Metas internacionales de seguridad del paciente en centro de salud: un artículo de revisión bibliográfica / International goals of patient safety in health centers: a bibliographic review article

Las metas internacionales de seguridad del paciente fueron implementadas por la Joint Commision International (JCI), a nivel mundial, con la finalidad de reducir los eventos adversos en los centros de salud. El objetivo de esta revisión bibliográfica fue identificar las metas internacionales de seguridad del paciente (MISP) incorporadas en centros de salud en el marco de la cultura de seguridad y calidad de la atención. Se realizó una revisión bibliográfica narrativa sistematizada utilizando las bases de datos de PubMed y EBSCO Host, utilizando criterios de inclusión y exclusión para la selección de los artículos para análisis. Los ámbitos evaluados relacionados a las metas internacionales de seguridad, identificados en los artículos seleccionados fueron: i) cultura de seguridad, ii) calidad de la atención, iii) comunicación efectiva, iv) cirugía de alto riesgo, v) medicamentos de alto riesgo. Las metas internacionales de calidad están incorporadas en los diferentes centros de salud, algunos de ellos definidos explícitamente en los sistemas de evaluación de calidad y otros de manera implícita en ámbitos generales en los sistemas de evaluación.

The Joint Commission International (JCI) implemented international patient safety goals worldwide to reduce adverse events in health centers. The objective of this literature review was to identify the international patient safety goals (MISP) incorporated in healthcare facilities within the framework of safety culture and quality of care. A systematized narrative literature review was carried out using PubMed and EBSCO Host databases, using inclusion and exclusion criteria to select articles for analysis. The areas evaluated related to the international safety goals identified in the selected articles were: i) safety culture, ii) quality of care, iii) effective communication, iv) high-risk surgery, v) high-risk drugs. International quality goals are incorporated in the different health centers, explicitly defined in the quality evaluation systems and others in general areas in the evaluation systems.

Guía sobre equipo de protección personal y procedimientos para instalaciones no hospitalarias / Guidance on Personal Protective Equipment and Procedures for Non-Hospital Facilities

El documento está pensado en el personal de salud, desde los administrativos, pasando por el personal de mantenimiento, hasta quienes están en primera fila de riesgo. La idea es implementar una serie de medidas para contrarrestar, contener o evitar la propagación del COVID-19.

Uso de equipo de protección personal para actividades administrativas y de mantenimiento en ambientes no hospitalarios / Use of Personal Protective Equipment for administrative and maintenance activities in non-hospital environments

Propone, implementa y describe las medidas para la prevención de riesgo por COVID 19, reforzando las normas ya implementadas en los trabajadores administrativos y técnicos del propio Ministerio de Salud. El objetivo del documento a nivel nacional es: establecer las características técnicas y normativas de los elementos de protección personal- EPP - que constituyen el equipo de prevención de los trabajadores expuestos a factores de riesgo durante el desarrollo de su trabajo.

Recomendaciones de salud pública ambiental en establecimientos de salud, 11 de mayo del 2020 / Recommendations on Public Environmental Health in Health Care Facilities, 11 May 2020

El abordaje de las normas mínimas de salud pública ambiental en los establecimientos de salud es un componente clave para la seguridad del paciente, del personal de salud, los acompañantes y visitantes. Asegurar el agua, el saneamiento y la higiene del establecimiento de salud es responsabilidad de todos: del personal de salud, de los gestores en los establecimientos, de los proveedores de servicios, de los pacientes y de los acompañantes y visitantes. • Implementar medidas de inspección y vigilancia sobre las condiciones del agua, saneamiento e higiene en los establecimientos de salud. • Asegurar que todo el personal del establecimiento tenga conocimiento de las medidas de agua, saneamiento e higiene a implementar, por ejemplo, acciones para almacenar el agua de manera segura y como garantizar su calidad, el manejo que se le debe dar a los residuos, etc. • Asegurar que el establecimiento de salud cuenta con las instalaciones básicas de agua, saneamiento e higiene para operar, cumpliendo con las normas nacionales. • Adecuar espacios o edificios para la atención hospitalaria que asegure las condiciones óptimas para la prevención de brotes de legionela,2 en coordinación con los operadores de agua e instituciones responsables de salud pública ambiental.

This technical note deals with the minimum environmental public health standards in health facilities, a key component for the safety of the patient, health personnel, visitors, and companions. Recommendations are provided on safe water, sanitation, solid waste, hand washing, and cleaning and disinfection. Ensuring the water, sanitation, and hygiene of the health care facility is the responsibility of everyone: health personnel, facilities managers, service providers, patients, companions, and visitors. • Implement inspection and surveillance measures on water, sanitation, and hygiene conditions in health care facilities. • Ensure that all facility personnel are aware of the water, sanitation, and hygiene measures to be implemented, for example, actions to store water safely and how to guarantee its quality, health care waste management, etc. • Ensure that the health care facility has the basic water, sanitation, and hygiene facilities to operate, complying with national standards. • Adapt spaces or buildings for health care that ensure optimal conditions for the prevention of legionella outbreaks,2 in coordination with water operators and institutions responsible for environmental public health.

Orientações para empregadores, trabalhadores e pacientes dos serviços de psicologia: medidas de prevenção e controle da disseminação do SARS-COV-2 (COVID-19) / Guidelines for employers, workers and patients in psychology services: measures to prevent and control the spread of SARS-COV-2 (COVID-19)

Protocolos Específicos com Medidas de Prevenção e Controle da Disseminação do SARSCoV-2 (COVID-19) para os serviços relativos à saúde humana, e dá outras providências

Percepciones subjetivas del personal de enfermería sobre la Violencia en el lugar de trabajo, resultados preliminares / Workplace Violence among nursing staff subjective perceptions, preliminary results

ABSTRACT Introduction: Several studies have established the prevalence of workplace violence in the health sector being the nursing staff more likely to experience physical and non-physical violence than other health workers. Objective: Thus, we aimed to research the perceptions of workplace violence in nursing staff in association to type of violence, perpetrators, consequences and protecting measures available in the health institutions. Methods: The study was conducted with a phenomenological method in a major hospital in Quito, Ecuador. N=13/210 professional nurses were selected from a convenience sample and, before starting the discussion, were given information consent forms to sign. The considered selection criteria were being professional, over age 18, and being employers at the hospital as minimum 2 years. The technique selected in data collection was Focus Group Discussion. Results: showed that nursing staff had clarity about what constitutes violence in the workplace such as understanding about the magnitude of the problem, nurses affected by verbal abuse and threats mostly tried to ignore the situation because they considered this to be a typical incident in the workplace, they did not report the situation and it has caused underregistration. The aggressors were mostly staff members, supervisors and relatives of patients. Conclusion: The evidence allowed us to admit that the situation is a significance problem in magnitude and severity. Our recommendations will be oriented toward the implementation of a preventative and minimizing aggression program in the Hospital(AU)

RESUMEN Introducción: Varios estudios han establecido la prevalencia de la violencia en el lugar de trabajo en el sector salud, y es el personal de enfermería quien tiene más probabilidades de sufrirla. Objetivo: Investigar las percepciones de la violencia en el lugar de trabajo en profesionales de la enfermería en asociación con el tipo de violencia, perpetradores, consecuencias y medidas de protección disponibles en las instituciones de salud. Métodos: Estudio fenomenológico en un hospital de especialidades de Quito, Ecuador. N = 13/210 enfermeras profesionales se seleccionaron en una muestra de conveniencia. Antes de comenzar la discusión, se les proporcionaron los formularios de consentimiento informado. Los criterios de selección fueron: ser profesionales, mayores de 18 años y empleadas en el hospital con tiempo mínimo de 2 años. La técnica seleccionada en la recopilación de datos fue Grupo Focal de Discusión. Resultados: El personal de enfermería tenía claridad sobre lo que constituye violencia en el lugar de trabajo, como la comprensión de la magnitud del problema, las enfermeras afectadas por el abuso verbal y las amenazas intentaban ignorar la situación porque consideraban que se trataba de un incidente típico en el lugar de trabajo. No informaron la situación y causó un subregistro. Los agresores eran en su mayoría miembros del personal, supervisores y familiares de pacientes. Conclusión: La evidencia permitió admitir que la situación es un problema de importancia en magnitud y gravedad. Las recomendaciones estarán orientadas a la implementación de un programa preventivo en el hospital(AU)

Certificación de establecimientos de atención médica en México: análisis de los incentivos para su continuidad / Certification of medical care facilities in Mexico: analysis of the incentives for its continuity

Resumen: Objetivo: Analizar el posible efecto de los modelos de certificación y de los incentivos implementados en la participación de establecimientos de atención médica (EAM) en la certificación del Consejo de Salubridad General entre 1999-2017. Material y métodos: Se colectaron documentos oficiales, impresos y en línea, sobre la certificación de EAM y se solicitó información a diversas instancias relacionadas mediante mecanismos de transparencia. Se analizó la participación de EAM en los períodos político-administrativos entre 1999-2017. Resultados: El promedio anual de participación entre 1999-2000 fue de 259.5 EAM; entre 2013-2016, de 72.5. La participación de EAM públicos es decreciente. En 2017, los EAM certificados eran <1%. Conclusiones: No se identificaron efectos positivos ni sostenidos de ajustes al modelo, ni de los incentivos implementados. Se observa disminución de la participación en los distintos periodos político-administrativos. Debe evaluarse profundamente el Sistema Nacional de Certificación de EAM y su posible efecto en la calidad clínica.

Abstract: Objective: To analyze the possible effect of certification models and healthcare organizations' (HOs) participation incentives in the General Health Council certification process in the 1999-2017 period. Materials and methods: Official printed and online documents about HOs' certification were collected. Information from instances related to the process was requested through transparency mechanisms. Health organizations' participation in political-administrative periods between 1997-2017 was analyzed. Results: The annual average participation in the certification process during the 1999-2000 period was 259.5 HOs; during the 2013-2016 period, the average was 72.5. Public units' participation in this process has been decreasing. In 2017, certified HO were <1%. Conclusions: No positive effects of adjustments to the certification model or the incentives applied were identified. Conversely, there is decreasing participation in the different political-administrative periods. The National HO Certification System and its possible effect on clinical quality must be thoroughly evaluated.

Diretriz Técnica da ANAMT (DT 05): prevenção de lombalgia ocupacional por uso de cinta, suporte ou órtese lombar / ANAMT Technical Guideline (DT 05): prevention of occupational low back pain through back belts, lumbar support or braces

Introdução: Lombalgia é um problema internacional importante de saúde pública. O uso de cinta lombar no meio ocupacional emerge da expectativa de inúmeros benefícios biomecânicos que, em conjunto, promoveriam a prevenção desse problema. Objetivo: Orientar estudantes, médicos e estabelecimentos de saúde sobre o uso de cinta lombar, suporte ou órtese lombar como prevenção da lombalgia ou de lesões lombares em trabalhadores sem sintomatologia atual. Método: Ela foi desenvolvida a partir da revisão sistemática da literatura: da base de dados MEDLINE, foram recuperados 809 trabalhos e das bases EMBASE e Central Cochrane, 571. Avaliar a cinta lombar como intervenção preventiva de lombalgia envolve a quantificação de benefícios, malefícios e facilidade de sua implementação, assim como a qualidade metodológica dos estudos primários. Conclusão: Apesar do benefício demonstrado fracamente em resultados individuais, parciais e isolados em poucos estudos, não há evidência consistente que sustente a utilização de cinta lombar, suporte ou órtese lombar na prevenção primária da lombalgia ou de lesões lombares ocupacionais em trabalhadores. As evidências, agrupadas, apontam para ausência de redução de absenteísmo com o uso da cinta lombar.

Background: Low back pain is a considerable global public health problem. Use of back belts in occupational settings arises from the expectation of countless biomechanical benefits, which together would contribute to the prevention of this problem. Objective: To orient students, physicians and health institutions on the use of back belts, lumbar support or braces for prevention of low back pain or injury among asymptomatic workers. Method: The present guideline was developed based on a systematic literature review; 809 studies were located in database MEDLINE and 571 in EMBASE and Cochrane CENTRAL. Evaluating back-belt use as preventive intervention against low back pain demands quantifying benefits, harms and difficulties to implementation, as well as the methodological quality of primary studies. Conclusion: Despite the weak benefits reflected in the individual, partial and isolated results of a few studies, there is no consistent evidence for the use of back belts, lumbar supports or braces for primary prevention of low back pain or occupational low back injury among workers. According to the available evidence, back-belt use is not associated with reduction of absenteeism

Distúrbios osteomusculares relacionados ao trabalho autorreferidos por profissionais de saúde de um hospital em Portugal / Self-reported work-related musculoskeletal disorders among health professionals at a hospital in Portugal

Introdução: Os distúrbios osteomusculares relacionados com o trabalho (DORT) são responsáveis pela morbidade de muitos profissionais de saúde. Objetivo: Realizar um diagnóstico da prevalência de DORT autorreferidos por profissionais de saúde. Métodos: Foi realizado um estudo, descritivo e exploratório, envolvendo profissionais de saúde de uma instituição hospitalar no norte de Portugal. Os dados foram coletados ao longo do mês de dezembro de 2017, mediante aplicação de questionário eletrônico à população total (n=435). Foram utilizados instrumentos de caracterização sociodemográfica, percepção de conhecimentos sobre ergonomia e mobilização manual de cargas, avaliação da percepção de carga (Escala de Percepção de Carga de Manuseio do Paciente ­ EPCMP) e sintomas osteomusculares autorreferidos (Questionário Nórdico de Sintomas Osteomusculares ­ QNSO). Resultados: A amostra foi constituída de 105 profissionais, essencialmente enfermeiros e assistentes operacionais, apresentando uma ocorrência elevada de sintomas em diversas regiões corporais, maioritariamente na coluna vertebral. Conclusões: DORT em profissionais de saúde devem ser considerados um problema nas instituições de saúde que carecem de intervenções além dos tradicionais programas formativos, especialmente programas multifatoriais de natureza sistémica

Background: Work-related musculoskeletal disorders (WMSDs) are responsible for morbidity among many health professionals. Objective: To establish the prevalence of self-reported WMSDs among health professionals. Methods: Descriptive and exploratory study with health professionals at a hospital in northern Portugal. Data were collected in December 2017 by means of an electronic questionnaire applied to the total target population (n=435). We applied instruments for sociodemographic characterization, perception of knowledge on ergonomics and manual mobilization of loads, the Patient Handling Burden Scale (PHBS) and the Nordic Musculoskeletal Questionnaire (NMQ) for self-reporting musculoskeletal symptoms. Results: The sample comprised 105 professionals, mainly nurses and nursing assistants, who exhibited high frequency of symptoms in several body areas, mainly the spine. Conclusions: WMSDs involving health professionals should be considered a problem for health institutions which do not implement interventions beyond traditional training programs, especially multifactorial programs of systemic nature

Participação e controle social nos Conselhos Locais de Saúde sob a ótica de alguns conceitos da Análise Institucional / Participation and social control in Local Health Councils from the perspective of some Institutional Analysis concepts

O Sistema Único de Saúde (SUS) vem sofrendo medidas governamentais que dificultam sua implementação como, por exemplo, seu desfinanciamento. Consideramos a participação e o controle social como uma força na luta pela melhoria e manutenção da saúde como direito de todos e dever do estado. Um dos espaços legitimados da participação e do controle social são os Conselhos Locais de Saúde (CLS), que visam atender as demandas e necessidades de saúde da população que reside na área de abrangência das unidades básicas de saúde. Para os trabalhadores de saúde, em especial o profissional enfermeiro, que tem ocupado espaços de gerência, é importante seu conhecimento sobre esta temática, para a defesa do SUS. Trata-se de uma pesquisa qualitativa descritiva-exploratória, que utilizou alguns conceitos da análise institucional, linha sócio analítica, tais como: instituição, instituinte e processo de institucionalização. Teve por objetivo geral analisar os modos de funcionamento dos CLS em um município do estado de São Paulo sob a ótica do referencial teórico; e como objetivos específicos caracterizar os CLS em relação ao perfil dos participantes e duração das reuniões, bem como analisar se os achados em pesquisa realizada nas escolas francesas iluminam o modo de funcionamento dos CLS. Foram selecionados dois CLS, por meio dos critérios de inclusão e foram eles os dois mais antigos, com reuniões mensais e em vigor durante a produção dos dados. Para essa produção foram utilizadas a observação nas reuniões e atividades dos CLS, contato com as atas e entrevistas com questões semiestruturadas, afim de identificar os modos de funcionamento dos CLS. Foram entrevistados 28 participantes, dentre eles, 24 membros do CLS e 4 informantes-chave; as entrevistas foram gravadas em mídia digital e posteriormente transcritas na íntegra. Foi utilizado registro de impressões, sentimentos e expectativas no diário de pesquisa. Os dados foram organizados pelas proposições de Paille e Mucchielli, seguindo as etapas interrelacionadas: transcrição, transposição e reconstituição. O material foi analisado confrontando os objetivos e o referencial teórico. Os resultados foram apresentados em categorias e subcategorias, sendo elas: I- Os Conselhos Locais de Saúde: composição, atividades realizadas e livros-ata; II - Relações no conselho, como subcategorias à relação do conselheiro com a função, a visão dos conselheiros e gerentes, representar e ser representado, e a relação entre gestores e conselheiros; e III - Controle Social explícito e implícito. Os CLS surgiram com um movimento instituinte e ao serem institucionalizados conjugam os modos instituídos de participação como a hierarquização e os jogos de interesse. Concluímos que os CLS funcionam na perspectiva mais de satisfazer os projetos individuais aos coletivos, há valorização de sua permanência para benefício da unidade de saúde, do gerente e para atender aos requisitos de avaliação do Programa Nacional de Melhoria do Acesso e da Qualidade. Foi observada a materialização das relações hierárquicas presente na sociedade brasileira e que reproduzem relações históricas servindo a interesses restritos. A pesquisa na França ilumina os achados nos CLS brasileiro com a questão da proximidade sociocultural entre os gerentes, trabalhadores e os conselheiros

Some governmental measures, such as underfunding, have made it harder to implement the Unified Health System (UHS). However, social participation and control are powerful weapons in the fight for a better public healthcare and its maintenance as a right to every citizen and a duty of the State. The Local Health Councils (LHC) are one of the legal places for social participation and control that seeks to attend the demands and health needs of the population residing in the area of coverage of the basic health units. Health professionals, especially nurse practitioners, who occupy management positions, must have an understanding of these organizations in order to defend SUS. The present study is a qualitative and descriptive exploratory research that used some concepts of institutional analysis, socio-analytic line, and institutionalization process. The general purpose of this study was to analyze the modes of operation of the LHC in a city of the State of São Paulo under the perspective of the theoretical reference. The specific objectives was to characterize the LHC (concerning the profile of the participants and duration of the meetings) as well as to analyze if findings of researches carried out in French schools would help to understand the way that the LHC works. Two LHC were selected using the inclusion criteria: the oldest with monthly meetings during the production of the data. Data were collected by the observation of meetings and activities of the LHC, evaluation of documents and interviews with semi-structured questions, in order to identify the modes of operation of the LHC. 28 participants were interviewed, including 24 LHC members and 4 key informants. The interviews were recorded on digital media and later completely transcribed. Impressions, feelings and expectations were registered and used in the research diary. The data were organized by the propositions of Paille and Mucchielli, following the interrelated stages: transcription, transposition and reconstitution. The material was analyzed confronting the objectives and the theoretical reference. The results were presented in categories and subcategories, as follows: I- The Local Health Councils: composition, activities and documents; II - Relationships in the council, as subcategories the relationship of the advisor with the function, the vision of the advisors and managers, to represent and be represented, and the relationship between managers and advisors; and III - Explicit and implicit Social Control. The LHC emerged as an institutional movement and when they were institutionalized, they combine some modes of participation like hierarchy and games of interest. It was found that the CLS works more in the perspective of individual projects than collective projects. There is an interest of its permanence to benefit the health unit, the advisor and to meet the evaluation requirements of the National Program for Improving Access and Quality. It was also observed the materialization of hierarchical relations present in Brazilian society that reproduce a historical relation of serving personal interests. The research made in French schools helps to understand the Brazilian LHC concerning sociocultural proximity between managers, workers and advisors

A experiência de adoecimento de mulheres com endometriose: narrativas sobre violência institucional / The experience of illness of women with endometriosis: narratives about institutional violence

Resumo O artigo evoca a centralidade ocupada pela categoria relacional de gênero, para iluminar as narrativas de vida de mulheres com uma doença crônica - a endometriose. O objetivo é discutir o significado da experiência de adoecimento de mulheres com endometriose na interface com a violência institucional. À luz do referencial de Bertaux, no método Narrativas de Vida, 20 foram as participantes desta pesquisa convidadas a partir de dois espaços virtuais de discussão e encontros sobre o viver com endometriose. As entrevistas foram realizadas pessoalmente no circuito RJ, SP e MG. A abordagem teórica foi abalizada por autores que tratam da experiência do adoecimento crônico enquanto fenômeno sociocultural, leituras metafóricas do problema e críticas à violência institucional. Os resultados identificam situações de violência de gênero/institucional perpetradas nos diversos espaços de atenção às mulheres. Expressam-se a partir da banalização dos discursos das mulheres; das tensões estabelecidas entre usuárias e médicos, onde o suposto saber leigo funciona como ultraje ao saber biomédico oficial e, precipuamente, na dificuldade de acesso aos serviços, levando as mulheres a uma peregrinação por cuidados e a se submeterem a formas de assistência não necessariamente baseadas em boas práticas.

Abstract This paper conjures up the centrality of the relational category of gender to shed a light on women's life narratives with a chronic disease named endometriosis. It aims to discuss the meaning of the illness experience of women with endometriosis in the interface with institutional violence. Based on Bertaux reference, in the Narratives of Life method, twenty women participated in this research. They were invited from two virtual spaces of discussion and gatherings about living with endometriosis. Interviews were conducted in person in the States of Rio de Janeiro, São Paulo and Minas Gerais circuit. Authors sustained the theoretical approach and addressed the experience of chronic illness as a sociocultural phenomenon, metaphorical readings of the problem and criticism of institutional violence. The results identify situations of gender/institutional violence perpetrated in various women care settings. They are expressed through the trivialization of women's discourses; user-physician tensions, where the supposed lay knowledge appears as an insult to official biomedical knowledge and, mainly, the difficult access to services, leading women to a care pilgrimage and to submit themselves to care types not necessarily based on best practices.

Retos de la planificación estratégica en instituciones de salud / Challenges of strategic planning in health institutions

La planificación estratégica constituye una de las actividades clave de todas las organizaciones, urgidas de extender su actuación más allá del corto plazo, en un entorno marcado por la incertidumbre, el riesgo y los cambios multicausales. Particularmente para las instituciones de salud este es un tema trascendental, si se considera su alta responsabilidad social que implica a diversos grupos internos y externos, cuyos objetivos deberán ser manejados con coherencia a través de un adecuado proceso de planificación estratégica. El objetivo de la presente comunicación es analizar los principales retos que tiene esta actividad en instituciones de salud, satisfaciendo las necesidades de todos los involucrados y garantizando el rigor técnico requerido(AU)

Strategic planning is one of the key activities of all organizations, urged to extend their actions beyond the short term, in an environment marked by uncertainty, risk and multicausal changes. Particularly for health institutions, this is a transcendental issue, considering their high social responsibility, which involves various internal and external groups, whose objectives must be managed consistently through an adequate process of strategic planning. The objective of this communication is to analyze the main challenges that this activity has in health institutions, meeting the needs of all involved and guaranteeing the required technical rigor(AU)

A provisão emergencial de médicos pelo Programa Mais Médicos e a qualidade da estrutura das unidades básicas de saúde / Emergency supply of doctors by the Mais Médicos (More Doctors) Program and the quality of the structure of primary health care facilities

Resumo No contexto das políticas de saúde no Brasil, observa-se um conjunto de ações para qualificação da atenção primária à saúde (APS), entre as quais os Programas Nacional de Melhoria do Acesso e da Qualidade (PMAQ-AB), Mais Médicos (PMM) e Requalificação das UBS (Requalifica UBS). O artigo analisa a inserção de médicos do PMM segundo qualidade da estrutura das UBS, buscando reconhecer sinergias entre os três programas. Trata-se de estudo transversal com base em dados secundários do PMAQ-AB ciclos 1 e 2, do PMM e do Requalifica UBS. As UBS recenseadas no PMAQ-AB Ciclo 1 foram classificadas, segundo tipologia previamente elaborada, em cinco grupos hierarquizados de A (melhores) a E (reprovadas). Em seguida foram cotejadas com a alocação de profissionais do PMM e propostas Requalifica. Os resultados sinalizam convergências de investimentos dos três programas. Observa-se predomínio de incentivos nas UBS tipos B e C, indicando concentração de esforços em UBS com potencialidade de melhora da qualidade de sua estrutura. Além da ampliação do acesso, o componente provisão emergencial de médicos do PMM, somado à melhoria da infraestrutura e qualificação do processo de trabalho conflui para enfrentar a rotatividade e garantir a permanência de médicos na APS.

Abstract The health policy context in Brazil has featured a series of measures to improve primary health care (PHC), including a national access and quality improvement program (Programa Nacional de Melhoria do Acesso e Qualidade, PMAQ-AB) and the Mais Médicos Program (More Doctors, PMM) and upgrading PHC centers (‘Requalifica UBS’). The paper examines the PMM's placement of doctors, by quality of PHC structure, in an endeavor to identify synergies among the three programs. It reports on a transverse study based on secondary data from PMAQ-AB Cycles 1 and 2, the PMM and ‘Requalifica UBS’. The PHC facilities inventoried during PMAQ-AB Cycle 1 were classified, on pre-established typology, into five groups ranked from A (best) to E (failed). They were then compared in terms of PMM personnel allocated and Requalifica UBS proposals. The results point to convergences in investments by the three programs. Incentives targeted predominantly PHC facilities of types B and C, indicating a concentration of efforts on PHC facilities with potential for structural quality improvements. In addition to expanding access, the provision of doctors by the PMM, added to infrastructure upgrades and work process improvements, contributes to addressing high turnover and guaranteeing retention of doctors in PHC.

Características de documentos utilizados para estructurar las políticas internas relacionadas a las metas internacionales de seguridad de pacientes / Characteristics of documents used for establishing internal policies which agree with international standards for patient safety

La gestión de riesgos de eventos adversos es un tema fundamental en las instituciones de salud, esta se inicia con la elaboración de normas, protocolos e indicadores, los cuales deben ser construidos de acuerdo a normativas internacionales. Objetivo: Describir las características del documento formal que utilizan las instituciones en nuestro país para estructurar las políticas internas relacionadas a las metas internacionales de seguridad de pacientes. Material y método: Estudio cuantitativo, descriptivo, de corte transversal; siendo evaluados un total de 90 documentos de instituciones de salud pública y privada. Se recolectó la información vía on line, entrevista directa y mediante envío de correos electrónicos a los comités de calidad de las instituciones. Los criterios de selección se basaron en las 6 metas internacionales de seguridad del paciente. Fueron respetadas las normas éticas internacionalmente definidas. Resultados: Se evaluaron un total de 30 instituciones de salud. Los ítems con cumplimiento sobre 90% fueron "Nombre de la institución y Título del documento". Por su parte "existencia de programa de supervisión "y "presencia de indicador o indicadores" representaron porcentajes de cumplimiento igual a 40%. De las instituciones evaluadas se encontró la documentación sobre "Identificación de pacientes" en el 90% (27/30). Conclusión: La presente investigación muestra la diversidad de formatos de estructuración de documentos relacionados a la seguridad de pacientes y exigidos en la acreditación de prestadores.

The management of adverse events is a key issue in health institutions; this effort begins with the development of standards, protocols and indicators, which must be built according to international standards. Objective: To assess the official document used by health centers in our country for establishing internal policies with regards to international quality criteria in the area of patient safety. Method: Quantitative, descriptive, cross-sectional study, with a total of 90 documents which were assessed, from private and public health care centers. Information was collected online, through direct interview or e-mails sent to the quality committees of the institutions involved. The selection criteria were based on 6 international patient safety goals. Internationally defined ethical norms were respected. Results: A total of 30 health institutions were assessed. Items reaching above 90% compliance were "name of institution and title of document". On the other hand, the items "existence of the monitoring program" and "presence of indicator or indicators" had a 40% compliance. Out of the institutions assessed, documentation about "Patient Identification" was found in 90 % (27/30) of them. Conclusion: The present study shows the diversity of formats for the elaboration of documents for patient safety, which are also required for accreditation.

Caracterización de los desechos sólidos en instituciones de salud como etapa básica para el plan de manejo / Solid waste characterization at healthcare institutions as a basic stage in the management plan

Introducción: la gestión de los desechos sólidos de instituciones de salud es un proceso destinado a garantizar la adecuada higiene y seguridad para los trabajadores, la comunidad y el medio ambiente que la rodea. De primordial importancia para abordar cualquier programa de control de las situaciones de riesgo derivadas del manejo inadecuado de los desechos sólidos de instituciones de salud, es su caracterización según los tipos y el estimado de las cantidades generadas. Objetivo: caracterizar los desechos sólidos generados en instituciones de los tres niveles de atención a la salud. Métodos: se realizó un estudio descriptivo en siete instituciones de los tres niveles de atención a la salud de la provincia La Habana durante el período comprendido de Enero/2009 a Septiembre/2009. Se aplicó un cuestionario elaborado a los efectos de este estudio y tuvo como instrumento básico de referencia la Encuesta de residuos de hospitales, desarrollada por el CEPIS. Resultados: la cantidad de desechos sólidos generados varió entre las instituciones de los diferentes niveles de atención y las categorías consideradas, con predominio en el nivel secundario donde se destacaron los desechos infecciosos. Conclusiones: el estimado de las cantidades de desechos sólidos generados brindó una información útil para su manejo en las instituciones participantes, lo cual permitió fomentar acciones para el reuso y el reciclaje,así como, estimar los recursos humanos y materiales y programar las actividades de capacitación necesarias para el establecimiento de un sistema de manejo seguro en las instituciones participantes en el estudio(AU)

Introduction: Solid waste management at healthcare institutions is aimed at ensuring appropriate hygiene and safety for workers, the community and the environment. Programs for the control of risk situations stemming from inadequate management of solid waste at healthcare institutions should indispensably be based on characterization of wastes according to type and estimation of the volumes generated. Objective: Characterize solid wastes generated at institutions from the three health care levels. Methods: A descriptive study was conducted at seven institutions from the three health care levels in the province of Havana from January to September 2009. A dedicated questionnaire was applied, whose basic reference tool was the "Hospital waste survey" developed by CEPIS. Results: The volume of solid wastes varied between the various health care levels and categories considered, with a predominance of the secondary level, where infectious wastes stood out. Conclusions: Estimation of the volume of solid wastes revealed useful information for their management by the institutions involved, making it possible to foster reuse and recycling actions, estimate the human and material resources required, and program the training activities necessary for the establishment of a safe management system(AU)

Estrategia para la preparación de unidades de salud en buenas prácticas clínicas / Strategy for the preparation of health units for good clinical practices

Introducción: El entorno regulatorio mundial es cada vez más exigente para establecer, implementar y mantener el cumplimiento de las buenas prácticas clínicas (BPC). En Cuba, una respuesta necesaria derivada del desarrollo creciente de la industria farmacéutica y biotecnológica nacional fue la creación del Centro Nacional Coordinador de Ensayos Clínicos (CENCEC). Una de las misiones del CENCEC es preparar a las unidades-sitios clínicos seleccionados que realizan investigaciones clínicas, para su posterior certificación en BPC por la autoridad reguladora nacional, con la finalidad de avalar la calidad que corresponde al proceso de investigación clínica que redunda en una esmerada atención y protección al paciente objeto de estudio. Objetivo: Describir la estrategia del CENCEC para la preparación en BPC de los sitios clínicos seleccionados del Sistema Nacional de Salud (SNS) que participan en ensayos clínicos. Métodos: Se revisan más de 250 documentos normativos emitidos por Europa, Estados Unidos, Japón y los países nórdicos relacionados con aspectos prácticos y éticos para la implementación de las BPC...

Background: The global regulatory environment is increasingly demanding to establish, implement, and maintain the compliance with Good Clinical Practices (GCP). In Cuba, The National Coordinating Center for Clinical Trials (CENCEC) was created as a necessary response derived from the increasing development of the national pharmaceutical and biotechnological industry. One of the missions of the CENCEC is to prepare selected clinical units/sites that conduct clinical research for a further certification in GCP by the national regulatory authority in order to guarantee the quality that corresponds to the process of clinical research, resulting in a careful attention and protection of the patient under study. Objective: To describe the strategy of the CENCEC for the preparation of good clinical practices in the selected clinical sites of the National Health System (SNS) that participate in clinical trials. Methods: More than 250 regulatory documents issued by Europe, the United States, Japan and the Nordic countries, related to ethical and practical aspects for the implementation of good clinical practices, were reviewed...

Vector control services: malaria supply chain management in facilities standard operations manual

Use of malaria medicines is essential and critical in our response to the malaria situation in Guyana. It is part of the final link between patients and health services. Availability of malaria medicines and diagnostic supplies can only be realized by improving the opportunity to manage these commodities in an efficient manner. For these reasons, this manual will address all aspects of the pharmaceutical management cycle. The manual provides basic information for the successful operation of the supply chain for Malaria Medicines and Supplies. The intention is to use this manual for training and orientation of health workers in best practices of the drug management cycle, in pursuit of securing performance improvements to the malaria program.