RESUMO
Abstract Objectives: to evaluate the application of hand hygiene technique, according to the World Health Organization (WHO) recommendations, in the neonatal intensive care unit, at a Maternity in Salvador de Bahia, Brazil. Methods: cross-sectional study. Hand hygiene technique by professional category and alcohol solution consumption were systematically registered. For this task an adapted instrument created by the WHO was used and applied using factsheets. The sample was taken from medical physicians, physiotherapists, nurses and nursing technicians. Results: hand hygiene adherence regarding WHO recommendations was deficient in terms of technique and in terms of frequency (adequate technique ranged from 0% to 13.3% between professional categories). Hand hygiene was frequently ignored (27% between physicians and 51.8% between nursing technicians). The moment right after touching surfaces next to patients was the most ignored one. Alcohol gel solution monthly use was only 35% of the expected value for the unit. Conclusions: despite the international investigations and efforts for better results, the adherence and compliance to the hand hygiene guidelines is still deficient and continues to be a major problem.
Resumo Objetivos: avaliar aplicação da técnica de higienização das mãos numa unidade de terapia intensiva neonatal em uma maternidade de Salvador, Bahia, Brasil. Métodos: estudo transversal no qual foi avaliada a técnica de higienização das mãos com água e sabão e álcool gel e o consumo de solução de álcool gel e por categoria profissional. Um instrumento adaptado da OMS foi usado e aplicado usando questionários. A amostra foi composta por médicos, fisioterapeutas, enfermeiros e técnicos de enfermagem. Resultados: a aderência à higienização das mãos foi deficiente em termos de técnica e de frequência (a execução correta da técnica variou de 0 a 13,3% entre as categorias profissionais). A higienização das mãos foi ignorada por 27% dos médicos e 51,8% dos técnicos de enfermagem. Depois de tocar superfícies próximas aos pacientes foi o momento mais ignorado. O uso mensal de álcool gel foi 35% do valor esperado. Conclusões: apesar das investigações internacionais e esforços para melhores resultados, a adesão e o cumprimento das diretrizes de higienização das mãos ainda é deficiente.
Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Lactente , Organização Mundial da Saúde , Terapia Intensiva Neonatal , Serviços de Saúde Materno-Infantil , Higiene das Mãos/métodos , Staphylococcus epidermidis , Brasil , Estudos Transversais , Atenção à Saúde , Candida parapsilosisRESUMO
OBJECTIVES: To examine the impact of cardiovascular disease (CVD) events on patient functionality and productivity on the basis of patient use of public or social/private institution health care. METHODS: A secondary analysis was conducted of data drawn from records of Argentinian patients, 3 to 15 months posthospitalization after a CVD event, who had originally participated in a multicountry, cross-sectional study assessing the microeconomic impact of a CVD event. Respondents were stratified according to their use of health care institution (public or social/private). Among these groups, pre- and post-CVD event changes in functionality and productivity were compared. RESULTS: Participants' (N = 431) mean age was 56.5 years, and 73.5% were men. Public sector patients reported significantly higher rates of decline in ability to perform moderate activities (P < 0.05), a greater decrease in time spent at work (P < 0.01), a greater limit in the type of work-related activities (P < 0.01), and a higher rate of emotional problems (P < 0.01). Having health insurance (private or social) (odds ratio [OR] = 0.55; 95% confidence interval [CI] 0.35-0.85; P < 0.01) and a higher income (OR = 0.99; 95% CI 0.99-0.99; P < 0.01) were inversely and significantly associated with loss of productivity. Cerebrovascular disease (OR = 2.55; 95% CI 1.42-4.60; P < 0.01) was also significantly associated with productivity loss. CONCLUSIONS: In Argentina, patients receiving care in the public sector experienced a greater impact on functionality and productivity after their hospitalization for a CVD event. Lack of insurance, low income, and cerebrovascular disease event were the major determinants of productivity loss. Further investigation is needed to better understand contributors to these differences.
Assuntos
Doenças Cardiovasculares , Renda , Argentina , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/terapia , Estudos Transversais , Eficiência , Emprego , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Purpose. In Argentina, tuberculosis (TB) control measures have not achieved key treatment targets. The purpose of this study was to identify modes of treatment delivery and explore patient and healthcare personnel perceptions of barriers and facilitators to treatment success. Methods. We used semistructured group and individual interviews for this descriptive qualitative study. Eight high burden municipalities were purposively selected. Patients in treatment for active TB (n = 16), multidisciplinary TB team members (n = 26), and TB program directors (n = 12) at local, municipal, regional, and national levels were interviewed. Interviews were recorded, transcribed verbatim, and analyzed using thematic analysis. Results. Modes of treatment delivery varied across municipalities and types of healthcare facility and were highly negotiated with patients. Self-administration of treatment was common in hospital-based and some community clinics. Barriers to TB treatment success were concentrated at the system level. This level relied heavily on individual personal commitment, and many system facilitators were operating in isolation or in limited settings. Conclusions. We outline experiences and perspectives of the facilitating and challenging factors at the individual, structural, social, and organizational levels. Establishing strong patient-healthcare personnel relationships, responding to patient needs, capitalizing on community resources, and maximizing established decentralized system could mitigate some of the barriers.