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

Abstract

OBJECTIVE:To validate the construct and discriminant properties of a hospital infection prevention and control program. METHODS:The program consists 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 Cronbach's α coeffi cient was used to evaluate the internal consistency. The discriminant validity was analyzed by comparing indicator scores between groups of hospitals: with versus without quality certifi cation. 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 signifi cant mean conformity scores among the group of institutions with healthcare certifi cation or accreditation processes. In the construct validation, two dimensions were identifi ed 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 identifi ed. 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 scientifi c manner in order to obtain a quality diagnosis in this fi eld.

Avaliação de Programas de Controle de Infecção relacionada a Assistência à Saúde de Hospitais

“…Believing that the practices for control and prevention of HAI respond directly to these demands, the proposal of this study was to recognize the performance of PCIRAS in hospitals in the state of Paraná, linking factors that contribute to or complicate results. To achieve this, a system of evaluation previously constructed and validated regarding its content and measurement properties was utilized (9)(10) , in the method of clinical indicators used in the evaluation system (8) .…”

“…Regarding the quality of the actual PCIRAS we found four evaluations that applied the same indicators as the present study in hospitals of other Brazilian cities. One of them, in São Paulo, is responsible for the validation of these indicators (10) . The others were in Ribeirão Preto (24) , Aracaju (25) , and Teresina (26) .…”

“…Data collection took place between 2012 and 2014, among nurses from the HAI Control Committees (CCIH) and the HAI Control Services (SCIH) of these hospitals, via the application of two research instruments. The first of these is an evaluation instrument in itself, previously put together and validated regarding its content, theoretical concepts, discriminant function and reliability (internal consistency) (9)(10) , being comprised of four clinical indicators: 1) Structure of PCIRAS (PCET): structural evaluation of its formation and technical operational support, such as human resources, infrastructure, and technical and administrative instruments to identify, define, discuss, and divulge events in HAI; 2) Operational guidelines for HAI control and prevention (PCDO): structural evaluation regarding the existence of these guidelines in hospital areas or services, in the form of manuals, operational standards and procedures, and resolutions, among other factors, elaborated or incorporated by the PCIRAS; 3) System of HAI epidemiological surveillance (PCVE): to evaluate if the PCIRAS possesses and exercises such a system, through the active seeking of, notification about, and formulation and communication of epidemiological indicators in HAI cases, as well as carrying out consultations. 4) HAI control and prevention activities (PCCP): processual evaluation of these activities in the different services and sectors, by the SCIH professionals, including inspections, orientations and guidelines introduced, participation in meetings, consultations and clarifications on spontaneous demands, among others.…”

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

“…The CCIH, with decisionmaking and organizational functions, coordinates and establishes guidelines of control and prevention of these infections in their hospitals. The SCIH, which has an executive character, is in charge of the actions scheduled by the CCIH (8,12) . This Decree also determines the specific responsibilities and competencies in the area of the three spheres of government (Federal, State, and Municipal) (7) .…”

“…2616/98, known to be out of date and insufficient. In addition, there is no evidence that this instrument of inspections was submitted to a validation process, in order to guarantee interpretations and allow different evaluations to reach similar temporal results at the same institution (12) . Other attempts to evaluate or qualify the processes of HAI control and prevention were developed by ANVISA, such as the Information System for Infection Control in Health Services (SINAIS) in 2004, based on the National Nosocomial Infections Surveillance System (NNISS) of the Center for Disease Control and Prevention (CDC).…”