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Master's Dissertation
DOI
https://doi.org/10.11606/D.5.2007.tde-31052007-121005
Document
Author
Full name
Lourenia Mendonça Cassoli
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2007
Supervisor
Committee
Lopes, Marta Heloisa (President)
Gryschek, Ronaldo Cesar Borges
Machado, Alcyone Artioli
Title in Portuguese
Acidente ocupacional com material biológico: adesão ao seguimento ambulatorial segundo as características do acidente e do acidentado
Keywords in Portuguese
Acidentes e eventos biológicos
Assistência ambulatorial
Exposição ocupacional
Ferimentos penetrantes produzidos por agulha
Pessoal de saúde
Abstract in Portuguese
INTRODUÇÃO: Os profissionais de saúde estão constantemente sob risco de sofrerem acidentes ocupacionais, através de exposição percutânea ou mucosa, envolvendo material biológico. Consequentemente ficam expostos a agentes veiculados pelo sangue, como os vírus das hepatites B e C (VHB e VHC), vírus da imunodeficiência humana (HIV) e o Trypanosoma cruzi, agente da doença de Chagas. MÉTODOS: Estudo descritivo, retrospectivo, de análise de prontuários. Foi utilizado um banco de dados, com base no seguimento ambulatorial de profissionais de saúde acidentados no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC FMUSP), no período de agosto de 1998 a agosto de 2005. O banco de dados foi construído e alimentado no programa EpiInfo 6.0 e posteriormente transferido para o Excel, a partir do qual foi realizada análise dos dados. As variáveis qualitativas foram representadas por freqüência absoluta e relativa (%) e as quantitativas por média, desvio padrão (dp), mediana, valores mínimo e máximo. A presença de associação entre as variáveis qualitativas foi avaliada pelo teste do Qui-quadrado. RESULTADOS: Foram analisados 1091 casos. 1) 76,5% dos acidentados eram do gênero feminino; 2) a média de idade foi de 33,3 anos e mediana de 30 anos; 3) principais categorias profissionais acidentadas: auxiliares de enfermagem (42,3%), médicos residentes (11,5%), funcionários da limpeza (11,1%); 4) acidentes percutâneos com agulhas com lúmen, envolvendo sangue, foram os mais freqüentes; 5) a mediana do intervalo de tempo entre o acidente e procura pelo atendimento foi de 30 minutos; 6) 60% dos acidentados tinha pesquisa de anti-HBs positiva no momento do acidente; 7) 2,7% dos acidentados tinha sorologia positiva pra VHC no momento do acidente; 8) A maior procura por atendimento ocorreu entre acidentados cuja fonte era conhecida e positiva para HIV e VHC; 9) adesão completa ao seguimento ambulatorial após exposição a material biológico foi de 70%, sendo mais freqüente em acidentados do gênero feminino, cuja fonte era conhecida e tinha perfil sorológico totalmente negativo para os patógenos avaliados; 10) dos profissionais que receberam antiretrovirais apenas 45,2% completaram o tratamento; 11) não ocorreu soroconversão para HIV, VHB e Doença de Chagas; 12) foram observados três possíveis casos de soroconversão para VHC. CONCLUSÕES: A alta taxa de abandono do seguimento é motivo de preocupação. Considerando-se que sabidamente nem todos os profissionais de saúde acidentados procuram atendimento, e dos que o fazem, cerca de 30% não o completam, estima-se que haja importante parcela de profissionais acidentados não investigados. Embora a maior procura por atendimento tenha sido de acidentados com fontes suspeitas ou positivas para VHC e HIV, a adesão ao seguimento foi menor nestes casos. Adesão à terapêutica antiretroviral também foi baixa.
Title in English
Occupational accident with biological material: compliance to the ambulatory follow-up according to the characteristics of the accident and the victim
Keywords in English
Ambulatory assistance
Biological accidents and events
Health personnel
Occupational exposure
Penetrating wounds caused by needle
Abstract in English
INTRODUCTION: Healthcare professionals are constantly under risk of suffering occupational accidents, due to percutaneous or mucosa exposure, involving biological material. They are consequently exposed to agents diffused into blood, such as hepatitis B and C virus (HBV and HCV), human immunodeficiency virus (HIV) and the Trypanosoma cruzi, agent of the Chagas disease. METHODS: Descriptive, retrospective study of promptuary analysis. A data base was used, based on the ambulatory follow-up of health professional victims in the Clinics' Hospital from the Medicine School of the University of São Paulo (HC FMUSP), from August, 1998 until August, 2005. The data base was built and fed in the EpiInfo 6.0 program and afterwards it was transferred to Excel, where the data analysis was executed. The qualitative variables were represented by absolute and relative frequency (%) and the quantitative by average, standard deviation (sd), median, minimum and maximum values. The presence of association among the qualitative variables was evaluated by the Chi-square test (x 2 ). RESULTS: 1091 cases were analyzed. 1) 76.5% of the victims were women; 2) the age average was 33.3 years old and the median 30 years old; 3) main professional categories: nursing assistants (42.3%), resident doctors (11.5%), cleaning employees (11.1%); 4) percutaneous accidents with needles with lumen, involving blood, were the most frequent; 5) the median of the time interval between accident and search for assistance was 30 minutes; 6) 60% of the victims had a positive anti-HBs search at the moment of the accident; 7) 2.7% of the victims had positive serology for HCV at the moment of the accident; 8) the highest search for assistance happened among victims which source was known and positive for HIV and HCV; 9) complete compliance to the ambulatory follow-up after the exposure to biological material was of 70%, being more frequent in female victims, which source was known and had a serologic profile totally negative for the evaluated pathogens; 10) from the professionals who received antiretroviral, only 45.2% completed the treatment; 11) there wasn?t seroconversion for HIV, HBV and Chagas Disease; 12) three possible seroconversion cases for VHC were observed. CONCLUSIONS: The high abandonment tax of the segment is a reason for concerning. Considering that not all of the health professional victims search for assistance, and from the ones that do, around 30% don?t complete it, it is estimated that there is an important parcel of professional victims not investigated. Although the higher search for assistance has been from victims with suspicious sources or positive for HCV and HIV, the compliance to follow-up was lower in these cases. Compliance to antiretrovirals was also low.
 
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Publishing Date
2007-07-02
 
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