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- Cultural adaptation and content validation of the RAC (Rodríguez-Almeida-Cañon) adult infection risk assessment scale for portuguese from PortugalPublication . Martins, Mónica; Paiva-Santos, Filipe; Bom, Luís Todo; Dixe, Maria dos Anjos; Costeira, CristinaIntroduction: Healthcare-Associated Infections (HAIs) have been a concern in the healthcare field due to their impact on public health. Therefore, risk stratification of hospitalized populations, using validated instruments, is essential for implementing effective measures to prevent HAIs. Objective: Aimed to culturally adapt the RAC Infection Risk Assessment Scale (Rodríguez-Almeida-Cañon) for adult patients. This article describes the following steps: preparation, preliminary translation, back-translation, review of the back-translation, and content validation through a panel of experts. Methods: After translating and back-translating the scale using bilingual translators, content validation was carried out through a Delphi panel involving 11 experts in the field of HAIs, of both sexes, with clinical experience and/or previous involvement in infection prevention and control research. The items of the RAC scale were evaluated for clarity, theoretical relevance, and practical pertinence. La validez de contenido se determinó mediante el índice de validez de contenido. Results: Based on the feedback from the experts, there was consensus to retain the 15 assessment items, grouped into intrinsic and extrinsic factors. The Portuguese (Portugal) version of the scale achieved a 95% agreement level. Conclusion: The RAC scale proved to be valid in terms of content. The use of infection risk assessment instruments is essential for infection prevention, contributing to improved quality of care and guiding healthcare professionals’ interventions. To ensure the validity of the scale, a psychometric validation will also be conducted.
- Teleconsulta de Enfermagem como Estratégia de Follow-up em Utentes com Ferida Traumática: Estudo ComparativoPublication . Rosa, Cátia de Sousa; Bom, Luís Filipe Pereira Todo; Costeira, Cristina Raquel BatistaBackground: Follow-up telenursing is recommended as an effective strategy for reducing hospital admissions and associated costs. A telenursing service was implemented in an outpatient clinic to monitor patients with traumatic wounds. Objective: To compare satisfaction and healthcare utilization among patients with traumatic wounds who received follow-up telenursing and those who did not. Methodology: A descriptive-comparative study was conducted. The experimental group (n = 33) received follow-up telenursing in addition to conventional care, while the control group (n = 35) received conventional care only. The study was conducted between May and July 2022, with data collected via questionnaire and analyzed using SPSS® software. Ethical standards were observed. Results: Males predominated in both groups, with a mean age of 40 years. The experimental group reported higher satisfaction with nursing care and lower use of in-person services (p ≤ 0.05). Conclusion: Telenursing contributed to health improvements, supporting its potential as an effective tool for monitoring patients with traumatic wounds.
- Mapping the Second Victim Experience Among Western Nurses: A Scoping ReviewPublication . Costeira, Cristina; Junqueira, Helena; Quintas, Pedro; Pragosa, Ângela; Mata, Ema; Duarte, Hugo; Bom, Luís; Pais, NelsonBackground/Objectives: The second victim phenomenon is increasingly recognized as a significant issue affecting nurses involved in adverse events resulting from clinical decisions or interventions. Although patients and families, considered the first victims, are directly impacted, nurses often undergo challenges as second victims. With the growing awareness of these effects, this study aimed to map recent evidence on the second victim phenomenon among nurses in Western countries. Methodology: A Scoping Review was conducted following the Joanna Briggs Institute methodology in September 2024 and updated in November 2025. Eligibility criteria were defined using the PCC (Population, Concept, Context) framework. Searches were performed in PubMed, CINAHL, SciELO, and Scopus. Two independent reviewers carried out study selection, data extraction, and synthesis. Rayyan® supported screening, performed in two phases: title/abstract review and full-text analysis. Data extraction was conducted in Excel®, and data were analyzed using descriptive statistics and categorized into thematic areas. The review followed PRISMA-ScR guidelines and was registered in the Open Science Framework. Results: Of the 111 articles retrieved, 39 met the inclusion criteria. Evidence shows that although several support programs exist for nurses as second victims, they are often perceived as inadequate or inconsistently implemented. Second victim experience is associated with physical (e.g., sleep disturbances), emotional (e.g., fear), and psychological (e.g., distress) symptoms, with consequences such as absenteeism, professional dissatisfaction, loss of meaning in life, and even suicide. Conclusion: Findings highlight the need for more comprehensive, accessible, and consistently implemented support strategies to meet the complex needs of nurses affected by the second victim phenomenon.
- Prevalence and determinants of infection risk in hospitalised adults: a multicentre cross-sectional study using a structured risk assessment toolPublication . Bom, Luís Todo; Pragosa, Ângela; Mata, Ema; Costeira, Cristina; Duarte, Hugo; Mendes, Ana Rita; Gonçalves, Telma; Mendes, Maria José; Cunha, Helena; Cunha, Helena; Dixe, Maria dos Anjos; Maria dos Anjos Dixe; Marques, Maria do CéuBackground – Healthcare-associated infections remain a major public health challenge, contributing to increased morbidity, mortality, length of hospital stays, and healthcare costs. Systematic assessment of infection risk is essential to support preventive strategies and improve patient safety however remains insufficiently structured in many clinical settings. Objective – To estimate the prevalence of infection risk among hospitalised adults and to identify intrinsic and extrinsic factors associated with high infection risk using a structured risk assessment instrument. Methods – A multicentre, observational, cross-sectional study was conducted in adult inpatient wards across multiple Local Health Units of the Portuguese National Health Service during 2025. Infection risk was assessed using the Risk Assessment for Infection (RAC) scale, which evaluates intrinsic and extrinsic risk factors. Risk stratification was performed using complementary approaches, including receiver operating characteristics (ROC) analysis and percentile-based classification. The study was conducted in accordance with ethical requirements. Results – A total of 1, 092 hospitalised adults were included. Most participants were classified as having moderate (53.6%) or high (11.4%) infection risk according to percentile-based stratification. Higher risk levels were significantly associated with intrinsic factors such as older age, multimorbidity, impaired tissue integrity, and reduced mobility, as well as extrinsic factors including previous hospitalisation, intra- or inter-hospital transfer, prolonged length of stay, invasive procedures, and pharmacological therapy. ROC analysis identified a cut-off point with good discriminative performance, while percentile-based stratification enabled a more granular three-level risk classification. Patients hospitalised in medical wards had significantly higher risk scores compared with those in surgical wards. Conclusion – This study demonstrates a high prevalence of infection risk among hospitalised adults and confirms the multifactorial nature of infection risk in hospital settings. The RAC scale proved to be a useful tool for systematic risk stratification, with the three-level classification providing enhanced clinical applicability. Integrating structured infection risk assessment into routine care may support early identification of high-risk patients, enable targeted preventive interventions, and strengthen infection prevention and control programmes.
- Effectiveness of nursing interventions on preventing the risk of infection in hospitalized adults: a systematic reviewPublication . Bom, Luís Filipe Pereira Todo; Mata, Ema Soraia Fazenda; Cunha, Helena Margarida Pereira; Santos, Ana Rita Melo; Pereira, Ana Sofia Ferreira; Castanheira, Joana Antunes; Dixe, Maria dos Anjos Coelho Rodrigues; Marquês, Maria do CéuBackground Healthcare-associated infections (HAIs) remain a global challenge for patient safety and quality of care, affecting millions of individuals each year and resulting in substantial morbidity, mortality, and financial burden. In Europe alone, over 4.2 million episodes of HAI occur annually. Nurses play a pivotal role in infection prevention through the implementation of evidence-based interventions aimed at disrupting transmission chains and reducing infection risk. Despite the widespread dissemination of preventive strategies, marked heterogeneity persists in their implementation and effectiveness, influenced by institutional, behavioural, and contextual factors. Objective To critically evaluate the effectiveness of nursing interventions in preventing infection risk among hospitalised adults through a systematic review of the literature. Methods A systematic review of Randomised Controlled Trials (RCTs) was conducted following the Joanna Briggs Institute (JBI) methodology and PRISMA 2020 guidelines, with prior registration in PROSPERO (CRD42024582820). Searches were performed across MEDLINE, CINAHL, Scopus, Web of Science, and the Cochrane Library up to January 2025. Methodological quality was assessed using JBI critical appraisal tools, and the certainty of the evidence was rated using the GRADE approach. Given the heterogeneity of the included studies, a narrative synthesis was undertaken. Results Out of 8,123 records identified, 22 RCTs (1979–2024) met the inclusion criteria. Nursing interventions, including daily body bathing with chlorhexidine, prevention bundles for catheters and other devices, promotion of hand hygiene, educational strategies, and environmental disinfection (e.g. ultraviolet-C light) demonstrated a significant reduction in HAI incidence compared with usual care. Multimodal and integrated interventions proved more effective than isolated measures. The overall certainty of evidence was moderate for infection reduction and adherence improvement, but inconsistent for patient mortality and satisfaction outcomes. Conclusions Evidence-based nursing interventions, particularly when applied in a coordinated and multimodal manner, substantially reduce infection risk among hospitalised adults. These findings support the integration of such interventions into institutional programmes and infection control policies. Further multicentre RCTs are recommended to assess implementation fidelity, cost-effectiveness, and patient-centred outcomes.