Avaliação da aplicação de medidas de prevenção de acidentes com material biológico entre alunos de graduação e residentes de medicina e enfermagem
Arquivos
Data
2006
Autores
Sassi, Silvia Janice Gomes 
Orientadores
Medeiros, Eduardo Alexandrino Servolo de
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivos: determinar a incidência de acidentes com material biológico entre alunos de graduação e residentes de medicina e de enfermagem; verificar a ocorrência de subnotificação de acidentes; avaliar o conhecimento sobre o Programa de Atendimento de Acidentes com Material Biológico e avaliar o efeito da aplicação de programa de prevenção de acidentes na subnotificação das exposições e no conhecimento sobre o Programa.
Casuística e métodos: estudo tipo coorte, que acompanhou a população de alunos e residentes para avaliação da exposição ocupacional no período de junho/2000 a maio/2005. Os profissionais da área da saúde (PAS) que sofreram acidentes com risco biológico ocorridos no complexo Hospital São Paulo – UNIFESP/EPM foram atendidos na Comissão de Controle de Infecção Hospitalar (CCIH), que disponibilizou atendimento 24 horas. As informações sobre o PAS, o acidente e as condutas foram registradas em instrumento específico. Os PAS expostos receberam atendimento e acompanhamento conforme as Recomendações do Ministério da Saúde. Para o cálculo da
densidade de incidência (DI) de acidente ocupacional foi utilizado como
numerador o número de acidentes da categoria e como denominador, o número
de indivíduos-dia/ano sob risco de exposições. Para avaliação da
subnotificação de acidentes e, do conhecimento do Programa de Atendimento
de Acidentes com Material Biológico, foram incluídos no estudo os alunos e
residentes que responderam questionários, após consentimento, sendo
divididos em dois períodos: A – antes da aplicação do programa educativo; e B
– após a aplicação sua aplicação, respectivamente. As atividades educativas
corresponderam à participação na recepção de novos residentes de medicina;
colocação de cartazes com orientações sobre risco biológico, medidas
preventivas e notificação de acidentes no HSP; distribuição de folhetos
educativos e discussões com alunos de graduação e residentes sobre o
assunto e realização de aulas.
Resultados: Foram notificados 1815 acidentes por PAS de diversas categorias.
Destes, 461 (25,4%) ocorreram com alunos e residentes. Do total de acidentes
desta população, 79,8% foram exposição pérfuro-cortante. O paciente-fonte foi
xvii
identificado em 86,6% das exposições, destes 79,6% apresentaram sorologias
negativas para HIV, VHB e VHC; 8,6% apresentaram HIV, 6,9% VHC, 1,7%
VHB. Em 13,4% das notificações a fonte do acidente foi desconhecida.
Verificou-se que 86,3% dos alunos e residentes apresentavam o esquema
vacinal completo contra hepatite B e, em 74,0% dos acidentes, referiram utilizar
equipamento de proteção individual. A DI de acidentes nestas três categorias
variou sensivelmente entre si. No grupo de alunos, observou-se queda na DI de
1,46 / 10.000 alunos-ano em 2000 para 0,69 / 10.000 alunos-ano em 2005.
Entre os residentes de enfermagem verificou-se que em 2000 a DI era 9,13 /
10.000 residentes-ano e em 2005 caiu para 3,95 / 10.000 residentes-ano. Na
categoria de residentes de medicina a DI caiu de 5,46 / 10.000 residentes-ano
em 2000 para 3,04 / 10.000 residentes-ano, em 2005. A subnotificação dos
acidentes foi constatada em 44,4% no Período A e, em 57,1% no Período B (p
= 0,17). Quanto à taxa de conhecimento do Programa de Atendimento de
Acidentes, verificou-se aumento significativo no Período B, após o início das
ações educativas (p = 0,001).
Conclusões: A população de alunos e residentes está constantemente sob
risco de exposições ocupacionais, durante as atividades práticas e as medidas
de prevenção de acidentes são fundamentais para minimizar estes riscos.
Dentre estas medidas destacam-se os programas educacionais. A DI de
acidentes na população acompanhada apresentou queda no período estudado.
O programa educacional para prevenção de acidentes foi importante para
aumentar o conhecimento sobre as práticas de prevenção, porém não teve
impacto na taxa de subnotificação das exposições.
Objectives: to determine the incidence of accidents with biological material among undergraduate students and medical and nurse residents; to determine if accidents are underreported and to evaluate the effects of applying a program for the prevention of accidents with biological material. Casuistic and methods: we performed a cohort study which evaluated the occupational exposure of a population of students and residents to biological agents during the period between June 2000 and May 2005. Healthcare workers (HCW) who suffered accidents with biological risks in the Hospital São Paulo (HSP) - UNIFESP/EPM were seen at the Committee for Control of Hospital Infection (CCHI), where a 24-h service was available. Information about HCW, the accident and the measures adopted were registered in specific records. Exposed HCW were seen and assisted as recommended by the Brazilian Ministry of Health (2004) guidelines. The incidence density (ID) of occupational accidents was determined by dividing the number of accidents in the category by the number of individuals-day/year under risk of exposure. To evaluate underreporting of accidents and the level of awareness of the Program of Assistance for Accidents with Biological Material, students and residents answered questionnaires and were included in the study, after having given informed consent, being divided in two periods: A – before the application of the educative program; and B – after its application, respectively. The prevention program included educative activities during reception to new medical residents; placards with orientations about biological risks, preventive measures and notification of accidents at the HSP; distribution of educative folders, discussions and classes with undergraduate students and residents. Results: A total of 1,815 accidents among HCW were reported; among them, 461 (25.4%) involved students and residents, and 79.8% were percutaneous injuries. The source patients were identified in 86.6% of the cases; 79.6% of them were serologically negative for HIV, BHV and CHV, whereas 8.6% presented positive serology for HIV, 6.9% for C hepatitis and 1.7% for B hepatitis virus. The source was unknown in 13.4% of the cases reported. It was 94 observed that 86.3% of the students and residents had the complete vaccine program for B hepatitis, and that in 74.0% of the accidents the individuals reported the use of adequate individual protection. The accident ID was very different when the three categories were compared. Among undergraduate students, the ID was 1.46/10,000 students-year in 2000, and lowered to 0.69/10,000 students-year in 2005. Among nurse residents, the ID which was 9.13/10,000 residents-year in 2000 decreased to 3.95/10,000 residents-year in 2005. In the category of medical residents, the ID was 5.46/10,000 residentsyear in 2000 and was decreased to 3.04/10,000 residents-year in 2005. Underreporting of accidents was checked in 44.4% in Period A and 57.1% in Period B (p = 0.17). The level of awareness of the Program of Assistance for Accidents presented significant increase after the establishment of the educative program (p = 0.001). Conclusions: Students and residents are constantly at risk of occupational exposure, during practical activities, and measures for the prevention of accidents are of fundamental importance to minimize these risks. The accident ID decreased during the period in which the population was investigated. The educational program for accident prevention was important in increasing the knowledge about measures of prevention, but had no impact on the ratio of underreporting of exposures.
Objectives: to determine the incidence of accidents with biological material among undergraduate students and medical and nurse residents; to determine if accidents are underreported and to evaluate the effects of applying a program for the prevention of accidents with biological material. Casuistic and methods: we performed a cohort study which evaluated the occupational exposure of a population of students and residents to biological agents during the period between June 2000 and May 2005. Healthcare workers (HCW) who suffered accidents with biological risks in the Hospital São Paulo (HSP) - UNIFESP/EPM were seen at the Committee for Control of Hospital Infection (CCHI), where a 24-h service was available. Information about HCW, the accident and the measures adopted were registered in specific records. Exposed HCW were seen and assisted as recommended by the Brazilian Ministry of Health (2004) guidelines. The incidence density (ID) of occupational accidents was determined by dividing the number of accidents in the category by the number of individuals-day/year under risk of exposure. To evaluate underreporting of accidents and the level of awareness of the Program of Assistance for Accidents with Biological Material, students and residents answered questionnaires and were included in the study, after having given informed consent, being divided in two periods: A – before the application of the educative program; and B – after its application, respectively. The prevention program included educative activities during reception to new medical residents; placards with orientations about biological risks, preventive measures and notification of accidents at the HSP; distribution of educative folders, discussions and classes with undergraduate students and residents. Results: A total of 1,815 accidents among HCW were reported; among them, 461 (25.4%) involved students and residents, and 79.8% were percutaneous injuries. The source patients were identified in 86.6% of the cases; 79.6% of them were serologically negative for HIV, BHV and CHV, whereas 8.6% presented positive serology for HIV, 6.9% for C hepatitis and 1.7% for B hepatitis virus. The source was unknown in 13.4% of the cases reported. It was 94 observed that 86.3% of the students and residents had the complete vaccine program for B hepatitis, and that in 74.0% of the accidents the individuals reported the use of adequate individual protection. The accident ID was very different when the three categories were compared. Among undergraduate students, the ID was 1.46/10,000 students-year in 2000, and lowered to 0.69/10,000 students-year in 2005. Among nurse residents, the ID which was 9.13/10,000 residents-year in 2000 decreased to 3.95/10,000 residents-year in 2005. In the category of medical residents, the ID was 5.46/10,000 residentsyear in 2000 and was decreased to 3.04/10,000 residents-year in 2005. Underreporting of accidents was checked in 44.4% in Period A and 57.1% in Period B (p = 0.17). The level of awareness of the Program of Assistance for Accidents presented significant increase after the establishment of the educative program (p = 0.001). Conclusions: Students and residents are constantly at risk of occupational exposure, during practical activities, and measures for the prevention of accidents are of fundamental importance to minimize these risks. The accident ID decreased during the period in which the population was investigated. The educational program for accident prevention was important in increasing the knowledge about measures of prevention, but had no impact on the ratio of underreporting of exposures.
Descrição
Citação
Sassi, Silvia Janice Gomes. 2006. 113 f. Avaliação da aplicação de medidas de prevenção de acidentes com material biológico entre alunos de graduação e residentes de medicina e enfermagem.Dissertação (Mestrado em Ciências) - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2006.