Modelo ecológico espaço-temporal de preditores de infecções relacionadas à assistência à saúde em unidades de terapia intensiva do estado de São Paulo
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Data
2023-04-26
Autores
Limaylla, Dayanne Conislla
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
As Infecções Relacionadas a Assistência à Saúde (IRAS) são infecções frequentemente encontradas no ambiente hospitalar, e são causantes de alta morbidade e mortalidade no mundo. Dentre os pacientes hospitalizados, aqueles em maior risco de adquirir IRAS são os hospitalizados em Unidades de Terapia Intensiva (UTI). Realizamos um estudo ecológico com o objetivo de identificar preditores de IRAS associadas a dispositivos em UTI do Estado de São Paulo, incluído características hospitalares, socioeconômicas e espaciais. Informações do sistema de notificação do Programa Estadual de Controle de Infecção para o período 2011-2018 foram coletadas. Dados foram georreferenciados e seus preditores analisados com regressão binomial negativa inflada de zeros. Constatou-se que a incidência de todos os três tipos de IRAS diminuiu ao longo do tempo, mas houve importantres diferenças regionais nas taxas. As incidências de Pneumonia Associada a Ventilação Mecânica (PAV) e de Infeçcção do trato Urinario (ITU) foram maiores nas regiões do interior do Estado e as taxas de Infecções primarias da Corrente Sanguinea (IPCS) ligeiramente superiores na Região Metropolitana da capital. Em análise multivariada, a distância da capital foi um fator associado positivamente a PAV (IRR:1,06, IC95%: 1,04-1,08) e ITU (IRR:1,03, IC95%: 1,01-1,05), e negativamente para as IPCS (IRR: 0,95, IC-95%: 0,93-0,97). Hospitais privados e filantrópicos assim como maior número de leitos hospitalares também apresentaram menores taxas para PAV, ITU e IPCS. Indicadores como o Indice de Desenvolvimento Humano Municipal (IDHM) e Renda foram significativos apenas para as PAV, sugerindo que melhores índices desses determinantes se associam a menores casos da doença. Durante a análise espaço-temporal, vários clusters e hotspots significativos foram identificados próximos à Região Metropolitana. No entanto, com o passar do tempo, aglomerados menores e menos focos de calor foram encontrados, indicando ocorrências isoladas e redução da incidência nas áreas sob estudo. Estas descobertas nos mostram a necessidade de estratégias diferentes para redução de infecções em UTI nos hospitais localizados em áreas ao redor da região metropolitana e áreas distantes especificas no interior do estado.
Healthcare-associated infections (HAIs) cause high morbidity and mortality worldwide. Among inpatients, those at greater risk of acquiring HAI are those admitted to Intensive Care Units (ICU). We carried out an ecological study with the aim of identifying predictors of Device-associated hospital-acquired infections (DA-HAIs) in an ICU in São Paulo State, including hospital, socioeconomic and spatial characteristics. Data from the São Paulo HAI surveillance for the period from 2011 through 2018 were collected. The incidence of device-associated infections was georeferenced and submitted to zero-inflated binomial regression analysis. We found that the incidence of all three types of device-associated HAIs under study decreased over time, but there were regional differences in the incidence rates, with Ventilator Associated Pneumonia (VAP) and Urinary Tract Infections (UTI) rates being higher in the upstate regions and Blood-stream Infections (BSI) rates slightly higher in the metropolitan region. In the multivariate analysis, distance from the state capital was positively associated with VAP (IRR:1.06, 95%CI: 1.04-1.08) and UTI (IRR:1.03, 95%CI: 1.01-1.05 ), and negatively associated with BSI (IRR: 0.95, 95%CI: 0.93-0.97) meaning that the factor is indeed significant but affect the infection frequency in opposite ways. Private and non-profit hospitals, as well as those with a greater number of hospital beds, were likely to have lower HAI rates. Indicators such as city Human Development Index (HDI) and mean Income were significant only for VAP, suggesting that better rates of these determinants are associated with lower cases of the disease. During the space-time analysis, several clusters and significant hotspots were identified close to the metropolitan region of the state. However, over time, smaller clusters and fewer hot spots were found, indicating isolated occurrences and reduced incidence in the study areas. These findings show us the need for targeted intervention strategies to reduce infections in ICUs in hospitals located in areas around the metropolitan region and in specific distant areas in the interior of the state
Healthcare-associated infections (HAIs) cause high morbidity and mortality worldwide. Among inpatients, those at greater risk of acquiring HAI are those admitted to Intensive Care Units (ICU). We carried out an ecological study with the aim of identifying predictors of Device-associated hospital-acquired infections (DA-HAIs) in an ICU in São Paulo State, including hospital, socioeconomic and spatial characteristics. Data from the São Paulo HAI surveillance for the period from 2011 through 2018 were collected. The incidence of device-associated infections was georeferenced and submitted to zero-inflated binomial regression analysis. We found that the incidence of all three types of device-associated HAIs under study decreased over time, but there were regional differences in the incidence rates, with Ventilator Associated Pneumonia (VAP) and Urinary Tract Infections (UTI) rates being higher in the upstate regions and Blood-stream Infections (BSI) rates slightly higher in the metropolitan region. In the multivariate analysis, distance from the state capital was positively associated with VAP (IRR:1.06, 95%CI: 1.04-1.08) and UTI (IRR:1.03, 95%CI: 1.01-1.05 ), and negatively associated with BSI (IRR: 0.95, 95%CI: 0.93-0.97) meaning that the factor is indeed significant but affect the infection frequency in opposite ways. Private and non-profit hospitals, as well as those with a greater number of hospital beds, were likely to have lower HAI rates. Indicators such as city Human Development Index (HDI) and mean Income were significant only for VAP, suggesting that better rates of these determinants are associated with lower cases of the disease. During the space-time analysis, several clusters and significant hotspots were identified close to the metropolitan region of the state. However, over time, smaller clusters and fewer hot spots were found, indicating isolated occurrences and reduced incidence in the study areas. These findings show us the need for targeted intervention strategies to reduce infections in ICUs in hospitals located in areas around the metropolitan region and in specific distant areas in the interior of the state
Descrição
Palavras-chave
Unidades de Terapia Intensiva, Epidemiologia espacial, Infecções Relacionadas à Assistência à Saúde, Países em desenvolvimento, Estudo ecológico