Thesis (doctoral)--Lund University, 1998. / Added t.p. with thesis statement inserted. Includes bibliographical references.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2015-01-13T11:13:59Z No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Dissertação - Thaís de Arvelos Salgado - 2014.pdf: 1262659 bytes, checksum: f5f6c4703743d2bdb330aa4168a4b5f5 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2015-01-13T11:14:52Z (GMT) No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Dissertação - Thaís de Arvelos Salgado - 2014.pdf: 1262659 bytes, checksum: f5f6c4703743d2bdb330aa4168a4b5f5 (MD5) / Made available in DSpace on 2015-01-13T11:14:52Z (GMT). No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Dissertação - Thaís de Arvelos Salgado - 2014.pdf: 1262659 bytes, checksum: f5f6c4703743d2bdb330aa4168a4b5f5 (MD5) Previous issue date: 2014-08-15 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / Most recorded accidents with biological material are related to accidents in Health Care Facilities, which are considered unhealthy environments where the group with the highest exposure is professionals in the healthcare field. However, it should be understood that, any individual who passes through a healthcare facility is exposed to biological risk. The objectives of this study were: to identify the profile of victims of accidents with biological material, occurring in healthcare facilities among those with no presumed risk; to identify the frequency and profile of accidents in this group; to classify pre and post-exposure conduct in accidents with biological material in this group. This retrospective epidemiological study was conducted based on data from two service centers and accident reporting services: Hospital for Tropical Diseases in the State of Goias, Brazil, and the Center of Reference on Worker's Health (CEREST) in the city of Goiania. The two databases were linked. This study analyzed accidents reported by workers who were not trained in healthcare practice that had accidents with biological material inside the healthcare service independent of their professional duties. The study received approval in two Ethics Committee reports, the Hospital for Tropical Diseases, under protocol No. 033 / 2010, and by the IRB of the Hospital das Clinicas, Federal University of Goias, under protocol 414258/2013. There were 8,568 records of accidents with biological material recorded between 1989 and June 2012, 181 of these (2.1%) occurred in health services among those with no presumed risk. The highest frequency of accidents occurred among people between 20 and 29 years, female, and the most frequent occupation was the receptionist's office or lab, followed by administrative assistant. Needlestick accidents were most common (91.7 %) and involved a needle lumen, with higher incidence among females, and blood was the most common biological material. With regard to the circumstances of the accidents, most occurred due to inappropriate disposal of sharps, 20.1% referred to assistance activities such as recapping of needles, injections, or punctures, and material processing support procedures. Less than half of the subjects were vaccinated (49.7 %) against hepatitis B. The source patient was identified in 64 (35.6 %) cases, and of these, 43 (67.2 %) did not undergo serological testing. Post-exposure prophylaxis was recommended in 41 (22.6 %) and immunotherapy in 58 cases (32.0 %), and in 96 (53.0 %) cases completed, 74.0% indicated giving up clinical and laboratory monitoring. There were gaps in the data recorded in the notification forms, which reveals the need for professional training for the correct completion of notifications and active search for cases for follow-up. Data support the fact that healthcare facilities should have a organizational structure focused on resolution, prepared to provide care and / or refer the victim to postexposure prophylactic measures, since the office needs to be responsible for people who have accidents in their area, once the injured person, regardless of the employment relationship becomes a "victim of an accident with biological material" and in need of care, to minimize the risk of disease by taking proper preventive measures after the accident. / A maioria dos registros de acidente com material biológico é referente aos acidentes ocorridos nos Estabelecimentos Assistenciais de Saúde (EAS), que são ambientes considerados insalubres, onde o grupo de maior exposição são os profissionais da área da saúde. Entretanto compreende-se que qualquer indivíduo que transite pelos EAS está exposto ao risco biológico. Os objetivos deste estudo foram: identificar o perfil das vítimas de acidentes com material biológico ocorridos em Estabelecimentos de Assistência à Saúde entre pessoas sem risco presumido; identificar a frequência e o perfil dos acidentes nesse grupo; caracterizar as condutas pré e pós-exposição nos casos de acidentes com material biológico nesse grupo. Estudo epidemiológico retrospectivo, realizado com base de dados de duas instituições de atendimento e registro de acidente com material biológico do Estado de Goiás: Hospital de Doenças Tropicais (HDT), e o Centro de Referência em Saúde do Trabalhador (CEREST) regional de Goiânia. Foi realizado olinkage dos bancos de dados. Foram analisadas as fichas de registro de acidentes com pessoas sem risco presumido que se acidentaram com material biológico em um serviço de saúde independente do exercício profissional. O estudo foi aprovado em dois Comitês de Ética em Pesquisa, o do Hospital de Doenças Tropicais, sob o protocolo nº 033/2010 e do Hospital das Clínicas da Universidade Federal de Goiás, sob o protocolo 414258/2013. Totalizaram 8.568 registros de acidentes com MB registrados de 1989 a junho de 2012, desses 181 (2,1%) ocorreram em serviços de saúde com pessoas sem risco presumido. A maior frequência de acidentes ocorreu com pessoas de idade entre 20 e 29 anos, do sexo feminino e ocupação de recepcionista de consultório ou laboratório, seguida de auxiliar administrativo. Os acidentes foram predominantemente percutâneos (91,7%) e envolvendo agulha com lúmen com maior ocorrência entre o sexo feminino, e o sangue foi o material biológico mais presente. Entre as circunstâncias de acidente, o maior número ocorreu pelo descarte inadequado de perfurocortantes e 20,1% se referiam a atividades assistenciais, como reencape de agulha, injeções ou punções, processamento de material e auxílio em procedimento o que evidenciou uma relação dessas pessoas com os cuidados assistenciais. Menos da metade dos sujeitos era vacinada (49,7%) contra hepatite B. O paciente-fonte foi identificado em 64 (35,6%) casos, e desses, 43 (67,2%) não realizaram testes sorológicos. A profilaxia pós-exposição foi recomendada em 41 (22,6%) casos e a imunoprofilaxia em 58 (32,0%) e de 96 (53,0%) casos concluídos, 74,0% indicava abandono do acompanhamento clínicolaboratorial. Houve falha nos registros de dados nas fichas de notificação, o que revela a necessidade de capacitação dos profissionais para o correto preenchimento das notificações e busca ativa dos casos para o acompanhamento. Os dados apontam para o fato de que os EAS devem ter uma estrutura organizacional resolutiva, preparada para providenciar e/ou encaminhar o acidentado para as medidas profiláticas pós-exposição, pois o serviço deve se responsabilizar pelo indivíduo que se acidenta nos seus espaços físicos, uma vez a pessoa acidentada, independente do vínculo trabalhista passa à condição de “vítima de acidente com material biológico” e a carecer de cuidados para a minimização diminuição do risco de adoecimento pela adoção das medidas preventivas após o acidente.

Magister Curationis - MCur / Everyday thousands of nurses are rendering bedside nursing care in health care settings as a result they are exposed to blood, body fluids and sharp objects that are contaminated with Hepatitis B, Hepatitis C and HIV. Therefore they are at risk of getting infected. In 1996, standard precautions were implemented by the Centre of Disease Control to reduce the risk of transmission of micro-organisms from any source of infection in the hospital. In the year 2008, the three tertiary hospitals together in the Western Cape reported that they had 733 needle prick injuries. Therefore the aim of the study was to determine if nurses comply with and have adequate knowledge of standard precautions. A non-experimental design and a self administered questionnaire were used to collect the data for the study. The study was done at Tygerberg Hospital and the participants (n=143) that were involved in the study were all nursing categories (professional, enrolled nurse and auxiliary nurse). Stratified random sampling was used to ensure that there was a representation of all the nurses working in the different modules at Tygerberg Hospital. Therefore three wards were randomly selected from each module and all the nurses on duty working in the three selected wards were given a questionnaire by the Assistant Director of the specific module. After the data was collected it was analysed through the statistical package for social sciences. The findings of the study showed that nurses have inadequate knowledge regarding standard precautions and the mean score of the nurses overall self reported compliance of standard precautions was 87.5%. The results also showed that when patients are HIV positive nurses intend to over comply the use of personal protective equipment. No association was found between the nurses knowledge and compliance regarding standard precautions. It is therefore important that every nurse should be educated about the basic principles of standard precautions and also the policies and protocols of infection control in order to prevent each nurse from getting infected. Training needs to be implemented starting in the wards through the unit manager to improve all the nurses knowledge and practice. / South Africa

Magister Public Health - MPH / Introduction: The Universal Safety Precautions (USP) are a set of principles including practices and protocols, which is meant to reduce or prevent occupational exposures to blood borne pathogens among health care workers (HCWs), during the course of their duties in health care settings. Globally and in Nigeria, significant number of HCWs are currently being exposed to blood and other body fluids while working in the hospital setting (Amoran, 2013; Samuel et al., 2008; Akinboro et al., 2012; Ajibola et al., 1994; Okechukwu et al., 2012). These exposures contribute annually to about 16,000 HCV infections and 66,000 HBV infections among HCWs worldwide (Prüss-Üstün et al., 2003) and about 1000 cases of HIV per annum in Nigeria since the first recorded case in 1984 (Okechukwu et al., 2012; Patricia et al., 2007). The objectives of the study were to describe the awareness of the USP among HCWs in Kogi State Specialist Hospital (KSSH), Lokoja and to describe the adherence to the USP among HCWs at KSSH. Methods: A descriptive cross-sectional study was conducted among HCWs working in departments where contacts with patients' blood and other body fluids are possible in KSSH. An anonymous self-administered questionnaire was used for data collection. Analysis of the data collected was with Software Package for Social Sciences (SPSS) V23.0.0 for Mac. Results: Of the 125 participants that returned their questionnaires, 37.6% were nurses, 17.6% were doctors and the remainder were laboratory staff, dentists and hospital attendants. Sixty four percent (64%) of them were females, 49.6% had tertiary education while their average age was 38.5 years. Awareness of and adherence to the USP were observed to be 5.6% and 2.4% respectively. Statistically, complete awareness of the USP was not significantly associated with complete adherence to the USP. More so, 3% and 2.2% of the participants with the number of years in services within the ranges of 5-9 years and 1-4 years respectively had complete adherence to the USP. Statistically significant association was only noted between participants' age and complete adherence to the USP. Post-exposure prophylaxis (PEP) and use of personal protective equipment (PPE) were the two USP principles with the lowest levels of awareness and adherence, with 46% and 47.6% on awareness respectively and, 43.8% and 44.6% on adherence respectively. Conclusion: The levels of awareness of and adherence to the USP among the HCWs in KSSH were observed to be very low. There is an urgent need for capacity building of the HCWs on the USP in the form of trainings, and in the long term, there is need to conduct a study to assess possible reasons for the observed outcome.

Bakgrund: De tre vanligaste blodburna smittor som vårdpersonalen träffar på är humant immunbristvirus (HIV), hepatit C samt hepatit B. Dessa sjukdomar sprider sig via blodprodukter och medför en risk att vårdpersonalen kan bli smittade i sitt arbete. Risk för stigmatisering hos vårdpersonalen finns då sjukdomarna ofta förknippas med homosexualitet och intravenöst drogmissbruk. Risken är att patienter upplever sig diskriminerade av vårdpersonalen och att det påverkar omvårdnaden. Syfte: Syftet var att undersöka vårdpersonalens attityd mot patienter med blodburen smitta samt patienters upplevelse av vården och omvårdnaden. Metod: En litteraturstudie bestående av sex kvantitativa artiklar, fyra kvalitativa artiklar samt två mix-metod artiklar där det gjordes en induktiv analys av artiklarna för att tolka resultatet. Resultat: Det existerar en stigmatiserande attityd hos viss vårdpersonal mot patienter med blodburen smitta. En del i vårdpersonalen känner även av en viss rädsla mot patienterna med blodburen smitta, då rädslan grundar sig i att själva bli smittade. Rädslan och den stigmatiserande attityden påverkar vårdpersonalens vilja samt trygghet att vårda patienter med blodburen smitta. Patienter upplever och känner sig diskriminerade av vårdpersonal som har en stigmatiserande attityden samt visar rädsla gentemot dem. Patienterna har då större risk att undvika vården. Det som patienter upplever bra är när de får träffa samma personal som de kan lära känna och som vet deras historia. Slutsats: Viss vårdpersonal har en stigmatiserande attityd och rädsla mot patienter med blodburen smitta och detta grundar sig i vårdpersonalens okunskap och låga utbildning. Patienter märker av och känner sig diskriminerade av vårdpersonal som visar rädsla samt en stigmatiserande attityd mot dem. Detta påverkar patienters vård då patienter undviker vården eller inte får samma vård av vårdpersonalen på grund av sin sjukdom. / Background: The three most common blood-borne pathogens that the healthcare professional encounters are human immunodeficiency virus (HIV), hepatitis C and hepatitis B. These pathogens spread through blood products and there is a risk that the healthcare staff gets infected in their work. There is a risk of stigma among healthcare professionals as the pathogens are often associated with homosexuality and intravenous drug abuse. At the same time, the risk is that patients feel discriminated by the healthcare staff and that it affects their care. Purpose: The aim was to investigate the attitudes of the healthcare professionals towards patients with blood-borne pathogens as well as patients' experience of their care and nursing. Method: A literature study was based on six quantitative articles, four qualitative articles and two mix-method articles in which an inductive analysis of the articles was performed to interpret the results. Result: There is a stigmatizing attitude among healthcare professionals towards patients with bloodborne infection. Some of the healthcare staff also feel a certain fear of the patients with blood-borne infection and the fear is based on being infected themselves. Fear and stigmatizing attitudes affect the will of the healthcare staff and the safety of caring for patients with blood-borne infection. Patients experience and feel discriminated against by healthcare professionals who have a stigmatizing attitude and fear of them. Patients are then at greater risk of avoiding care. What patients feel good about is when they get to meet the same staff they can get to know and that knows their history. Conclusion: Some healthcare professionals have a stigmatizing attitude and fear of patients with blood-borne infection and this is based on the healthcare staff's knowledge and low education. Patients notice and feel discriminated against by healthcare professionals who display fear as well as a stigmatizing attitude towards them. This affects patients' care as patients avoid the care or do not receive the same care from the care staff due to their illness. Keywords: Blood-Borne Pathogens, healthcare professionals, patient, HIV, hepatitis B & hepatits C.

Bakgrund: På en operation finns det en risk för att exponeras för blodsmittor när operationssjuksköterskor handhar vassa föremål samt kan utsättas för blodstänk. Blodburna sjukdomar som hiv, hepatit B och C sprids via smittat blod som kommer i kontakt med skadad hud eller slemhinnor. Stick- eller skärskador samt blodstänk är vanligast. Patienter med en blodsmitta kan uppleva ett stigma på grund av sin sjukdom. Vårdpersonal ska behandla alla lika och får inte diskriminera patienter.  Motiv: Operationssjuksköterskor arbetar i en miljö där det finns en risk för exponering av blodsmittor, det är därför av värde att undersöka operationssjuksköterskors erfarenheterrelaterade till blodsmitta. Syfte: Att belysa operationssjuksköterskors erfarenheter relaterade till blodsmitta.  Metod: Individuella semistrukturerade intervjuer genomfördes med operationssjuksköterskor (n=8). Insamlade data analyserades enligt kvalitativ innehållsanalys Resultat:  Analysen resulterade i tre olika kategorier: “Att uppleva risk”, “Att känna sig trygg” samt “Att ständigt utvecklas”.   Konklusion: Med erfarenhet blir specialistsjuksköterskan inom operation mer trygg i arbetet med en patient med känd blodsmitta. Tillgänglighet till information och bra rutiner är en central del då det annars kan skapa osäkerhet då operationssjuksköterskans arbete är i ständig utveckling och nya rutiner tillkommer. Det finns en risk att patienter inte vågar berätta för risk av stigmatisering och diskriminering och det är inte säkert att alla bärare av blodsmitta har testats. Alla patienter ska därför ses som potentiella smittbärare. / Background: During surgery there is a risk of exposure to blood-borne pathogens due to the handlings of sharp objects and exposure from blood splash. Blood-borne pathogens like HIV, hepatitis B and hepatitis C spread when contaminated blood comes in contact with damaged skin, mucous membranes or by an injury with a contaminated instrument. Sharps-injuries and blood-splash are the most common forms of exposure in the operating theatre. Patients with a blood-borne infection can feel stigmatized due to their illness. Health care personnel must provide equal care, and not discriminate against patients Motive: Theatre nurses work in an environment where there is risk of exposure of blood-borne pathogens, it is therefore of value to examine theatre nurses' experiences related to blood-borne pathogensAim: To shed light on operating theatre nurses' experiences related to blood-borne pathogens. Methods: Individual semi-structured interviews were conducted with operating theatre nurses (n=8). Collected data were analyzed according to qualitative content analysis. Result: The analysis resulted in three different categories: "Experiencing risk", "Feeling safe" and "Constantly developing". Conclusion: The theatre nurse gains confidence in working with patients with known blood-borne pathogens with experience. Availability of information and good routines are important factors as it can otherwise create uncertainty due to the constantly developing nature of the operating theatre nurse's work, and the adding of new routines. There is a risk that patients avoid disclosure of infection in fear of stigmatization and discrimination, and not all carriers of blood-borne pathogens have been tested and diagnosed.  Therefore, all patients should be seen as potential carriers.

Submitted by Marlene Santos (marlene.bc.ufg@gmail.com) on 2014-11-06T20:32:32Z No. of bitstreams: 2 Dissertação- Liwcy Keller de Oliveira Lopes Lima- 2012.pdf: 870422 bytes, checksum: 431b648a9e85b9fc37769b57a0dc46e8 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Jaqueline Silva (jtas29@gmail.com) on 2014-11-10T20:09:55Z (GMT) No. of bitstreams: 2 Dissertação- Liwcy Keller de Oliveira Lopes Lima- 2012.pdf: 870422 bytes, checksum: 431b648a9e85b9fc37769b57a0dc46e8 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2014-11-10T20:09:55Z (GMT). No. of bitstreams: 2 Dissertação- Liwcy Keller de Oliveira Lopes Lima- 2012.pdf: 870422 bytes, checksum: 431b648a9e85b9fc37769b57a0dc46e8 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2012-05-07 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG / The dental care practice is characterized by the constant possibility of the staff and patients exposure to biological material (BM) potentially contaminated with infectious various agents, and requiring the epidemiology expertise of these exposures in order to develop the risk management procedures. The present study aimed to analyze the epidemiology of occupational accidents with exposure to BM among dental professionals and students in the State of Goias, and as specific goals, to ferify the frequency and profile of the accidents with biological material exposure among the dental care students and professionals enrolled in a reference hospital with service in compliance with occupational exposure to BM, to characterize the pre-and postexposure behavior and monitoring program recommended for this population and to analyze the socio-demographic and labor factors related to the accidents with BM by percutaneous exposure between dental care professionals and students assisted in a reference service. This is an epidemiological, retrospective and analytical study developed in a referral hospital for the treatment of occupational accidents with exposure to BM of the State of Goiás. All records of the accidents with BM between dental care professionals and students attended in this institution by December 2010 were analysed. Data were collected by completing a standardized form containing personal information, description of the accident, time elapsed between the accident and the first service, and post-exposure and prophylaxis procedures. The data were analyzed by SPSS 15.0 and the OpenEpi 2.3.1., Statistical analysis was performed by descriptive frequency measures and univariate analysis using qui-square and Fisher exact test. 628 accidents were recorded between dental care professionals and students from 1996, the year of first registration, to 2010, in which 77.1% were women. Some individuals reported more than one accident, totalling 701 accidents with exposure to BM that comprise the study population. Among the accidents, the majority (97, 13.8%) occurred in 2008 and 48.6% between dentists. In 92.2% of cases, hepatitis B vaccination status of the victims was described, and out of these, 70.8% received all three doses. In 84.9% of cases there was no record of the completion of anti-HBs by the victims. The accidents were predominantly (658, 93.9%) percutaneous, being the needle the instrument that caused the injury in 49.7%. Performing any dental care procedure was the most comum circumstance in which the accidents occurred most frequently (388, 55.4%), and the finger, the body area most affected (493, 70.3%). We highlight the lack of information in many cases, especially in relation to BM involved in the accident, the use of personal protective equipment at the time of the accident, where the victims performed their activities at the time of the accident and / or were linked and fullfilling of Work Accident Communication form. With the post-exposure procedures, the majority (635, 90.6%) of the institution accidents enrollments occurred within 72 hours, however only 44.9% were in the first two hours. The use of chemoprophylaxis and prophylaxis of hepatitis B in 14.8% and 12.8% of the cases, respectively were recommended. In 82.6% of the accidents, the patients were identified, and their HIV, HBV and HCV condition ignored in 93.6% of records. Among the accidents in which the victim must return to the intitution for the post-exposure follow up (264, 37.7%), only 20.8% returned and 3.8% were discharged. Accidents by percutaneous exposures showed a high prevalence for all variables analysed. It was observed that the higher is the demand for the service the less is the individual chance to undergo a percutaneous exposure (p = 0.000). The occurrence of accidents among dental auxiliaries was significant (p = 0.016) compared to dentists. The lack of data in the records of the institution reveals the need for greater disclosure of ministerial protocols for caring the victims of occupational accidents by BM among professionals responsible for this service. The integration of biosafety, infection control procedures for dental care practice and prevention and prophylaxis for BM accidents issues with undergraduate, graduate courses should develop and provide effective behavior changes. / A prática odontológica é caracterizada pela constante possibilidade de exposição tanto da equipe quanto dos pacientes a material biológico (MB) potencialmente contaminados com diversos agentes infecciosos, sendo necessário o conhecimento da epidemiologia dessas exposições para o desenvolvimento de medidas de gerenciamento de risco. O presente estudo teve como objetivo geral analisar a epidemiologia dos acidentes ocupacionais com exposição a MB entre profissionais e estudantes de odontologia em Goiás e como específicos verificar a frequência e o perfil dos acidentes com MB em estudantes e profissionais de odontologia atendidos em um serviço de referência para atendimento à exposição ocupacional com MB, caracterizar as condutas pré e pós-exposição e de acompanhamento recomendadas para essa população e analisar os fatores sociodemográficos e laborais associados à ocorrência de acidentes com MB por exposição percutânea entre profissionais e estudantes de odontologia atendidos em um serviço de referência. Trata-se de um estudo epidemiológico, retrospectivo e analítico desenvolvido em um hospital de referência para o atendimento de acidentes ocupacionais com exposição a MB do Estado de Goiás. Foram analisadas todas as fichas de registro de acidente com MB entre profissionais e estudantes de odontologia atendidos nessa instituição até dezembro de 2010. Os dados foram coletados por meio do preenchimento de um formulário padronizado contendo informações pessoais, descrição do acidente, tempo decorrido entre o acidente e o primeiro atendimento, condutas pós-exposição e medidas profiláticas. Os dados foram analisados pelo SPSS 15.0 e pelo OpenEpi 2.3.1., foi realizada análise estatística descritiva pelas medidas de frequência e análise univariada por meio de testes qui-quadrado e exato de Fisher. Foram notificados 628 acidentes entre profissionais e estudantes de odontologia no período de 1996, ano do primeiro registro, a 2010, sendo que 77,1% eram do sexo feminino. Alguns indivíduos relataram mais de um acidente, totalizando assim 701 acidentes com exposição a MB que compõem a população do estudo. No ano de 2008 houve a maior frequência de registros de acidentes (97; 13,8%) e desses 18,6% eram CD. Em 92,2% dos casos, a situação vacinal contra hepatite B dos acidentados foi descrita, sendo que desses 70,8% receberam as três doses. Em 84,9% dos casos não havia registro da realização do anti-HBs pelas vítimas. Os acidentes foram predominantemente (658; 93,9%) percutâneos, sendo a agulha o instrumento causador da lesão em 49,7%. Durante a realização de algum procedimento odontológico, foi a circunstância em que os acidentes mais ocorreram (388; 55,4%), e o dedo da mão a área corporal mais atingida (493; 70,3%). Destacou-se a ausência de informações em diversos casos, principalmente em relação ao MB envolvido no acidente, uso de equipamento de proteção individuaI no momento do acidente, instituições onde as vítimas exerciam suas atividades no momento do acidente e/ou eram vinculadas e o preenchimento da Comunicação de Acidente de Trabalho. Quanto às condutas pós-exposição, na maioria (635; 90,6%) dos acidentes, o atendimento na instituição ocorreu em até 72 horas, entretanto apenas 44,9% foram nas primeiras duas horas. Foi recomendado o uso de quimioprofilaxia e profilaxia da hepatite B em 14,8% e 12,8% dos casos, respectivamente. Em 82,6% dos acidentes, os pacientes-fonte eram passíveis de identificação, sendo a condição dos mesmos, quanto à infecção pelo HIV, HBV e HCV, ignorada em 93,6% dos registros. Entre os acidentes em que a vítima deveria retornar ao ambulatório para a realização do acompanhamento pós-exposição (264; 37,7%), apenas 20,8% retornaram e 3,8% receberam alta. Os acidentes por exposições percutâneas apresentaram alta prevalência para todas as variáveis analisadas. Observou-se que quanto maior a procura pelo atendimento, menor a chance do indivíduo ter sofrido uma exposição percutânea (p=0,000). A ocorrência de acidentes entre auxiliares de saúde bucal foi significativa (p=0,016) comparada às CD. A ausência de dados nos registros da instituição revela a necessidade de maior divulgação dos protocolos ministeriais para o atendimento às vítimas de acidentes ocupacionais por MB entre os profissionais responsáveis por esse atendimento. A inserção de conteúdos como prevenção e controle de infecção na prática odontológica e medidas pré e pósacidentes com MB, nos cursos de graduação, aperfeiçoamento e pós-graduação têm o potencial de resultar em mudanças efetivas nas condutas.

Submitted by Erika Demachki (erikademachki@gmail.com) on 2016-09-09T17:59:04Z No. of bitstreams: 2 Tese - Zilah Cândida Pereira das Neves - 2016.pdf: 2900186 bytes, checksum: cfefb1ed9137da82dc5cb133b19682f5 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-09-12T14:30:18Z (GMT) No. of bitstreams: 2 Tese - Zilah Cândida Pereira das Neves - 2016.pdf: 2900186 bytes, checksum: cfefb1ed9137da82dc5cb133b19682f5 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2016-09-12T14:30:18Z (GMT). No. of bitstreams: 2 Tese - Zilah Cândida Pereira das Neves - 2016.pdf: 2900186 bytes, checksum: cfefb1ed9137da82dc5cb133b19682f5 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-03-30 / Accidents with biological material are reportable events, health care workers (TAS), victims of these accidents may be exposed to the hepatitis B and C and HIV, among others. The aims of this study were: to analyze the epidemiology of occupational accidents with biological material among health care workers of the metropolitan area of Goiania-GO (general); describe the socio-demographic and occupational profile of health care workers, victims of occupational accidents with biological material; describe the profile of accidents with biological material among health care workers; characterize the adoption of pre-exposure behaviours related to the latest accident; identify the serological status related to hepatitis B, C and HIV in victims of occupational accidents involving biological material and source patients, and establish the demographic and employment factors associated with the occurrence of multiple accidents among health care workers of the metropolitan area of Goiania-GO. Epidemiological Cross and analytical study which included all registration records of accidents involving biological material of HCW from two sources: A - records of injured HCW in a reference hospital for notification in Goiania, from the first record in 1989 to 2010, and B - records of Sinan, including the first record in 2006 until those available at 31/12/2014. Linkage of databases was performed and data analyzed using the Statistical Package for Social Sciences (SPSS). Socio-demographic and employment variables were the predictor variables and have suffered more than one accident, the outcome. Univariate analysis was performed and variables with P<0.10 were included in a logistic regression model. Ethical precepts were followed (Approval Ethics Committees: 033/2010 and 414.258/2013). A total of 11,536 accidents were recorded from 1989 to December 2014. Of these, 9,575 (83.0%) occurred among HCW and the majority was female. It was found that 665 (7.5%) of the HCW experienced more than one accident, while 70 (0.8%) experienced three or more accidents, totaling 8,825 victims. Nursing staff, auxiliary cleaning, physician, and dental and laboratory teams were the ones who were more frequently hurted, respectively. Most of the victims had completed high school (3,719 (48.0%). Blood/serum/plasma were the biological materials found to be the most involved (6,480/67.7%), at the time of administering medications/vascular access puncture occurring in 2.759 (28.9%), and involving needles with and without lumen in 6,097 (63.7%). A total of 6,653 (75.4%) HCW were vaccinated for hepatitis B. Incomplete information on Sinan records such as, use of PPE (gloves, masks, boots and safety glasses) and serological markers (HBsAg; Anti-HBs, Anti-HCV and Anti-HIV) was found to be the major factor that hampered data analysis. Age, type of material, and organic fluid were predictors risk factor for multiple accidents involving biological material among health care workers. / Os acidentes com material biológico são eventos de notificação compulsória. Os trabalhadores da área da saúde (TAS), vítimas desses acidentes, podem se expor aos vírus das hepatites B e C e HIV, dentre outros. Foram objetivos deste estudo: analisar a epidemiologia dos acidentes ocupacionais com material biológico entre trabalhadores de serviços de saúde, da região metropolitana de Goiânia-GO (geral); descrever o perfil sociodemográfico e laboral dos trabalhadores de serviços de saúde, vítimas de acidentes ocupacionais com material biológico; descrever o perfil dos acidentes com material biológico entre trabalhadores dos serviços de saúde; caracterizar a adoção das condutas pré-exposição relacionadas ao último acidente; identificar a situação sorológica referente às hepatites B, C e HIV, das vítimas de acidentes ocupacionais com material biológico e dos pacientes-fonte e estabelecer os fatores sociodemográficos e laborais associados à ocorrência de múltiplos acidentes entre trabalhadores de serviços de saúde da região metropolitana de Goiânia-GO (específicos). Estudo epidemiológico, transversal e analítico no qual foram incluídas todas as fichas de registro de acidentes de trabalho com material biológico de TAS a partir de duas fontes, A prontuários de TAS acidentados em um hospital de referência para notificação no município de Goiânia, desde o primeiro registro em 1989 até 2010 e B - fichas do Sinan, incluindo o primeiro registro em 2006, até os disponíveis em 31/12/2014. Foi realizado o Linkage dos bancos de dados que foram processados e analisados no Statistical Package for the Social Sciences (SPSS). As variáveis sociodemográficas e laborais foram as variáveis preditoras e ter sofrido mais de um acidente, o desfecho. Foi realizada a análise univariada, e as variáveis que apresentaram valor de p < 0,10 foram incluídas em um modelo de regressão logística. Preceitos éticos foram seguidos (aprovações em Comitês de Ética: 033/2010 e 414.258/2013). Foram registrados 11.536 acidentes, no período de 1989 a dezembro de 2014. Destes registros, 9.575 (83,0%) ocorreram entre os trabalhadores da área de saúde e a maioria era do sexo feminino. Verificou-se que 665 (7,5%) TAS sofreram mais de um acidente, 70 (0,8%) apresentaram três ou mais acidentes, perfazendo 8.825 vítimas. A equipe de enfermagem, o auxiliar de limpeza, médicos e a equipe de odontologia e de laboratório foram os que mais se acidentaram, respectivamente. A maioria das vítimas possuía o ensino médio completo 3.719 (48,0%). O sangue/soro/plasma foram os materiais biológicos mais envolvidos 6.480(67,7%), no momento de administrar medicamentos/punção de acesso vascular em 2.759 (28,9%), com o envolvimento de agulhas com e sem lúmen em 6.097 (63,7%). Em 6.653 (75,4%) dos TAS vacinaram para hepatite B. Para várias informações, predominou a falta de registro nas fichas do Sinan que dificultou a análise: uso dos EPI (luvas, máscaras, botas e óculos) e marcadores sorológicos (HBSAG; Anti-HBs, AntiHCV e o Anti-HIV). Verificou-se que idade, tipo de material, fluido orgânico foram fatores de risco preditores para múltiplos acidentes envolvendo material biológico, entre os trabalhadores dos serviços de saúde.