Major article
Structure for prevention of health care–associated infections in Brazilian hospitals: A countrywide study

Previous presentation: Presented in part at the International Conference on Prevention and Infection Control, June 2013, Geneva, Switzerland.
https://doi.org/10.1016/j.ajic.2015.08.004Get rights and content

Highlights

  • This study evaluated the structure for infection prevention in 153 Brazilian hospitals.

  • The conformity index of main structure resources was identified.

  • The conformity index of the infection prevention committee varied from 0.55-0.94 among hospital categories.

  • Most hospitals did not have a laboratory of microbiology within their premises.

  • The conformity index was balanced among components of the structure for infection prevention.

Background

Minimal structure is required for effective prevention of health care–associated infection (HAI). The objective of this study was to evaluate the structure for prevention of HAI in a sample of Brazilian hospitals.

Methods

This was a cross-sectional study from hospitals in 5 Brazilian regions (n = 153; total beds: 13,983) classified according to the number of beds; 11 university hospitals were used as reference for comparison. Trained nurses carried out the evaluation by using structured forms previously validated. The evaluation of conformity index (CI) included elements of structure of the Health Care–Associated Prevention and Control Committee (HAIPCC), hand hygiene, sterilization, and laboratory of microbiology.

Results

The median CI for the HAIPCC varied from 0.55-0.94 among hospital categories. Hospitals with >200 beds had the worst ratio of beds to sinks (3.9; P < .001). Regarding alcoholic product for handrubbing, the worst ratio of beds to dispensers was found in hospitals with <50 beds (6.4) compared with reference hospitals (3.3; P < .001). The CI for sterilization services showed huge variation ranging from 0.0-1.00. Reference hospitals were more likely to have their own laboratory of microbiology than other hospitals.

Conclusion

This study highlights the need for public health strategies aiming to improve the structure for HAI prevention in Brazilian hospitals.

Section snippets

Design and settings

A cross-sectional study was carried out from August 2011-August 2013. Hospitals located in the 5 Brazilian regions were evaluated.

Sampling

A list of all acute care hospitals in the country was obtained from the free-access national database of health care facilities (CNES: http://cnes.datasus.gov.br/). The sample size included 10 out of 26 Brazilian states (Ceará, Goiás, Minas Gerais, Pará, Paraná, Paraíba, Pernambuco, Rio Grande do Sul, Rio de Janeiro, and São Paulo). These states were selected by

Results

The distribution of the number of hospitals and beds among the sample is shown in Table 1. The intended sample was 270 hospitals (6.8% of all hospitals in the studied states; 4.3% of the total number in Brazil). However, there was sample loss for the following reasons: (1) relevant incongruity between CNES (official registry) data and actual hospital data (type of health care facility did not fit the inclusion criteria; inexistence of health care facility, lack of inpatient units, or other);

Discussion

Brazil is a highly populated country (192 million) with approximately 6,266 hospitals (2012 data) spread in a large territory, posing a challenge to countrywide studies aiming at driving governmental strategies for prevention and control of HAI.6 To our knowledge, this study presents the first scaled evaluation of structure for HAI prevention in the country.

Despite being mandatory by law since 1997,7 the HAIPCC is still not fully compliant with all legal and recommended issues. This is

Conclusions

The findings from this study have major implications in national policies in promoting patient safety. A national plan should be driven to strengthen the main structures in HAI prevention, HAIPCC, SS, and laboratories of microbiology, giving high priority for the Midwest, North, and Northeast regions.

Acknowledgments

The Research Group of the Project IRAS-BRASIL acknowledges the efforts from nurses that contributed with data collection and thank the cooperation of the health care team in the visited hospitals.

References (23)

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Funding/Support: Supported by the National Council for Scientific and Technological Development (CNPq: 563225/2010-6) in partnership with the Ministry of Health of Brazil, under the call MCT/CNPq/CT-Saúde/MS/SCTIE/DECIT N° 40/2010.

Conflicts of interest: None to report.

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