegetative bacteria that presented their curve of death at around 80ºC

Em 1967, uma carta enviada ao British Medical Journal relatou que a re-esterilização em Óxido de Etileno (EO) do Cloreto de Polivinil (PVC) previamente gamairradiado forma grandes quantidades de etileno cloridrina, um composto altamente tóxico. Mesmo não apresentando dados mensurados, esta carta iniciou uma polêmica que até hoje divide a opinião de pesquisadores. Dirimir esta dúvida é relevante, uma vez que produtos de PVC esterilizados em Radiação Gama são habitualmente reesterilizados em EO em caso de vencimento do período de validade da esterilização, que é determinado pelo fabricante. Este estudo objetivou evidenciar a toxicidade de tubos de PVC por meio do teste de citotoxicidade pelo método da difusão em ágar em culturas celulares NCTC clone 929. Foram criados quatro grupos experimentais com 81 unidades de análise: G1, constituído de tubos in natura; G2 constituído de tubos esterilizados em Radiação Gama; G3 constituído de tubos esterilizados em EO e G4 constituído de tubos esterilizados em Raios Gama e re-esterilizados em Óxido de Etileno. Os testes foram realizados em triplicata e cada tubo foi testado de forma a representar as superfícies internas, externas e massa. Após a mensuração do halo incolor, as unidades de análise foram graduadas de acordo com os graus de reatividade biológica descritos na norma ISO 10993-5:2009. Foram consideradas citotóxicas apenas as unidades análise que obtiveram grau três ou acima. Os resultados revelaram toxicidade celular apenas no grupo G3, no qual foram observadas placas com morte de todas as células, fato que demandou repetições, conforme a metodologia adotada. Na primeira repetição houve persistência de unidades de análise capazes de causar a morte de todas as células da placa. Na segunda repetição, nenhuma unidade de análise foi classificada como citotóxica. Inferiu-se que houve falhas no processo de aeração no grupo G3 e na primeira repetição. O resultado da cromatografia gasosa dos grupos G3 e G4 atestou que os materiais de ambos os grupos estariam seguros para uso. O valor máximo dos resíduos encontrados em ambos os grupos foi idêntico, contradizendo os resultados do teste de citotoxicidade. Concluiu-se que, nas condições deste experimento, os materiais de PVC esterilizados em Radiação Gama e, consecutivamente, reesterilizados em EO não são citotóxicos e a cromatografia gasosa, utilizada isoladamente, pode produzir resultados questionáveis quanto à segurança dos materiais esterilizados em EO.<br>In 1967, a letter sent to the British Medical Journal reported that the re-sterilization with Ethylene Oxide (EtO) of previously irradiated Polyvinyl Chloride (PVC) formed large amounts of ethylene chlorohydrin, a highly toxic compound. Even though it did not present measured data, this letter initiated a controversy that still divide the opinion of researchers to date. To solve this doubt is relevant, as PVC products submitted to gamma radiation are usually re-sterilized with EtO, when the sterilization validity has expired, which is determined by the manufacturer. The present study aimed at assessing the toxicity of PVC tubes through the cytotoxicity test, using the NCTC clone 929 cell culture agar diffusion test. Four experimental groups were created with 81 analysis units: G1, consisting of tubes in natura; G2, consisting of tubes submitted to gamma radiation; G3, consisting of tubes submitted to EtO sterilization and G4, consisting of tubes submitted to gamma-radiation and re-sterilized with EtO. The tests were carried out in triplicate and each tube was tested in order to represent its internal and external surfaces, as well as its mass. After the measurement of the colorless halo, the analysis units were graded according to the degrees of biological reactivity described in the ISO 10993-5:2009. Only the analysis units that were considered grade 3 and above were considered cytotoxic. The results showed evidence of cell toxicity only in G3, which disclosed plaques that presented death of all cells, a fact that necessitated repetition of the experiment, according to the adopted methodology. The first repetition showed the persistence of the analysis units to cause the death of all cells in the plaque. At the second repetition, none of the analysis units was classified as being cytotoxic. It was inferred that there were failures in the process of aeration in group G3 and in the first repetition. The results of the gas chromatography of groups G3 and G4 demonstrated that the materials from both groups would be safe for use. The maximum value of residues found in both groups was identical, in disagreement with the cytotoxicity test results. It was concluded that, according to the conditions of this experiment, the PVC materials submitted to gamma-radiation and consecutively sterilized by EtO are not cytotoxic and that the gas chromatography, when used alone, can yield debatable results regarding the safety of materials sterilized with EtO.

Introdução: Na prática clínica odontológica, justificada pela praticidade, tempo curto disponível entre os atendimentos, associados à insuficiente previsão e provisão das Canetas de Alta Rotação (CAR), a descontaminação destas por meio de aplicação direta do álcool 70% p/v, sem limpeza prévia, é uma realidade. Este procedimento contraria, a priori, os protocolos de processamento que recomendam, no mínimo, limpeza seguida de desinfecção de alto nível para prevenção de infecção cruzada. Objetivo: avaliar a desinfecção das CAR com álcool 70% p/v, sem limpeza prévia com vistas ao risco de causar infecção cruzada. Método: caracterizou-se como uma pesquisa pragmática em um Estabelecimento Odontológico, onde rotineiramente as práticas de interesse para o estudo estavam presentes. O grupo experimental foi composto por 100 amostras de CAR utilizadas em tratamentos diversos, após a fricção do desinfetante por 90 segundos em sua superfície externa. Para avaliação dos resultados, uma gaze umedecida com soro fisiológico foi utilizada como carreador para o arraste dos possíveis micro-organismos nas superfícies desinfetadas. Metade do número das amostras (50) foi analisada pelo método de filtração por membrana (Método I - quantitativo), sendo cada gaze imersa em 300 mL de solução fisiológica. Sequencialmente, as amostras foram expostas a sonicação e agitação. Em seguida, o lavado foi filtrado em três partes iguais para diferentes análises (micro-organismos aeróbios, anaeróbios e específicos da microbiota oral humana), por meio da membrana com porosidade de 0,45 m. As outras 50 amostras foram analisadas pelo método de imersão direta da gaze em meio de cultura Fluid Thioglycollate Medium (Método II qualitativo). O tubo contendo a gaze foi agitado e incubado a 37ºC por 21 dias. Resultados: as amostras analisadas pelo Método I apresentaram crescimento positivo em 27/50 (54%) das amostras na faixa de 100 a 102 UFC/amostra. Deste total, foram identificados sete micro-organismos distintos, representados por 37,1% do Staphylococcus coagulase negativa, 28,5% dos Bacillus spp, 17,1% dos Bacilo Gram positivos não esporulados, 5,7% dos Micrococcus spp, 5,7% dos Penicillium spp, 2,8% Acinetobacter baumannii e 2,8% da Candida spp. No grupo analisado pelo Método II, o total de tubos com crescimento positivo foi de 12/50 (24%) amostras. Deste total, foram identificados três micro-organismos distintos, sendo 38,4% de Bacilos Gram positivos inespecíficos, seguidos dos Staphylococcus spp e Peptococcus spp com a mesma porcentagem de positividade de 30,7% cada. O grupo controle negativo, composto por amostras submetidas à limpeza e esterilização consecutiva, apresentaram resultados satisfatórios de ausência microbiana na totalidade das amostras. O crescimento médio encontrado no grupo controle positivo foi de 17,5 UFC/placa, com exceção de uma amostra que apresentou crescimento incontável. Conclusão: os resultados da presente investigação reprovam a prática da descontaminação das CAR com álcool 70% p/v, sem limpeza prévia, substanciada pela sobrevivência de micro-organismos que não corresponderam à ação fungicida e bactericida esperada do álcool 70% p/v na condição de desinfetante de nível intermediário. Outro aspecto que reforça a reprovação da prática analisada é a consideração de que os micro-organismos recuperados, mesmo sendo de baixo potencial patogênico, podem comportar-se como anfibiontes, isto é, são capazes de agredir o hospedeiro quando as condições ambientais e imunológicas são favoráveis aos micro-organismos, causando infecção.<br>Introduction: In dental clinical practice, decontamination of high-speed dental equipment (HSDE) by direct use of 70% ethanol without previous cleaning, justified by practicality, the short-time available between appointments, together with inadequate predicting and provision of HSDE, is a reality. This procedure, a priori, contradicts the processing protocols recommended to prevent cross-infection. Objective: to evaluate the disinfection of HSDE with 70% ethanol without previous cleaning, with views of cross-infection risk. Method: the present study was characterized as a pragmatic research in a Dental Office, which practices of interest to the study were routinely performed. The experimental group consisted of 100 samples of HSDE used in different treatments after rubbing the disinfectant for 90 seconds on its outer surface. To evaluate the results, gauze moistened with saline solution was used as a carrier for obtaining microorganisms from the disinfected surfaces. Half of the samples (50) were analyzed by membrane filtration (Method I - quantitative), with the gauze being immersed in 300 mL of saline solution. Sequentially, the sample was exposed to sonication and agitation. After that, the lavage was filtered in three equal parts for different analyses, through a membrane with 0.45 m porosity and seeded on blood agar culture medium, for recovery of aerobic and anaerobic microorganisms, as well as those specifically found in the human oral microbiota. The other 50 samples were analyzed by direct immersion of the gauze in culture medium (Method II - Qualitative): after rubbing the wet gauze on the outer surface of the HSDE, it was placed directly in Fluid Thioglycollate culture medium. The tube containing the gauze was shaken in a vortex mixer and then incubated at 37 ° C for 21 days. Results: samples analyzed by Method I, showed positive growth in 27/50 (54%) of the samples within the range of 100 to 102 CFU/sample. Of this total, 7 different microorganisms were identified, represented by 37.1% of coagulase-negative Staphylococcus, 28.5% of Bacillus spp, 17.1% of non-sporulating Gram-positive bacillus, 5.7% of Micrococcus spp, 5.7 % of Penicillium spp, 2.8% of Acinetobacter baumannii and 2.8% of Candida spp. In the group analyzed by Method II, the total number of tubes with positive growth was 12/50 (24%) samples. Of this total, we identified 2 different microorganisms, being 38.4% of Gram-positive bacillus nonspecific, followed by Staphylococcus spp and Peptococcus spp with the same percentage of positivity of 30.7% each. The negative control group, composed of samples subjected to cleaning and sterilization consecutive showed satisfactory results. The average growth found in the positive control group was 17.5 CFU/sample, except for one sample that showed growth uncountable. Conclusion: the results of the present study do not support the practice of decontamination of HSDE with 70% ethanol without previous cleaning, based on the evidence of microorganism survival that did not meet the expected bactericidal and fungicidal action of alcohol as an intermediate level disinfectant. Another aspect that reinforces the disapproval this practice, it is the consideration that the micro-organisms recovered, even being low pathogenic potential, may behave as anfibionte, which are capable of harming the host when the environmental and immune conditions are favorable to micro-organisms, causing infection.

Some patients in nursing homes require extra attention to enable staff to detect and manage deterioration at an early stage. Nursing skills are vital to make systematic observations and assessments of a patient’s condition. It is challenging for nurses in nursing homes to make professional decisions without being able to consult other nurses. To improve the quality and safety of health care for patients and their relatives, the focus must be on working to ensure patient safety in nursing homes. Simulation-based learning can be one way to increase reflection on patient safety and develop health professionals’ knowledge, skills and attitudes, while protecting patients from unnecessary risks. Simulation-based learning as a method in medical education offers activities that mimic a clinical environment, where students can practice procedures and decision-making and where their critical thinking can be enhanced through role-play, videos or simulators. While simulation often takes place in a simulation center, in situ simulation refers to a learning activity that takes place in participants’ everyday work environment where they actually provide patient care. In this chapter, we aim to describe nurses’ experiences of in situ simulation and their subsequent reflections on patient safety in nursing homes. Data were collected from two focus groups with 5–6 nurses per group. The transcribed material was analyzed using qualitative content analysis, and two categories were identified that described the nurses’ experiences: “to doubt oneself” and “being dependent on others”.