Propostas de melhoria nas ações de cuidado ao paciente, a partir do diagnóstico de infecções relacionadas à assistência à saúde (IRAS) em um hospital universitário de Fortaleza

Abstract

Infections related to health care (IRHC) are considered to be one of the major public health problems, with an impact on mortality, length of hospital stay, and spending on diagnostic and therapeutic procedures. Increased bacterial resistance and the use of invasive methods that aid in diagnosis and therapeutics are the major challenges to the control of IRHC. Epidemiological studies in the area of IRHC have become more relevant and sophisticated in recent years. Recognition, prevention, and control of IRHC are essential for mediation on risk in health services, improving the quality of patient care. This study aims to answer the following question: How to direct actions of prevention and control of IRHC in order to provide subsidies that guide improvements in the quality of patient care? The research aims to present proposals for the improvement of patient care actions based on the diagnosis of IRHC in a university hospital in Fortaleza. It is a case study, descriptive in nature regarding the objectives, documentary about technical procedures, with a qualitative-quantitative approach. The first stage of the research consists of the epidemiological diagnosis of IRHC in hospitalized patients at the Hospital Universitário Walter Cantídio (HUWC), from June 2017 to May 2018. The second stage included the collection of data through structured observation of the care actions practiced in the hospital routine. The third step consists in the application of a structured interview to specialists in the area of health care, through the Delphi Method. As results, we obtain the epidemiological profile of the IRHC in the hospital under study, we identified the facilities and difficulties for the development of the actions of prevention and control of IRHC in the view of the collaborators interviewed. And as a contribution we propose to notify the Primary Bloodstream Infections (PBI) associated to the Central Venous Catheter (CVC) in Clinic I, to broaden the discussion on the indicators of IRAS among the professionals, to carry out periodic training with the specialists and to guide the companions better. We conclude that the HUWC presented for the global diagnosis of indicators related to infections and hospital quality, rates considered satisfactory, except for the IRHC Density parameter, and among the main needs for improvement in the quality of care are the professionals' continuing education and better guidance of the companions. In fact, we hope that the results can contribute to the increase of the quality of services offered and the reduction of cases of IRHC in the HUWC.