Avaliação das salas de vacina das unidades de atenção primária à saúde de Fortaleza/Ceará

Abstract

Health promotion has highlighted the importance of immunization for the population and shown how health evaluations can be used to improve public health services. Considering the contribution of vaccination to the improvement of health and well-being, the purpose of this evaluative study was to evaluate the structure and work processes of vaccination rooms at primary health care facilities in Fortaleza (a Northeast Brazilian state capital) with regard to general/technical aspects and cold chain. The sample consisted of 89 vaccination rooms located in the cityʼs six subprefectures (SP I-VI). Data were collected using a vaccination room supervision checklist developed by the Ministry of Health, and through interviews with vaccinators. The study protocol was approved by the research ethics committee of the Federal University of Ceará (filed under #954.086). Most vaccinators (76.4%) were nursing technicians. Most rooms (51%) had only one vaccinator on duty. Many vaccinators (31.5%) had never received formal training. With regard to structure, in 69.7% of the rooms the component ‛general/technical aspectsʼ was classified as good, while 23.6% required maintenance (mainly due to infiltrations in the walls and ceiling). Several rooms (22.5%) had no table for vaccine preparation. Half (49.4%) were cleaned less frequently than prescribed, and 43.8% contained decorative objects. Monthly supplies of vaccines and syringes/needles were insufficient in 41.6% and 52%, respectively. With regard to work processes, in 76.4% of the rooms the component ‛general/technical aspectsʼ was classified as fair. Vaccination was not postponed when contraindicated (66.3%), and no investigation of adverse effects was conducted (72%). Although 76.4% of the vaccinators used correct vaccination techniques, 40.4% did not wash their hands properly. With regard to structure, the component ‛cold chainʼ was classified as good in 45.0%, but preventive/corrective maintenance was inadequate and cold boxes lacked thermometers (64.2%). With regard to work processes, the component ‛cold chainʼ was classified as fair in 59.6%, with inadequate temperature (48.8%) and cleaning (71.9%) of refrigerators. In 84.3%, cold box temperature was not monitored and in 69.7% the ice packs were inadequately conditioned. When analyzed according to subprefecture, SP VI had the most vaccination rooms classified as ideal or good in terms of ‛general/technical aspectsʼ (both structure and work processes), while SP II (structure) and SP III (work processes) had the best cold chain. SP I (structure) and SP V (work processes) had the most vaccination rooms classified as fair or poor with regard to ‛general/technical aspectsʼ, while SP III (structure) and SR IV (work processes) had the worst cold chain. Our study identified problems of structure and work processes (especially the latter) in primary care vaccination rooms in Fortaleza in need of urgent correction.