Infecções em serviço de saúde: estudo retrospectivo

Abstract

Evidence indicates that infection is one of the leading causes of morbidity and mortality among the hemodialysis population in the world and in Brazil. Epidemiological data show a high prevalence of infections in patients undergoing hemodialysis. The objective of this study is to evaluate the occurrence of healthcare-associated infections (Iras) in a hemodialysis service. It is a cross-sectional and retrospective study with a quantitative approach. Data were collected from the medical records of participants. The population consisted, in its portrait (2018-2022), of 272 patient records. The study included data from all patients over 18 years of age, registered in the care program for patients with end-stage chronic kidney disease, who underwent outpatient hemodialysis at a teaching hospital in the interior of Minas Gerais. The medical records of patients who underwent hemodialysis in transit and those who underwent peritoneal dialysis, but, for some reason, underwent hemodialysis were excluded from the study. Furthermore, patients whose physical records could not be located were excluded, totaling a final population of 255 patient records. Sociodemographic, clinical, and laboratory data were collected, as well as information related to access type, hospitalization, and death. To confirm the occurrence of infections, the diagnostic criteria for hemodialysis infection according to the Technical Note from the Health Service Surveillance and Monitoring Management/General Management of Health Service Technology/Anvisa were applied. Descriptive and inferential analyses were performed. Association tests, such as chi-square and Fisher’s exact test, were conducted to analyze associations between sociodemographic and clinical characteristics and outcomes: Iras, hospitalization, and death. Logistic regression analyses were used to study the magnitude of associations between independent variables and outcomes, with significance set at 5% and 95% confidence intervals. Most participants were male (n=143; 56.08%) and white (n=150; 58.82%). The mean age of participants was 62.49 years. The most prevalent etiology was diabetic kidney disease (n=72; 29.39%). The most frequent type of access was the tunneled catheter (n=165; 64.71%). An association was found between infections, such as healthcareassociated infections, pneumonia, and other respiratory infections, and hospitalization. Regarding the outcome of death, the statistically significant variables were age group and access type. The most frequent type of access was the tunneled catheter (n=165; 64.71%). An association was found between infections, such Iras, pneumonia, and other respiratory infections, and hospitalization. Regarding the outcome of death, the statistically significant variables were age group and access type. There was a higher prevalence of carbapenem-resistant Klebsiella pneumoniae in blood cultures. In conclusion, infections are significant causes of hospitalization in participants undergoing hemodialysis. These findings contribute to understanding the characteristics of this population and assist in defining actions to plan healthcare services aimed at improving patient quality and safety.