Reprocessing of critical items at basic healthcare units / Reprocessamento de artigos criticos em unidades basicas de saude

AUTOR(ES)
DATA DE PUBLICAÇÃO

2008

RESUMO

The reprocessing of critical items is conducted at Basic Healthcare Units (Unidades Básicas de Saúde - UBS). The complexity and implications of such processes demand that the person responsible conducts it with technical and scientific skills and knowledge, according to pre-established methods and criteria, for control and monitoring of each stage, following procedural and legal guidelines. When done under adverse conditions, reprocessing may endanger the health of the users who undergo invasive procedures, thus compromising the quality and safety of the services provided to National Healthcare System (Sistema Unificado de Saúde - SUS) users. Objectives: Gather data to identify how the reprocessing of critical items is being conducted at UBS and compare to existing legislation, as well as scientific criteria. Methodology: Descriptive study, exploratory, with data obtained through the application of a previously verified questionnaire, to those responsible for reprocessing critical items at UBS. Statistical analysis of data was done with the help of Minitab 15® software. Results: Data collection occurred between March and December 2006. Among the 46 existing UBS, 34 were surveyed; where the individuals responsible for reprocessing critical devices were interviewed, and the areas, designated for processing, observed. Invasive procedures that used reprocessed items at UBS were as follows: dental and dressings (100%), gynecological (97%), sutures (94%), small surgical procedures (76%) and abscess drainage (59%). The majority of staff responsible for conducting reprocessing was nursing auxiliaries (88,23%). Besides reprocessing critical devices, they executed concurrently activities such as: immunization (11,74%), dressing (26,4%) and collection of exam samples (23,52%). Among these staff members, 32,4% had undergone training when they started conducting reprocessing activities and 8,82% during the conduction of such activities, at least, during the previous year. During the handling of such devices, all staff members conducted cleaning manually, with water; inert detergent solution and cleaning pad, and none used all the PPE recommended. Sterilization agent was saturated vapor under pressure (88,24%). Containers used for all devices were Kraft paper (100%), double cotton fabric (21%), open metallic box (11,76%) and aluminum foil (11,76%). Methods employed for monitoring sterilization process quality, were class I chemical marker (97,06%) and biological selfcontained marker (91,18%), the latter being systematically used in 55,8% of UBS. There were references to use of Bowie &Dick in 5,24% of UBS. We were able to observe that all the UBS had an area designated for cleaning of critical devices, among which 70,59% were exclusive, 2,94% shared the cleaning area with the area for preparation of items for sterilization and 26,47% shared areas for cleaning, preparation and sterilization of critical devices. 52,95% had an area for cleaning such items, which was equal or larger than recommended size (4,8m2). 70,59% of UBS had a physical barrier between the cleaning and sterilization areas. All the cleaning areas had sinks with cold water, bench and a drain for outflow of liquid residue, 91,17% had windows without nets, however there wasn t any hot water line. Floor finishing in the cleaning areas was as follows: 79,41% had granolith flooring, 14,7% had vitrified ceramic, 2,95% had rough finish ceramic and 2,95% were painted. The benches were as follows: 85,3% made of stone, 11,75% were made with bricks covered with tiles, and 2,95% in stainless steel. 91,17% of the wall finishing was done with grouted tiles, 5,88% were painted and 2,95% were covered with tiles halfway to the ceiling, and the remaining surface was painted. In relation to the sterilization area; all of the units have a designated sterilization area, but all shared this areas with other reprocessing phases: 23,53% shared it with the preparation of devices, 50% shared with preparation and storage of devices, and 26,47% shared the cleaning area, with the areas for preparation and storage, as well. The dimensions of sterilization areas are as follows: 81,18% was equal or larger than recommended (3,2 m2). In 70,59% of UBS facilities, the areas designated for sterilization had physical barriers between the cleaning and sterilization areas, 88,24% had cold water and drainage of liquid residue, 8,82% had a hot water line, 91,18% had windows without nets and 8,82% had no windows. Finishing used in the areas destined for sterilization, was as follows: 79,41% had granolith flooring, 14,7% vitrified ceramics, 5,9% rustic ceramic; benches: 85,3% were made in stone, 14,7% brick covered with ties; walls: 91,17% were covered with grouted tiles, 5,88% were painted and 2,95% were covered with tiles halfway to the ceiling, and the remaining surface was painted. 8,82% had specific areas designated exclusively for storage. Conclusion: In the UBS surveyed, reprocessing of critical devices is being conducted in an unsystematic manner. This calls for a revision and reevaluation of procedures, and an intervention for professional capacitation of the staff involved. Areas designated for reprocessing must comply with minimum required criteria in order to ensure the quality of the process. Reprocessing of critical items, in these locations, must not become a limiting factor or interfere in cross infection control, but must contribute for the safety of the population who uses the healthcare system

ASSUNTO(S)

enfermagem sterilization serviços de saude esterilização health service nursing

ACESSO AO ARTIGO

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