Cristiane Pavanello Rodrigues Silva

Indicadores de avaliação do processamento de artigos odonto-médico-hospitalares: elaboração e validação

Methodological study to elaborate and validate measures of evaluation in health contributing to an evaluation system of practices related to the control and prevention of hospital infection. It was elaborated eight dental-medical-hospital supply reprocessing conformity indicators. Indicators are described using items of the structure, process and outcomes that permitted the elaboration of conformity indicators related to the best practices (gold pattern). It was performed the content validity of the attributes of applicability and representativeness by a consensus expert judgment process using a psychometric scale. All the indicators showed to have content validity. Expert judgments, including comments and suggestions, evidenced the importance of perform validity of the evaluation processes, independently of the existence of golden pattern criteria and/or relevancies to the nursing practice.Estudio de desenvolvimiento metodologico para la elaboracion y validacion de medidas de evaluacion en salud, con la finalidad de contribuir con los sistemas de evaluacion de practicas para el control y prevencion de las infecciones hospitalarias, por la elaboracion y validacion de ocho indicadores de evaluacion del procesamiento de instrumentos odonto-medico-hospitalarios. A partir de la fundamentacion teorico cientifico, tales indicadores contemplan evaluaciones de estructura, proceso y resultado asi como permiten la elaboracion de indices de conformidad con relacion a las mejores practicas esperadas (padron-oro). La evaluacion se refirio a la validez del contenido, por la tecnica de consenso de especialistas para el juzgamiento de representatividad y aplicabilidad. Todos los indicadores fueron aprobados. Los juzgamientos efectuados, incluyendo comentarios y sugestiones, demostraron la importancia de realizar la validacion de procesos de evaluacion, independiente da existencia de criterios padron-oro y/o a la relevancia de su repercusion en la practica asistencial.* Extracted from project “Indicadores de Avaliação de Práticas de Controle de Infecção Hospitalar”, School of Nursing at University of São Paulo, 2006. 1 Full Professor of Medical-Surgery Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. kugrazia@usp 2 Associate Professor of Medical-Surgery Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. rlacerda@usp.br 3 Doctorate Professor of Medical-Surgery Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. rturrini@usp.br 4 Student. PostGraduation Program PROESA at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. caquartim@yahoo.com.br 5 Student. Post-Graduation Program PROESA at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. cris_pr_silva@hotmail.com 6 Student. Post-Graduation Program PROESA at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. cristianeschmmitt@yahoo.com.br 7 Student. Post-Graduation Program PROESA at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. gioaraujo@yahoo.com.br 8 Student. Post-Graduation Program PROESA at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. lilian.torres@superig.com.br O R IG IN A L A R IC LE

Validação de proposta de avaliação de programas de controle de infecção hospitalar

OBJETIVO: Validar las propiedades de constructo y discriminante de programa de prevencion y control de infeccion hospitalaria. METODOS: El programa consiste de cuatro indicadores: estructura tecnico-operacional; directrices operacionales de control y prevencion; sistema de vigilancia epidemiologica; actividades de control y prevencion. Estos indicadores, cuyo contenido fue previamente validado, fueron aplicados en 50 instituciones de salud de Sao Paulo, Sureste de Brasil, en 2009. Se utilizo estadistica descriptiva para caracterizar los hospitales y escores de los indicadores y el coeficiente α de Cronbach para evaluar la consistencia interna. El analisis de la validez discriminante fue realizado comparandose escores de los indicadores entre grupos de hospitales, con versus sin certificacion en calidad. El analisis de la validez de constructo se baso en el analisis factorial exploratorio con matriz de correlacion tetracorica. RESULTADOS: Los indicadores de estructura tecnico-operacional y vigilancia epidemiologica presentaron casi 100% de conformidad en toda muestra. Los indicadores de directrices operacionales de control y prevencion, y los de actividades de control y prevencion presentaron consistencia interna con variacion de 0,67 a 0,80. La validez discriminante de estos indicadores indico promedio de escores de conformidad superiores y con significancia estadistica en el grupo de instituciones con procesos de calificacion o acreditacion en salud. En la validacion de constructo fueron identificadas dos dimensiones para directrices operacionales de control y prevencion: recomendaciones para prevencion de infeccion hospitalaria y recomendaciones para estandarizacion de procedimientos de profilaxia, con buena correlacion de las unidades de analisis que lo compone. Lo mismo ocurrio para actividades de control y prevencion: se identifico interface con unidades de tratamiento e interface con unidades de apoyo. CONCLUSIONES: La validacion de las propiedades de medidas de los indicadores de programas de control de infeccion hospitalaria permite desarrollar herramienta de evaluacion de dichos programas de forma etica y cientifica para diagnostico de calidad en el area.OBJECTIVE To validate the construct and discriminant properties of a hospital infection prevention and control program. METHODS The program consisted of four indicators: technical-operational structure; operational prevention and control guidelines; epidemiological surveillance system; and prevention and control activities. These indicators, with previously validated content, were applied to 50 healthcare institutions in the city of São Paulo, Southeastern Brazil, in 2009. Descriptive statistics were used to characterize the hospitals and indicator scores, and Cronbachs α coefficient was used to evaluate the internal consistency. The discriminant validity was analyzed by comparing indicator scores between groups of hospitals: with versus without quality certification. The construct validity analysis was based on exploratory factor analysis with a tetrachoric correlation matrix. RESULTS The indicators for the technical-operational structure and epidemiological surveillance presented almost 100% conformity in the whole sample. The indicators for the operational prevention and control guidelines and the prevention and control activities presented internal consistency ranging from 0.67 to 0.80. The discriminant validity of these indicators indicated higher and statistically significant mean conformity scores among the group of institutions with healthcare certification or accreditation processes. In the construct validation, two dimensions were identified for the operational prevention and control guidelines: recommendations for preventing hospital infection and recommendations for standardizing prophylaxis procedures, with good correlation between the analysis units that formed the guidelines. The same was found for the prevention and control activities: interfaces with treatment units and support units were identified. CONCLUSIONS Validation of the measurement properties of the hospital infection prevention and control program indicators made it possible to develop a tool for evaluating these programs in an ethical and scientific manner in order to obtain a quality diagnosis in this field.

Assistência individualizada: posso trazer meu cachorro?

Estudo de caso com objetivo de conhecer a percepcao de uma adolescente portadora de leucemia linfocitica aguda recidivada e da sua mae sobre a visita do seu cao de estimacao durante a hospitalizacao, bem como descrever a experiencia enquanto intervencao de enfermagem. Os dados foram obtidos e organizados mediante relato de experiencia. Beneficios dessa medida terapeutica foram observados demonstrando que a Terapia Assistida por Animais deve ter sua utilizacao ampliada para outras situacoes clinicas, constituindo alvo de novas investigacoes.A case study aimed at knowing the perception of a teenager suffering from recurrent acute lymphocytic leukemia and of her mother regarding the visit of her pet dog during hospitalization, as well as at describing the experience as a nursing intervention. Data was obtained and organized through reports on the experience. Beneficial effects of such therapeutic action were observed, thus demonstrating that Animal Assisted Therapy may be extended to other clinical situations and should be the object of new investigations.

Indicators for evaluation of processing dental-medical-hospital supplies: elaboration and validation

Methodological study to elaborate and validate measures of evaluation in health contributing to an evaluation system of practices related to the control and prevention of hospital infection. It was elaborated eight dental-medical-hospital supply reprocessing conformity indicators. Indicators are described using items of the structure, process and outcomes that permitted the elaboration of conformity indicators related to the best practices (gold pattern). It was performed the content validity of the attributes of applicability and representativeness by a consensus expert judgment process using a psychometric scale. All the indicators showed to have content validity. Expert judgments, including comments and suggestions, evidenced the importance of perform validity of the evaluation processes, independently of the existence of golden pattern criteria and/or relevancies to the nursing practice.Estudio de desenvolvimiento metodologico para la elaboracion y validacion de medidas de evaluacion en salud, con la finalidad de contribuir con los sistemas de evaluacion de practicas para el control y prevencion de las infecciones hospitalarias, por la elaboracion y validacion de ocho indicadores de evaluacion del procesamiento de instrumentos odonto-medico-hospitalarios. A partir de la fundamentacion teorico cientifico, tales indicadores contemplan evaluaciones de estructura, proceso y resultado asi como permiten la elaboracion de indices de conformidad con relacion a las mejores practicas esperadas (padron-oro). La evaluacion se refirio a la validez del contenido, por la tecnica de consenso de especialistas para el juzgamiento de representatividad y aplicabilidad. Todos los indicadores fueron aprobados. Los juzgamientos efectuados, incluyendo comentarios y sugestiones, demostraron la importancia de realizar la validacion de procesos de evaluacion, independiente da existencia de criterios padron-oro y/o a la relevancia de su repercusion en la practica asistencial.* Extracted from project “Indicadores de Avaliação de Práticas de Controle de Infecção Hospitalar”, School of Nursing at University of São Paulo, 2006. 1 Full Professor of Medical-Surgery Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. kugrazia@usp 2 Associate Professor of Medical-Surgery Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. rlacerda@usp.br 3 Doctorate Professor of Medical-Surgery Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. rturrini@usp.br 4 Student. PostGraduation Program PROESA at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. caquartim@yahoo.com.br 5 Student. Post-Graduation Program PROESA at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. cris_pr_silva@hotmail.com 6 Student. Post-Graduation Program PROESA at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. cristianeschmmitt@yahoo.com.br 7 Student. Post-Graduation Program PROESA at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. gioaraujo@yahoo.com.br 8 Student. Post-Graduation Program PROESA at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. lilian.torres@superig.com.br O R IG IN A L A R IC LE

Validation of a proposal for evaluating hospital infection control programs

OBJETIVO: Validar las propiedades de constructo y discriminante de programa de prevencion y control de infeccion hospitalaria. METODOS: El programa consiste de cuatro indicadores: estructura tecnico-operacional; directrices operacionales de control y prevencion; sistema de vigilancia epidemiologica; actividades de control y prevencion. Estos indicadores, cuyo contenido fue previamente validado, fueron aplicados en 50 instituciones de salud de Sao Paulo, Sureste de Brasil, en 2009. Se utilizo estadistica descriptiva para caracterizar los hospitales y escores de los indicadores y el coeficiente α de Cronbach para evaluar la consistencia interna. El analisis de la validez discriminante fue realizado comparandose escores de los indicadores entre grupos de hospitales, con versus sin certificacion en calidad. El analisis de la validez de constructo se baso en el analisis factorial exploratorio con matriz de correlacion tetracorica. RESULTADOS: Los indicadores de estructura tecnico-operacional y vigilancia epidemiologica presentaron casi 100% de conformidad en toda muestra. Los indicadores de directrices operacionales de control y prevencion, y los de actividades de control y prevencion presentaron consistencia interna con variacion de 0,67 a 0,80. La validez discriminante de estos indicadores indico promedio de escores de conformidad superiores y con significancia estadistica en el grupo de instituciones con procesos de calificacion o acreditacion en salud. En la validacion de constructo fueron identificadas dos dimensiones para directrices operacionales de control y prevencion: recomendaciones para prevencion de infeccion hospitalaria y recomendaciones para estandarizacion de procedimientos de profilaxia, con buena correlacion de las unidades de analisis que lo compone. Lo mismo ocurrio para actividades de control y prevencion: se identifico interface con unidades de tratamiento e interface con unidades de apoyo. CONCLUSIONES: La validacion de las propiedades de medidas de los indicadores de programas de control de infeccion hospitalaria permite desarrollar herramienta de evaluacion de dichos programas de forma etica y cientifica para diagnostico de calidad en el area.OBJECTIVE To validate the construct and discriminant properties of a hospital infection prevention and control program. METHODS The program consisted of four indicators: technical-operational structure; operational prevention and control guidelines; epidemiological surveillance system; and prevention and control activities. These indicators, with previously validated content, were applied to 50 healthcare institutions in the city of São Paulo, Southeastern Brazil, in 2009. Descriptive statistics were used to characterize the hospitals and indicator scores, and Cronbachs α coefficient was used to evaluate the internal consistency. The discriminant validity was analyzed by comparing indicator scores between groups of hospitals: with versus without quality certification. The construct validity analysis was based on exploratory factor analysis with a tetrachoric correlation matrix. RESULTS The indicators for the technical-operational structure and epidemiological surveillance presented almost 100% conformity in the whole sample. The indicators for the operational prevention and control guidelines and the prevention and control activities presented internal consistency ranging from 0.67 to 0.80. The discriminant validity of these indicators indicated higher and statistically significant mean conformity scores among the group of institutions with healthcare certification or accreditation processes. In the construct validation, two dimensions were identified for the operational prevention and control guidelines: recommendations for preventing hospital infection and recommendations for standardizing prophylaxis procedures, with good correlation between the analysis units that formed the guidelines. The same was found for the prevention and control activities: interfaces with treatment units and support units were identified. CONCLUSIONS Validation of the measurement properties of the hospital infection prevention and control program indicators made it possible to develop a tool for evaluating these programs in an ethical and scientific manner in order to obtain a quality diagnosis in this field.

Klebsiella pneumoniae outbreak in a cancer unit of a general hospital: predisposing factors and evaluation of the impact of intervention measures

We made a retrospective cohort study of a primary bloodstream infection outbreak in patients of a cancer unit in a general hospital, evaluated the impact of intervention measures and investigated the predisposing factors. The targeted predisposing factors were selected based on the medical literature. The data were treated with univariate analysis to calculate the relative risk, and statistical significance was set at p<0.05. The presence of a long-term totally-implanted central venous catheter appears to be a predisposing factor, while a peripheral venous catheter appears to have offered protection from infection. This is reinforced by fact that intervention measures controlled the outbreak, suggesting cross-contamination from a common source. These findings corroborate the fundamental role of the hospital infection control service in early intervention and reinforce the need for continued training of health professionals that perform this type of care.

Policies for control and prevention of infections related to healthcare assistance in Brazil: a conceptual analysis

This article is a theoretical-reflexive study that aims to discuss the development and changes in the quality of healthcare assistance to the patient over the years in Brazil, in light of the policies of control and prevention of Healthcare-associated Infection (HAI). Aspects of HAI and the process of change in health policy in Brazil, as well as the quality of assistance associated with its control, are approached in relation to policies of patient safety. There are various new theoretical and practical proposals created in Brazil. In spite of the difficulty of measuring patient safety, directed to the prevention and control of HAI, we emphasize that to only create policies and establish norms, guidelines, and indicators is not sufficient. If no structural support or conditions exist for interventions in the practices of healthcare professionals, aiming at results in acceptable levels, the control of HAI will not be achieved. Resumo Trata-se um estudo teórico-reflexivo, que objetiva discutir a evolução e as mudanças na qualidade da assistência ao paciente, ao longo dos anos no Brasil, à luz das políticas de controle e prevenção da Infecção Relacionada à Assistência à Saúde (IRAS). Aspectos sobre IRAS e o processo de mudança nas políticas de saúde no Brasil, bem como a qualidade da assistência associada ao seu controle, são abordados em relação às políticas de segurança do paciente. Há novas e várias propostas teóricas e práticas criadas no Brasil. Apesar da dificuldade de medir a segurança do paciente, direcionada à prevenção e controle das IRAS, enfatiza-se que somente criar políticas, estabelecer normas, diretrizes e indicadores não são suficientes. Se não houver suporte de estrutura e condições para as intervenções nas práticas dos profissionais na assistência prestada ao paciente, visando resultados em níveis aceitáveis, o controle das IRAS não será alcançado.

P242: Benchmarking of infection related to health care indices: 14 Brazilian health intensive care pediatric and neonatal units

Infections Related to Health Care (IRHC) today are considered as a public health problem worldwide, therefore it is essential that institutions focus their efforts on the continuous improvement of quality of care using the IRHC indices as indicators of quality, validated and recognized for this purpose, but in Brazil the comparison of IRHC (benchmarking) with the purpose of evaluation is arduous task, since there is no national database for external comparisons, is even scarcer such information in pediatrics and neonatology.

Validación de propuesta de evaluación de programas de control de infección hospitalaria

OBJETIVO: Validar las propiedades de constructo y discriminante de programa de prevencion y control de infeccion hospitalaria. METODOS: El programa consiste de cuatro indicadores: estructura tecnico-operacional; directrices operacionales de control y prevencion; sistema de vigilancia epidemiologica; actividades de control y prevencion. Estos indicadores, cuyo contenido fue previamente validado, fueron aplicados en 50 instituciones de salud de Sao Paulo, Sureste de Brasil, en 2009. Se utilizo estadistica descriptiva para caracterizar los hospitales y escores de los indicadores y el coeficiente α de Cronbach para evaluar la consistencia interna. El analisis de la validez discriminante fue realizado comparandose escores de los indicadores entre grupos de hospitales, con versus sin certificacion en calidad. El analisis de la validez de constructo se baso en el analisis factorial exploratorio con matriz de correlacion tetracorica. RESULTADOS: Los indicadores de estructura tecnico-operacional y vigilancia epidemiologica presentaron casi 100% de conformidad en toda muestra. Los indicadores de directrices operacionales de control y prevencion, y los de actividades de control y prevencion presentaron consistencia interna con variacion de 0,67 a 0,80. La validez discriminante de estos indicadores indico promedio de escores de conformidad superiores y con significancia estadistica en el grupo de instituciones con procesos de calificacion o acreditacion en salud. En la validacion de constructo fueron identificadas dos dimensiones para directrices operacionales de control y prevencion: recomendaciones para prevencion de infeccion hospitalaria y recomendaciones para estandarizacion de procedimientos de profilaxia, con buena correlacion de las unidades de analisis que lo compone. Lo mismo ocurrio para actividades de control y prevencion: se identifico interface con unidades de tratamiento e interface con unidades de apoyo. CONCLUSIONES: La validacion de las propiedades de medidas de los indicadores de programas de control de infeccion hospitalaria permite desarrollar herramienta de evaluacion de dichos programas de forma etica y cientifica para diagnostico de calidad en el area.OBJECTIVE To validate the construct and discriminant properties of a hospital infection prevention and control program. METHODS The program consisted of four indicators: technical-operational structure; operational prevention and control guidelines; epidemiological surveillance system; and prevention and control activities. These indicators, with previously validated content, were applied to 50 healthcare institutions in the city of São Paulo, Southeastern Brazil, in 2009. Descriptive statistics were used to characterize the hospitals and indicator scores, and Cronbachs α coefficient was used to evaluate the internal consistency. The discriminant validity was analyzed by comparing indicator scores between groups of hospitals: with versus without quality certification. The construct validity analysis was based on exploratory factor analysis with a tetrachoric correlation matrix. RESULTS The indicators for the technical-operational structure and epidemiological surveillance presented almost 100% conformity in the whole sample. The indicators for the operational prevention and control guidelines and the prevention and control activities presented internal consistency ranging from 0.67 to 0.80. The discriminant validity of these indicators indicated higher and statistically significant mean conformity scores among the group of institutions with healthcare certification or accreditation processes. In the construct validation, two dimensions were identified for the operational prevention and control guidelines: recommendations for preventing hospital infection and recommendations for standardizing prophylaxis procedures, with good correlation between the analysis units that formed the guidelines. The same was found for the prevention and control activities: interfaces with treatment units and support units were identified. CONCLUSIONS Validation of the measurement properties of the hospital infection prevention and control program indicators made it possible to develop a tool for evaluating these programs in an ethical and scientific manner in order to obtain a quality diagnosis in this field.

Indicadores para la evaluación del reprocesamiento del productos medicos del hospital: construcción y validación

Methodological study to elaborate and validate measures of evaluation in health contributing to an evaluation system of practices related to the control and prevention of hospital infection. It was elaborated eight dental-medical-hospital supply reprocessing conformity indicators. Indicators are described using items of the structure, process and outcomes that permitted the elaboration of conformity indicators related to the best practices (gold pattern). It was performed the content validity of the attributes of applicability and representativeness by a consensus expert judgment process using a psychometric scale. All the indicators showed to have content validity. Expert judgments, including comments and suggestions, evidenced the importance of perform validity of the evaluation processes, independently of the existence of golden pattern criteria and/or relevancies to the nursing practice.Estudio de desenvolvimiento metodologico para la elaboracion y validacion de medidas de evaluacion en salud, con la finalidad de contribuir con los sistemas de evaluacion de practicas para el control y prevencion de las infecciones hospitalarias, por la elaboracion y validacion de ocho indicadores de evaluacion del procesamiento de instrumentos odonto-medico-hospitalarios. A partir de la fundamentacion teorico cientifico, tales indicadores contemplan evaluaciones de estructura, proceso y resultado asi como permiten la elaboracion de indices de conformidad con relacion a las mejores practicas esperadas (padron-oro). La evaluacion se refirio a la validez del contenido, por la tecnica de consenso de especialistas para el juzgamiento de representatividad y aplicabilidad. Todos los indicadores fueron aprobados. Los juzgamientos efectuados, incluyendo comentarios y sugestiones, demostraron la importancia de realizar la validacion de procesos de evaluacion, independiente da existencia de criterios padron-oro y/o a la relevancia de su repercusion en la practica asistencial.* Extracted from project “Indicadores de Avaliação de Práticas de Controle de Infecção Hospitalar”, School of Nursing at University of São Paulo, 2006. 1 Full Professor of Medical-Surgery Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. kugrazia@usp 2 Associate Professor of Medical-Surgery Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. rlacerda@usp.br 3 Doctorate Professor of Medical-Surgery Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. rturrini@usp.br 4 Student. PostGraduation Program PROESA at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. caquartim@yahoo.com.br 5 Student. Post-Graduation Program PROESA at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. cris_pr_silva@hotmail.com 6 Student. Post-Graduation Program PROESA at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. cristianeschmmitt@yahoo.com.br 7 Student. Post-Graduation Program PROESA at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. gioaraujo@yahoo.com.br 8 Student. Post-Graduation Program PROESA at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. lilian.torres@superig.com.br O R IG IN A L A R IC LE