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- Effectiveness of Nursing Interventions on Preventing the Risk of Infection in Adult Inpatients: Protocol for a Systematic ReviewPublication . Todo Bom, Luís Filipe Pereira; Mata, Ema Soraia Fazenda; Cunha, Helena Margarida Pereira; Marquês, Maria do Céu Mendes Pinto; Dixe, Maria dos AnjosBackground/Objectives: Healthcare-associated infections (HAIs) are a major global public health concern, significantly impacting patient safety and healthcare quality. These infections are associated with high morbidity and mortality rates, prolonged hospital stays, and increased healthcare costs. Nurses play a critical role in infection prevention, implementing evidence-based interventions to reduce infection risks. This systematic review aims to identify and synthesize the most effective nursing interventions to prevent HAIs in hospitalized adults, analyzing their variability across different clinical settings and populations. Methods: This systematic review follows the Joanna Briggs Institute (JBI) methodology for systematic reviews of effectiveness and is reported according to PRISMA guidelines. The protocol is registered in the PROSPERO database (CRD42024582820). This review includes randomized controlled trials, quasi-experimental studies, and observational studies (cohort, case-control, and cross-sectional) assessing the effectiveness of nursing interventions in reducing HAIs. A comprehensive search is conducted in the PubMed, CINAHL, Scopus, Web of Science, and Cochrane databases. Study selection, data extraction, and quality assessment are performed by two independent reviewers, with disagreements resolved by a third reviewer. Results: The primary outcomes include reductions in HAI incidence rate, increased adherence to preventive interventions, decreased hospital length of stay, reduced readmission rates due to infections, and overall patient safety improvements. A meta-analysis is conducted when feasible; otherwise, results are synthesized narratively. Conclusions: The findings of this review contribute to the standardization of evidence-based nursing practices for HAI prevention, promoting safer healthcare environments. By identifying the most effective interventions, this study aims to support healthcare professionals and policymakers in implementing targeted infection control strategies.
- 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.
- Autoperceção dos enfermeiros face à avaliação do risco de infeção no adulto hospitalizadoPublication . Faria, Beatriz; Carreira, Maria João; Figueiras, Diana; Jardim, André; Mata, Ema; Loureiro, Ricardo; Cunha, MadalenaIntrodução: As infeções associadas aos cuidados de saúde têm impacto na morbilidade, mortalidade e custos. A avaliação sistemática do risco é essencial para implementar medidas preventivas. Objetivo: Avaliar a autoperceção dos enfermeiros relativamente à avaliação e ao controlo do risco de infeção no adulto hospitalizado e analisar a relação dessa perceção com variáveis sociodemográficas e profissionais. Métodos: Estudo quantitativo, transversal e descritivo-correlacional, com amostra de mestrandos de uma Escola Superior de Saúde portuguesa, enfermeiros de um hospital da região Oeste de Portugal e enfermeiros recrutados via plataformas sociais. Os dados foram recolhidos por questionário de caracterização sociodemográfica e escala de Likert sobre práticas de prevenção e controlo de infeções. Resultados: A média global foi de 1,95 (DP=0,466), indicando integração frequente dos itens na prática. Não se verificaram diferenças significativas entre enfermeiros com/sem especialidade ou formação específica. Encontraram-se correlações fracas, mas significativas, entre idade/experiência nos itens: dias de antibioterapia (ρ = −0,294; p = 0,017), rastreio de SAMR (idade: ρ = 0,297; p = 0,026; experiência: ρ = 0,308; p = 0,021), reconhecimento de risco em doentes reoperados (ρ = −0,270; p = 0,042) e classe de antibiótico (ρ = −0,314; p = 0,013). Conclusão: Os enfermeiros valorizam a avaliação do risco de infeção referindo práticas alinhadas com as recomendações, embora passíveis de melhoria. Recomendam-se reforço formativo e uso de métodos observacionais para avaliar a prática real.
- Autoperceção dos enfermeiros na prevenção da infeção associada ao cateter venoso centralPublication . Gomes, Ana Rita; Mata, Ema; Cunha, MadalenaIntrodução: As infeções da corrente sanguínea associadas ao cateter venoso central (CVC) podem ser prevenidas através da adesão ao feixe de intervenções definido pela Direção-Geral da Saúde.Objetivo:Avaliar a autoperceção dos enfermeiros quanto ao cumprimento do feixe de intervenções para prevenção de infeção relacionada com CVC,e analisar associações com variáveis sociodemográficas e profissionais.Métodos: Estudo quantitativo, transversal e correlacional, com amostragem por conveniência (n=77). Aplicou-se questionário eletrónico composto por caracterização sociodemográfica/profissional e escala de 14 itens tipo Likert (1=“Nunca” a 5=“Sempre”), baseada no instrumento de auditoria da DGS, para avaliar a autoperceção do cumprimento das intervenções.Resultados: A média global foi 4,22 (DP=0,43), indicando cumprimento “Muitas vezes”. Enfermeiros com formação específica apresentaram médias superiores e diferenças estatisticamente significativas em componentes como seleção de CVC com menos lúmens, uso de barreira máxima, higiene das mãos antes da manipulação, utilização da técnica assética no realização do penso e mudança de penso com compressas em 48h. Idade e experiência correlacionaram-se positivamente com várias práticas, salientando-se correlação moderada com a utilização da técnica assética, e associações mais fracas com higiene das mãos e mudança de penso quando indicado.Conclusão: A autoperceção de adesão ao feixe foi elevada, com menor cumprimento percebido na avaliação diária da necessidade de remoção do CVC. Formação específica e maior experiência associaram-se a melhores pontuações em alguns itens, reforçando a importância de estratégias formativas dirigidas e padronizadas. Recomenda-se a realização de estudos com medidas observacionais e amostras probabilísticas para robustecer a evidência.
- 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.