Competency assessment tools for infection preventionists: A scoping review.

Background: Infection prevention competencies are critical for successful job performance, career progression and robust performance of infection prevention and control programs. Aim/objective: Identify competency assessment tools available to infection preventionists and describe their characteristics, validation processes and reliability. Methods: A scoping review was conducted on five databases and grey literature from 1999 to 2022. A descriptive synthesis approach was undertaken to analyse the data. Finding/results: Seven tools that meet the inclusion criteria were identified. Of those, one tool was reviewed twice. All tools were developed in the United Kingdom, Canada, China and the United States, and were published between 2009 and 2022. All tools use a rating scale; and the most used method to assess competencies was self-assessment. Levels of competency were cited by five tools. Two tools provided information on validation methods and reliability tests for internal consistency. Discussion: Few competency assessment tools are available in the literature, and there is a lack of information on their development process. A global effort to develop an assessment tool that allows comparison across countries and cultures can be a step forward to propel infection preventionists' careers and enhance the efficacy of Infection Prevention and Control Programs.

Workload assessment: cross-cultural adaptation, content validity and instrument reliability.

OBJECTIVES: to adapt, validate the content and assess the reliability of the instrument National Aeronautics and Space Administration - Task Load Index, translated into Brazilian Portuguese. METHODS: a methodological study, divided into five steps: translation; synthesis; back-translation; assessment of the Portuguese version by an expert committee; pre-test and content validity of the final version by health professionals working in inpatient units. The Content Validity Index (CVI) (minimum 0.80) and Cronbach's alpha (minimum 0.70) were calculated. RESULTS: in the first round, in the agreement analysis of the translated version, three items did not reach the minimum CVI value. It was decided to remove the statement. The instrument title and items "performance" and "effort" were changed. There was consensus and approval of the final version in the pre-test step. CONCLUSIONS: the NASA Task Load Index instrument, adapted to Brazilian Portuguese, presents reliability and content validity evidence.

The governance of antimicrobial resistance in Brazil: Challenges for developing and implementing a one health agenda.

This article explores stakeholders' perceptions of the challenges for developing a One Health agenda to tackle antimicrobial resistance (AMR) in Brazil, including the development and implementation of the Brazilian National Action Plan (BR-NAP). The data originate from 27 interviews conducted with human, environmental, and animal health stakeholders, including academics, managers, and policymakers involved in developing the BR-NAP. Through thematic analysis, we identified three interconnected themes: governance, the health system, and technical and scientific challenges. The findings draw particular attention to failures in the agenda-setting process, revealed by interviewees strongly emphasising that AMR is not considered a policy priority in Brazil. The lack of political will and awareness of the clinical, social, and economic impacts of AMR are considered the main impediments to the agenda's progress. The joint work across disciplines and ministries must be reinforced through policymaker engagement and better environmental sector integration. The agenda must include sustainable governance structures less affected by political winds. Policies should be designed jointly with state and local governments to create strategies to engage communities and improve their translation into effective implementation.

Workload assessment: cross-cultural adaptation, content validity and instrument reliability / Evaluación de la carga de trabajo: adaptación transcultural, validez de contenido y confiabilidad del instrumento / Avaliação da carga de trabalho: adaptação transcultural, validade de conteúdo e confiabilidade de instrumento

ABSTRACT Objectives: to adapt, validate the content and assess the reliability of the instrument National Aeronautics and Space Administration - Task Load Index, translated into Brazilian Portuguese. Methods: a methodological study, divided into five steps: translation; synthesis; back-translation; assessment of the Portuguese version by an expert committee; pre-test and content validity of the final version by health professionals working in inpatient units. The Content Validity Index (CVI) (minimum 0.80) and Cronbach's alpha (minimum 0.70) were calculated. Results: in the first round, in the agreement analysis of the translated version, three items did not reach the minimum CVI value. It was decided to remove the statement. The instrument title and items "performance" and "effort" were changed. There was consensus and approval of the final version in the pre-test step. Conclusions: the NASA Task Load Index instrument, adapted to Brazilian Portuguese, presents reliability and content validity evidence.

RESUMEN Objetivos: adaptar, validar el contenido y evaluar la confiabilidad del instrumento National Aeronautics and Space Administration - Task Load Index , traducido al portugués brasileño. Métodos: estudio metodológico, dividido en cinco etapas: traducción; síntesis; traducción inversa; evaluación de la versión portuguesa por un comité de expertos; pretest y validación de contenido de la versión final por profesionales de la salud que actúan en unidades de hospitalización. Se calculó el Índice de Validez de Contenido (IVC) (mínimo 0,80) y el alfa de Cronbach (mínimo 0,70). Resultados: en la primera ronda, en el análisis de concordancia de la versión traducida, tres ítems no alcanzaron el valor mínimo de IVC. Se decidió eliminar la declaración. Se modificó el título del instrumento y los ítems "desempeño" y "esfuerzo". Hubo consenso y aprobación de la versión final en la etapa de pre-prueba. Conclusiones: el instrumento NASA Task Load Index , adaptado al portugués brasileño, presenta evidencias de confiabilidad y validez de contenido.

RESUMO Objetivos: adaptar, validar o conteúdo e avaliar a confiabilidade do instrumento National Aeronautics and Space Administration - Task Load Index , traduzido para o português brasileiro. Métodos: estudo metodológico, dividido em cinco etapas: tradução; síntese; retrotradução; avaliação da versão em português por comitê de especialistas; pré-teste e validação de conteúdo da versão final por profissionais de saúde atuantes em unidades de internação. Foram calculados o Índice de Validade de Conteúdo (IVC) (mínimo 0,80) e o alfa de Cronbach (mínimo 0,70). Resultados: na primeira rodada, na análise de concordância da versão traduzida, três itens não alcançaram o valor mínimo do IVC. Optou-se pela remoção do enunciado. O título do instrumento e os itens "desempenho" e "esforço" foram alterados. Houve consenso e aprovação da versão final na etapa de pré-teste. Conclusões: o instrumento Índice NASA de carga de tarefa, adaptado para o português brasileiro, apresenta evidências de confiabilidade e validade de conteúdo.

Desempenho dos programas de prevenção e controle de infecções em pequenos hospitais / Desempeño de programas de prevención y control de infecciones en pequeños hospitales / Performance of infection prevention and control programs in small hospitals

RESUMO Objetivo Avaliar a conformidade de estrutura e processo dos programas de prevenção e controle de infecções relacionadas à assistência à saúde. Método Estudo prospectivo, transversal, realizado de 2015 a 2016, em pequenos hospitais de até 70 leitos de uma região do estado de São Paulo. Foram avaliados 4 indicadores previamente validados, expressos em índice de conformidade (porcentagem em relação aos itens avaliados). Resultados Dentre os 27 hospitais recrutados, 14 consentiram em participar. Os valores médios de conformidade para cada indicador foram: Estrutura dos programas 61,0%; Diretrizes operacionais 84,5%; Vigilância epidemiológica 57,9%; Atividades de prevenção 74,5%. Maior conformidade foi observada em hospitais privados (73,9%) e com presença de unidade de terapia intensiva (90,3%). Os hospitais possuíam enfermeiros designados para o programa (92,9%), mas somente 23,1% das instituições privadas atuavam com dedicação exclusiva de seis horas. Conclusão Apenas o indicador referente às Diretrizes Operacionais dos programas avaliados esteve acima de 90% de conformidade na mediana dos hospitais. A maior dispersão dos resultados de conformidade entre os hospitais estudados foi referente ao indicador de Vigilância Epidemiológica.

RESUMEN Objetivo Evaluar la conformidad de estructura y proceso de los programas de prevención y control de infecciones relacionados a la asistencia a la salud. Método Estudio prospectivo, transversal, realizado de 2015 a 2016, en pequeños hospitales de hasta 70 camas de una región del estado de São Paulo. Fueran evaluados 4 indicadores previamente validados, expresos en índice de conformidad (porcentaje en relación a los ítems evaluados). Resultados Dentro los 27 hospitales reclutados, 14 consentirán en participar. Los valores medios de conformidad para cada indicador fueran: Estructura de los programas 61,0%; Directrices operacionales 84,5%; Vigilancia epidemiológica 57,9%; Actividades de prevención 74,5%. Mayor conformidad fue observada en hospitales privados (73,9%) y con presencia de la unidad de terapia intensiva (90,3%). Los hospitales poseían enfermeros designados para o programa (92,9%), mas solamente 23,1% de las instituciones privadas actuaban con dedicación exclusiva de seis horas. Conclusión Apenas el indicador referente a las Directrices Operacionales de los programas evaluados estuvo arriba de 90% de conformidad en la media de los hospitales. La mayoría de la dispersión de los resultados de conformidad entre los hospitales estudiados fue referente al indicador de Vigilancia Epidemiológica.

ABSTRACT Objective To evaluate the structure compliance and prevention and control processes of Healthcare-Associated Infections (HAIs). Method A prospective and cross-sectional study conducted from 2015 to 2016 in small hospitals with up to 70 beds in a region of São Paulo state. Four previously validated indicators were evaluated and expressed as a compliance index (percentage in relation to the evaluated items). Results Fourteen (14) among the 27 recruited hospitals consented to participate in the study. The average compliance values for each indicator were: Program structure (61.0%); Operational guidelines (84.5%); Epidemiological surveillance (57.9%); and Prevention activities (74.5%). Greater compliance was observed in private hospitals (73.9%) and with the presence of an intensive care unit (90.3%). The hospitals had nurses assigned to the program (92.9%), but only 23.1% of the private institutions worked exclusively for six hours. Conclusion Only the indicator referring to the Operational Guidelines of the evaluated programs was above 90% compliance for the median of hospitals. The greatest dispersion of compliance results among the studied hospitals was related to the Epidemiological Surveillance indicator.

Public policies on healthcare associated infections: A case study of three countries.

Healthcare-associated infections (HAIs) are a global concern due to the impact on healthcare safety. Consequently, they demand the implementation of effective public policies for their prevention and control. The objective of this study was to analyze and compare the implementation of national programs for the prevention and control of HAIs in Brazil, Chile, and Israel. The triangle of health policy analysis was used to compare the context, process, and content of national HAI prevention and control programs. Common elements identified among the three countries led to the proposal of an explanatory theoretical model constituted of two nuclei: formation, and development & sustainability.This model may favor to understand the factors that can influence the progress of a national HAI program, providing insights into the elements for establishing programsin countries where they are still inceptive.

Public policies on healthcare-associated infections: a Brazil and UK case study.

To summarize the historical events and drivers underlying public policy for the prevention and control of healthcare-associated infections in Brazil and in the United Kingdom. In doing so, the article aims to identify lessons and recommendations for future development of public policy. The analysis is based on a historical overview of national healthcare-associated infections programs taken from previously published sources. Findings highlight how the development of healthcare-associated infections prevention and control policies followed similar trajectories in Brazil and the United Kingdom. This can be conceptualized around four sequential phases: Formation, Consolidation, Standardization, and Monitoring and Evaluation. However, while we identified similar phases of development in Brazil and the United Kingdom, it can be seen that the former entered each stage around 20 years after the latter.

Public policies on healthcare-associated infections: a Brazil and UK case study

ABSTRACT To summarize the historical events and drivers underlying public policy for the prevention and control of healthcare-associated infections in Brazil and in the United Kingdom. In doing so, the article aims to identify lessons and recommendations for future development of public policy. The analysis is based on a historical overview of national healthcare-associated infections programs taken from previously published sources. Findings highlight how the development of healthcare-associated infections prevention and control policies followed similar trajectories in Brazil and the United Kingdom. This can be conceptualized around four sequential phases: Formation, Consolidation, Standardization, and Monitoring and Evaluation. However, while we identified similar phases of development in Brazil and the United Kingdom, it can be seen that the former entered each stage around 20 years after the latter.

Adaptation and validation of indicators concerning the sterilization process of supplies in Primary Health Care services.

OBJECTIVES: to adapt and validate, by expert consensus, a set of indicators used to assess the sterilization process of dental, medical and hospital supplies to be used in PHC services. METHOD: qualitative methodological study performed in two stages. The first stage included a focal group composed of experts to adapt the indicators to be used in PHC. In the second stage, the indicators were validated using a 4-point Likert scale, which was completed by judges. A Content Validity Index of ≥ 0.75 was considered to show approval of the indicators. RESULTS: the adaptations implemented by the focal group mainly referred to the physical structure, inclusion of dental care professionals, inclusion of chemical disinfection, and replacement of the hot air and moist heat sterilization methods. The validation stage resulted in an index of 0.96, which ranged from 0.90 to 1.00, for the components of the indicators. CONCLUSION: the judges considered the indicators after adaptation to be validated. Even though there may be differences among items processed around the world, there certainly are common characteristics, especially in countries with economic and cultural environments similar to Brazil. The inclusion of these indicators to assess the safety of healthcare supplies used in PHC services should be considered.

Adaptation and validation of indicators concerning the sterilization process of supplies in Primary Health Care services / Adaptação e validação de indicadores para o processamento de produtos na atenção primária à saúde / Adaptación y validación de indicadores para el procesamiento de productos en la atención primaria a la salud

OBJECTIVES: to adapt and validate, by expert consensus, a set of indicators used to assess the sterilization process of dental, medical and hospital supplies to be used in PHC services. METHOD: qualitative methodological study performed in two stages. The first stage included a focal group composed of experts to adapt the indicators to be used in PHC. In the second stage, the indicators were validated using a 4-point Likert scale, which was completed by judges. A Content Validity Index of ≥ 0.75 was considered to show approval of the indicators. RESULTS: the adaptations implemented by the focal group mainly referred to the physical structure, inclusion of dental care professionals, inclusion of chemical disinfection, and replacement of the hot air and moist heat sterilization methods. The validation stage resulted in an index of 0.96, which ranged from 0.90 to 1.00, for the components of the indicators. CONCLUSION: the judges considered the indicators after adaptation to be validated. Even though there may be differences among items processed around the world, there certainly are common characteristics, especially in countries with economic and cultural environments similar to Brazil. The inclusion of these indicators to assess the safety of healthcare supplies used in PHC services should be considered. .

OBJETIVOS: adaptar e validar para o uso no âmbito da APS, por meio de consenso de especialistas, um conjunto de indicadores para avaliação do processamento de artigos odonto-médico-hospitalares. MÉTODO: estudo metodológico quantitativo, realizado em duas fases subsequentes. Na primeira fase, um grupo focal foi desenvolvido com especialistas, a fim de adaptar os indicadores para uso em Atenção Primária em Saúde. Na segunda fase, os indicadores foram submetidos à validação pelos juízes, através de uma escala tipo Likert de 4 pontos, considerando-se Índice de Validade de Conteúdo ≥0,75 para aprovação dos indicadores. RESULTADOS: as adaptações do grupo focal foram principalmente quanto à: estrutura física, inserção de profissionais de odontologia, inclusão de desinfecção química e substituição de métodos de esterilização por calor seco por calor úmido. A fase de validação resultou num total de 0,96 de índice para os componentes dos indicadores, variando 0,90-1,00. CONCLUSÃO: após adaptação os indicadores foram considerados validados pelos juízes. Embora haja diferença entre os produtos de processamento em todo o mundo, certamente características comuns podem ser encontradas, principalmente em países com ambiente econômico e cultural similares. Deve-se considerar a inclusão desses indicadores para avaliação da segurança dos produtos na atenção primária à saúde. .

OBJETIVOS: adaptar y validar para uso en el ámbito de la APS, por medio de consenso de especialistas, un conjunto de indicadores para evaluación del procesamiento de artículos médicos odontológicos hospitalarios. MÉTODO: estudio metodológico cuantitativo, realizado en dos fases subsecuentes. En la primera fase, un grupo focal fue creado con especialistas con la finalidad de adaptar los indicadores para ser usados en la Atención Primaria de la Salud. En la segunda fase, los indicadores fueron sometidos a validación por los jueces a través de una escala tipo Likert de 4 puntos, considerándose el Índice de Validez de Contenido ≥ 0,75 para aprobación de los indicadores. RESULTADOS: las adaptaciones del grupo focal se refirieron principalmente a la: estructura física, inserción de profesionales de odontología, inclusión de desinfección química y sustitución de métodos de esterilización de calor seco por calor húmedo. La fase de validación resultó en un total de 0,96 de índice para los componentes de los indicadores, variando entre 0,90 y 1,00. CONCLUSIÓN: los indicadores después de la adaptación fueron considerados validados por los jueces. A pesar de que puede haber diferencias entre los productos de procesamiento en todo el mundo, ciertamente características comunes pueden ser encontradas, principalmente en países con ambiente económico y cultural similar. Se debe considerar la inclusión de esos indicadores para evaluar la seguridad de los productos para la salud en la atención primaria. .

Evaluating the quality of outbreak reports on health care-associated infections in São Paulo, Brazil, during 2000-2010 using the ORION statement findings and recommendations.

BACKGROUND: The standard of outbreak reports must be improved to a level where they are robust enough to properly influence preventive strategies. We aimed to verify compliance with mandatory outbreak notification, describing epidemiologic characteristics and management, and evaluating the quality of outbreak reports on health care-associated infections in São Paulo State, Brazil. METHODS: A systematic search was carried out on PubMed, the Latin American and Caribbean Health Sciences Literature database, Embase, Outbreak Database, the Annals of Brazilian Conferences on Healthcare-Associated Infection Prevention and Infectious Diseases, and reports from the São Paulo State Hospital Infection Division. The quality of reports was evaluated according to the Outbreak Reports and Intervention studies of Nosocomial Infection (ORION) statement guidelines. RESULTS: A total of 87 outbreak reports were identified; however, only 15 outbreaks (17.2%) were reported to the São Paulo State Hospital Infection Division. Bloodstream infection and neonatal intensive care units were mostly implicated (23% and 19.5%, respectively). Quality, evaluated according to ORION statement recommendations, was generally poor. The ORION categories of Background, Objectives, Participants, Setting, Infection-Related Outcomes, and Generality were properly described in 32.2%, 74.7%, 2.3%, 46%, 2.3%, and 12.6% of reports, respectively. Interventions and Culture-Typing were described with details in 51.9% and 55.2% of outbreak reports, respectively. CONCLUSIONS: Our findings pointed out the need for strategies to improve competence in outbreak reports, and the ORION statement guidelines may help in this matter. Efforts to promote confidence and consequent compliance with mandatory notification of outbreak reports are essential.

Evidências sobre a melhor concentração de clorexidina para higiene bucal: metanálise / Evidence on the best chlorhexidine concentration to perform oral hygiene: meta-analysis

Embora a literatura científica tenha demonstrado a importância da higiene bucal com clorexidina na prevenção de pneumoniaassociada à ventilação, existe uma grande variação das concentrações, frequência e técnica de aplicação do antisséptico.O objetivo desta pesquisa foi avaliar a melhor concentração de clorexidina usada para realizar a higiene bucalna prevenção de pneumonia associada à ventilação mecânica. Foi realizada uma revisão sistemática seguida de quatrometa-análises usando como critério a concentração de clorexidina. Foram selecionados artigos em Inglês, Espanhol ouPortuguês indexados nas bases de dados eletrônicas: Cochrane, Embase, Lilacs, PubMed / Medline e Ovid. A pesquisa foirealizada no período de maio a junho de 2011. O desfecho primário de interesse foi a pneumonia associada à ventilaçãomecânica. Dez estudos primários foram divididos em 4 grupos (G1-4), com base no critério de concentração de clorexidina.G1 (5 estudos primários, clorexidina 0,12%) apresentaram homogeneidade e o uso de clorexidina demonstrou efeitoprotetor; G2 (3 estudos primários, clorexidina 0,20%) houve heterogeneidade entre os estudos e clorexidina não representouum fator de proteção; G3 (2 estudos primários, clorexidina 2,00%) homogeneidade entre os estudos e a utilização declorexidina foi significativa; G4 (10 estudos preliminares com diferentes concentrações de clorexidina) homogeneidadeentre os estudos e o Risco Relativo comum foi significativo. A análise estatística mostrou um efeito protetor da higiene bucalcom clorexidina na prevenção de pneumonia associada à ventilação mecânica. No entanto, não foi possível identificarum padrão para estabelecer a concentração ideal de clorexidina para realização de higiene bucal.(AU)

Although scientific literature has demonstrated the relevance of oral hygiene with chlorhexidine in preventing ventilation--associated pneumonia, there is a wide variation of concentrations, frequency and techniques when using the antiseptic.The aim of this research was to assess the best chlorhexidine concentration used to perform oral hygiene to prevent ventilation-associated pneumonia. A systematic review followed by four meta-analysis using chlorhexidine concentration ascriterion was carried out. Articles in English, Spanish or Portuguese indexed in the Cochrane, Embase, Lilacs, PubMed/Medlineand Ovid electronic databases were selected. The research was carried out from May to June 2011. The primary outcomemeasure of interest was ventilation-associated pneumonia. Ten primary studies were divided in four groups (G1-4),based on chlorhexidine concentration criterion. G1 (5 primary studies, chlorhexidine 0.12%) showed homogeneity amongstudies and the use of chlorhexidine represented a protective factor. G2 (3 primary studies, chlorhexidine 0.20%) showedheterogeneity among studies and chlorhexidine did not represent a protective factor. G3 (2 primary studies, chlorhexidine2,00%) showed homogeneity among studies and the use of chlorhexidine was significant. G4 (10 primary studies withdifferent chlorhexidine concentrations) showed homogeneity among studies and the common Relative Risk was significant.Statistic analyses showed a protective effect of oral hygiene with chlorhexidine in preventing ventilation-associatedpneumonia. However, it was not possible to identify a standard to establish optimal chlorhexidine concentration.(AU)

Melhorando o processo para reduzir o cancelamento de cirurgias oftalmológicas e as queixas de pacientes / Mejorando el proceso como para reducir cancelaciones de cirugías oftalmológicas y quejas de pacientes / Improving the process to reduce ophthalmologic surgery cancellation and patient complaints

This study aims to describe a quality intervention program to reduce the rates of ophthalmologic surgery cancellation and patient complaints. The methodology applied was based on the model of process improvement. The goals of the project were: to reduce the rate of surgery cancellations and to reduce the number of patient complaints. An action plan was established based on the assessment of the main causes of the problems. The rates of surgery cancellation before and after the intervention were compared using the chi square test and significance was assumed if P was less than. 05. Results: in the baseline period (2004-2005) the monthly rate of surgery cancellations ranged from 32 to 45 percent. In the year 2006 this rate increased from 38 to 66 percent. The main causes for surgery cancellations were: patient absence (33 percent), faults in surgical product provision (32 percent) and unpropitious clinical conditions (15 percent). Patient absence was reduced through improvement of communication between resident surgeons and the social workers team. Modifications were achieved in the provision chain for essential surgical products (intraocular lens, balanced salt solution, viscoelastic solution) and there was no more surgery cancellation caused by fault in product provision. Although there was no change in the overall rates of surgery cancellation between the baseline period (37 percent) and the intervention period (38 percent), the rates decreased compared to the year 2006 (51 percent) (P match 0.0001; RR: 0.75; IC: 0.71-0.78). The main cause of patient complaint was surgery cancellation; the physician-patient relationship was the object of many complaints. Patient complaints dropped from up to 20 in 2006 to about 10 per month in 2007. Conclusion: the methodology for process improvement showed to be useful in reducing the main causes of surgery cancellation and patient complaints. (AU)

Este estudo visa descrever um programa de intervenção de qualidade para reduzir as taxas de cancelamento de cirurgias oftalmológicas e as queixas de pacientes. A intervenção ocorreu de julho a dezembro de 2007. A metodologia aplicada se baseou no modelo de melhoria do processo. Os objetivos do projeto eram: reduzir a taxa de cancelamentos de cirurgias e o número de queixas de pacientes. As taxas de cancelamento de cirurgias antes e depois da intervenção foram comparadas usando o teste qui quadrado e a significância foi estabelecida como P menor que. 05. Resultados: no período basal (2004-2005) a taxa mensal de cancelamentos de cirurgias variou de 32 a 45 por cento. No ano de 2006 esta taxa aumentou de 38 para 66 por cento. As causas principais de cancelamentos da cirurgia foram: ausência do paciente (33 por cento), falhas na provisão de produtos cirúrgicos (32 por cento) e circunstâncias clínicas não adequadas (15 por cento). A ausência de pacientes foi reduzida com a melhoria da comunicação entre os cirurgiões residentes e a equipe de assistentes sociais. Obtiveram-se modificações na cadeia de provisão de produtos cirúrgicos essenciais (lente intraocular, solução salina estabilizada, solução viscoelástica) e não houve mais cancelamentos de cirurgias causado por problemas de provisão de produtos. Embora não tenha havido nenhuma mudança nas taxas totais de cancelamento de cirurgias entre o período basal (37 por cento) e o período da intervenção (38 por cento), as taxas diminuídas se compararam às do ano de 2006 (51 por cento) (P igual à 0.0001; RR: 0.75; CI: 0.71-0.78). A causa principal de queixas de pacientes era o cancelamento de cirurgias; o relacionamento médico-paciente era objeto de muitas queixas. As queixas de pacientes caíram de 20 em 2006 a aproximadamente 10 por mês em 2007. Conclusão: a metodologia de melhoria de processo mostrou ser útil na redução das principais causas de cancelamento de cirurgias e de queixas de pacientes. (AU)

Este estudio intenta describir un programa de intervención de calidad para reducir los índices de cancelación de cirugías oftalmológicas y quejas de pacientes. La metodología aplicada fue basada en el modelo de mejoría de proceso. Las metas del proyecto fueran: reducir el índice de cancelaciones de cirugía y reducir el número de quejas de pacientes. Los índices de cancelación de cirugías antes y después de la intervención fueran comparados utilizando la prueba chi-cuadrado, y la significancia fue considerada P menor que .05. Resultados: en el período basal (2004-2005) el índice mensual de cancelaciones de cirugías subió del 32 per ciento al 45 per ciento. El año 2006 el valor subió del 38 al 66 per ciento. Las causas principales para las cancelaciones de cirugías fueran: ausencia del paciente (el 33 per ciento), ausencia de aparatos quirúrgicos (el 32 per ciento) y condiciones clínicas non propicias (el 15 per ciento). La ausencia del paciente fue reducida con La mejora de la comunicación entre los cirujanos residentes y el equipo de asistentes sociales. Se lograran modificaciones en la cadena de productos quirúrgicos esenciales (lente intraocular, solución salina estabilizada, solución viscoelástica) y no hubo cancelación de cirugía causada por ausencia de aparatos quirúrgicos. Aunque no hubiera cambio en los índices totales de cancelación de cirugías entre el período basal (el 37 per ciento) y el período de la intervención (el 38 per ciento), los índices han disminuido en comparación al año 2006 (el 51 per ciento) (P igual a 0.0001; RR: 0.75; IC: 0.71-0.78). La causa principal de las quejas de pacientes era las cancelaciones de cirugías; la relación médico-paciente era causa de muchas quejas. Las quejas de pacientes cayeron del 20 en 2006 a cerca de 10 por mes en 2007. Conclusión: la metodología para la mejoría de proceso demostró ser útil en la reducción de las causas principales de las cancelaciones de cirugías y las quejas de pacientes. (AU)