Percepción del riesgo por parte del trabajador: la realidad ecuatoriana

El presente estudio demuestra la reducción del nivel de riesgo biológico por inoculación percutánea con material corto-punzante en la actividad de toma de muestras sanguíneas en el laboratorio de un centro médico de atención primaria de salud de Ecuador aplicando medidas higiénicas y de bioseguridad. Material y métodos: se aplicó la metodología BIOGAVAL de evaluación de riesgo biológico considerando; la identificación de los agentes biológicos principales, daños a la salud, mecanismos de transmisión, porcentaje de trabajadores vacunados, frecuencia de exposición y aplicación de medidas higiénicas. El presente estudio es de carácter descriptivo y longitudinal. Resultados: De los resultados obtenidos en la Fase 1, tras la aplicación del Método Biogaval, se evidenció que el nivel de riesgo biológico para la exposición a VHB, VHC y VIH superaba los niveles LEB y NAB, siendo el porcentaje de cumplimiento del cuestionario (medidas higiénicas) del 21%. Estableciendo un plan de corrección de las medidas higiénicas y de bioseguridad se cumplimentó hasta el 93% el cuestionario propuesto por el método, Fase 2, reduciendo de este modo, el nivel de riesgo para los agentes biológicos a niveles aceptables. Conclusiones: El método de cuantificación del nivel de riesgo por exposición a agentes biológicos empleado permite establecer las medidas higiénicas y de bioseguridad apropiadas para reducir el nivel de riesgo en la actividad de toma de muestras hasta condiciones no peligrosas en los trabajadores de laboratorio.

Development of the Andalusian Registry of Patients Receiving Community Case Management, for the follow-up of people with complex chronic diseases.

Background: Complex chronic diseases are a challenge for the current configuration of Health services. Case management is a service frequently provided for people with chronic conditions and despite its effectiveness in many outcomes, such as mortality or readmissions, uncertainty remains about the most effective form of team organization, structures, and the nature of the interventions. Many processes and outcomes of case management for people with complex chronic conditions cannot be addressed with the information provided by electronic clinical records. Registries are frequently used to deal with this weakness. The aim of this study was to generate a registry-based information system of patients receiving case management to identify their clinical characteristics, their context of care, events identified during their follow-up, interventions developed by case managers, and services used. Methods and design: The study was divided into three phases, covering the detection of information needs, the design and its implementation in the healthcare system, using literature review and expert consensus methods to select variables that would be included in the registry. Objective: To describe the essential characteristics of the provision of ca re lo people who receive case management (structure, process and outcomes), with special emphasis on those with complex chronic diseases. Study population: Patients from any District of Primary Care, who initiate the utilization of case management services, to avoid information bias that may occur when including subjects who have already been received the service, and whose outcomes and characteristics could not be properly collected. Results: A total of 102 variables representing structure, processes and outcomes of case management were selected for their inclusion in the registry after the consensus phase. Total sample was composed of 427 patients, of which 211 (49.4%) were women and 216 (50.6%) were men. The average functional level (Barthel lndex) was 36.18 (SD 29.02), cognitive function (Pfeiffer) showed an average of 4.37 {SD 6.57), Chat1son Comorbidity lndex, obtained a mean of 3.03 (SD 2.7) and Social Support (Duke lndex) was 34.2 % (SD 17.57). More than half of patients include in the Registry, correspond lo immobilized or transitional care for patients discharged from hospital (66.5 %). The patient's educational level was low or very low (50.4%). Caregivers overstrain (Caregiver stress index), obtained an average value of 6.09% (SD 3.53). Only 1.2 % of patients had declared their advanced directives, 58.6 had not defined the tutelage and the vast majority lived at home 98.8 %. Regarding the major events recorded at RANGE Registry, 25.8 % of the selected patients died in the first three months, 8.2 % suffered a hospital admission at least once time, 2.3%, two times, and 1.2% three times, 7.5% suffered a fall, 8.7% had pressure ulcer, 4.7% had problems with medication, and 3.3 % were institutionalized. Stroke is the more prevalent health problem recorded (25.1%), followed by hypertension (11.1%) and COPD (11.1%). Patients registered by NCMs had as main processes diabetes (16.8%) and dementia (11.3 %). The most frequent nursing diagnoses referred to the self-care deficit in various activities of daily living. Regarding to nursing interventions, described by the Nursing Intervention Classification (NIC), dementia management is the most used intervention, followed by mutual goal setting, caregiver and emotional support. Conclusions: The patient profile who receive case management services is a chronic complex patient with severe dependence, cognitive impairment, normal social support, low educational level, health problems such as stroke, hypertension or COPD, diabetes or dementia, and has an informal caregiver. At the first follow up, mortality was 19.2%, and a discrete rate of readmissions and falls.