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Previous issue date: 2016-07-27 / Introdu??o: As Infec??es Relacionadas ? Assist?ncia ? Sa?de (IRAS) s?o um grave problema de qualidade do cuidado em todo o mundo, mas pouco se sabe se a ado??o de estrat?gias de Gest?o da Qualidade (GQ) pode colaborar para a redu??o desses agravos quando implementadas de forma externa e em n?vel nacional. Objetivo: O objetivo deste estudo foi avaliar o efeito de um ciclo de melhoria da qualidade nacional direcionado ?s a??es de preven??o das IRAS institu?das pelas Comiss?es de Controle de Infec??o Hospitalar (CCIH) de hospitais brasileiros. Metodologia: A Ag?ncia Nacional de Vigil?ncia Sanit?ria (ANVISA), respons?vel pelo controle de riscos nos servi?os de sa?de brasileiros, realizou um ciclo de melhoria da qualidade de abrang?ncia nacional usando um desenho quase experimental antes-depois. Ap?s definir 11 crit?rios de qualidade baseados em evid?ncias para a preven??o das IRAS, foi realizada uma avalia??o nacional (mar?o de 2015) dirigida a todos os hospitais brasileiros com Unidades de Terapia Intensiva (UTI) adulto, pedi?trica ou neonatal (N=1.869). Utilizando as informa??es desta avalia??o, foi planejada e implementada uma interven??o nacional externa (abril de 2015 a fevereiro de 2016), com o objetivo de melhorar a ades?o aos crit?rios de qualidade avaliados. Depois da interven??o, foi realizada uma reavalia??o nacional (01/03 a 15/04/2016), para mensurar os efeitos da interven??o e identificar as oportunidades de melhoria remanescentes que pudessem orientar a continuidade das a??es nacionais. Calculou-se a estimativa pontual e intervalo de confian?a (95%) dos crit?rios em cada avalia??o, a melhoria absoluta e relativa depois da interven??o e a signific?ncia estat?stica da melhoria com teste Z unilateral.
Resultados: 563 hospitais brasileiros com leitos de UTI participaram da 1? avalia??o (30,1% de resposta, soma de 86.837 leitos), 681 hospitais participaram da 2? avalia??o (36,4% de resposta, soma de 101.231 leitos) e 388 hospitais participaram das duas avalia??es. Ao comparar os resultados das duas avalia??es, evidenciou-se a efetividade do ciclo de melhoria, pois houve melhoria significativa (p<0,05) em 10 dos 11 crit?rios de qualidade avaliados. Na avalia??o do indicador composto: Qualidade da preven??o de IRAS, constru?do a partir da an?lise conjunta de todos os 11 crit?rios, verificou-se melhoria significativa: de 82,4% para 88,3%, p= 0,001 (melhoria relativa m?dia de 33,5%). Os pontos positivos dos hospitais, revelados nos crit?rios com maior conformidade ap?s a interven??o, foram que ?as UTIs possu?am condi??es estruturais e insumos de qualidade para a higiene das m?os (HM) dos profissionais de sa?de? (97,9% vs 100%; p= 0,001) assim como ?possu?am protocolo para HM implantado? (92,9% vs 96,9%; p= 0,001); e ainda que ?os servi?os de sa?de realizavam a notifica??o das IRAS, regularmente, baseando-se nos crit?rios diagn?sticos nacionais? (91,8% vs 92,4%; p= 0,407). Por outro lado, as principais fragilidades, destacadas pelo menor n?mero de conformidades, s?o o ?monitoramento da ades?o ? higiene das m?os pelos profissionais? (60,7% vs 70%; p= 0,001); a ?exist?ncia de protocolo institucional implantado para a prescri??o orientada de antimicrobianos? (73,2% vs 80,7%; p= 0,001) e ?os profissionais das CCIHs promovem estrat?gias para aumentar a participa??o dos pacientes/acompanhantes/familiares das UTIs nas a??es de preven??o e controle de IRAS.? (76,6%% vs 82,8%; p= 0,004). Conclus?es: O ciclo de melhoria da qualidade foi ?til para identificar prioridades de atua??o tanto no n?vel nacional como nos estados e no Distrito Federal e para orientar a institui??o de um projeto de interven??o para a qualidade e seguran?a do paciente baseado em um processo avaliativo. Al?m disso, este projeto demonstrou que ? poss?vel se obter melhoria real de abrang?ncia nacional das a??es de preven??o de IRAS por meio da utiliza??o de estrat?gias de GQ. / Introduction: Healthcare-Associated Infections (HAIs) are a serious care quality related problem throughout the world, but little is known whether the adoption of quality management strategies (QA) can collaborate to reduce these undesired outcomes when implemented externally and nationally.
Objective: The objective of this study was to promote the improvement of adherence to the HAI prevention recommendations implemented by the Hospital Infection Control Committees (CCIH) of Brazilian hospitals.
Methodology: The National Health Surveillance Agency (ANVISA), responsible for risk control in the Brazilian health services, held an improved nationwide quality cycle using a quasi-experimental before-after design. After setting 11 quality criteria based on evidence for the prevention of HAIs, a national evaluation was conducted (March,2015) addressed to all Brazilian hospitals with adult, pediatric or neonatal (N = 1,869) Intensive Care Units (ICU). Using the information from this assessment an external national intervention was planned and implemented (April,2015 to February,2016), in order to improve adherence to the assessed quality criteria. After the intervention, a national revaluation was performed (03/01 to 04/15//2016), to measure the effects of the intervention and identifying the remaining opportunities for improvement that could guide the continuity of national actions. The point estimate is calculated and confidence interval (95%) of the criteria in each evaluation, absolute and relative improvement after the intervention and the statistical significance of improvement with one-sided Z test. Results: 563 Brazilian hospitals with ICU beds participated in the 1st assessment (30.1% response, total of 86,837 beds), 681 hospitals participated in the second assessment (36.4% response, the sum of 101,231 beds) and 388 hospitals participated in both assessments. When comparing the results of the two evaluations, it was demonstrated the effectiveness of the improvement cycle, as there was significant improvement (p <0.05) in 10 of the 11 quality criteria assessed. In the assessment of the compound indicator: Quality of prevention of HAIs, constructed from the pooled analysis of all 11 criteria, there was significant improvement: 82.4% to 88.3%, p = 0.001 (relative improvement average 33.5%). The overall strengths of hospitals, revealed the criteria with greater compliance after the intervention, were that "the ICUs had structural conditions and quality of supplies for hand hygiene (HM) of health professionals" (97.9% vs 100%; p = 0.001) as well as "owned implemented protocol for HM" (92.9% vs. 96.9%; p = 0.001); and that "health services performed notification of IRAS regularly, based on national diagnostic criteria" (91.8% vs 92.4%; p = 0.407). On the other hand, the main weaknesses highlighted by fewer compliances are "monitoring of adherence to hand hygiene by professionals" (60.7% vs 70%, p = 0.001); "existence of institutional protocol deployed to the targeted use of antimicrobial agents" (73.2% vs 80.7%; p = 0.001) and "professionals of CCIHs promote strategies to increase the participation of patients / caregivers / family members of ICU in prevention and control of HAI "(76.6 %% vs. 82.8%; p = 0.004). Conclusions: The quality improvement cycle was helpful to identify priorities for action at the national level as much as in the states and the Federal District and to guide the establishment of an intervention project for quality and patient safety based on an evaluation process. In addition, this project demonstrated that it is possible to achieve real improvement nationwide of HAI prevention actions through the use of QA strategies.
| Identifer | oai:union.ndltd.org:IBICT/oai:repositorio.ufrn.br:123456789/21933 |
| Date | 27 July 2016 |
| Creators | Costa, Magda Machado de Miranda |
| Contributors | 01016659466, Medeiros, Eduardo Alexandrino Servolo de, 09217725803, Freitas, Marise Reis de, 30594766320, Hern?ndez, Pedro Jes?s Saturno, 00000000000, Gama, Zenewton Andr? da Silva |
| Publisher | MESTRADO PROFISSIONAL GEST?O DA QUALIDADE EM SERVI?OS DE SA?DE, UFRN, Brasil |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Source | reponame:Repositório Institucional da UFRN, instname:Universidade Federal do Rio Grande do Norte, instacron:UFRN |
| Rights | info:eu-repo/semantics/openAccess |
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