Infection prevention and control in households: nursing challenges and implications

Valle, Andréia Rodrigues Moura da Costa; Andrade, Denise de; Sousa, Álvaro Francisco Lopes de; Carvalho, Priscila Rodrigues Moura de

doi:10.1590/1982-0194201600033

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Acta Paulista de Enfermagem

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Original Articles • Acta Paul Enferm. 29 (2) • Mar-Apr 2016 • https://doi.org/10.1590/1982-0194201600033 copy

Infection prevention and control in households: nursing challenges and implications

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

Identify the theoretical competences of nurses for the prevention and control of infections in home care based on the opinion of experts.

Methods

A quasi-experimental study based on the Delphi method, conducted in Basic Health Units of a capital in the Northeast region of Brazil and universities of four Brazilian regions. In total, 19 nurses from Family Health Strategy teams and 15 investigators recruited through snowball sampling participated in this study.

Results

After an evaluation and consensus among participants, a list was developed containing the competences that would allow the analysis of conceptual, procedural and contextual aspects for the prevention of infection in households.

Conclusion

Practices of infection prevention and control in home care are theoretical competences recognized by nurses; however, the theoretical bases should be reviewed and adapted at the healthcare and teaching levels. The categories listed in this study represent an instrument for future analysis and consideration for infection control in households.

Infection/prevention & control; Home nursing; Professional competence; Primary care nursing

Conceptual knowledge (CK) dimension
The theoretical competence to build knowledge of infection prevention and control in home care was synthesized in six conceptual groups:
CK I - Master knowledge of signs and symptoms of bacterial, fungal, viral and parasite infections, transmission mechanism and treatment;
CK II - Master and coordinate knowledge of microbiology with physiology, immunology, pathology, pharmacology (aspects of antimicrobial therapy) that may contribute to clinical diagnosis and support nursing interventions in infection prevention and control in home care;
CK III - Master knowledge of hospital infection and distinguish it from healthcare-associated infections;
CK IV - Master knowledge of the epidemiological surveillance system, its concepts and diseases of compulsory notification;
CK V - Master knowledge of microbial resistance and its implications, such as the policy for the rational use of antimicrobials.

Procedural knowledge (PK) dimension

The competences listed below highlight the need of nurses to master technical and scientific aspects of infection prevention and control procedures in home care for patients, their families, health professionals, community/environment, public policies:
PK I - Master knowledge of personal protective equipment, its use, handling and disposal of home care waste, including secretions, products and materials, as well as biosafety measures according to regulations and ministerial directives for home care;
PK II - Master knowledge of nursing techniques and care with biological risk in direct care provision (medication preparation and administration, use of indwelling catheters, nasogastric tubes and other catheters);
PK III - Master knowledge of maintenance procedures for a biologically safe home environment through surface cleaning and disinfection (starting from less contaminated to more contaminated areas, among other principles);
PK IV - Master knowledge of principles of asepsis and techniques of cleaning, decontamination, disinfection and sterilization of items used in home care, such as catheters, tweezes, scalpel blades;
PK V - Master knowledge of immunization schedule of the family and other situations requiring vaccine intervention, as well as vaccine-preventable diseases and adverse events following immunization.

Contextual knowledge (XK) dimension

Contextual knowledge is related to knowledge of specific characteristics of the public health system and framework, especially about home care and its insertion in the Brazilian Unified Health System (SUS, as per its acronym in Portuguese), its complexities, boundaries, potentialities, users and expectations in this context:
XK I - Master knowledge of home care policies, service categories, resources available, healthcare teams according to the level of complexity, specific competences and responsibilities of each service category;
XK II - Master knowledge of the factors that influence the individual and that can change daily situations in health processes of cultural, social, economic, spiritual and emotional nature.

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

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[1] Corresponding author. Álvaro Francisco Lopes de Sousa. Avenida dos Bandeirantes, 3900, 14040-902, Ribeirão Preto, SP, Brazil. alvarosousa@usp.br