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Prevenção e controlo das infeções e resistência aos antimicrobianos:
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Abstract(s)
No âmbito do protocolo de colaboração entre a Escola Superior de Enfermagem
de Lisboa (ESEL) e a Direção Geral da Saúde (DGS) realizou-se uma avaliação
do do Plano Nacional de Segurança do Doente (PNSD) 2015 -2020.
Na presente dissertação faz-se a análise do objetivo estratégico 9 do referido
plano “Prevenir e controlar as infeções e as resistências aos antimicrobianos”
através do acesso à base da DGS com os dados do PNSD de 2015 a 2019
inclusive. Objetivo: Responder à questão “Qual o nível de implementação do
objetivo estratégico 9.º do PNSD 2015-2020?”. Nesse sentido procurou-se
compreender nomeadamente em relação às metas estabelecidas se foi
possível “atingir uma taxa de prevalência de infeção hospitalar de 8%” e “uma
taxa de MRSA de 20%”; bem como reduzir “em 50%, face a 2014, o consumo
de antimicrobianos”, ” de carbapenemes” e “de quinolonas. Metodologia:
Estudo quantitativo e retrospetivo resultante de um instrumento em forma de
questionário, aplicado pela DGS às instituições do SNS de Portugal continental
junto das suas Comissões da Qualidade e Segurança (CQS). Resultados: Os
dados obtidos permitem relacionar as várias questões com o objetivo em
estudo, enquadrando-se em várias dimensões, nomeadamente a vigilância
epidemiológica das infeções descritas previamente, o controlo da
administração de antibioterapia e o feixe de intervenções adotado e a adotar.
Destacam-se alguns resultados, como a evolução favorável e maioritariamente
sim na monitorização das IACS e de acordo com os programas de vigilância
europeia e nacional, embora se assuma noutra questão que esta vigilância não
assume um carater frequente na maioria das instituições; verifica-se,
efetivamente, uma redução na taxa infeções associadas a MRSA. Ainda neste
contexto, apesar de se compreender respostas maioritariamente negativas na
implementação da norma da DGS/PPCIRA para a prevenção e controlo de
MRSA, simultaneamente denota-se um aumento progressivo de respostas
positivas, assinalando-se uma tendência para a melhoria de resultados,
embora seja possível perceber que as respostas negativas estão interligadas
com a ausência na aplicação de uma avaliação do risco individual na admissão.
Observa-se, também, que as instituições têm implementado um programa de
apoio à prescrição de antimicrobianos, verificando-se uma resposta favorável,
por exemplo, na diminuição do consumo de quinolonas. Em termos da adoção
de feixe de intervenções verifica-se um aumento no número de instituições que
identifica esse feixe na prevenção da infeção do local cirúrgico, bem como uma
maior monitorização da adesão dos profissionais à higienização das mãos,
confirmando-se uma preocupação das instituições em definir programas de
formação referentes à prevenção e controlo da infeção e resistência a
antimicrobianos, inclusive através da formação de profissionais recém admitidos. Conclusão: Não foi possível avaliar a evolução das instituições nas
questões apresentadas pela anonimização da base, embora esse controlo seja
efetuado pelo Departamento da Qualidade em Saúde (DQS) da DGS, contudo,
é possível obter resultados gerais desta análise, permitindo uma comparação
na evolução nas diferentes tipologias institucionais e anos. Assim, sugere-se
estabelecer novas metas que permitam uma avaliação no sentido de reforçar
em planos futuros a problemática das IACS e do consumo de antimicrobianos,
bem como a elaboração de instrumentos que permitam aferir as metas que
venham a ser desenvolvidas. Por outro lado, sugere-se a utilização de
instrumentos de auditoria a aplicar pelas entidades de saúde, facilitando a sua
comparação, e tendo em consideração a tipologia de instituição, bem como
aprofundar o modelo de acompanhamento das instituições conducente à sua
certificação e acreditação pelo Ministério da Saúde de forma mais efetiva.
Within the scope of the collaboration agreement between the Nursing School of Lisbon (ESEL) and the Directorate-General of Health (DGS), an assessment of the National Patient Safety Plan (PNSD) 2015-2020 was conducted. This dissertation analyses the strategic objective 9 of the plan "To prevent and control infections and antimicrobial resistance" by accessing the DGS database with PNSD data from 2015 to 2019. Objective: To answer the question "What is the level of implementation of the strategic objective 9 of the NSDP 2015-2020? In this sense, we sought to understand whether it was possible to "achieve a prevalence rate of hospital infection of 8%" and "a MRSA rate of 20%", as well as to reduce "by 50% compared to 2014, the consumption of antimicrobials", "of carbapenems" and "of quinolones". Methodology: Quantitative and retrospective study resulting from an instrument in the form of a questionnaire, applied by the DGS to SNS institutions in mainland Portugal at their Quality and Safety Committees (CQS). Results: The data obtained allow relating the various questions to the objective under study, falling within several dimensions, namely the epidemiological surveillance of the previously described infections, the control of antibiotic therapy administration and the bundle of interventions adopted and to be adopted. We highlight some results, such as the favourable evolution and mostly yes in the monitoring of HAIs and in accordance with the European and national surveillance programmes, although we assume in another question that this surveillance is not a frequent feature in most institutions; a reduction in the rate of infections associated with MRSA was effectively observed. Also in this context, although there were mostly negative answers regarding the implementation of the DGS/PPCIRA standard for the prevention and control of MRSA, there was a progressive increase in the number of positive answers, indicating a trend towards improved results, although it is possible to perceive that the negative answers are interconnected with the lack of application of an individual risk assessment upon admission. It is also observed that institutions have implemented a programme to support the prescription of antimicrobials, with a favourable response, for example, in the decrease in the consumption of quinolones. In terms of the adoption of a bundle of interventions, we found an increase in the number of institutions that identify this bundle in the prevention of surgical site infections, as well as a greater monitoring of the professionals' adherence to hand hygiene, confirming the institutions' concern in defining training programs on infection prevention and control and antimicrobial resistance, including through the training of newly hired professionals. Conclusion: It was not possible to assess the evolution of institutions in the issues presented by the anonymization of the database, although this control is performed by the Department of Quality in Health (DQS) of the DGS; however, it is possible to obtain general results from this analysis, allowing for a comparison in the evolution in different institutional typologies and years. Thus, it is suggested to establish new goals that allow an evaluation in order to strengthen the problem of HAIs and antimicrobial consumption in future plans, as well as the development of instruments that allow measuring the goals that will be developed. On the other hand, it is suggested the use of auditing instruments to be applied by health entities, facilitating their comparison, and taking into consideration the type of institution, as well as deepening the monitoring model of institutions leading to their certification and accreditation by the Ministry of Health in a more effectively way.
Within the scope of the collaboration agreement between the Nursing School of Lisbon (ESEL) and the Directorate-General of Health (DGS), an assessment of the National Patient Safety Plan (PNSD) 2015-2020 was conducted. This dissertation analyses the strategic objective 9 of the plan "To prevent and control infections and antimicrobial resistance" by accessing the DGS database with PNSD data from 2015 to 2019. Objective: To answer the question "What is the level of implementation of the strategic objective 9 of the NSDP 2015-2020? In this sense, we sought to understand whether it was possible to "achieve a prevalence rate of hospital infection of 8%" and "a MRSA rate of 20%", as well as to reduce "by 50% compared to 2014, the consumption of antimicrobials", "of carbapenems" and "of quinolones". Methodology: Quantitative and retrospective study resulting from an instrument in the form of a questionnaire, applied by the DGS to SNS institutions in mainland Portugal at their Quality and Safety Committees (CQS). Results: The data obtained allow relating the various questions to the objective under study, falling within several dimensions, namely the epidemiological surveillance of the previously described infections, the control of antibiotic therapy administration and the bundle of interventions adopted and to be adopted. We highlight some results, such as the favourable evolution and mostly yes in the monitoring of HAIs and in accordance with the European and national surveillance programmes, although we assume in another question that this surveillance is not a frequent feature in most institutions; a reduction in the rate of infections associated with MRSA was effectively observed. Also in this context, although there were mostly negative answers regarding the implementation of the DGS/PPCIRA standard for the prevention and control of MRSA, there was a progressive increase in the number of positive answers, indicating a trend towards improved results, although it is possible to perceive that the negative answers are interconnected with the lack of application of an individual risk assessment upon admission. It is also observed that institutions have implemented a programme to support the prescription of antimicrobials, with a favourable response, for example, in the decrease in the consumption of quinolones. In terms of the adoption of a bundle of interventions, we found an increase in the number of institutions that identify this bundle in the prevention of surgical site infections, as well as a greater monitoring of the professionals' adherence to hand hygiene, confirming the institutions' concern in defining training programs on infection prevention and control and antimicrobial resistance, including through the training of newly hired professionals. Conclusion: It was not possible to assess the evolution of institutions in the issues presented by the anonymization of the database, although this control is performed by the Department of Quality in Health (DQS) of the DGS; however, it is possible to obtain general results from this analysis, allowing for a comparison in the evolution in different institutional typologies and years. Thus, it is suggested to establish new goals that allow an evaluation in order to strengthen the problem of HAIs and antimicrobial consumption in future plans, as well as the development of instruments that allow measuring the goals that will be developed. On the other hand, it is suggested the use of auditing instruments to be applied by health entities, facilitating their comparison, and taking into consideration the type of institution, as well as deepening the monitoring model of institutions leading to their certification and accreditation by the Ministry of Health in a more effectively way.
Description
Keywords
Administração em enfermagem Gestão em saúde Resistência microbiana a medicamentos Infeções Infeção hospitalar