Title : Primary health care: a challenge for infection control
The World Health Organization has placed patient safety as a high priority on the agenda, being the first challenge to reduce healthcare-associated infections (HAIs). HAIs are considered undesirable events arising out of the process of health care and represent a major concern for global public health. These infections prolong the length of hospital stay, increasing costs and mortality rates, besides prolonging the suffering experienced by the patients and their families.
The term HAIs has been used since the beginning of the 1990s replacing the term “hospital infection” actually considering that infections can be acquired wherever the health care is provided. This means that prevention measures should be applied not only in hospitals but also in outpatient services, hemodialysis services, nursing homes for the elderly, home care, dental clinics, and primary care.
In Brazil, primary care is mainly provided at Primary Health care Units (PHU), and, interconnected with other levels of care (secondary and tertiary) forms the Health Unic System (HUS). Despite the large number of patients being cared at PHU, there are only a few studies that assessed the incidence or risk of HAIs at these settings. Unlike hospitals that have well-structured surveillance systems, the PHU still lacks information HAIs rates, which is maybe due to the complexity and dynamics of the work process but also largely due to the lack of awareness about the problem.
The study included 65 patients, with a prevalence of Staphylococcus aureus and MRSA (wound and/or nasal cavity) of 64.6% (n=42) and 10.7% (n=7), respectively. No association was identified to either healthcare exposure or conformity of structure and process and the presence of MRSA. However, the mean value of the conformity index of the dressing process was low (59.7%). As for process evaluated, hand hygiene displayed a lower index, being performed only 41% of the times before and 72% after the completion of the dressing. This information leads to the question whether certain factors could favor the propagation of this agent among patients attending the same PHU. In this study, potential factors related to the work process, physical structure and the prescription of antibiotics were researched and demonstrated the occurrence of MRSA and the vulnerability to pathogen transmission of patients receiving wound care at PHU due to the low conformity index of structure and process for infection prevention.