Integrative review of the clean and sterile technique: agreement and disagreement in the execution of dressing Revisión integrada de la tecnica limpia y esteril: consensos y controversias en la realización de curaciones Revisão integrativa da técnica limpa e estéril: consensos e controvérsias na realização de curativos

OBJECTIVE: This study aimed to describe, analyze, and categorize the evidence associated to the use of the clean and sterile technique in wounds. METHODS: It is an integrative literature review using Lilacs, Medline and Cinahl databases. RESULTS: Seven publications were found,, of which four compare the clean and sterile technique, regarding the occurrence of infection; two evaluate the microbiological safety of gloves, and one analyzed the cleansing solution. CONCLUSION: There is consensus that the clean technique reduces costs. Considering the scarcity of studies, we stress the need to perform more level I and II research, according to the evidence hierarchy.<br>OBJETIVO: Este estudio tiene como objetivo describir, analizar y categorizar las evidencias asociadas al uso de la técnica limpia y estéril en curaciones. MÉTODOS: Se trata de una revisión integrada de la literatura en las bases de datos Lilacs, Medline y Cinahl. RESULTADOS: Se tuvo un total de 7 publicaciones de las cuales 4 compararon la técnica limpia y estéril desde el punto de vista de la ocurrencia o no de infección; 2 evaluaron la seguridad microbiológica de los guantes y 1 analizó la solución de la limpieza. CONCLUSIÓN: Es consenso que la técnica limpia reduce costos. Considerando la escasez de estudios se resalta la necesidad de más investigaciones de nivel I y II según la jerarquía de evidencias.<br>OBJETIVO: Analisar a literatura que descreve aspectos que envolvem a técnica limpa e estéril no cuidado de feridas. MÉTODOS: Trata-se de uma revisão integrativa da literatura, nas bases de dados Lilacs, Medline e Cinahl. RESULTADOS: Dentre as sete publicações identificadas, quatro compararam a técnica limpa e estéril do ponto de vista da ocorrência ou não de infecção; duas avaliaram a segurança microbiológica das luvas e uma analisou a solução de limpeza. CONCLUSÃO: É consenso que a técnica limpa reduz custos. Considerando a escassez de estudos, ressalta-se a necessidade de mais pesquisas de níveis I e II, segundo a hierarquia de evidências

Infrastructure and Organization of Adult Intensive Care Units in Resource-Limited Settings

In this chapter, we provide guidance on some basic structural requirements, focusing on organization, staffing, and infrastructure. We suggest a closed-format intensive care unit (ICU) with dedicated physicians and nurses, specifically trained in intensive care medicine whenever feasible. Regarding infrastructural components, a reliable electricity supply is essential, with adequate backup systems. Facilities for oxygen therapy are crucial, and the choice between oxygen concentrators, cylinders, and a centralized system depends on the setting. For use in mechanical ventilators, a centralized piped system is preferred. Facilities for proper hand hygiene are essential. Alcohol-based solutions are preferred, except in the context of Ebola virus disease (chloride-based solutions) and Clostridium difficile infection (soap and water). Availability of disposable gloves is important for self-protection; for invasive procedures masks, caps, sterile gowns, sterile drapes, and sterile gloves are recommended. Caring for patients with highly contagious infectious diseases requires access to personal protective equipment. Basic ICU equipment should include vital signs monitors and mechanical ventilators, which should also deliver noninvasive ventilator modes. We suggest that ICUs providing invasive ventilatory support have the ability to measure end-tidal carbon dioxide and if possible can perform blood gas analysis. We recommend availability of glucometers and capabilities for measuring blood lactate. We suggest implementation of bedside ultrasound as diagnostic tool. Finally, we recommend proper administration of patient data; suggest development of locally applicable bundles, protocols, and checklists for the management of sepsis; and implement systematic collection of quality and performance indicators to guide improvements in ICU performance