Orientador: Maria Isabel Pedreira de Freitas / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-11T17:51:54Z (GMT). No. of bitstreams: 1 Costa_LidianaFloraVidotoda_M.pdf: 1945007 bytes, checksum: a09edb1f7acc4bb62ac78e8b301c3723 (MD5) Previous issue date: 2008 / Resumo: O reprocessamento de artigos críticos é realizado nas Unidades Básicas de Saúde (UBS). A complexidade desse processo e suas implicações, exigem que o responsável faça-o com habilidades e conhecimento técnico-científicos, dentro de métodos e critérios preestabelecidos para controle e monitorização de cada etapa, seguindo diretrizes norteadoras e legais. Quando realizado sob condições adversas, pode colocar em risco a saúde dos usuários submetidos aos procedimentos invasivos comprometendo, portanto, a qualidade e segurança ao usuário do Sistema Unificado de Saúde (SUS). Objetivos: Identificar como o reprocessamento dos artigos críticos vem sendo realizado nas UBS. Método: Estudo descritivo-exploratório, com dados obtidos pela aplicação de um questionário previamente testado, aos responsáveis pelo reprocessamento de artigos críticos nas UBS. Resultados: A coleta de dados ocorreu entre março e dezembro 2006. Das 46 UBS foram estudadas 34, das quais os responsáveis pela realização do reprocessamento dos artigos críticos foram entrevistados e as áreas físicas, destinadas a esse processo, observadas. Dos procedimentos invasivos que utilizavam artigos reprocessados nas UBS encontram-se: odontológicos e curativos (100%), ginecológicos (97%), suturas (94%), pequenos procedimentos cirúrgicos (76%) e drenagens de abscessos (59%). Os ocupacionais responsáveis pela realização do reprocessamento eram na maioria, auxiliares de enfermagem (88,23%). Além de realizarem o reprocessamento de artigos críticos, exerciam concomitantemente atividades como: imunização (11,74%), curativos (26,4%) e coletas de exames (23,52%). Desses ocupacionais, 32,4% receberam treinamentos no início das atividades com reprocessamento e 8,82% durante o exercício dessas atividades, há menos de um ano. Durante a limpeza desses artigos, todos os ocupacionais realizavam a limpeza manualmente com água, solução detergente neutra e esponja e nenhum fazia uso de todos os EPI recomendados. O agente usado para a esterilização tem sido o vapor saturado sob pressão (88,24%). O invólucro usado para os artigos, foi o papel Kraft (100%), os campos duplos de algodão (21%), caixa metálica aberta (11,76%) e papel alumínio (11,76%). Os métodos usados para a monitoração da qualidade do processo de esterilização, era o indicador químico classe I (97,06%) e o indicador biológico autocontido (91,18%), sendo esse de forma sistemática em 55,8% das UBS. Houve referências ao uso do teste de Bowie e Dick em 5,24% das UBS. Observou-se que todas as UBS possuíam uma área destinada à limpeza dos artigos críticos sendo que dessas: 70,59% exclusivas, 2,94% compartilhadas a área de limpeza e com a do preparo de artigos para a esterilização e 26,47% compartilhadas entre a área de limpeza, com a do preparo e com a da esterilização dos artigos críticos. 52,95% possuíam uma área para a limpeza desses artigos igual ou maior o recomendado (4,8m2). Das UBS estudadas, 70,59% possuíam barreira física entre a área de limpeza e de esterilização. Das áreas destinadas à limpeza, todas possuíam cubas com torneira e água fria, bancada, ponto para escoamento de resíduos líquidos, 91,17% possuíam janelas sem telas, porém não havia, em nenhuma, instalação de água quente. Sobre o acabamento das áreas destinadas à limpeza: 76,47% dos pisos eram do tipo granilite, 14,7% de cerâmicas vitrificadas, 2,95% pintados e 2,95% de cerâmicas rústicas; das bancadas, 85,3% eram constituídas de pedra, 11,75% de alvenaria revestida por azulejos, e 2,95% de aço inoxidável; as paredes, 91,17% eram revestidas por azulejos rejuntados, 5,88% pintadas e 2,95% revestidas de azulejo do piso até a parede central e pintadas do centro até o teto. Sobre a área destinada à esterilização, todas as unidades possuem este local, porém todas compartilham essa área com outras etapas do reprocessamento de artigos: 23,53% compartilhavam com o preparo dos artigos, 50% compartilhavam com a do preparo e com a de armazenamento dos artigos e 26,47% compartilhavam com a área de limpeza, com a área do preparo e a de armazenamento dos mesmos. Sobre a dimensão das áreas de esterilização, 81,18% era igual ou maior que o recomendado (3,2 m2). Das instalações dos ambientes destinados à esterilização, 70,59% das UBS possuíam barreira física entre a área de limpeza e de esterilização, 88,24% possuíam água fria e escoamento de resíduos líquidos, 8,82% apresentaram ponto para água quente, 91,18% com janelas sem telas e 8,82% sem janelas. Dos acabamentos utilizados no ambiente destinado à esterilização, o piso, 79,41% eram em granilite, 14,7% em cerâmicas vitrificadas, 5,9% em cerâmicas rústicas; as bancadas, 85,3% eram feitas em pedra e 14,7% em alvenaria revestidas por azulejos; as paredes, 91,17% eram revestidas por azulejos rejuntados, 5,88% pintadas e 2,95% revestidas de azulejo do piso até a metade da parede e do centro até o teto com tinta. Da área destinada ao armazenamento, 8,82% possuíam uma área exclusiva. Conclusão: Nas UBS estudadas, o reprocessamento de artigos críticos vem sendo realizado de forma assistemática, necessitando de revisão, avaliação processual e de intervenções para capacitação profissional dos ocupacionais responsáveis. As áreas físicas destinadas ao reprocessamento devem contemplar critérios mínimos recomendados á fim de se assegurar a qualidade desse processo. O reprocessamento de artigos críticos não deve se tornar fator limitante e de interferência no controle de infecção cruzada nesses locais, devem porém contribuir com a segurança da população usuária do sistema de saúde. / Abstract: The reprocessing of critical items is conducted at Basic Healthcare Units (Unidades Básicas de Saúde - UBS). The complexity and implications of such processes demand that the person responsible conducts it with technical and scientific skills and knowledge, according to pre-established methods and criteria, for control and monitoring of each stage, following procedural and legal guidelines. When done under adverse conditions, reprocessing may endanger the health of the users who undergo invasive procedures, thus compromising the quality and safety of the services provided to National Healthcare System (Sistema Unificado de Saúde - SUS) users. Objectives: Gather data to identify how the reprocessing of critical items is being conducted at UBS and compare to existing legislation, as well as scientific criteria. Methodology: Descriptive study, exploratory, with data obtained through the application of a previously verified questionnaire, to those responsible for reprocessing critical items at UBS. Statistical analysis of data was done with the help of Minitab 15® software. Results: Data collection occurred between March and December 2006. Among the 46 existing UBS, 34 were surveyed; where the individuals responsible for reprocessing critical devices were interviewed, and the areas, designated for processing, observed. Invasive procedures that used reprocessed items at UBS were as follows: dental and dressings (100%), gynecological (97%), sutures (94%), small surgical procedures (76%) and abscess drainage (59%). The majority of staff responsible for conducting reprocessing was nursing auxiliaries (88,23%). Besides reprocessing critical devices, they executed concurrently activities such as: immunization (11,74%), dressing (26,4%) and collection of exam samples (23,52%). Among these staff members, 32,4% had undergone training when they started conducting reprocessing activities and 8,82% during the conduction of such activities, at least, during the previous year. During the handling of such devices, all staff members conducted cleaning manually, with water; inert detergent solution and cleaning pad, and none used all the PPE recommended. Sterilization agent was saturated vapor under pressure (88,24%). Containers used for all devices were Kraft paper (100%), double cotton fabric (21%), open metallic box (11,76%) and aluminum foil (11,76%). Methods employed for monitoring sterilization process quality, were class I chemical marker (97,06%) and biological selfcontained marker (91,18%), the latter being systematically used in 55,8% of UBS. There were references to use of Bowie & Dick in 5,24% of UBS. We were able to observe that all the UBS had an area designated for cleaning of critical devices, among which 70,59% were exclusive, 2,94% shared the cleaning area with the area for preparation of items for sterilization and 26,47% shared areas for cleaning, preparation and sterilization of critical devices. 52,95% had an area for cleaning such items, which was equal or larger than recommended size (4,8m2). 70,59% of UBS had a physical barrier between the cleaning and sterilization areas. All the cleaning areas had sinks with cold water, bench and a drain for outflow of liquid residue, 91,17% had windows without nets, however there wasn't any hot water line. Floor finishing in the cleaning areas was as follows: 79,41% had granolith flooring, 14,7% had vitrified ceramic, 2,95% had rough finish ceramic and 2,95% were painted. The benches were as follows: 85,3% made of stone, 11,75% were made with bricks covered with tiles, and 2,95% in stainless steel. 91,17% of the wall finishing was done with grouted tiles, 5,88% were painted and 2,95% were covered with tiles halfway to the ceiling, and the remaining surface was painted. In relation to the sterilization area; all of the units have a designated sterilization area, but all shared this areas with other reprocessing phases: 23,53% shared it with the preparation of devices, 50% shared with preparation and storage of devices, and 26,47% shared the cleaning area, with the areas for preparation and storage, as well. The dimensions of sterilization areas are as follows: 81,18% was equal or larger than recommended (3,2 m2). In 70,59% of UBS facilities, the areas designated for sterilization had physical barriers between the cleaning and sterilization areas, 88,24% had cold water and drainage of liquid residue, 8,82% had a hot water line, 91,18% had windows without nets and 8,82% had no windows. Finishing used in the areas destined for sterilization, was as follows: 79,41% had granolith flooring, 14,7% vitrified ceramics, 5,9% rustic ceramic; benches: 85,3% were made in stone, 14,7% brick covered with ties; walls: 91,17% were covered with grouted tiles, 5,88% were painted and 2,95% were covered with tiles halfway to the ceiling, and the remaining surface was painted. 8,82% had specific areas designated exclusively for storage. Conclusion: In the UBS surveyed, reprocessing of critical devices is being conducted in an unsystematic manner. This calls for a revision and reevaluation of procedures, and an intervention for professional capacitation of the staff involved. Areas designated for reprocessing must comply with minimum required criteria in order to ensure the quality of the process. Reprocessing of critical items, in these locations, must not become a limiting factor or interfere in cross infection control, but must contribute for the safety of the population who uses the healthcare system. / Mestrado / Enfermagem e Trabalho / Mestre em Enfermagem

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The purpose of the thesis The Place of Private Clinics in the Czech System of Health Service with an Accent on Marketing Strategy is to describe current situation of Czech Health Service and find out if there is a actual posibility of prosperous emplacement of private clinics. Due to intention of suggestion for the future of Health Service it is important to consider existing image of the Czech System.

The graduation thesis is focused on the health of the economy . The aim of this work is to identify and evaluate regional differences in the availability of health care in the regions of the Czech Republic , which was achieved by using the data obtained from ÚZIS institute. Attention was focused on the availability of outpatient doctors, hospital doctors and hospital beds . This availability was evaluate on the basis of the density of the phenomenon in the every region. The thesis used the methods of statistical data analysis , comparison , synthesis of acquired knowledge and literature search and resources. In the area of outpatient care, there was found that the Czech Republic is from the 90s to increase of specialists at the expense of primary care. There were no significant regional differences in access to outpatient care. However, we find large disparities in hospital care. For districts with disturbing the availability of hospital care can mark the border counties Tachov and Jeseník.

Many individuals, especially those in rural areas, experience barriers to accessing medical care. Some barriers are attitudinal and represent perceived quality of care, such as patient satisfaction; however, some rural residents report elevated patient satisfaction scores, regardless of limited access to these services. Identifying how perceived need for medical care is related to patient satisfaction has not been previously explored. Using an online survey to collect data from a national sample (n=535), the current study used the Patient Satisfaction Questionnaire-Short Form (PSQ-18) and a single-item measure of perceived need to examine the association between these two variables, and further, whether rural status, measured by a single-item measure, moderated this association. Results indicated a significant negative correlation between patient satisfaction and perceived need, r(423)=-.12, p=.012. Although the overall moderation model was significant, F(5, 388)=7.10, p<.001, perceived need was not significantly associated with patient satisfaction, b=-.14, p=.20, and rurality status did not significantly moderate the relationship, F(1, 388)=.44, p=.51, ��R2=0.01. However, the covariates of income, b=.11, p<.001, and sexual orientation, b=.23, p=.01, significantly predicted patient satisfaction. This study identified an association between patient satisfaction with perceived need for medical care that has not been previously explored, although this relationship was no longer significant in a larger model, indicating other important factors likely influence this relationship and contribute to the elevated satisfaction scores identified in some rural areas. The lack of moderation by rurality may be due to consistently high barriers to accessing care across all regions of the United States; while rural areas certainly experience unique barriers to care, the barriers present in urban environments may be significant enough that level of rurality in itself does not significantly affect the relationship between perceived need and patient satisfaction. Furthermore, this study highlights the importance of social determinants of health in patients’ perceptions of quality of care. Sexual orientation and income emerged as significant predictors of patient satisfaction, in that higher satisfaction was associated with those who identified as heterosexual and had higher income, consistent with previous literature. Further investigation is necessary to determine the reasons why these relationships exist; however, it is important to acknowledge that individuals with low-income and who identify as sexual minorities experience stigma and discrimination in healthcare settings. These negative experiences with healthcare likely influence perceptions and health disparities that exist within these individuals and may directly impact patient satisfaction levels, which may be influential to these findings.

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Immigrant women are at greater risk for postpartum depression (PPD) compared to non-immigrant women and experience multiple barriers to accessing health services to address their needs. This mixed method study explored the multi-level factors that contribute to the postpartum mental health of immigrant women in Canada and their ability to access requisite health services. In the quantitative phase, data from a longitudinal prospective cohort survey of women were used to examine predictors of PPD over the first postpartum year for a sample of women who delivered at two hospitals in Toronto, Ontario. In the qualitative phase, an interpretive descriptive design shaped by an integrated knowledge translation approach was used to understand the factors immigrant women living in Scarborough, Ontario (a region of Toronto) perceive as contributing to their postpartum emotional health and the factors immigrant women and care providers perceive as influencing access to health services. Across quantitative and qualitative findings, factors contributing to PPD among immigrant women included a lack of social support, individual and community-level challenges faced in terms of the social health determinants, physical health status, and client-provider relationships. Factors contributing to reduced access to health services included: lack of system knowledge, social health determinants, organizational and system barriers, limited access to treatment, and a need for service integration and system navigation support. Immigrant women in Canada experience numerous health inequities that increase their risk for PPD and v prevent them from accessing service supports to address PPD concerns. The Canadian health care system needs to be responsive to individual needs in order to facilitate equitable access and address the health needs of Canadian immigrant women and their families. The diversity and proportion of immigrants in Canada calls for a linguistically and culturally supportive health care system with a strategic approach to enhancing accessibility to address health inequities. / Dissertation / Doctor of Philosophy (PhD) / Immigrant women have a 2-3 times higher risk for postpartum depression (PPD) than native-born women. This study explored the factors that contribute to PPD among immigrant women in Canada and how health services can help them get the care they need, from the perspective of immigrant women and care providers. This study found increased PPD risk when women lacked social support, had physical health issues, and faced challenges such as low income and lack of English language skills. Working with care providers could help address these challenges or make it more difficult to get care. Immigrant women had more difficulty getting services when they lacked knowledge about the health care system, faced social, financial, and language-based barriers to care, and experienced barriers when using available services. The findings from this research can inform the design and delivery of health care to best meet the needs of immigrant women with PPD.

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Yes / Personalised nutrition (PN) has the potential to reduce disease risk and optimise health and performance. Although previous research has shown good acceptance of the concept of PN in the UK, preferences regarding the delivery of a PN service (e.g. online v. face-to-face) are not fully understood. It is anticipated that the presence of a free at point of delivery healthcare system, the National Health Service (NHS), in the UK may have an impact on end-user preferences for deliverances. To determine this, supplementary analysis of qualitative data obtained from focus group discussions on PN service delivery, collected as part of the Food4Me project in the UK and Ireland, was undertaken. Irish data provided comparative analysis of a healthcare system that is not provided free of charge at the point of delivery to the entire population. Analyses were conducted using the ‘framework approach’ described by Rabiee (Focus-group interview and data analysis. Proc Nutr Soc 63, 655-660). There was a preference for services to be led by the government and delivered face-to-face, which was perceived to increase trust and transparency, and add value. Both countries associated paying for nutritional advice with increased commitment and motivation to follow guidelines. Contrary to Ireland, however, and despite the perceived benefit of paying, UK discussants still expected PN services to be delivered free of charge by the NHS. Consideration of this unique challenge of free healthcare that is embedded in the NHS culture will be crucial when introducing PN to the UK.