OCCUPATI ONAL ACCI DENTS I NVOLVI NG BI OLOGI CAL MATERI AL AMONG PUBLI C
HEALTH W ORKERS
Mônica Bonagam ba Chiodi1 Mar ia Helena Palucci Mar ziale2 Mar ia Lúcia do Car m o Cr uz Robazzi3
Ch iodi MB, Mar ziale MHP, Robazzi MLCC. Occu pat ion al acciden t s inv olv in g biological m at er ial am on g pu blic healt h w or k er s. Rev Lat ino- am Enfer m agem 2007 j ulho- agost o; 15( 4) : 632- 8.
This descript ive research aim ed t o recognize t he occurrence of work accident s ( WA) involving exposure t o biological m at er ial am ong healt h w or ker s at Public Healt h Unit s in Ribeir ão Pr et o- SP, Br azil. A quant it at iv e appr oach w as adopt ed. I n 2004, 155 accident s w er e not ified by m eans of t he Wor k Accident Com m unicat ion ( WAC) . Sixt y- t wo accident s ( 40% ) involved exposure t o biological m at erial t hat could cause infect ions like Hepat it is and Aids. The highest num ber of vict im s ( 42 accident s) cam e from t he cat egory of nursing aids and t echnicians. Needles were responsible for 80.6% of accident s and blood was t he biological m at erial involved in a m aj orit y of occu p at ion al ex p osu r e cases. Th is su b j ect n eed s g r eat er at t en t ion , so t h at p r ev en t ion m easu r es can b e im plem ent ed, which consider t he peculiarit ies of t he act ivit ies carried out by t he different professional cat egories.
DESCRI PTORS: nur sing; w or k ; occupat ional healt h; public healt h
ACCI DENTES DE TRABAJO CON MATERI AL BI OLÓGI CO ENTRE TRABAJADORES DE
UNI DADES DE SALUD PÚBLI CA
La finalidad de est a invest igación descript iva con aproxim ación cuant it at iva fue invest igar la ocurrencia de accident es de t r abaj o ( AT) con ex posición a m at er ial biológico ent r e t r abaj ador es de salud que act úan en Unidades de Salud Publica del Municipio de Ribeirão Pret o- SP, Brasil. Se regist raron, m ediant e la Com unicación de Acciden t e de Tr abaj o ( CAT) , 1 5 5 acciden t es du r an t e el añ o de 2 0 0 4 . En 6 2 de est os acciden t es ( 4 0 % ) ocur r ió la ex posición del t r abaj ador a m at er iales biológicos que podr ían causar infecciones com o hepat it is y sida. An t e la pr opor cion alidad de las cat egor ías ex pu est as, se obser v ó u n m ay or n ú m er o de v íct im as en la cat eg or ía d e au x iliar es y t écn icos d e en f er m er ía, con 4 2 accid en t es. Las ag u j as f u er on r esp on sab les p or 80, 6% de los accident es y la sangr e fue el m at er ial biológico inv olucr ado en la m ay or ía de las ex posiciones ocu pacion ales. El t em a m er ece m ay or at en ción par a qu e m edidas pr ev en t iv as pu edan ser im plem en t adas, consider ándose las peculiar idades de las act iv idades r ealizadas en las difer ent es cat egor ías pr ofesionales.
DESCRI PTORES: enfer m er ía; t r abaj o; salud ocupacional; salud pública
ACI DENTES DE TRABALHO COM MATERI AL BI OLÓGI CO ENTRE TRABALHADORES DE
UNI DADES DE SAÚDE PÚBLI CA
Pesq u isa d escr it iv a d e ab or d ag em q u an t it at iv a q u e t ev e com o ob j et iv o in v est ig ar a ocor r ên cia d e aciden t es de t r abalh o ( AT) com ex posição a m at er ial biológico en t r e t r abalh ador es da saú de, at u an t es em Unidades de Saúde Pública do Município de Ribeirão Pret o, SP. Foram regist rados por m eio da Com unicação de Aciden t e de Tr abalh o ( CAT) 1 5 5 AT n o an o 2 0 0 4 , sen do qu e em 6 2 aciden t es ( 4 0 % ) h ou v e ex posição do t r ab alh ad or a m at er ial b iológ ico p assív el d e ocasion ar in f ecções com o Hep at it e e AI DS. Con sid er an d o a p r o p o r ci o n a l i d a d e d a s ca t eg o r i a s ex p o st a s, f o i co n st a t a d o q u e a ca t eg o r i a d e a u x i l i a r es e t écn i co s d e enfer m agem foi a m ais v it im ada, com 42 acident es ( 67, 7% ) . As agulhas for am r esponsáv eis por 80, 6% das inj úr ias e o sangue foi o m at er ial biológico envolvido na m aior ia das exposições ocupacionais. O t em a m er ece m aior at enção par a que m edidas pr ev ent iv as possam ser im plem ent adas, consider ando- se as peculiar idades das at iv idades ex ecu t adas nas difer ent es cat egor ias pr ofissionais.
DESCRI TORES: enfer m agem ; t r abalho; saúde ocupacional; saúde pública
Disponible en castellano/ Disponível em língua portuguesa SciELO Brasil w w w .scielo.br/ rlae 1
I NTRODUCTI ON
A
ccording t o t he Minist ry of Social Securit y( 1), occu pat ion acciden t s ( OA) ar e def in ed as acciden t st hat occur in perform ing work in a firm ’s service or yet
by t he exercise of work by especially insured workers,
causing body inj ur y or funct ional disor der t hat leads
t o d eat h , t o t h e p er m an en t o r t em p o r ar y l o ss o r
reduct ion of work capacit y. Occupat ional accident s are
t radit ionally classified as t ype or t ypical accident s ( t hose
t hat occurred in t he w ork environm ent and/ or during
t he w or k j our ney ) , r out e accident s ( t hose t hat occur
in t he t raj ect ory from hom e t o work and from work t o
hom e) and t hose relat ed t o work.
This is an issue of nat ional and int er nat ional
r e l e v a n ce d u e t o t h e l o sse s i t ca u se s t o h e a l t h
w or k er s, em ploy m en t in st it u t ion s an d gov er n m en t al
inst it ut ions.
Regar ding healt h inst it ut ion w or k er s, t he OA
can b e r elat ed t o a ser ies of p r ed isp osin g f act or s,
due t o t he peculiarit ies of hum an care act ivit ies. Am ong
t h e se , o ccu p a t i o n a l v i o l e n ce , p h y si ca l , ch e m i ca l ,
biological, psy chosocial and er gonom ic fact or s st and
out( 2).
A st udy perform ed at healt h unit s in
Cuiaba-MT, Brazil, dem onst rat ed t hat violence in t he nur sing
w or k cont ex t in healt h unit s happens in t w o dist inct
w a y s : s t r u c t u r a l / i n s t i t u t i o n a l a n d b e h a v i o r a l /
r el a t i o n a l , w h i ch t u r n i n t o t h e f o l l o w i n g t y p es o f
v iolen ce: st r u ct u r al v iolen ce ( im posit ion t o w or k er s
of physical and m ent al overload) ; repressive violence
( denying t he right t o im plem ent care act ivit ies safely
an d t o act in a saf e w or k en v ir on m en t ) ; v iolen ce
alien at ion ( ex p licit ly im p ed in g w or k er s t o p er f or m
com pet ent ly, effect ively and pr ofessionally and t o be
socially v alu ed) ; an d classic v iolen ce ( ph y sical an d
v er b a l a g g r essi o n s b y h ea l t h t ea m m em b er s a n d
user s)( 2 ).
Th e p h y sical f act or s ar e r elat ed t o sev er al
for m s of ener gy w or k er s m ight be ex posed t o, such
as: n oise, v ibr at ion s, abn or m al pr essu r es, ex t r em e
t e m p e r a t u r e s , i o n i z i n g r a d i a t i o n s , n o n - i o n i z i n g
radiat ions such as infrasound and ult rasound. Chem ical
f a ct o r s a r e ca u se d b y ch e m i ca l a g e n t s, t h a t i s,
subst ances, com pounds or chem ical product s t hat can
penet r at e t he or ganism by t he r espir at or y r out e, in
t he form of dust , sm oke, haze, fog, gases or vapors,
o r y e t w h i ch , b y t h e n a t u r e o f t h e a ct i v i t y a n d
exposur e, can be in cont act w it h or absor bed by t he
or ganism t hr ough t he sk in or ingest ion( 3).
Psy ch o so ci al f act o r s can b e asso ci at ed t o
fat igue and t ension; loss of cont rol on t he j ob; im pact
of night and shift w or k schedules, ov er t im e, double
sh i f t s; su b o r d i n a t ed w o r k ; d i sq u a l i f i ca t i o n o f t h e
w o r k e r ; w o r k i n t e r r u p t e d b y f r a g m e n t e d a n d
r e p e t i t i v e t a s k s ; a c c e l e r a t e d p a c e o f w o r k( 4 ).
Er gonom ic fact or s ar e r elat ed t o t he adopt ion of an
i n a d e q u a t e a n d / o r p r o l o n g e d p o st u r e d u r i n g t h e
t r a n s p o r t a n d m o v e m e n t o f u s e r s , e q u i p m e n t ,
m at er ials and t o non- adapt able fur nit ur e, w or k pace
and shift w or k schem e am ong ot her s( 5).
B i o l o g i c a l f a c t o r s a r e r e p r e s e n t e d b y
biological agent s like bact eria, fungi, bacilli, parasit es,
m icr oor gan ism s an d v ir u ses( 4 ). Th ese ar e t h e m ost
evident due t o t he exposure t o blood and body fluids
t hat cause infect ion, due t o bloodborne pat hogens like
t he hepat it is B ( HBV) , hepat it is C ( HCV) and Acquired
I m m u n odef icien cy Sy n dr om e ( AI DS) v ir u ses, w h ich
c a n b e l e t h a l . Th i s c o n t a m i n a t i o n o c c u r s m o r e
f r equ en t ly t h r ou gh t h e cu t an eou s r ou t e, du e t o OA
w it h pier cing and cut t ing m at er ial.
The m ain causes at t ribut ed t o t he occurrence
of OA wit h piercing and cut t ing m at erial are: discarding
in inadequat e sit es or overloaded recipient s, t ransport
o r m a n i p u l a t i o n o f u n p r o t e c t e d n e e d l e s a n d
disconnect ion of needle from t he syringe, but t he m ain
associat ed fact or is needle recapping w hich, alt hough
r ecom m ended for y ear s t hr ough st andar d pr ecaut ion
m easures, has been evidenced as a cause of bet ween
15 and 35% of OA wit h piercing and cut t ing m at erial( 6).
Th e OA h a v e b e e n a d d r e sse d i n se v e r a l
s t u d i e s i n v o l v i n g h e a l t h w o r k e r s i n h o s p i t a l
inst it ut ions. How ev er, lit t le at t ent ion has been giv en
t o Prim ary Healt h Net work Unit s: Prim ary Healt h Unit
( PHU) ; Dist r ict Pr im ar y Healt h Un it ( DPHU) ; Fam ily
Healt h Cent er ( FHC) and Urgency Medical Care Service
( UMCS) , w h i ch d eser v e at t en t i o n d u e t o t h e h i g h
num ber of workers act ing in t hese inst it ut ions in Brazil,
who com pose t he st ruct ure of t he Single Healt h Syst em
( SUS) , an d also du e t o t h e pecu liar it ies pr esen t in
t h e se w o r k u n i t s, w h i ch d i f f e r f r o m t h e h o sp i t a l
en v ir on m en t .
The work act ivit ies perform ed in t he PHU are
r el at ed t o w el co m i n g an d em er g en cy car e o f l o w
severit y or com plexit y. I t is t he ent rance door t o t he
SUS. At t he DPHU, which funct ions 24 hours per day,
t he act ivit ies are direct ed t o t he delivery of care t hat
cor r esponds t o t he fir st lev el of m edium - com plex it y
car e ( secon dar y lev el)( 7 ). At t h e FHC, t h e act iv it ies
and recovery of people in an int egral and cont inuous
w ay( 8).
The UMCS is av ailable 24 hour s per day for
r escu e ca l l s f r o m t h e en t i r e ci t y( 9 ). Th e w o r k e r s’
act iv it ies ar e r elat ed t o h ealt h car e in u r gen cy an d
em er gency sit uat ions. The w or k er s go t o t he sit e of
t he occurrence, offer first aid and forward t he pat ient
t o t h e i n st i t u t i o n s d e t e r m i n e d b y t h e Re g u l a t i o n
Cen t r al .
Most st udies about occupat ional risks carried
o u t i n t h e Pr i m a r y H e a l t h N e t w o r k a p p o i n t t h e
psychosocial risk as t he m ost report ed by workers( 10).
I n a r esear ch per f or m ed at a Pu blic Healt h Un it in
Ribeir ão Pr et o, SP, Br azil, it w as dem onst r at ed t hat
46.7% of t he workers populat ion considered t he work
env ir onm ent as t he m ost st r essing fact or and t hat a
m aj orit y ident ified t he risk of infect ion due t o exposure
t o biological m at erial and t he exist ence of dangerous
sit uat ions in t he work sit e, due t he aggressiveness of
t he assist ed client ele, as one of t he t riggering fact ors
of st ress( 11- 12).
What m ot ivat ed us t o perform t his st udy was
t he fact t hat , in 2001, 52% of t he t ot al num ber of OA
not ified by Nursing professionals from t he healt h unit s
of t he Municipal Gov er nm ent of Ribeir ão Pr et o- SP( 13)
inv olv ed ex posur e t o biological m at er ial.
OBJECTI VE
I n v est ig at e t h e occu r r en ce of occu p at ion al
accid en t s in v olv in g ex p osu r e t o b iolog ical m at er ial
am ong healt h w or k er s in Public Healt h Unit s.
MATERI AL AND METHOD
I t is an explorat ory research wit h a qualit at ive
a p p r o a c h f o r d a t a a n a l y s i s . Co m m u n i c a t i o n s o f
Occupat ion Accident s ( COA) w ere surveyed, involving
exposure t o biological m at erial in 2004, at t he Dist rict
Pr i m a r y Hea l t h Un i t s, Fa m i l y Hea l t h Cen t er s a n d
Ur g en cy Med ical Car e Ser v ices of Rib eir ão Pr et o
-SP. Th e au t h o r s co l l ect ed d at a i n t h e f i l es o f t h e
Occu p at ion al Med icin e an d Saf et y Div ision ( OMSD)
of t he Municipal Governm ent of Ribeirão Pret o - SP in
Ma y 2 0 0 5 . Th e d a t a w e r e r e c o r d e d i n a s c r i p t
elaborat ed by t he aut hors, wit h inform at ion regarding
t h e i n j u r ed w o r k er s’ ch ar act er i st i cs ( g en d er, ag e,
m a r i t a l s t a t u s , p l a c e o f w o r k a n d p r o f e s s i o n a l
cat egor y ) and OA char act er ist ics ( inj ur ed body par t ,
biological m at er ial inv olv ed, w hat obj ect caused t he
a c c i d e n t ; a c t i v i t y p e r f o r m e d w h e n t h e a c c i d e n t
occu r r ed; acciden t m ot iv e) .
The st udy was perform ed in accordance wit h
t h e r equ ir em en t s of Resolu t ion 1 9 6 / 9 6 on r esear ch
i n v o l v i n g h u m a n b e i n g s a n d a p p r o v e d b y t h e
inst it ut ional r ev iew boar d fr om t he Univ er sit y of São
Paulo at Ribeir ão Pr et o College of Nur sing/ USP.
RESULTS AND DI SCUSSI ON
St udy sit e char act er ist ics
The OMSD is r esponsible t o r egist er OA t hat
o ccu r i n al l h eal t h u n i t s f r o m t h e Pr i m ar y Heal t h
Net w or k of Ribeir ão Pr et o- SP, div ided in fiv e r egions
called Healt h Dist rict s. They are locat ed in t he following
r egions: Nor t h - Sim ioni Dist r ict , Sout h - Vila Vir ginia
D i s t r i c t , Ea s t Ca s t e l o B r a n c o D i s t r i c t , We s t
-Su m ar ezin h o Dist r ict an d Cen t r al - Cen t r al Dist r ict .
There is a Dist rict Prim ary Healt h Unit in each Healt h
D i st r i ct w h i ch , i n a d d i t i o n t o p r i m a r y ca r e i n i t s
c o v e r a g e a r e a , i s a l s o a r e f e r r a l u n i t f o r s o m e
specialt ies for t he ent ire dist rict . The Dist rict s are also
com posed by sev er al Healt h Pr im ar y Unit s, aim ed at
d eliv er in g p r im ar y car e in t h e m ed ical, d en t al an d
nursing areas t o t he populat ion in it s coverage area( 14).
I n 2 0 0 4 , 2 8 1 8 w or k er s w er e act iv e in t h e
Rib eir ão Pr et o Healt h Secr et ar y( 1 4 ). A t ot al of 1 5 5
occu pat ion acciden t s w er e r egist er ed in t h is per iod
an d , in 4 0 % of t h em , t h e w or k er w as ex p osed t o
biological m at er ial. The incidence of OA r epr esent ed
a coefficient of 22 OA per 1000 exposed workers per
y ea r.
These r esult s suggest t he occur r ence of OA
u n d er n ot if icat ion w h en w e con sid er t h e n u m b er of
w o r k e r s e x p o se d a n d t h e h i g h n u m b e r o f t a sk s
p er f o r m ed w i t h p i er ci n g an d cu t t i n g m at er i al an d
exposure t o secret ions, which are vehicles of infect ions
am on g h ealt h w or k er s, especially f r om t h e n u r sin g
a r ea .
Th e OA u n d e r n o t i f i ca t i o n a m o n g n u r si n g
w or k er s w as alr eady iden t ified in t h e h ospit al ar ea,
where it reaches alarm ing levels. I n a st udy perform ed
in a hospit al in Ribeirão Pret o- SP, OA undernot ificat ion
w as r ev ealed in 9 1 . 9 % an d acciden t s w it h pier cin g
an d cu t t in g m at er ial r ep r esen t ed t h e h ig h est r at e
j ust ified by workers because t hey considered t he inj ury
v e r y s m a l l ( 5 3 . 1 % ) a n d a l s o d u e t o a l a c k o f
k now ledge about t he obligat ion t o com m unicat e t he
OA( 6).
Dur ing dat a collect ion, w e obser ved t hat t he
m aj or it y of t he COA w as not pr oper ly filled out and
t hat t he r ecor ds cont ained blank s. Such infor m at ion
is im por t ant t o ident ify t he act ual accident sit uat ion
at t h e ser v ice. Th is f act in d icat es t h at t h e ser v ice
under st udy needs t o adopt new st r at egies in or der
t o im pr ov e t he infor m at ion r ecor ds.
Char act er ist ics of t he inj ur ed w or k er
Dat a indicat ed t hat 82.3% of t he OA occurred
wit h fem ale workers. This result is relat ed t o t he fact
t hat m ost ( 75.6% ) w or k er s in t he PHU and DPHU in
Ribeir ão Pr et o ar e w om en( 12). The nur sing pr ofession
in Brazil is com posed by 88.26% of wom en, according
t o dat a by t he Federal Nursing Council( 15).
Regar din g t h e ch ar act er ist ics of t h e in j u r ed
workers, t he average age was 41 years, wit h 23 years
as t he m inim um and 61 as t he m axim um age; 51.6%
of t hem w er e bet w een 40 and 61 y ear s and 48. 4%
bet ween 20 and 39 years old. Regarding m arit al st at us,
61.3% of t hem w er e m ar r ied.
The following t able shows t he dat a relat ed t o
t h e n u m b er o f w o r k er s ex p o sed acco r d i n g t o t h e
p r o f e ssi o n a l ca t e g o r y a n d t h e n u m b e r o f i n j u r e d
w or k er s in t he st udy per iod.
Table 1 - Dist ribut ion of t he num ber of inj ured workers
e x p o se d t o b i o l o g i ca l m a t e r i a l a cco r d i n g t o t h e
p r o f e ssi o n a l ca t e g o r y a n d n u m b e r o f r e g i st e r e d
w or ker s. Ribeir ão Pr et o, SP, 2004
of w or k er s in t he nur sing aid cat egor y at t he st udy
i n s t i t u t i o n . Th i s p r o f e s s i o n a l c a t e g o r y i s a l s o
r esponsible for t he highest num ber of OA r ecor ds in
t he hospit al sect or according t o t he result s of a st udy
perform ed in Ribeirão Pret o- SP, where 62.99% of t he
not ified OA occur r ed am ong nur sing aids( 16).
I n Br azil, nur sing aids r epr esent m or e t han
h alf of t h e t ot al n u m b er of n u r sin g w or k er s in t h e
cou n t r y. Accor din g t o dat a in f or m ed b y t h e Feder al
Nu r sin g Cou n cil ( COFEN) , t h e n u r sin g w or k for ce is
com posed by : nur ses ( 13. 35% ) , nur sing t echnicians
( 2 4 . 4 7 % ) , n u r s i n g a i d s ( 5 9 . 0 4 % ) a n d n u r s i n g
at t endant s ( 3.12% )( 15).
Dent al surgeons were t he second professional
cat egor y in t er m s of in j u r ed pr of ession als, w it h 1 1
( 17.7% ) r egist er ed accident s, follow ed by phy sicians
wit h 05 ( 8.1% ) exposures. One ( 1.6% ) of t he inj ured
professionals did not inform t he professional cat egory.
When t he r isk coefficient w as calculat ed for
t h e OA per 1 0 0 0 w or k er s ex posed per y ear, it w as
v er if ied t h at n u r sin g t ech n ician s an d aids w er e t h e
cat eg or y w it h t h e h ig h est occu r r en ce of accid en t s
( 70.35) , follow ed by dent al surgeons ( 30.38) , nurses
( 14.85) and physicians ( 7.78) . I n one of t he r ecor ds
an aly zed , on e of t h e in j u r ed p r of ession als d id n ot
infor m t he pr ofessional cat egor y.
The places of work corresponded t o t he public
h ealt h u n it s of t h e cit y. Figu r e A sh ow s t h e r esu lt s
obt ained in t he analy sis of t his r efer r ed v ar iable.
l a n o i s s e f o r P y r o g e t a C s r e k r o w f o o N l a p i c i n u M n i d e r e t s i g e r y r a t e r c e S h tl a e H s r e k r o w o N d e r u j n
i 1C00o0efeifcxipeonsteodfrwisokrkpeerrs
s e s r u
N 202 3 14.85 , s n a i c i n h c e T s d i A g n i s r u
N 597 42 70.35 s t s it n e
D 362 11 30.38 s n a i c i s y h
P 642 5 7.78 d e m r o f n i t o
N - 1
-l a t o
T 1803 62 34.38
* Technicians and aids are considered as t he sam e cat egory since t hey execut e t he sam e work act ivit ies. The nur sing w or k er s r egist er ed 45 OA ( 72.5
% ) w it h exposure t o biological m at erial. Fort y- t w o of
t hese ( 67.7% ) belonged t o t he nursing t echnician and
aid* cat egory and t hree vict im s ( 4.8% ) w ere nurses.
These dat a were expect ed due t o t he high cont ingency
2*7 &2*7 7/%5 %/% (*% 0QVKPHQTOGF
2*72TKOCT[*GCNVJ7PKV &2*7&KUVTKEV2TKOCT[*GCNVJ7PKV 7/%57TIGPE[/GFKECN%CTG5GTXKEG %/%%CTG/CPCIGOGPV%GPVGT (*%(COKN[*GCNVJ%GPVGT
Figure 1 - Num ber of WA according t o work sit e
A t ot al of 30 OA w as r egist er ed at t he PHU
( 48,38% ) . These dat a differ fr om t hose pr esent ed in
a st udy carried out earlier at t he sam e inst it ut ion( 13),
where DPHU were responsible for t he highest num ber
Reg ar d in g t h e accid en t ch ar act er ist ics, t h e
follow ing variables w ere analyzed: inj ured body part ;
biological m at er ial in v olv ed; obj ect t h at cau sed t h e
accid en t ; act iv it y p er f or m ed at t h e m om en t of t h e
a cci d e n t ; r e a so n t h e p e r so n g o t i n j u r e d . Th e se
v a r i a b l e s w e r e s e l e c t e d f o r a n a l y s i s s i n c e t h e y
perm it t ed showing t he circum st ances in which t he OA
occur r ed, w it h a v iew t o planning st r at egies for t he
pr ev ent ion of t hese OA.
Regarding t he inj ured body part , t he superior
lim bs cor r espon ded t o 9 3 . 5 % of t h e OA, w h ile t h e
fingers were inj ured in 80.6% of t he event s. The dat a
corroborat e wit h ot her st udies and wit h t he m ost recent
nat ional st at ist ics, where m ore t han 1/ 3 of occupat ional
accident s in Brazil affect t he workers’ hands. I n 2004,
for ex am ple, in 161, 000 accident s, hands, w r ist and
finger s w er e inj ur ed( 17).
Regar ding t he biological m at er ial inv olv ed in
t he exposure, 82.3% of t he workers had cont act wit h
blood. The cont act w it h blood can be r esponsible for
t he t ransm ission of t he HI V and hepat it is viruses. The
lit er at ur e show s t hat , due t o OA inv olv ing ex posur e
t o blood, 99 healt h workers were infect ed wit h HI V as
consequence of accident al inoculat ions( 6 ).
I n 80.6% of t he OA, needles caused piercing
in j u r ies an d , in 4 . 8 % , scalp el b lad es cau sed cu t s.
Th ese f igu r es ar e sim ilar t o t h ose f ou n d in st u dies
perform ed in t he hospit al area of t he sam e cit y, where
89.35% of t he OA were caused by needles and 6.4%
by scalpel blades( 1 8 ). Th ese obj ect s, called pier cin g
and cut t ing m at er ial, also caused 52.01% of t he OA
acco r d i n g t o a st u d y p r ev i o u sl y p er f o r m ed at t h e
W MSD( 1 3 ). Ta b l e 2 sh o w s t h e d i st r i b u t i o n o f OA
accor ding t o t he obj ect t hat caused t he inj ur ies.
Table 2 - Dist r ibut ion of t he num ber of OA involv ing
ex posu r e t o biological m at er ial at t h e Pu blic Healt h
unit s of Ribeirão Pret o, SP, 2004
execut ion of glucose and penicillin t est s and 9.7% in
m ed icat ion ad m in ist r at ion . Th ese d at a cor r ob or at e
findings of a st udy perform ed in hospit als of Ribeirão
Pret o - SP( 19), where 89.5% of t he OA occurred when
t h e se sa m e a ct i v i t i e s t h a t i n v o l v e d t h e co n st a n t
handling of needles w er e per for m ed.
Dent al surgeries were responsible for 17.74%
o f t h e OA. Su t u r es co r r esp o n d ed t o 1 1 . 2 9 % a n d
d i sca r d i n g cu t t i n g m a t e r i a l t o 9 . 6 8 % o f t h e OA.
Re g a r d i n g t h e d i sca r d i n g o f p i e r ci n g a n d cu t t i n g
m at er ial, ot h er st u dies r epor t t h is occu r r en ce, w it h
an av er age of 10 t o 20% of OA( 6). The cleansing of
t h e w or k p lace af f ect ed 4 . 8 4 % of w or k er s, 3 . 2 2 %
occu r r ed d u r in g w ou n d d r essin g an d 1 . 6 1 % in t h e
placem ent of nasogast r ic t ubes.
As t o t he m ot ive why t he worker got inj ured,
in 59.68% of t he COA, t here was no inform at ion about
t he r eason at t r ibut ed t o t he OA. Am ong t he m ot iv es
infor m ed, 1 6 . 1 3 % indicat ed t he user as r esponsible
for t he OA, due t o m ov ing dur ing car e deliv er y and,
in 3 . 2 2 % , t h e m ot iv e w as t h e accid en t al collision
bet w een w or k er s.
Am ong t he not ified accident s, 6. 45% of t he
w or k er s g ot in j u r ed w h en t h ey w er e d iscon n ect in g
t h e u n cap p ed n eed le f r om t h e sy r in g e an d 9 . 6 8 %
w hen act iv ely r ecapping t he needle, pr ocedur es not
r ecom m en d ed b y saf et y n or m s an d in t er n at ion ally
r e c o m m e n d e d s t a n d a r d p r e c a u t i o n s . Th e r e i s
ev iden ce in lit er at u r e t h at t h e n on u se of st an dar d
p r ecau t ion s f av or s t h e occu r r en ce of OA in v olv in g
exposure t o pot ent ially cont am inat ed m at erial am ong
nur sing w or k er s( 6). The im plem ent at ion of in- ser v ice
educat ion st rat egies is recom m ended in t his sit uat ion.
CONCLUSI ONS
The workers act ive in Public Healt h Unit s are
e x p o se d t o t h e r i sk o f OA i n v o l v i n g e x p o su r e t o
b i o l o g i ca l m a t e r i a l b e ca u se t h e y h a n d l e se v e r a l
piercing and cut t ing m at erials and are in cont act wit h
m at er ial an d p at ien t s con t am in at ed b y p at h og en ic
m icr oor ganism s, including HI V ( AI DS) , HBV and HCV
( h e p a t i t i s) . Th i s r i sk o f e x p o su r e i s a so u r ce o f
concern because of t he high incidence of pat ient s wit h
t heses v ir uses in Brazil. How ever, a lit erat ur e r ev iew
r ev ealed lit t le r esear ch st u d y in g t h is p op u lat ion of
w o r k er s.
I t was found t hat , in 2004, from t he 155 OA
regist ered am ong t he 2818 workers from t he Ribeirão s t c e j b o g n i t t u c d n a g n i c r e i
P N %
e l d e e
N 50 80.6
e d a l b l e p l a c
S 04 6.5
ll i r d l a c i r e h p s
E 01 1.6
e l i f c i t n o d o d n
E 01 1.6
n w o n k n
U 02 3.2
y l p p a t o n s e o
D 04 6.5
l a t o
T 62 100
Th e act iv it ies per f or m ed at t h e m om en t of
t h e OA w er e of pr of ession al com pet en ce an d all of
t h em co n t ai n ed t h e r i sk of ex p osu r e t o b i ol og i cal
m at er ial, especially blood. Tw ent y- one per cent of t he
Pret o Healt h Secret ary, 62 were exposed t o biological
m at er ial. Wh en con sider in g t h e n u m ber of w or k er s
ex posed, t he num ber of OA and t he v ar iet y of t ask s
inv olv ing r isk of ex posur e t o biological m at er ial, it is
inferred t hat accident s m ust have been undernot ified,
w h i ch sh o u l d b e i n v est i g a t ed m o r e t h o r o u g h l y i n
a n o t h e r r e se a r ch . Th i s st u d y sh o u l d a t t e m p t t o
d i sco v er t h e m o t i v es t h at m ak e Heal t h Secr et ar y
w o r k er s n o t i f y t h e o ccu p a t i o n a l i n j u r i es t h ey a r e
vict im s of or not .
Th e a cci d e n t s t h a t o ccu r r e d i n t h e w o r k
sit uat ion under st udy can be charact erized as follows:
wom en were vict im s in 82.3% of t he event s regist ered
in t he public healt h unit s; 51.6% of t he inj ured workers
were m ore and 48.4% less t han 40 years old; 61.3%
m ar r ied; belon gin g t o t h e n u r sin g t ech n ician or aid
cat eg or y ( coef f icien t of accid en t occu r r en ce 7 . 0 4 ) ;
w or k ed in t he Dist r ict Pr im ar y Healt h Unit s; suffer ed
per cut aneous lesions ( 95% ) , especially in t he finger s
( 80.6% ) , and inv olv ing ex posur e t o blood ( 82.3% ) .
Alt hough less fr equent , m out h, eye and face
were also sit es of cont act wit h biological m at erial. This
warns us about t he need t o use I ndividual Prot ect ion
Equipm ent ( I PE) lik e glasses and m ask s.
The obj ect s t hat caused t he accident s w er e
needles ( 80.6% ) . Unfort unat ely, in Brazil, t he needles
available in t he pr im ar y healt h net w or k and in m any
hospit als do not hav e safet y dev ices. The discar ding
of piercing and cut t ing m at erial caused 9.68% of t he
in j u r ies.
The regist ered OA occurred w hile perform ing
v en i p u n ct u r e ( 4 8 . 4 % ) , m ed i ca t i o n a d m i n i st r a t i o n
( 9.7% ) . The result s of t his st udy call at t ent ion t o dent al
sur ger ies, w her e 17. 7% of t he OA occur r ed. Am ong
t h e m ot iv es f or t h e OA, in 5 9 . 7 % of t h e COA, t h is
i m p o r t an t i n f o r m at i o n w as n o t p r o v i d ed , w h i ch i s
co n si d e r e d a h i n d e r i n g f a ct o r t o p l a n p r e v e n t i v e
m easu r es.
A m o n g t h e r e g i s t e r e d m o t i v e s , 1 6 . 1 %
occu r r ed du e t o t h e pat ien t an d 3 . 2 % du e t o w or k
colleagu es. Ar ou n d 1 0 % of t h e OA occu r r ed du e t o
act iv e n eedle r ecappin g, w it h ou t f ollow in g st an dar d
p r ecau t ion s.
The dat a obt ained in t his st udy indicat e t hat
t he st r at egies t o pr ev ent t he occur r ence of OA w it h
p ier cin g an d cu t t in g m at er ial m u st in clu d e act ion s
est ablished bet ween workers and service m anagem ent
and m ust focus on t he im provem ent of work condit ions,
especially w or k or ganizat ion, supply of m at er ial w it h
safet y devices, im plem ent at ion of educat ive program s
an d ch an ge of w or k beh av ior s. I solat ed act ion s ar e
consider ed ineffect ive t o m inim ize such inj ur ies.
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