Segurança do paciente e prevenção de infecção na atenção domiciliar: evidências de validade de instrumento, avaliação de práticas e produção audiovisual

Abstract

Introduction: Home care (HC) is a health care modality that involves health promotion, prevention, treatment, rehabilitation and palliation at home. Patients in home health service or hospicy may have two or more chronic diseases, advanced diseases or be close to finitude, making them more susceptible to infections related to health care and adverse effects from the use of antibiotics. Patient safety (PS) configures a principle of care and a global concern in health. Protecting patients from errors, injuries, accidents and infections is the objective of these systems, however, not all of them obtain adequate results regarding PS. In a scenario of increasing prevalence of adverse events in HC, the issue of PS becomes relevant and reinforces the commitment to safe care. Evaluating services using instruments contributes to systematized measurements. Objective: Evaluate patient safety practices and prevention of care-related infections among professionals working in HC through the instruments “Instrument Related to Patient Safety in Home Care (iSPAD)” and “Research on Infection Control in Home Care ”; identify evidence of validity of the internal consistency of the instrument iSPAD; develop a user manual for iSPAD; develop audiovisual material to sensitize health professionals to the importance of safe care. Method: Methodological and cross-sectional research with application and validation of the instrument’s internal consistency. Data were collected from February to May 2022. Nurses, nursing technicians, nursing assistants, physiotherapists and physicians answered the “Instrument Related to Patient Safety in Home Care”. The instrument “Research on Infection Control in Home Care” was answered by nurses, nursing technicians and nursing assistants. For the validation of the internal consistency of the iSPAD, Exploratory Factor Analysis was chosen prior to the descriptive analysis of the data, which was performed with the items that obtained KMO = 0.809 and factoring 0.3. After exploratory factor analysis, iSPAD went from 34 to 22 items divided into two factors subdivided into dimensions. Percentages of adequate responses were calculated for the 22 items and the average percentage of the analysis categories, constructed by semantic grouping of items: guarantee of continuity of care, effective information and communication, safe practices, caregiver qualification, solid waste management, supply of inputs and transportation and permanent education of professionals. Data from the Survey on Infection Control in Home Care instrument underwent descriptive analysis, as they already have cross-cultural validation for Brazil. The manual was prepared based on the application experience and data analysis to facilitate the subsequent application in other contexts. The video proposes to present, in about 6 (six) minutes, situations in which patients and health professionals are faced with challenges and problematic issues in health care, addressing topics related to Patient Safety (PS) in different environments, such as clinics, hospitals and homes. Results: After exploratory factor analysis, the iSPAD went from 34 to 22 items divided into two factors subdivided into dimensions. Percentages of adequate responses were calculated. Ensuring continuity of care, effective information and communication, safe practices and caregiver qualification obtained the best percentages of adequate responses. Management of solid waste, supply of inputs and transport and permanent education of professionals obtained results that could be improved. The “Research on Infection Control in Home Care” demonstrated that the practices for prevention and control of infection by nursing professionals are adequate, however weaknesses are observed in carrying out training and courses. The perception of the risk of acquiring an infection related to health care was correlated with higher adequacy values for the “Attitudes” domain of nursing professionals. Such results were obtained through the analysis of the internal consistency of the instruments used. Products developed: Article submitted to the Revista da Escola de Enfermagem da USP, manual for the use of the Instrument Related to Patient Safety in Home Care, script for animation “Patient Safety in care environments” and technical data report on prevention and control of developing infections. Conclusions: The iSPAD instrument showed evidence of validity and will be made available for reapplications in other contexts through the Application Manual. Additionally, the instrument “Research on Infection Control in Home Care”, adapted cross-culturally for Brazil, proved to be adequate to assess infection prevention practices by HC professionals. Thus, this research, when disseminated to the HC service in the Federal District, may contribute to the improvement of these health services by offering permanent education to their teams. In addition, the wide dissemination of the video for professionals has stimulated reflection on safe care and can be used as didactic material for training processes.