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.

This study aimed to provide evidence on knowledge of attitudes toward standard precautions (SPs) and its practice of Healthcare Workers (HCWs) in government and private hospitals in Botswana. It utilised descriptive cross-sectional methodology. A range of significant findings were revealed. Good practice of SPs was noted more amongst the HCWs in government than in private hospitals. Knowledge of SPs amongst HCWs in government hospital was significantly and positively correlated to good practice of SPs. Registered Nurses (RNs) had better knowledge of SPs than HealthcareAssistants (HCAs).There was no significant difference between RNs and HCAs practice of SPS and attitudes toward the same. No significant difference in the knowledge, attitudes and practice of SPs was noted between General Practitioners (GPs) and RNs. No significant difference in the knowledge, attitudes and practice of SPs was observed between GPs and HCAs. The study findings have implications for the application of SPs in practice / Health Studies / M.A. (Public Health)

This study aimed to provide evidence on knowledge of attitudes toward standard precautions (SPs) and its practice of Healthcare Workers (HCWs) in government and private hospitals in Botswana. It utilised descriptive cross-sectional methodology. A range of significant findings were revealed. Good practice of SPs was noted more amongst the HCWs in government than in private hospitals. Knowledge of SPs amongst HCWs in government hospital was significantly and positively correlated to good practice of SPs. Registered Nurses (RNs) had better knowledge of SPs than HealthcareAssistants (HCAs).There was no significant difference between RNs and HCAs practice of SPS and attitudes toward the same. No significant difference in the knowledge, attitudes and practice of SPs was noted between General Practitioners (GPs) and RNs. No significant difference in the knowledge, attitudes and practice of SPs was observed between GPs and HCAs. The study findings have implications for the application of SPs in practice / Health Studies / M.A. (Public Health)