Caracterização dos sistemas de vigilância epidemiológica das infecções relacionadas à assistência à saúde (IRAS) no mundo e desafios para o Brasil Caracterización de los sistemas de vigilancia epidemiológica de las infecciones asociadas a la atención en salud (IAAS) en el mundo y los desafíos para Brasil

Objective: This study aimed to describe the structure of governmental surveillance systems for Healthcare Associated Infection (HAI) in the Brazilian Southeastern and Southern States. Method: A cross-sectional, descriptive and exploratory study, with data collection by means of two-phases: characterization of the healthcare structure and of the HAI surveillance system. Results: The governmental teams for prevention and control of HAI in each State ranged from one to six members, having at least one nurse. All States implemented their own surveillance system. The information systems were classified into chain (n=2), circle (n=4) or wheel (n=1). Conclusion: Were identified differences in the structure and information flow from governmental surveillance systems, possibly limiting a nationwide standardization. The present study points to the need for establishing minimum requirements in public policies, in order to guide the development of HAI surveillance systems.

Background Patient safety culture concerns the values, beliefs and standards shared by an organisation’s health staff and other personnel which influence their care provision actions and conduct. Several countries have made a priority of strengthening patient safety culture to improve the quality and safety of health care. In this direction, measuring the patient safety culture through validated instruments is a strategy applied worldwide. The purpose of this study was to adapt transculturally and validate the HSOPSC 2.0 to Brazilian Portuguese and the hospital context in Brazil. Methods Of the various validated scales for measuring safety culture, the instrument most used internationally is the Hospital Survey on Patient Safety Culture (HSOPSC) developed by the United States Agency for Healthcare Research and Quality in 2004 and revised in 2019, when version 2.0 was released. Adaptation was conducted on a universalist approach and the adapted instrument was then applied to a sample of 2,702 respondents (56% response rate) comprising staff of a large general hospital in the city of São Paulo. Construct validity was investigated by Exploratory Structural Equation Modelling-within-Confirmatory Factor Analysis (ESEM-within-CFA) and reliability was measured in each dimension by means of Cronbach alpha coefficients. Results ESEM fit indexes showed good data fit with the proposed model: χ2 = 634.425 df = 221 χ2/df ratio = 2.9 p-value < 0.0000; RMSEA = 0.045 (90% C.I. = 0.041—0.050) and probability RMSEA <  = .05 = 0.963; CFI = 0.986; TLI = 0.968. However, ten items had loads lower than 0.4. Cronbach alpha values were 0.6 or more for all dimensions, except Handoffs and information exchange ($$\alpha$$ α = 0.50) and Staffing and work pace ($$\alpha$$ α = 0.41). Conclusion The psychometric properties of the Brazilian version were found to be satisfactory, demonstrating good internal consistency and construct validity as expressed by estimates of reliability and indexes of model fit. However, given factor loadings smaller than 0.4 observed in ten items and considering that the scale translated and adapted to Portuguese was tested on a single sample during the Covid-19 pandemic, the authors recognize the need for it to be tested on other samples in Brazil to investigate its validity.

Introdução: As infecções relacionadas à assistência à saúde (IRAS) constituem um problema de interesse global por seu impacto para a segurança dos cuidados em saúde. Consequentemente, demandam a implantação de políticas públicas eficazes para sua prevenção e controle. Uma manifestação concreta das políticas públicas é o estabelecimento e manutenção de programas nacionais específicos para a prevenção e controle de IRAS. Objetivo: O objetivo do estudo foi analisar e comparar a implantação dos programas nacionais de prevenção e controle de IRAS no Brasil, Chile e Israel. Métodos: Trata-se de um estudo de caso descritivo e exploratório que utilizou o modelo do triângulo de análise de políticas de saúde para comparar o contexto, o processo, o conteúdo e os atores destes programas governamentais. Os dados foram coletados entre 2014 e 2017 em três fases: Fase I-acesso às páginas eletrônicas dos programas nos países selecionados; Fase II-visita à sede do programa nacional e Fase III-construção do modelo teórico explicativo. Resultados: Elementos comuns entre os três países foram identificados permitindo a proposição de um modelo teórico explicativo constituído de dois núcleos: núcleo de formaçãocomposto por três componentes estratégicos (gerador de necessidade, formador de alternativas e promotor do interesse social); e núcleo de desenvolvimento e sustentabilidade dos programas-composto por outros quatro componentes estratégicos (gerador de decisão, gerador de sustentação, gerador de renovação e patrocinadores do processo). Conclusão: O modelo proposto contribui na compreensão dos fatores que podem influenciar o progresso de um programa nacional de IRAS, fornecendo reflexões sobre elementos para o estabelecimento de programas em países nos quais ainda estão incipientes.