Indicators for evaluation of processing dental-medical-hospital supplies: elaboration and validation

Abstracts

Estudo de desenvolvimento metodológico de elaboração e validação de medidas de avaliação em saúde, com a finalidade de contribuir com sistemas de avaliação de práticas de controle e prevenção de infecção hospitalar, pela elaboração e validação de oito indicadores para avaliação do processamento de artigos odonto-médico-hospitalares. A partir de fundamentação teórico-científica e contemplando avaliações de estrutura, processo e resultado, tais indicadores permitem elaboração de índices de conformidade com relação às melhores práticas esperadas (padrão-ouro). A validação referiu-se à validade de conteúdo, pela técnica de consenso de especialistas para julgamento de representatividade e aplicabilidade. Todos os indicadores foram aprovados. Os julgamentos efetuados, incluindo comentários e sugestões, demonstraram a importância de se realizar validação de processos de avaliação, independentemente da existência de critérios padrão-ouro e/ou relevância na prática assistencial.

Avaliação em saúde; Almoxarifado Central Hospitalar; Controle de infecção

ORIGINAL ARTICLE

Indicators for evaluation of processing dental-medical-hospital supplies: elaboration and validation^*

Indicadores para la evaluación del reprocesamiento del productos medicos del hospital: construcción y validación

Kazuko Uchikawa Graziano^I; Rúbia Aparecida Lacerda^II; Ruth Teresa Natália Turrini^III; Camila Quartim de Moraes Bruna^IV; Cristiane Pavanello Rodrigues Silva^V; Cristiane Schmitt^VI; Giovana Abrahão de Araújo Moriya^VII; Lílian Machado Torres^VIII

^IFull Professor of Medical-Surgery Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. kugrazia@usp

^IIAssociate Professor of Medical-Surgery Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. [e-mail]

^IIIDoctorate Professor of Medical-Surgery Nursing Department at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. [e-mail]

^IVStudent. Post-Graduation Program PROESA at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. [e-mail]

^VStudent. Post-Graduation Program PROESA at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. [e-mail]

^VIStudent. Post-Graduation Program PROESA at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. [e-mail]

^VIIStudent. Post-Graduation Program PROESA at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. [e-mail]

^VIIIStudent. Post-Graduation Program PROESA at School of Nursing at University of São Paulo. São Paulo, SP, Brazil. [e-mail]

Correspondence addressed to

ABSTRACT

Methodological study to elaborate and validate measures of evaluation in health contributing to an evaluation system of practices related to the control and prevention of hospital infection. It was elaborated eight dental-medical-hospital supply reprocessing conformity indicators. Indicators are described using items of the structure, process and outcomes that permitted the elaboration of conformity indicators related to the best practices (gold pattern). It was performed the content validity of the attributes of applicability and representativeness by a consensus expert judgment process using a psychometric scale. All the indicators showed to have content validity. Expert judgments, including comments and suggestions, evidenced the importance of perform validity of the evaluation processes, independently of the existence of golden pattern criteria and/or relevancies to the nursing practice.

Key words: Health evaluation. Central Supply, Hospital. Infection control.

RESUMEN

Estudio de desenvolvimiento metodológico para la elaboración y validación de medidas de evaluación en salud, con la finalidad de contribuir con los sistemas de evaluación de prácticas para el control y prevención de las infecciones hospitalarias, por la elaboración y validación de ocho indicadores de evaluación del procesamiento de instrumentos odonto-médico-hospitalarios. A partir de la fundamentación teórico científico, tales indicadores contemplan evaluaciones de estructura, proceso y resultado así como permiten la elaboración de índices de conformidad con relación a las mejores prácticas esperadas (padrón-oro). La evaluación se refirió a la validez del contenido, por la técnica de consenso de especialistas para el juzgamiento de representatividad y aplicabilidad. Todos los indicadores fueron aprobados. Los juzgamientos efectuados, incluyendo comentarios y sugestiones, demostraron la importancia de realizar la validación de procesos de evaluación, independiente da existencia de criterios padrón-oro y/o a la relevancia de su repercusión en la práctica asistencial.

Descriptores: Evaluación en salud. Central de Suministros en Hospital. Control de infecciones.

INTRODUCTION

State health agencies have recognized the problem of infections acquired in health services (IASS) and have been developing policies either to orientate or to supervise its control and prevention⁽¹⁾. The increasing demand for evaluation systems of control and prevention practices of IASS requires the use of indicators, defined as measures of variables or attributes, which identify desirable or non-desirable results of a certain practice and establish conformity indexes^(2-6). They can incorporate three dimensions of quality evaluation⁽⁷⁾: structure, process and results, and the advantage of one evaluation over the other is in the appropriation of use.

Structure refers to the capacity of human and material resources to render assistance to health care quality. The processes refer to the way the practice is performed, and how it objectifies its dynamics. Results show how frequently an event happens, identifying desirable or non-desirable effects resultant from actions, efficiency and efficacy within acceptable limits, risk factors that determine good or bad quality, among others⁽⁷⁾.

The reprocessing quality of dental-medical-hospital (DMH) supplies represents one of the pillars of the control and prevention of IASS and is related either to guarantee its submission to processes of microbial reduction or destruction, or to its functionality and integrity, in order to prevent damages to the organism while using it. The concern with appropriate practices is the research theme, scientific events, as well as public consultations and legislation by the Brazilian National Agency for Sanitary Surveillance⁽⁸⁾.

Since the end of the 20^th century, evaluations of structure, process and results have been developed in the health care area, however incipient regarding both in controlling and preventing IASS and in methods for its validation. The system developed and validated in this study is unprecedented, not being found, even in the scientific literature, national and international production that favors similar comparison of results, as well as its discussion.

OBJECTIVE

Elaboration and validation of indicators for assessing the processing of articles DMH.

METHOD

It is a methodological study of construction and validation of measures for health evaluation⁽⁹⁾ by indicators. Considering the theoretical-scientific fundaments, eight indicators were constructed which consider the DMH supply processing stages (cleaning, preparation/packing, sterilization/storage/distribution) and encompass evaluations of structure, processing and results. Each indicator presents compounds to be evaluated, a way of obtaining information and a calculation formula for conformity measures. Validation refers to content validity⁽¹⁰⁾, by judging attributes of representativeness (capacity to access the phenomenon) and applicability (if it is applicable and measurable). The consensual technique^(10-11) used the psychometric scale: (1) attribute not considered; (2) incapable of considering attribute without review; (3) attribute considered, but with minimal alteration; (4) attribute considered. The instrument also took into account comments and suggestions. To reach a consensus, it was taken into consideration minimal average for Content Validity Index (CVI) of 0.75 of scale-values 3 and or 4, similar to the Index verified in literature which ranges from 0.5 to 0.8 0^(10,11,12). In accordance with literature for specialist composition^(10-12), six nurses with experience in the Material and Sterilization Center (MSC) area judged the instrument.

The formula to indicate the conformity of each processing stage is:

RESULTS

The following bibliography was used for a theoretical-scientific fundament of compounds: (1) Brazilian National Agency for Sanitary Surveillance. Public Consultation number 34, June 3^rd 2009. Technical regulation establishing requirements for processing health products, including surgery instruments. D.O.U. - Official Daily Government Newspaper; 2009. Available at: http://www4.anvisa.gov.br/base/visadoc/CP/CP%5B26720-1 -0%5D.PDF; (2) Brazilian National Agency for Sanitary Surveillance. Resolution RDC 50 online. Available at Internet site : httpp//www. anvisa.gov.br/legis/resol200250-02rdc.pdf; (3) American National Standard. Sterilization of health care products - chemical indicators. Part 1: general requirements. Arlington(US): Association for the Advancement of Medical Instrumentation (AAMI); 2005; (4) Association of Operating Room Nurses. Standards, Recommended Practices, and Guidelines. AORN Inc, Denver, 2004; (5) Graziano KU et al. Cleaning, disinfection, sterilization of supplies and antisepsis. In: Fernandes AT. Hospital Infection and interfaces in the health area. São Paulo: Atheneu, 2000; (6) Rutala WA et al. Guideline for Disinfection and Sterilization in Healthcare Facilities. CDC/HICPAC. 2008. Available: www. cdc.gov/ncidod/hip/dsguide.htm; (7)Guide elaborated by Brazilian nurses. Practical advice for sterilization process in Health Establishments - part 1: Health Sterilization. Campinas: Komedi, 2000; (8) Rodrigues E. Reutilization of cotton double-woven surgical drapes standardized by ABNT (Brazilian Association of Technical Standards) used to pack medical-hospital supplies at humid heat sterilization. [Essay] São Paulo: Nursing School/USP; 2000; (9) Brazilian Association of Technical Standards. NBR 14028: Hospital apparel - double drape confection. Rio de Janeiro; 1997; (10) Brazilian Association for Technical Standards. NBR ISO 11134: Sterilization of hospital supplies for validity and control of humid heat sterilization routine. Rio de Janeiro;2001.

During the judgment process, all indicators had favorable consensus (IVC minimal > a 0,75) for representativeness and applicability (Table 1). The most problematic indicator was the Result for Cleaning Dental-Medical-Hospital Supplies (7L); the judges only disagreed with instrumental evaluation, considering that other supplies are equally important or even more important. The average of IVC values obtained at judgment is present on Table 1.

Indicators approved and revised according to the judges' suggestion are presented herein. The information obtained for each compound was described as (E) interview, (I) inspection e (R) register. They were also numbered as follows: 1L, 2L and 7L for supply cleaning indicators; 3P, 4P and 8P for supply preparation and packing indicators; 5E and 6E for sterilization process indicators.

Chart 1

DISCUSSION

Evaluation systems of nursing practices must consider: 1) previous existence of gold pattern; 2) relevance of its repercussion of assistance; 3) validity of its performance^(2-6,13). The first two items are considered in the herein study object; resultant scientific knowledge enables recognization of better practices and it is proved to be important for preventing and controlling IASS⁽⁸⁾.

Some authors⁽²⁾ believe gold standard practices already have validity, whereas others think there is a necessity of a process of scientific validity. This study made an option for the second opinion and submitted the indicators to a consensual technique in accordance with literature suggestion⁽¹⁰⁾. Despite the approval of all indicators and their adjustments according to judges' suggestions, some points were considered such as difficulty in applying an objective evaluation, impossibility to compare institutions, necessity to previously consider assistance characteristics and precision checking tests of indicators.

Nevertheless, it is an advantage of this system to establish conformity indexes in relation to the best expected practice, as well as to identify and define immediate policies of improvement specially designated to the most problematic aspects, aiming continually to achieve better conformity indexes. These indicators offer the advantage of attendance to the conformity evolution of each institution with the objective of a continuous improvement of quality. As soon as the acceptable conformity standard is achieved, it will be possible to perform inter-institutional comparative evaluations.

CONCLUSION

All elaborated indicators obtained content validity, regardless of the existence of the gold standard and relevance of the impact of clinical practices in nursing. The validity process used in this study demonstrates the importance of conducting validity prior to evaluation procedures.

REFERENCES

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Correspondência:

Kazuko Uchikawa Graziano

Av. Dr. Enéas de Carvalho de Aguiar, 419 - Cerqueira César

CEP 05403-000 - São Paulo, SP, Brasil

*

Extraído do Projeto "Indicadores de Avaliação de Práticas de Controle de Infecção Hospitalar", 2006.

Publication Dates

• Publication in this collection
  07 Apr 2010
• Date of issue
  Dec 2009

History

• Accepted
  27 Oct 2009
• Received
  15 Sept 2009