Gerenciamento de resíduos químicos perigosos manuseados pela enfermagem de um hospital universitário

Abstract

This study focused on the Management of Hazardous Chemical Waste (MHCW) handled by nursing workers of a school hospital. Its purpose was to identify products of medical-hospital use that contain substances potentially generators of chemical waste, check the existing information on hazardous chemicals, handling of their respective waste, and analysis of the nursing workers´ perception of the handling and impact of hazardous chemicals waste and propose strategies for the Management of Hazardous Chemical Wastes. This study is characterized as exploratory, descriptive, with a qualitative approach. The population was formed by all chemicals stored at the pharmacy and storeroom and of 662 nursing workers with an intentional sample of 19 subjects. Three were used for data collection: the first was a form for the listing of all medical-hospital use chemicals in the institution and another for the identification of products capable of generating hazardous chemical wastes (HCW), in addition to the technique of focus groups to collect data on handling. The data were systematized and analyzed in two instances: during the first, we discussed the universe of the institution´s chemicals and of those with the potential to generate hazardous chemical wastes. The second instance involved the analysis of the four categories extracted from the talks of the subjects in the focus group as to the handling of HCW. The analysis of the data of the first instance found 387 types of chemicals in the inventory of the studied institution, out of which 139 were screened as generators of hazardous chemicals wastes. However, the institution ranks 23 of them as hazardous, but they are sent to health care units without data as to the features of flammability, corrosiveness, reactivity and toxicity, in addition to the lack of individual information related to waste handling. At a second moment of the analysis, four categories were determined: knowledge of the management of hazardous chemical wastes (MHCW); awareness of the exposure and impact of hazardous chemical wastes, preventive measures and suggestions to HCW. The dialogues with the subjects evidenced the lack of specific training on MHCW, of general knowledge on the amount of HCW, fragmented knowledge of the handling stages corresponding to segregation, packaging, identification and internal transport, in addition to total lack of knowledge of the study subjects from the stage of temporary storage to the final disposal, stages that were discussed during the first instance of the study. In the category of awareness of exposure and impacts, it was found that the dialogues mention that nursing workers are the people with more exposure among the multi-professional team and do not associate the impact of exposure on public health and on the environment. In the preventive actions category the dialogues evidenced emphasis on the use of IPE (Individual Protection Equipment), especially gloves and masks. As to suggestions regarding MHCW, nursing workers appointed training as one of the priorities, in addition to development of new products, attention to sporadic handling of HCW, adaptation of IPEs, and implementation of collective protection measures. Thus, the data analysis provided subsidies for the preparation of strategies for the Management Plan for Hazardous Chemical Wastes handled by the institution´s nursing team. Therefore, considering the analyzed data, the proposals were presented in two stages. In the first, an information flowchart between the institution that is the object of the study and the suppliers, in addition to an Information File of the Management of Hazardous Hospital Chemical Wastes (FMHHCW) to provide input for the Management Plan for Hazardous Chemical Wastes (MPHCW), followed by a suggestion of an information flowchart between the health care sectors and the pharmacy service, regarding the HCW handled by the nursing team. The second stage of proposals involved the general recommendations for MPHCW. It is still necessary to classify the universe of products generating HCW in the institution and application of strategies that will make effective the elaboration of MPHCW, with a view to the promotion of the health of workers, public health and environment.