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Acidente com material biológico: caracterização e percepção dos trabalhadores sobre o fluxo assistencial, estudo piloto, Vitória da Conquista, Brasil
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O acidente ocupacional com material biológico apresenta uma condição de potencial risco à saúde dos trabalhadores desse setor, insegurança frente à condução dessa ocorrência, além da necessidade de seguimento adequado ao longo do tempo pós-exposição. Esse trabalho tem como objetivo geral caracterizar a percepção dos trabalhadores da saúde acidentados em relação ao fluxo assistencial pós-exposição. Descreve o perfil do profissional acidentado, a caracterização da ocorrência e do seu seguimento assistencial (monitoramento biológico), avaliando o cumprimento do protocolo do Ministério da Saúde e o sentimento do trabalhador frente a essa condição. Trata-se de um estudo descritivo, transversal, associando dados de indivíduos de uma população definida colhidos de prontuários, complementado com a aplicação de um inquérito por entrevista a um subgrupo de indivíduos selecionados por amostra de conveniência. Os dados foram coletados no Centro de Testagem e Aconselhamento de Vitória da Conquista/BA que é nominado de Centro de Atenção e Apoio à Vida (CAAV), órgão de referência regional para a assistência na exposição biológica ocupacional, HIV e Infecção Sexualmente Transmissível. Os critérios de inclusão foram: maiores de 18 anos, trabalhador do setor saúde de Vitória da Conquista, ter estado exposto a material biológico. O ano de 2016 foi selecionado visando avaliar a aplicação do Protocolo Cínico e Diretrizes Terapêuticas para profilaxia antirretroviral pós exposição de risco a infecção pelo HIV lançado em 2015. Foram 271 atendimentos, sendo que após submissão aos critérios de inclusão, a amostra dos casos selecionados dos prontuários teve n=98 e 9 profissionais entrevistados. Os trabalhadores acometidos foi sua maioria do sexo feminino (84,7%) e o setor de enfermagem representou pouco mais da metade, com representatividade para os estudantes (16%). 62,24% das ocorrências foi em ambiente hospitalar com instrumentos perfuro-cortantes (87,7%), com atenção especial para o descarte ou limpeza daquele instrumental, compreendendo cerca de metade dos casos. Somente 27,55% das instituições de saúde fez encaminhamento com detalhamento da ocorrência (descrição do acidente, suporte inicial prestado), mas ainda assim esse trabalhador teve tempo hábil para usufruir com segurança da quimioprofilaxia. No centro de referência, os acidentados tiveram oportunidade de realizar os exames necessários conforme recomendado no protocolo nacional (testes rápidos e/ou no marco zero referencial e sequencial), sentindo-se seguros e acolhidos, reduzindo esse sentimento quando suporte vem da instituição onde trabalha. Foi visto que o trabalhador reconhece a existência de um programa ocupacional na sua instituição, mas declara não saber se conduzir adequadamente diante do evento acidentário. Uma parcela considerável desses acidentados não fazem o seguimento recomendado até finalização do caso (43,44% não há registro de retorno e cerca de 86% não fechou o caso). Mesmo com uma reduzida necessidade do uso de quimioprofilaxia ARV, de imunoglobulina ou profilaxia para sífilis, ainda foi preocupante a taxa de abandono de 41%.
Esse estudo aponta os nós, e procura oferecer ferramentas para melhoria das estratégias de monitoramento biológico das instituições, sempre envolvendo o trabalhador com informações para o entendimento e sugestões dele próprio como vítima, de como melhor ser conduzido nesse fluxo assistencial.
The occupational accident with biological material presents a condition of potential risk to the health of workers in this sector, insecurity in relation to the conduct of this occurrence, and the need for adequate follow-up over time after exposure. This paper aims to characterize the perception of injured health workers in relation to the post-exposure care flow. Describes the profile of the injured professional, the characterization of the occurrence and their attendance (biological monitoring), evaluating compliance with the protocol of the Ministry of Health and the feeling of the worker against this condition. This is a descriptive, cross-sectional study combining data from individuals from a defined population collected from medical records, complemented by the application of an interview survey to a subgroup of individuals selected by convenience sample. The data were collected at the Vitoria da Conquista / BA Testing and Counseling Center, which is nominated as a Center of Attention and Life Support (CAAV), a regional reference body for assistance in occupational biological exposure, HIV and Sexually Transmitted Infection. The inclusion criteria were: older than 18 years, a worker in the health sector of Vitória da Conquista, having been exposed to biological material. The year 2016 was selected in order to evaluate the application of the Cynic Protocol and Therapeutic Guidelines for antiretroviral prophylaxis after exposure of risk to HIV infection launched in 2015. There were 271 visits, and after submission to the inclusion criteria, the sample of cases selected from the medical records had n = 98 and 9 professionals interviewed. The majority of females were females (84.7%) and the nursing sector accounted for just over half, with representativeness for students (16%). 62.24% of the occurrences were in a hospital environment with puncture-sharp instruments (87.7%), with special attention to the disposal or cleaning of that instrument, comprising about half of the cases. Only 27.55% of the health institutions made referrals with details of the occurrence (description of the accident, initial support provided), but still this worker had time to enjoy the chemoprophylaxis safely. In the reference center, the accident victims had the opportunity to perform the necessary examinations as recommended in the national protocol (rapid tests and / or benchmark and sequential), feeling safe and welcomed, reducing this feeling when support comes from the institution where they work . It was seen that the worker recognizes the existence of an occupational program in his institution, but declares that he does not know if he is conducting properly in the event of an accident. A considerable number of these victims do not follow up the recommendation until the case is finalized (43.44% no return record and about 86% did not close the case). Even with a reduced need for the use of ARV chemoprophylaxis, immunoglobulin or prophylaxis for syphilis, the dropout rate of 41% was still worrying. This study points out the nodes and seeks to offer tools to improve the biological monitoring strategies of the institutions, always involving the worker with information for the understanding and suggestions of himself as a victim, on how best to be conducted in this care flow.
The occupational accident with biological material presents a condition of potential risk to the health of workers in this sector, insecurity in relation to the conduct of this occurrence, and the need for adequate follow-up over time after exposure. This paper aims to characterize the perception of injured health workers in relation to the post-exposure care flow. Describes the profile of the injured professional, the characterization of the occurrence and their attendance (biological monitoring), evaluating compliance with the protocol of the Ministry of Health and the feeling of the worker against this condition. This is a descriptive, cross-sectional study combining data from individuals from a defined population collected from medical records, complemented by the application of an interview survey to a subgroup of individuals selected by convenience sample. The data were collected at the Vitoria da Conquista / BA Testing and Counseling Center, which is nominated as a Center of Attention and Life Support (CAAV), a regional reference body for assistance in occupational biological exposure, HIV and Sexually Transmitted Infection. The inclusion criteria were: older than 18 years, a worker in the health sector of Vitória da Conquista, having been exposed to biological material. The year 2016 was selected in order to evaluate the application of the Cynic Protocol and Therapeutic Guidelines for antiretroviral prophylaxis after exposure of risk to HIV infection launched in 2015. There were 271 visits, and after submission to the inclusion criteria, the sample of cases selected from the medical records had n = 98 and 9 professionals interviewed. The majority of females were females (84.7%) and the nursing sector accounted for just over half, with representativeness for students (16%). 62.24% of the occurrences were in a hospital environment with puncture-sharp instruments (87.7%), with special attention to the disposal or cleaning of that instrument, comprising about half of the cases. Only 27.55% of the health institutions made referrals with details of the occurrence (description of the accident, initial support provided), but still this worker had time to enjoy the chemoprophylaxis safely. In the reference center, the accident victims had the opportunity to perform the necessary examinations as recommended in the national protocol (rapid tests and / or benchmark and sequential), feeling safe and welcomed, reducing this feeling when support comes from the institution where they work . It was seen that the worker recognizes the existence of an occupational program in his institution, but declares that he does not know if he is conducting properly in the event of an accident. A considerable number of these victims do not follow up the recommendation until the case is finalized (43.44% no return record and about 86% did not close the case). Even with a reduced need for the use of ARV chemoprophylaxis, immunoglobulin or prophylaxis for syphilis, the dropout rate of 41% was still worrying. This study points out the nodes and seeks to offer tools to improve the biological monitoring strategies of the institutions, always involving the worker with information for the understanding and suggestions of himself as a victim, on how best to be conducted in this care flow.
Descrição
Palavras-chave
Saúde tropical Doenças tropicais Saúde do trabalhador Acidente com material biológico Exposição biológica Saúde pública
Contexto Educativo
Citação
Editora
Instituto de Higiene e Medicina Tropical