O modelo brasileiro para o controle das infecções hospitalares: após vinte anos de legislação, onde estamos e para onde vamos?

Abstract

Hospital infections are a major problem in world public heath, increasing morbidity, mortality and length of hospitalization; they also bring on microbial resistance and consequent increase in health care costs In order to assess the impact of the model adopted officially, inaccordance with the rules and the legislation published by the FederalGovernment, we have carried out an analysis of two databases developed by the Brazilian Healthcare Surveillance Agency in association the University of São Paulo, School of Public Health. The databases comprise information on the organization of infection control committees and the development of infection control activities in 4,148 hospitals in 1,009 Brazilian municipalities. The contents of hospital databases show similarities in terms of proportion of federal, state, municipal and private hospitals, regarding the number of beds and geographic distribution of the 6,012 hospitals registered at the Ministry of Health in December 2003. The research on municipality organization shows a low rate of response. Only 18% of a total of 5,528 questionnaires sent to municipal health managers in Brazil were returned. Analysis of the results indicates that infection control activities made compulsory in 1983 are still not complied with by several hospitals. However, in the global analysis, 3,152 (76%) informed they have a nominated Infection Control Committee (CCIH); 3,194 institutions (77%) state they carry outhospital infection surveillance; 2,012 (49%) develop infection control programs (PCIH); 1,839 (44%) offer specific training in infection control; 1,356 (33%) adopt a plan in case of hospital outbreaks situations.Among the 1,102 institutions with intensive care beds, 92% (1,014)informed to have a CCIH; 94% (1,039), hospital infection surveillance; 78% (865), PCIH; 72% (790), education in hospital infection control; and 59% (655), have a plan for nosocomial infections outbreaks. The institutions that do not have intensive care beds presented the following percentages of such actions: 71% (2.163), 70% (2.119), 38% (1.147), 34% (1.049), and 23% (701), respectively. The hospital infection surveillance emerged as the most present infection control activity in hospitals. Nevertheless, only 7.2% (252) of the xviii 3,478 hospitals indicated the use of reference diagnosis criteria for hospital infection surveillance (NNIS/CDC criteria). Smaller hospitals (less than 50 beds), not complex hospitals (no intensive care beds) and hospitals managed by the municipalities have presented, in a statistical significant and independent way, the lowest rates in preventive actions in infection control demanded by federal legislation. These results show the necessity to review the current model, with an adjustment to the needs of hospitals of different size and complexity and administration. They have also indicated the need of greater technical improvement in order to allow essential actions, such as epidemiological surveillance, up to the execution of important infection control activities, such as education of healthcare professionals and the general population, as well as preparedness plans for hospital epidemics.