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      Adesão à prática de higienização das mãos por profissionais de saúde de um hospital universitário Translated title: Adhesión a la práctica de la higiene de las manos por los profesionales de salud de un hospital universitario Translated title: Adhesion to the practice of hand hygiene by professionals in the health area in a university hospital

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          Abstract

          A higienização das mãos (HM) é a medida mais simples e efetiva e de menor custo no controle das infecções relacionadas à assistência à saúde. Este estudo tem como objetivo avaliar a adesão dos profissionais da área de saúde quanto à prática de higienização das mãos. Pesquisa descritiva do tipo quantitativa realizada por meio de um banco de dados do Serviço de Controle de Infecção Hospitalar de um hospital escola da região Centro-oeste. A análise foi realizada por meio do programa SPSS versão 16.0. Foram analisadas 1316 oportunidades de HM, dessas 951 (72,3%) não ocorreram à adesão a essa prática. Em relação às situações que não ocorreram à adesão, destaca-se antes da realização de procedimento não invasivo com o paciente com 24%. A adesão à HM, segundo as normas regulamentadas pelos órgãos competentes, não se apresenta incorporada à prática diária dos profissionais de saúde dessa instituição e, desta forma, ações educativas com vistas a orientar e motivar esses profissionais à prática correta e frequente de HM devem ser discutidas e implementadas.

          Translated abstract

          El lavado de manos (LM) es la más sencilla y eficaz y menos costosa en el control de las infecciones relacionadas con el cuidado de la salud. Este estudio tiene como objetivo evaluar la adhesión de los profesionales de la salud cuanto la práctica de la higiene de las manos. La investigación cuantitativa de tipo descriptivo, realizado a través de una base de datos del Departamento de Control de Infecciones de un hospital de enseñanza en la región del Medio Oeste. El análisis se realizó mediante SPSS versión 16.0. Se analizaron 1316 oportunidades de LM, de esas 951 (72,3%) no se le ocurrió a la adhesión a esta práctica. En las situaciones en que la adhesión no se produjo, se destaca antes de la realización del procedimiento invasivo con el paciente, con 24%. La adhesión a el LM, de conformidad con los estándares regulados por las autoridades competentes, no se presenta incorporada a la práctica diaria de los profesionales de la salud de la institución educativa y, por tanto, son necesarias acciones afirmativas a fin de orientar y motivar a estos profesionales a la práctica correcta y frecuente de LM para que sea discutido y aplicado.

          Translated abstract

          The hand washing (HW) is the most simple and effective and less costly in the control of infections related to health care. This study aims to evaluate the adhesion of professional health care as the practice of hand hygiene. Quantitative research, descriptive type, conducted through a database of the Department of Infection Control from a teaching hospital in the Midwest region. The analysis was performed using SPSS version 16.0. Were analyzed 1316 opportunities HW, these 951 (72.3%) did not occur to the adhesion of this practice. For the situations that not occurred adhesion, stands before the completion of non-invasive procedure with the patient with 24%. The adhesion to HW in accordance with the standards regulated by the relevant authorities, it not incorporated into the daily practice of health professionals that institution and thus educational in order to guide and motivate these professionals to practice correctly and often must HW be discussed and implemented.

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          Most cited references19

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          Guideline for Hand Hygiene in Health-Care Settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force.

          The Guideline for Hand Hygiene in Health-Care Settings provides health-care workers (HCWs) with a review of data regarding handwashing and hand antisepsis in health-care settings. In addition, it provides specific recommendations to promote improved hand-hygiene practices and reduce transmission of pathogenic microorganisms to patients and personnel in health-care settings. This report reviews studies published since the 1985 CDC guideline (Garner JS, Favero MS. CDC guideline for handwashing and hospital environmental control, 1985. Infect Control 1986;7:231-43) and the 1995 APIC guideline (Larson EL, APIC Guidelines Committee. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251-69) were issued and provides an in-depth review of hand-hygiene practices of HCWs, levels of adherence of personnel to recommended handwashing practices, and factors adversely affecting adherence. New studies of the in vivo efficacy of alcohol-based hand rubs and the low incidence of dermatitis associated with their use are reviewed. Recent studies demonstrating the value of multidisciplinary hand-hygiene promotion programs and the potential role of alcohol-based hand rubs in improving hand-hygiene practices are summarized. Recommendations concerning related issues (e.g., the use of surgical hand antiseptics, hand lotions or creams, and wearing of artificial fingernails) are also included.
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            Epidemiologic background of hand hygiene and evaluation of the most important agents for scrubs and rubs.

            The etiology of nosocomial infections, the frequency of contaminated hands with the different nosocomial pathogens, and the role of health care workers' hands during outbreaks suggest that a hand hygiene preparation should at least have activity against bacteria, yeasts, and coated viruses. The importance of efficacy in choosing the right hand hygiene product is reflected in the new Centers for Disease Control and Prevention guideline on hand hygiene (J. M. Boyce and D. Pittet, Morb. Mortal. Wkly. Rep. 51:1-45, 2002). The best antimicrobial efficacy can be achieved with ethanol (60 to 85%), isopropanol (60 to 80%), and n-propanol (60 to 80%). The activity is broad and immediate. Ethanol at high concentrations (e.g., 95%) is the most effective treatment against naked viruses, whereas n-propanol seems to be more effective against the resident bacterial flora. The combination of alcohols may have a synergistic effect. The antimicrobial efficacy of chlorhexidine (2 to 4%) and triclosan (1 to 2%) is both lower and slower. Additionally, both agents have a risk of bacterial resistance, which is higher for chlorhexidine than triclosan. Their activity is often supported by the mechanical removal of pathogens during hand washing. Taking the antimicrobial efficacy and the mechanical removal together, they are still less effective than the alcohols. Plain soap and water has the lowest efficacy of all. In the new Centers for Disease Control and Prevention guideline, promotion of alcohol-based hand rubs containing various emollients instead of irritating soaps and detergents is one strategy to reduce skin damage, dryness, and irritation. Irritant contact dermatitis is highest with preparations containing 4% chlorhexidine gluconate, less frequent with nonantimicrobial soaps and preparations containing lower concentrations of chlorhexidine gluconate, and lowest with well-formulated alcohol-based hand rubs containing emollients and other skin conditioners. Too few published data from comparative trials are available to reliably rank triclosan. Personnel should be reminded that it is neither necessary nor recommended to routinely wash hands after each application of an alcohol-based hand rub. Long-lasting improvement of compliance with hand hygiene protocols can be successful if an effective and accessible alcohol-based hand rub with a proven dermal tolerance and an excellent user acceptability is supplied, accompanied by education of health care workers and promotion of the use of the product.
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              Understanding adherence to hand hygiene recommendations: the theory of planned behavior.

              Most health care workers (HCWs) are aware of the rationale for hand hygiene procedures, yet failure to adhere to guidelines is common. Little is known about factors that motivate HCWs to practice hand hygiene. The purposes of this study were to (1) estimate adherence to hand hygiene recommendations; (2) describe relationships among motivational factors, adherence, and intensity of nursing unit activity; and (3) test an explanatory model for adherence to hand hygiene guidelines based on the theory of planned behavior (TPB). A longitudinal, observational design was used to collect data from 120 registered nurses employed in critical care and postcritical care units. Nurses provided information about motivational factors and intentions and a self-report of the proportion of time they followed guidelines. At least 2 weeks later, the nurses' hand hygiene performance was observed while they provided patient care. Structural equation modeling was used to test the TPB-based model. Rate of adherence to recommendations for 1248 hand hygiene indications was 70%. The correlation between self-reported and observed adherence to handwashing recommendations was low (r = 0.21). TPB variables predicted intention to handwash, and intention was related to self-reported hand hygiene. Intensity of activity in the nursing unit, rather than TPB variables, predicted observed adherence to hand hygiene recommendations. The limited association between self-reported and observed hand hygiene scores remains an enigma to be explained. Actual hand hygiene behavior may be more sensitive to the intensity of work activity in the clinical setting than to internal motivational factors.
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                Author and article information

                Journal
                ree
                Revista Eletrônica de Enfermagem
                Rev. Eletr. Enf.
                Universidade Federal de Goiás (Goiânia, GO, Brazil )
                1518-1944
                June 2010
                : 12
                : 2
                : 266-271
                Affiliations
                [01] Goiânia GO orgnameUniversidade Federal de Goiás orgdiv1Hospital das Clinicas Brasil mariusa_primo_gb@ 123456hotmail.com
                [02] Goiânia GO orgnameUFG orgdiv1Programa de Pós-Graduação em Enfermagem Brasil luaufg@ 123456yahoo.com.br
                [03] Goiânia GO orgnameUFG orgdiv1Hospital das Clinicas Brasil suely.c.a.sirico@ 123456bol.com.br
                [04] Goiânia GO orgnameUFG orgdiv1Hospital das Clinicas Brasil martaantunes@ 123456bol.com.br
                Article
                S1518-19442010000200006 S1518-1944(10)01200206
                3913375a-cac9-4649-91c1-d2e831b8f329

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

                History
                : 25 February 2010
                : 06 October 2009
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 19, Pages: 6
                Product

                SciELO Revista de Enfermagem

                Categories
                Artigo Original

                Lavado de manos,Infección hospitalaria,Personal de salud,Lavagem de mãos,Infecção hospitalar,Pessoal de saúde,Handwashing,Cross infection,Health personnel

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