I NTENSI VE CARE UNI T PROFESSI ONALS’ KNOW LEDGE AND BEHAVI OR RELATED TO THE
ADOPTI ON OF CONTACT PRECAUTI ONS
Adr iana Cr ist ina de Oliv eir a1 Clar eci Silv a Car doso2 Dan iela Mascar en h as3
Oliv eir a AC, Car doso CS, Mascar enhas D. I nt ensiv e car e unit pr ofessionals’ k now ledge and behav ior r elat ed t o t he adopt ion of cont act pr ecaut ions. Rev Lat ino- am Enfer m agem 2009 set em br o- out ubr o; 17( 5) : 625- 31.
This st udy aim ed t o assess t he know ledge and behavior of professionals w orking in I nt ensive Care Unit s ( I CU) r elat ed t o t he adopt ion of cont act pr ecaut ions for t he cont r ol of hospit al infect ions ( HI ) . This cr oss- sect ional st udy used a sem i- st r uct ur ed quest ionnair e t o collect dat a. Descr ipt iv e and m ult iv ar iat e analy ses w er e car r ied out , including logist ic regression and decision t ree using CHAI D algorit hm . A t ot al of 102 professionals part icipat ed in t he st udy, of whom 36.3% present ed appropriat e knowledge and 51% appropriat e behavior in relat ion t o HI con t r ol m easu r es. Nu r sin g pr of ession als h ad alm ost f ou r t im es m or e ch an ce ( OR = 3 . 5 8 , CI 1 . 4 8 - 8 . 6 8 ) of pr esen t in g appr opr iat e beh av ior t h an t h e r em ain in g pr of ession als. Th e m u lt iv ar iat e an aly sis did n ot r ev eal v ar iables associat ed w it h know ledge. No st at ist ically significant associat ion w as found bet w een know ledge and behav ior ( p = 0. 196) . These r esult s suggest t he need t o im plem ent educat ional act iv it ies so as t o per m it a balan ce bet w een t h eor y an d pr of ession als’ pr act ice con cer n in g HI pr ev en t iv e m easu r es, aim in g t o im pr ov e k n ow ledge an d beh av ior .
DESCRI PTORS: int ensiv e car e unit s; cr oss infect ion; r isk fact or s
CONOCI MI ENTO Y COMPORTAMI ENTO DE LOS PROFESI ONALES DE UN CENTRO DE
TERAPI A I NTENSI VA EN RELACI ÓN A LA ADOPCI ÓN DE LAS PRECAUCI ONES DE
CONTACTO
El obj et iv o f u e ev alu ar el con ocim ien t o y com por t am ien t o de los pr of esion ales de u n CTI en r elación a la adopción de pr ecauciones de cont act o par a el cont r ol de las infecciones hospit alar ias ( I H) . Se r ealizó est udio t r an sv er sal, u t ilizan d o u n cu est ion ar io sem iest r u ct u r ad o p ar a r ecolección d e d at os. Fu e r ealizad o an álisis descr ipt iv o y m ult iv ar iado ( r egr esión logíst ica y algor it m o CHAI D) . Par t icipar on del est udio 102 pr ofesionales, 36, 3% pr esent ar on conocim ient o adecuado y 51% com por t am ient o adecuado par a las m edidas de cont r ol de I H. Los profesionales de enferm ería present aron casi cuat ro veces m ás probabilidad ( OR= 3,58; I C; 1,48–8,68) de t ener com port am ient o adecuado que los dem ás profesionales. Ninguna variable fue asociada al conocim ient o. No hubo asociación est adíst icam ent e significat iva ent re conocim ient o y com port am ient o ( p= 0,196) . Se evidenció la necesidad de im plem ent ar act iv idades de or ient ación capaces de per m it ir el equilibr io ent r e la t eor ía y la práct ica de los profesionales en lo que se refiere a m edidas de prevención de I H, con el obj et ivo de perfeccionar el conocim ient o y el com por t am ient o.
DESCRI PTORES: unidades de t er apia int ensiv a; infección hospit alar ia; fact or es de r iesgo
CONHECI MENTO E COMPORTAMENTO DOS PROFI SSI ONAI S DE UM CENTRO DE TERAPI A
I NTENSI VA EM RELAÇÃO À ADOÇÃO DAS PRECAUÇÕES DE CONTATO
Obj et iv ou- se av aliar o conhecim ent o e com por t am ent o dos pr ofissionais de um CTI em r elação à adoção das precauções de cont at o para o cont role das infecções hospit alares ( I H) . Realizou- se est udo t ransversal, ut ilizando-se quest ionário ilizando-sem iest rut urado para colet a de dados. Foi realizada análiilizando-se descrit iva e m ult ivariada ( regressão logíst ica e algor it m o CHAI D) . Par t icipar am do est u do 1 0 2 pr of ission ais, 3 6 , 3 % apr esen t ar am con h ecim en t o adequado e 51% com por t am ent o adequado par a as m edidas de cont r ole de I H. Pr ofissionais de enfer m agem apresent aram quase quat ro vezes m ais chance ( OR= 3,58; I C 1,48–8,68) de t er com port am ent o adequado que o s d e m a i s p r o f i s s i o n a i s . N e n h u m a v a r i á v e l f o i a s s o c i a d a a o c o n h e c i m e n t o . N ã o h o u v e a s s o c i a ç ã o est at ist icam ent e significat iv a ent r e conhecim ent o e com por t am ent o ( p= 0,196) . Ev idencia- se a necessidade de im plem ent ar at iv idades de or ient ação capazes de per m it ir equilíbr io ent r e t eor ia e pr át ica dos pr ofissionais no t ocant e às m edidas de pr ev enção de I H, v isando apr im or ar o conhecim ent o e o com por t am ent o.
DESCRI TORES: unidades de t er apia int ensiv a; infecção hospit alar ; fat or es de r isco
1RN, Ph.D. in Nursing, Adj unct Professor, Escola de Enferm agem , Universidade Federal de Minas Gerais, Brazil, e- m ail: acoliveira@ufm g.br; 2Psychologist ,
Ph.D., m em ber, Research Group in Epidem iology, Universidade Federal de Minas Gerais, Brazil, e- m ail: nepircs@hot m ail.com ; 3RN, M.Sc., Coordinat or,
I nt ensive Care Unit , Hospit al Felicio Rocho, Brazil, e- m ail: nepircs@hot m ail.com .
I NTRODUCTI ON
T
her e ar e r epor t s concer ning high m or t alit y r at es an d dissem in at ion of epidem ic diseases sin cea n c i e n t t i m e s . On l y r e c e n t l y, h o w e v e r, h o s p i t a l
infect ions becam e an im por t ant focus of at t ent ion of
gov er n m en t agen cies( 1 - 3 ).
The occur r ence of HI can be fav or ed by t he
d issem in at ion of m icr oor g an ism s, w h et h er t h r ou g h
professionals’ hands or t hrough equipm ent and/ or used
solu t ion s. Based on t h e ex p osed , ap p r op r iat e an d
u p d a t e d k n o w l e d g e a b o u t r e c o m m e n d a t i o n s t o
p r e v e n t a n d co n t r o l h o sp i t a l i n f e ct i o n s, m o d e o f
t r an sm ission an d w ay s t o pr ev en t dissem in at ion of
m icr oor g an ism s am on g h ealt h p r of ession als sh ou ld
b e i m p e r a t i v e . We s t r e s s t h a t a s i m p o r t a n t a s
k n o w l ed g e i t sel f i s i t s i m p l em en t at i o n i n p r act i ce
t h r o u g h c o r r e c t b e h a v i o r c o n c e r n i n g i s o l a t i o n
pr ecaut ions( 2- 6).
Am ong t he sev er al car e unit s, t he I nt ensiv e
Car e Unit ( I CU) st ands out as t he sect or t hat poses
t he highest risk of hospit al infect ion and dissem inat ion
o f b a c t e r i a l r e s i s t a n c e , c o n s i d e r i n g t h e t y p e o f
pat ient s, high fr equency of ant ibiot ics, pr ofessional/
pat ient cont act and t he r upt ur e of t he t issue bar r ier
in pat ient s subm it t ed t o inv asiv e pr ocedur es( 2- 5).
Thus, considering t he I CU as t he sect or wit h
t he highest risk for t he occurrence of hospit al infect ion
and a cent er for t he em ergence and dissem inat ion of
m i cr o o r g a n i sm s, t h i s st u d y a i m e d t o a sse ss t h e
knowledge and behavior of professionals from an I CU
in r elat ion t o t he adopt ion of cont act pr ecaut ions for
t he cont r ol of hospit al infect ions.
MATERI AL AND METHODS
Th is is a cr oss- sect ion al st u d y, car r ied ou t
bet ween May and Oct ober 2007 in a large philant hropic
general hospit al wit h capacit y for 180 beds locat ed in
Belo Horizont e, MG, Brazil. I t delivers care t o pat ient s
w it h pr iv at e healt h insur ance and t h ose cov er ed by
t h e p u b lic h ealt h in su r an ce. I t h as st at e- of - t h e- ar t
t echnology, highly specialized services and an int ensive
car e unit and is char act er ized as a com plex m edical
cent er, based on t he use of new t echnology and it s
per sonnel’s level of educat ion. The unit of st udy w as
t he int ensive adult m edical- surgery care unit , com posed
of 20 beds wit h an average perm anence of five days
and 1,156 adm issions/ year. I t t akes cares of severely
ill clinical pat ient s and pat ient s wit h surgical pat hologies
o f se v e r a l sp e ci a l t i e s, i n a d d i t i o n t o so l i d o r g a n
t ransplant at ions, including pancreas, kidneys and liver.
Th e st u d y ’s t ar g et p o p u l at i o n i n cl u d ed al l
m em ber s of t h e in t en siv e car e t eam . Th e f ollow in g
inclusion crit eria were used: belonging t o t he I CU t eam
an d b ein g act iv ely in v olv ed in car e d eliv er y at t h e
t im e of dat a collect ion. Professionals on vacat ion and/
or m edical leave during dat a collect ion were excluded.
Al l p r o f essi o n al s w o r k i n g i n t h e I CU w er e
individually invit ed t o part icipat e in t he st udy. The first
cont act w it h pr ofessionals w as v er bal, follow ed by a
free and inform ed consent agreem ent , explaining t he
st u d y ’s o b j ect i v es an d p u r p o se. Par t i ci p at i o n w as
v olunt ar y w it h no financial gr at ificat ion.
A sem i- st r u ct u r ed qu est ion n air e, div ided in
t h r ee par t s, w as dev eloped f or dat a collect ion : I –
d e m o g r a p h i c c h a r a c t e r i s t i c s ; I I – k n o w l e d g e o f
p r o f e s s i o n a l s a b o u t c o n t a c t p r e c a u t i o n s ; I I I –
p r o f essi o n al s’ b eh av i o r r eg ar d i n g t h e ad o p t i o n o f
cont act precaut ions. The inclusion of t hese t hree part s
in t he quest ionnair e aim ed t o sur v ey how t he m ult
i-p r o f e s s i o n a l t e a m e x i-p r e s s e d b e h a v i o r s a n d
k n o w l ed g e i n r el a t i o n t o t h e a d o p t i o n o f co n t a ct
p r ecau t ion s.
Kn o w l e d g e a n d b e h a v i o r w e r e t r e a t e d a s
d i c h o t o m o u s v a r i a b l e s , t h a t i s , a p p r o p r i a t e o r
inappr opr iat e: a r at e of cor r ect answ er s abov e 75%
for each quest ionnair e w as consider ed appr opr iat e( 5).
Dat a were analyzed t hrough descript ive st at ist ics wit h
pr esent at ion of fr equency dist r ibut ion. Pear son’s
Chi-s q u a r e o r Fi Chi-s c h e r ’ Chi-s e x a c t t e Chi-s t w a Chi-s u Chi-s e d w h e n
a p p r o p r i a t e , w i t h a 9 5 % co n f i d e n ce i n t e r v a l , i n
addit ion t o t he Kappa t est for analysis of agreem ent .
To evalu at e associat ion bet w een k n ow ledge
and behavior on t he one hand and sociodem ographic
charact erist ics on t he ot her, m ult ivariat e analysis was
used wit h t he decision t ree algorit hm t hrough t he
Chi-sq u ar e Au t om at ic I n t er act ion Det ect or ( CHAI D)( 7 ).
Binar y logist ic r egr ession w as car r ied out t o v alidat e
t he result s of t he classificat ion t ree, whereas variables
w it h p v alu es p≤0 . 2 5 in t h e biv ar iat e an aly sis w er e included in t he m ult ivariat e m odel. Collect ed dat a were
a n a l y zed u si n g St a t i st i ca l Pa ck a g e f o r t h e So ci a l Sciences ( SPSS) soft w ar e ( v er sion 13. 0) .
Th e p r o j e c t f o l l o w e d t h e g u i d e l i n e s f o r
r e se a r ch i n v o l v i n g h u m a n su b j e ct s a cco r d i n g t o
Resolut ion 196/ 96 of t he Nat ional Healt h Council( 8) and
was subm it t ed t o and approved by t he Research Et hics
RESULTS
Of t he 120 professionals working in t he I CU,
102 ( 85% ) w ere eligible and agreed t o part icipat e in
t h e s t u d y. Th e y w e r e a l l o t t e d i n t h e f o l l o w i n g
ca t e g o r i e s: n u r si n g t e ch n i ci a n s ( 5 4 9 % ) , n u r se s
( 1 2 , 7 % ) , p r e ce p t o r p h y si ci a n s ( 1 0 . 8 % ) , st u d e n t
p h y si o t h er ap i st ( 8 . 8 % ) , p r ecep t o r p h y si o t h er ap i st
( 7.8% ) and r esident phy sician ( 4.9% ) .
Th e f em ale g en d er p r ev ailed ( 7 3 . 5 % ) , t h e
m aj orit y w as bet w een 22 and 27 years old and ages
varied from 22 t o 57 years ( m edian 31.5) . Wit h regard
t o t im e of graduat ion, t here was a great er percent age
of pr ofessionals w it h 5 and 11 year s ( 30.7% ) .
As t o pr of ession al ex per ien ce, t h e m aj or it y
( 5 1 % ) h ad u p t o t h r ee y ear s of ex p er ien ce in t h e
h o sp i t a l a n d I CU ( 5 6 . 9 % ) . Fo r t y p e r ce n t o f t h e
par t icipant s w or k ed dur ing t he day shift , follow ed by
4 2 . 2 % w ho w or k ed in t he night shift and a sm aller
n u m b er ( 8 . 8 % ) o f p r o f essi o n al s ( p h y si ci an s) w h o
w o r k e d b o t h s h i f t s ( d a y a n d n i g h t ) . H a l f o f
pr ofessionals had only one j ob, 39. 2% had t w o and
10% had m ore t han t wo j obs.
Kn ow ledge of pr of ession als abou t h ospit al in f ect ion
con t r ol m easu r es
This st udy’s result s revealed t hat only 36.3%
of in t er v iew ees ob t ain ed a r at e of cor r ect an sw er s
superior t o 75% , which was considered t he m inim um
lev el of appr opr iat e k now ledge( 5 ).
Co m p a r i s o n b e t w e e n g r o u p s o f
p r of ession als, t ak in g in t o accou n t t h eir k n ow led g e,
sh ow ed on ly on e d if f er en ce f or t h e v ar iab le “ w or k
sh if t ” ( p = 0 . 0 4 9 ) , t h ou g h w it h b or d er lin e st at ist ical
si g n i f i ca n ce . Th e n i g h t sh i f t p r e se n t e d a sm a l l e r
p e r c e n t a g e o f p r o f e s s i o n a l s w i t h a p p r o p r i a t e
k n o w l e d g e .
Le s s t h a n h a l f o f p r o f e s s i o n a l s s c o r e d
ap p r op r iat e k n ow led g e lev els ( p r ecep t or p h y sician ,
n u r s e , n u r s i n g t e c h n i c i a n a n d s t u d e n t
p h y siot h er ap ist ) . We also v er if ied t h at t h e lev el of
k n o w l e d g e w a s d i f f e r e n t a m o n g t h e s e v e r a l
pr ofessional cat egor ies and t hat not all pr ofessionals
f r om an y of t h e cat eg or i es p r esen t ed ap p r op r i at e
k n ow led g e.
Accor din g t o t h e r esu lt s of t h e m u lt iv ar iat e
an aly sis t h r ou gh t h e classif icat ion t r ee, n o v ar iable
was kept in t he final m odel associat ed t o knowledge;
r esult s fr om t he logist ic r egr ession w er e sim ilar.
Result s on t he percent age of correct answers
r elat ed t o t h e ev alu at ed t op ics on k n ow led g e an d
pr of ession al cat egor y ar e pr esen t ed in Table 1 . We
observe t hat a sm aller percent age of correct answers
w as found am ong st udent phy siot her apist s.
All pr ofession al cat egor ies obt ain ed a sm all
p er cen t ag e of cor r ect an sw er s w i t h r eg ar d t o t h e
cont act pr ecaut ion r ecom m endat ions and t he use of
I n d i v i d u a l Pr o t e c t i o n Eq u i p m e n t ( I PE) , e x c e p t
p r ecep t o r p h y si o t h er a p i st s. Kn o w l ed g e a b o u t t h e
obj ect iv es of con t act pr ecau t ion s w as ≤5 0 % f or all ev alu at ed p r of ession als.
Table 1 – Dist r ibut ion of cor r ect answ er s by pr ofessional cat egor y in r elat ion t o t opics evaluat ing k now ledge
-Belo Hor izont e, 2007
* Nurs Tech – nursing t echnician; Prec phys – precept or physician; Res phys - resident physician; Prec physio – precept or physiot herapist ; St u physio – st udent physiot herapist .
s c i p o t e t a u l a v
E Nursef
% 3 1 = n h c e T s r u N * % 6 5 = n s y h p c e r P * % 1 1 = n s y h p s e R * % 5 = n o i s y h p c e r P * % 8 = n o i s y h P u t S * % 9 = n g n i h s a w d n a
H 100 96.4 100 100 100 100
r o t n e it a p h c a e o t y r e v il e d e r a c r e t f a s e v o l g e r u d e c o r p f o g n i d r a c s i D e r u d e c o r
p 100 96.4 100 100 100 100
g n i h s a w d n a h d n a s e v o l g e r u d e c o r
P 100 96.4 81.8 100 87.5 100
n o it c e f n i f o n o i s s i m s n a r
T 76.9 75 90.9 100 100 88.9
n o i s s i m s n a r t m s i n a g r o o r c i m f o n o it n e v e r
P 92.3 80.4 100 80 62.5 55.6
s n o it u a c e r p t c a t n o c f o n o it a d n e m m o c e
R 69.2 66 63.6 60 87.5 33.3
n i e s u t n e it a p r o f d e d n e m m o c e r t n e m p i u q e n o it c e t o r p l a u d i v i d n I n o it u a c e r p t c a t n o
c 61.5 43 54.6 60 75 44.4
s n o it u a c e r p t c a t n o C f o e v it c e j b
Beh av i or of p r of essi on al s con cer n i n g m easu r es t o cont r ol hospit al infect ion
Acco r d i n g t o p r o f essi o n a l s’ a n sw er s, o n l y 5 1 % sh o w e d a p p r o p r i a t e b e h a v i o r i n r e l a t i o n t o pr ecaut ion m easur es accor ding t o Table 2.
Th e c o m p a r i s o n b e t w e e n g r o u p s o f
Table 2 – Dist ribut ion of dem ographic variables according t o professionals’ behavior ( appropriat e x inappropriat e)
and st at ist ical significance ( n= 102) . Belo Hor izont e, 2007
* Chi- squar e
a- st udent physiot herapist b- precept or physiot herapist
The m ult ivar iat e m odel ( decision t r ee by t he
CHAI D al g o r i t h m ) u sed t o i n v est i g at e t h e f act o r s
a sso ci a t e d t o b e h a v i o r i n r e l a t i o n t o p r e ca u t i o n
m e a s u r e s r e v e a l e d t h a t t h e v a r i a b l e t h a t b e s t
d i scr i m i n a t ed b eh a v i o r w a s p r o f essi o n a l ca t eg o r y
( p= 0.003) . Nursing professionals present ed a great er
per cen t age of appr opr iat e beh av ior ( 6 0 . 8 7 % ) w h en
com p ar ed t o ot h er p r of ession als ( 3 0 . 3 0 % ) . Sim ilar
result s were found in t he logist ic regression, in which
n u r sin g p r of ession als p r esen t ed alm ost f ou r t im es
m o r e c h a n c e o f h a v i n g a p p r o p r i a t e b e h a v i o r
com p ar ed t o t h e r em ain in g p r of ession als OR= 3 . 5 8
( CI 95% : 1. 48 – 8. 68) .
Th e d i st r i b u t i o n o f b e h a v i o r a cco r d i n g t o
p r o f e s s i o n a l c a t e g o r y i s p r e s e n t e d i n Ta b l e 3 .
Pr e ce p t o r a n d r e si d e n t p h y si ci a n s p r e se n t e d t h e
h i g h e s t n u m b e r o f t o p i c s w i t h l o w l e v e l s o f
c o r r e c t a n s w e r s . A l l p r o f e s s i o n a l c a t e g o r i e s
o b t a i n e d a sm a l l p e r ce n t a g e o f co r r e ct a n sw e r s
f o r co n t a ct p r eca u t i o n s, w h en i n d i ca t ed , a n d u se
o f g o w n .
Glove use behavior w as m ore appropriat e as
opposed t o t he low adher ence t o hand w ashing.
Kn ow ledge an d beh av ior
No st at ist ically significant associat ion bet ween
knowledge and behavior was found in t his st udy, which
present ed a low level of agreem ent bet ween variables
( Kappa 0 . 4 3 6 ) .
p r o f e ssi o n a l s w i t h a p p r o p r i a t e a n d i n a p p r o p r i a t e
behavior reveals significant differences for t he variables
gender ( fem ale) , pr ofessional cat egor y ( nur sing) and
w o r k sh i f t ( d a y ) , p≤0 . 0 5 . An d , f o r i n a p p r o p r i a t e behavior, a difference was found bet ween professionals
working t wo work shift s: day and night ( 89% ) .
e l b a i r a v c i h p a r g o m e
D Appropriate ) % ( n r o i v a h e b e t a i r p o r p p a n I ) % ( n r o i v a h e
b Pvalue*
c i h p a r g o m e D e l b a i r a v e t a i r p o r p p A ) % ( n r o i v a h e b e t a i r p o r p p a n I ) % ( n r o i v a h e
b Pvalue*
r e d n e
G Timeofworkatthehospital
e l a m e
F 43(57.3) 32(42.7) 0.031 ≤1year 13(50) 13(50) 0.621
e l a
M 9(33.3) 18(66.7) >1to≤3years 16(61.5) 10(38.5)
e g n a r e g
A >3to≤10years 13(48.1) 14(51.9)
d l o s r a e y 7 2 o t 2
2 14(50) 14(50) 0.704 >10to≤25years 10(43.5) 13(56.5)
d l o s r a e y 1 3 o t 8
2 14(60.9) 9(39.1) TimeofworkattheICU
d l o s r a e y 8 3 o t 2
3 13(50) 13(50) ≤1year 12(48) 13(52) 0.270
d l o s r a e y 7 5 o t 9
3 11(44) 14(56) >1to≤3years 20(60.6) 13(39.4)
) 0 5 ( 4
1 14(50) >3to≤8years 11(57.9) 8(42.1)
y r o g e t a c l a n o i s s e f o r
P >8to≤25years 9(36) 16(64)
n a i c i n h c e t g n i s r u
N 32(57.1) 24(42.9) 0.019 Workshift
e s r u
N 10(76.9) 3(23.1) Day 28(56) 22(44) 0.042
n a i c i s y h p r o t p e c e r
P 3(27.3) 8(72.7) Night 23(53.5) 20(46.5)
t s i p a r e h t o i s y h P u t
S a 3(33.3) 6(66.7) DayandNight 1(11,1) 8(88.9)
t s i p a r e h t o i s y h P t p e c e r
P b 4(50) 4(50) Numberofjobs
n a i c i s y h P t n e d i s e
R 0(0) 5(100) 1job 25(49) 26(51) 0.183
n o it a u d a r g e c n i s e m i
T 2jobs 24(60) 16(40)
s r a e y 5 . 2
< 10(40) 15(60) 0.373 3jobs 2(22.2) 7(77.8)
≥2.5to<5years 11(57.9) 8(42.1) 4jobs 1(50) 1(50)
Table 3 – Percent age of correct answers in relat ion t o t opics evaluat ing behavior by professional cat egory. Belo
Hor izont e, 2007
* Nurs Tech – nursing t echnician; Prec phys – precept or physician; Res phys - resident physician; Prec physio – precept or physiot herapist ; St u physio – st udent physiot herapist .
DI SCUSSI ON
On l y 3 6 . 3 % o f p r o f e s s i o n a l s p r e s e n t e d
appropriat e knowledge in relat ion t o hospit al infect ion
co n t r o l m e a su r e s. No v a r i a b l e w a s a sso ci a t e d t o k n ow led g e ab ou t HI con t r ol m easu r es. Ap p r op r iat e
b e h a v i o r w a s f o u n d i n 5 0 % o f t h e p a r t i ci p a n t s, r e v e a l i n g s i g n i f i c a n t a s s o c i a t i o n w i t h n u r s i n g
p r o f essi o n al s. Ho w ev er, n o asso ci at i o n w as f o u n d
bet ween knowledge and behavior in relat ion t o cont act p r ecau t ion s.
This st udy’s result s appoint t o a considerable
d i v e r g e n c e o f k n o w l e d g e b e t w e e n p r o f e s s i o n a l cat egories, a fact t hat can be explained by t he different
ap p r oach es in t h e ed u cat ion an d t r ain in g of t h ese
p r o f e ssi o n a l s( 9 ). Ad d i t i o n a l l y, so m e p r o f e ssi o n a l s v olu n t ar ily seek t o im p r ov e k n ow led g e acq u ir ed in
under gr aduat e pr ogr am s and t r aining. For ex am ple,
a phy sician , w h et h er a r esiden t or pr ecept or, seek s t o deepen his/ er k now ledge about et iology, w ay s of
t r a n s m i s s i o n , d i s s e m i n a t i o n a n d p r e v e n t i o n o f
diseases. On t h e ot h er h an d, n u r sin g pr of ession als focus on t he car e pr ocess.
A s m a l l p e r c e n t a g e o f n e w l y g r a d u a t e
pr ofessionals and ev en pr ofessionals w it h m or e t im e sin ce g r ad u at ion w it h ap p r op r iat e k n ow led g e w er e
obser ved, w hich indicat es lack of updat ed know ledge
about precaut ion m easures for t he cont rol of HI . This finding is som ewhat int riguing if we consider t hat lack
of knowledge in t he analyzed sam ple was independent
o f t i m e si n ce g r a d u a t i o n . I t su g g est s a b eh a v i o r con t r ad ict or y t o t h e law s of t h e j ob m ar k et , sin ce
h e a v y c o m p e t i t i v e n e s s ( d u e t o t h e e x p o n e n t i a l
i n cr e a se i n t h e n u m b e r o f sch o o l s, e sp e ci a l l y i n
n u r sin g) an d lack of st abilit y at w or k ( sin ce it is a
privat e inst it ut ion, as opposed t o professional st abilit y
in public inst it ut ions) should encour age pr ofessionals
t o con st an t ly at t em p t t o u p d at e an d im p r ov e t h eir
pr ofessional per for m ance, w hich w as not v er ified.
I n addit ion , despit e “ easy ” access t o h igh er
edu cat ion , a st u dy car r ied ou t w it h sen ior st u den t s
in n u r sin g pr ogr am s appoin t ed a lack of k n ow ledge
i n r e l a t i o n t o p r e c a u t i o n m e a s u r e s r e l a t e d t o
d i s e a s e s w i t h h i g h l e v e l s o f t r a n s m i s s i b i l i t y b y
c o n t a c t , d r o p l e t s o r a e r o s o l s . Th i s f a c t e n t a i l s
im p or t an t im p licat ion s w h en on e ev alu at es sp ecif ic
k n ow ledge of a t eam in r elat ion t o t h e adopt ion of
c o n t a c t p r e c a u t i o n s a n d r e v e a l s t h a t q u a l i t y o f
ed u cat ion is a d ef icien t f act or( 9 ).
Th e l o w n u m b e r o f p r o f e s s i o n a l s w i t h
appr opr iat e k n ow ledge abou t con t act pr ecau t ion s is
w or r y ing, since bact er ial r esist ance has incr eased all
o v er t h e w o r l d an d i s p r ev al en t i n i n t en si v e car e
unit s( 10). However, research carried out am ong nurses
in a pu blic h ospit al in Goian ia, Br azil r ev ealed t h at
t h e im p lem en t at ion of st an d ar d p r ecau t ion s in t h e
pr act ice of t hese pr ofessionals is dir ect ed r elat ed t o
t h e i r k n o w l e d g e a n d u n d e r s t a n d i n g a b o u t t h e
subj ect( 11).
On l y 5 1 % o f p r o f e s s i o n a l s o b t a i n e d
a p p r o p r i a t e b e h a v i o r i n r e l a t i o n t o p r e c a u t i o n
m easures in t his st udy. I n t his perspect ive, im port ant
st u dies sh ow ed h ealt h pr of ession als’ low adh er en ce
t o p r ecau t ion m easu r es, w h ich m ay b e r elat ed t o
s t c e j b u S d e t a u l a v
E Nurses
% 3 1 = n h c e t s r u N * % 6 5 = n s y h P c e r P e r
P *n=11%
s y h p s e R * % 5 = n o i s y h p c e r P e r P *n=8%
o i s y h p r p m I * % 9 = n s t n e it a p ll a r o f g n i r a c r e t f a g n i h s a w d n a
H 69.2 73.2 36.4 80 100 66.7
s t n e it a p h t i w t c a t n o c r e t f a d n a e r o f e b g n i h s a w d n a
H 76.9 91 36.4 60 87.5 100
s e v o l g e r u d e c o r p g n i s u e r o f e b g n i h s a w d n a
H 84.6 78.6 63.6 60 62.5 66.7
s e v o l g e r u d e c o r p g n i s u r e t f a g n i h s a w d n a
H 84.6 87.5 63.6 60 100 77.8
s m s i n a g r o o r c i m f o n o i s s i m s n a r t e h t t n e v e r p o t g n i h s a w d n a
H 100 67.9 100 40 37.5 22.2
s d n a h n o t r i d t n e r a p p a f o e c n e s b a e h t n i g n i h s a w d n a
H 69.2 64.3 81.8 80 37.5 55.6
e r u d e c o r p h c a e r o t n e it a p h c a e o t y r e v il e d e r a c r e t f a s e v o l g g n i d r a c s i
D 100 96.4 90.9 100 100 88.9
t n a t s i s e r h t i w d e t c e f n i/ d e z i n o l o c s t n e it a p e t a l u p i n a m o t E P I s m s i n a g r o o r c i
m 100 89.3 81.8 80 100 100
d e t a c i d n i n e h w n o it u a c e r p t c a t n o
C 61.5 50 54.6 20 75 33
n o it u a c e r p t c a t n o c t p o d a n e h w s n w o g e s
U 53.8 69.6 27.3 20 62.5 77.8
n o it u a c e r p t c a t n o c t p o d a n e h w s e v o l g e r u d e c o r p e s
several aspect s of hum an behavior, including t he false
percept ion of no risk and underest im at ion of individual
r e sp o n si b i l i t y i n t h e i n cr e a se d r a t e s o f h o sp i t a l
infect ion( 4- 5,12- 13).
T h e n u r s i n g p r o f e s s i o n a l c a t e g o r y w a s
a sso ci a t e d t o a p p r o p r i a t e b e h a v i o r i n r e l a t i o n t o
HI con t r ol m easu r es in t h e m u lt iv ar iat e an aly ses,
t r ee o f cl assi f i cat i o n an d l o g i st i c r eg r essi o n . Th i s
f i n d i n g m i g h t b e r el a t ed t o t h e f a ct t h a t n u r si n g
p r o f e s s i o n a l s s p e n d m o r e t i m e w i t h p a t i e n t s ,
r epeat edly per f or m t h eir act iv it ies an d ar e r equ ir ed
t o at t en d m o r e ed u cat i o n al p r o g r am s as o p p o sed
t o o t h e r p r o f e s s i o n a l s . I n a d d i t i o n , n u r s e s ’
ap p r op r iat e b eh av ior can b e ex p lain ed b y t h e f act
t h a t t h e i r e d u c a t i o n i n c l u d e s m o r e i n f o r m a t i o n
a b o u t s t a n d a r d p r e c a u t i o n s . Pr o f e s s i o n a l s w h o
w o r k i n b o t h s h i f t s p r o b a b l y p r e s e n t e d
in ap p r op r iat e b eh av ior d u e t o p h y sical ex h au st ion
j u st if ied b y t h e h eav y w or k load .
A l t h o u g h 1 0 0 % o f p r e c e p t o r p h y s i c i a n s
r e p o r t e d a d h e r e n ce t o h a n d w a sh i n g t o p r e v e n t
t r an sm ission of m icr oor g an ism s, w e ob ser v ed t h at
t his cat egory present ed t he lowest adherence t o hand
w ashing, befor e and aft er cont act w it h pat ient s and
aft er car e deliv er y t o all pat ient s, r egar dless of t heir
d iag n oses.
An o t h e r i n t e r e s t i n g f i n d i n g w a s t h e l o w
adher ence t o hand w ashing by pr ecept or phy sicians
before and aft er using gloves, despit e t he fact t hat a
large num ber of t hese professionals present ed correct
k n ow led g e ab ou t t h at b eh av ior. Th is f in d in g m ig h t
su g g est t h at k n ow led g e is n ot b ein g u sed in d aily
p r act ice.
We a l s o v e r i f i e d h i g h a d h e r e n c e o f
professionals t o t he use of gloves, as opposed t o t he
low adher ence t o hand w ashing. This pr act ice m ight
in dicat e gr eat er con cer n w it h on eself, ign or in g t h at
glov es do n ot r epr esen t ef f ect iv e pr ot ect ion du e t o
t h e pot en t ial pr esen ce of m icr o h oles, t r an sm ission
of m icr oor g an ism s an d also t h at it s u se d oes n ot
r eplace t he need for hand w ashing.
CONCLUSI ON
Th e r esu lt s of t h is st u d y r ev ealed t h e low
num ber of pr ofessionals w it h appr opr iat e k now ledge
an d b eh av ior con cer n in g con t act p r ecau t ion s. I t is
not ew or t hy t hat none of t he pr ofessional cat egor ies
pr esent ed sufficient k now ledge about t he obj ect iv es
of cont act pr ecaut ions.
Anot her im port ant result is t hat knowledge is
not necessarily t ranslat ed in appropriat e behavior. This
f in d in g can b e at t r ib u t ed t o a g ap b et w een t h eor y
a n d p r a ct i ce , w h i ch l e a d s t o t h e co n cl u si o n t h a t
professionals are prepared t o m echanically repeat and
per for m pr ocedur es w it hout cr it ical t hink ing( 13- 14).
Th e s e r e s u l t s a l s o a p p o i n t t h e n e e d f o r
educat ive act ivit ies in m ult idisciplinary t eam s, including
per iodical pr esent at ions about r at es of infect ion and
r esist an t m icr oor gan ism s.
We suggest t rainings, t hem at ic sem inars and
c l i n i c a l m e e t i n g s t h a t c a n b e h e l d d u r i n g t h e
pr ofessionals’ shift s and include t heir par t icipat ion in
t he definit ion of t opics and effect iv e par t icipat ion in
c a m p a i g n s , s u c h a s h a n d w a s h i n g , a d o p t i o n o f
i n d i v i d u a l p r o t e ct i o n e q u i p m e n t , a m o n g o t h e r s.
Mor eover, all pr ofessionals need t o be encour aged t o
p a r t i ci p a t e, p r o m o t i n g t h ei r a ck n o w l ed g m en t a n d
v alu at ion .
One lim it at ion of t his st udy is t hat a cr oss–
sect ional design does not perm it t o est ablish a relat ion
of cau se an d effect . I t did allow t h e r esear ch er s t o
b e t t e r u n d e r st a n d t h e p h e n o m e n o n a n d f a v o r e d
i m p r o v e d k n o w l e d g e o f i t s c h a r a c t e r i s t i c s a n d
o ccu r r en ce. Hen ce, t h e r esu l t s can su p p o r t o t h er
st udies on t his subj ect , preferably w it h a longit udinal
design, seek ing t o ev aluat e t he r elat ion of causalit y
bet ween behavior and knowledge of m ult iprofessional
t eam s f o r ad h er en ce t o co n t act p r ecau t i o n s. Th i s
st udy’s result s also cont ribut e t o t he advancem ent of
knowledge, considering t he lack of st udies addressing
k n ow ledge an d beh av ior of m u lt ipr of ession al t eam s
in r elat ion t o cont act pr ecaut ions.
REFERENCES
1. Minist ério da Saúde ( BR) . Port aria n0. 2616, de 12 de Maio d e 1 9 9 8 . Co n t r o l e d e i n f e cçã o h o sp i t a l a r. Br a síl i a ( D F) : Min ist ér io da Saú de; 1 9 9 8 .
2. Voslylius S, Sipylait e J, I vaskevicius J. I nt ensive care unit acquired infect ion: a prevalence and im pact on m orbidit y and m or t alit y. Act a An aest h esiol Scan d 2 0 0 3 ; 4 7 ( 9 ) : 1 1 3 2 - 7 .
3. Chen YY, Chou YC, Chou P. I m pact of nosocom ial infect ion on cost of illness and lengt h of st ay in int ensiv e car e unit s. I n f ect Con t r ol Hosp Ep id em iol 2 0 0 5 Mar ch ; 2 6 ( 3 ) : 2 8 1 - 7 . 4 . Ask ar ian M, Mclaw s ML, Mey lan M. Kn ow ledge, at t it u de, an d p r act ices r elat ed t o st an d ar d p r ecau t ion s of su r g eon s and physicians in universit y- affiliat ed hospit als of Shiraz, I ran. I n t er J I n f ect Diseases 2 0 0 7 Oct ob er ; 1 1 : 2 1 3 - 9 .
Pit t et D. Know ledge of st andart and isolat ion precaut ions in a lar ge t eaching hospit al. I nfect Cont r ol Hosp Epidem iol 2005; 2 6 ( 3 ) : 2 9 8 - 3 0 4 .
6. Askarian M, Ram in S, Mclaw s M. Know ledge, at t it ude, and p r a ct i ce o f co n t a ct p r eca u t i o n s a m o n g I r a n n u r ses Am J I n f ect Con t r ol 2 0 0 5 Oct ob er ; 3 3 ( 8 ) : 4 8 6 - 8 .
7 . B r e i m a n L, Fr e i d m a n JH , O l s h e n RA , S t o n e C J. Cl a ssi f i ca t i o n a n d r eg r essi o n t r ees. Bel m o n t . Ca l i f ó r n i a : Wad sw or t h , 1 9 8 4 . p . 1 - 5 4 .
8. Conselho Nacional de Saúde. Aspect os ét icos da pesquisa envolvendo ser es hum anos Resolução 196 de 10 de out ubr o d e 1 9 9 6 .
9 . Br ev id elli M, Cian ciar u llo T. Com p lian ce w it h st an d ar d -pr ecaut ions am ong m edical and nur sing st aff at a univ er sit y h ospit al. On lin e Br az J Nu r s [ per iódico n a in t er n et ] . 2 0 0 6 . [ cit ado 2007 set . 28] ; 5( 1) : [ cerca de 8 p.] . Disponível em : < ht t p: / / www.uff.br/ obj nursing/ index.php/ nursing/ art icle/ view/ 2 9 1 / 5 7 > .
10. Larson EL, Saim an L, Haas J, Neum ann A, Low y FD, Fat at o
B, et al. Perspect ive on ant im icrobial resist ance: est ablishing an in t er disciplin ar y r esear ch appr oach . Am J I n fect Con t r ol 2 0 0 5 Sep t em b er ; 3 3 ( 7 ) : 4 1 0 - 8 .
1 1 . Mel o D S, Si l v a e So u za AC, Ti p p l e AFV, Nev es Z CP, Per eir a MS. Nu r ses’ u n der st an din g of st an dar d pr ecau t ion s at a public hospit al in Goiania - GO, Br azil. Rev Lat ino- am En f er m ag em 2 0 0 6 set em b r o- ou t u b r o; 1 4 ( 5 ) : 7 2 0 - 7 . 1 2 . Pit t et D. Pr om ot ion of h an d h y g ien e: m ag ic, h y p e, or sci en t i f i c ch al l en g e? I n f ect Co n t r o l Ho sp Ep i d em i o l 2 0 0 2 Mar ch ; 2 3 ( 3 ) : 1 1 8 - 9 .
13. Bear m an GML, Mar ra AR, Sessler CN, Sm it h RW, Rosat o A, Laplant e KJ, et al. A cont r olled t r ial of univ er sal glov ing v er su s con t act pr ecau t ion s f or pr ev en t in g t h e t r an sm ission of m ult idr ug- r esist ant or ganism s. Am J I nfect Cont r ol 2 0 0 7 Decem b er ; 3 5 : 6 5 0 - 5 .
1 4 . Melo DS, Silv a SAC, Tip p le ACFV, Nev es Z CP, Per eir a MS. O en sin o do con t r ole de in f ecção: u m en saio t eór ico-p r á t i co . Re v La t i n o - a m En f e r m a g e m 2 0 0 3 m a r ço - a b r i l ; 1 1 ( 2 ) : 2 4 5 - 5 0 .
