Philanthropic Hospital Research Articles

Factors associated with engagement in nursing workers

Objective: to measure the engagement of nursing workers and verify the association between engagement and sociodemographic variables in these workers. Method: quantitative cross-sectional research, with nursing workers, from the Mother and Child Department, of a private and philanthropic hospital, in the city of São Paulo - SP/Brazil. Data collection took place in 2022, via the REDcapTM digital platform, with sociodemographic questions and the UWES-9 (Utrecht Work Engagement Scale). Descriptive analyzes were carried out and correlations between variables were obtained using Spearman's correlation coefficient, using the free software R version 4.2.2 for the analyses. Result: for half of the 210 respondents, all dimensions and the total scale score presented median values above 5.00, indicating high worker engagement. The variables Age and Professional category had a positive statistical association with engagement, and it was identified that nursing workers who did not have health issues in the previous month had a higher median score. Conclusion: the study showed high participant engagement, with all items scoring greater than or equal to 5.00. Engagement was positively correlated with the variables age, with greater engagement among older ages, and with the professional category, which showed the highest median score among nursing assistants and technicians, 5.33, while nurses had a median score of 5.06.

Análise do perfil de devoluções de quimioterapias endovenosas em um hospital filantrópico de Salvador-BA

Introduction: The increase in the costs of cancer treatments is configured as a relevant problem for health services linked to the constant incorporation of new drugs for cancer treatment. This growth in expenses reflects the challenge of managing resources to meet the needs of the oncologic area. It is necessary to optimize resources in view of the growing demand and associated costs. In the scenario where patients receive personalized treatments, changes in therapy are possible, causing some returns of antineoplastic drugsand increasing costs in health services. Objective: To analyze the profile of returns of chemotherapy drugs handled by the Pharmacy sector and the relationship with costs in a philanthropic hospital in Salvador. Method: This was a cross-sectional, retrospective, and analytical study conducted between August 2019 and August 2020. Data were collected through forms obtained after the return of chemotherapy. Information such as the drug name, dose, reuse status, and reason for return were evaluated. Data were tabulated using SPSS software. Results: 171 chemotherapy bags were returned involving 19 active ingredients. The clinical factor accounted for 59.1% of the returns. Cisplatin accounted for 14.6% of the returns. Carboplatin was the most discarded drug, representing 16.9% of the lost bags, whereas Cisplatin had the highest rate of reuse. In pharmacoeconomics, the returns represented the value of R$ 13,887.87. The hospital lost R$ 7,475.61 with the discarded products but saved R$ 6,412.21 through reuse. Conclusions: Oncology needs to be linked to pharmacoeconomics and to minimize discards, strategies should be adopted.

Impact of water quality on reprocessing equipment: Assessment of neurosurgical instruments cleaning and biofilm formation in hospital pipes.

The presence of contamination and microorganisms at any stage of processing renders a method unsafe, leading to a high risk of cross-transmission and cross-infection. The objective of this study was to assess the cleaning quality of aspirator instruments used in neurosurgical procedures. The experimental study was conducted at the materials and sterilization center, as well as the microbiology laboratory, of a philanthropic hospital in Brazil. A study protocol was implemented, which involved the analysis of 10 samples of Yasargil aspirators with varying dimensions. The samples were subjected to protein tests to detect the presence of organic matter and microbiological analysis. Descriptive statistics were used to analyze the data. The results indicated that 40% of the instruments tested positive for protein after manual cleaning. Furthermore, after automated cleaning, samples showed an increased microbiological load, with Escherichia coli accounting for 20% and Klebsiella aerogenes for 10% of the identified microorganisms. This study provides evidence of failures in the cleaning process of healthcare products and highlights the presence of biofilm in the pipes, thereby compromising the drinking water quality standard.

Fatores associados ao estresse parental em unidade de terapia intensiva neonatal: estudo transversal

Abstract Objectives: verify the factors associated with parental stress in Neonatal Intensive Care Unit (Neonatal ICU) of small municipalities. Methods: cross-sectional quantitative study, with parents of newborns admitted in the neonatal ICU in two philanthropic hospitals. The instruments used were the Parental Stress Scale: Neonatal ICU and Perceptions of Family-Centered Care - Parents. The analysis was performed according to the nature of the distribution of the variables. Results: of the 129 volunteers, 79.8% showed parental stress. The averages of stress in the domains “sights and sounds”, “baby looks and behaviors” and “alteration in the mother/father role” was observed, respectively, 1.9, 2.9 and 3.7 in Parental Stress Scale: Neonatal ICU. There was a significant association between the gender of the participants (p=0.0182) and clinical complications during the period of hospitalization (p= 0.0443) with parental stress. A difference was observed in the groups of the variable “hospitalization time to the moment of the data collection” (p= 0.0112), in the domains “respect” (p=0.0266), “collaboration” (p=0.0060) and in the total sum (p= 0.0112) of the Perceptions of Family-Centered Care - Parents scale. Conclusion: parental stress was associated with changes in the role of the mother/father; with the mothers and the occurrence of clinical complications with the baby during its hospitalization.

Territorial dynamics of highly complex health services in the Belém Metropolitan Region, Brazil: is specialized health care subsidized by the SUS?

This article presents an analysis of the territorial dynamics of the specialized healthcare network, focusing on medium and high complexity care in hospitals in the municipalities that make up the Belém Metropolitan Region. The analysis is based on secondary data from DATASUS available on the National Health Facility Registry (CNES) up to January 2022. The findings show that the private network accounts for the largest proportion of services in the region; however, the service capacity of the SUS is greater than that of the private sector due to the large volume of services outsourced to private facilities via public-private partnerships, with philanthropic hospitals allocating the largest proportion of services to public patients. This should not be confused with universal coverage, as public patient access to private services may be restricted by legal and institutional barriers depending on the form of access (open-door or closed-door).

Contamination of equipment and surfaces in the operating room anesthesia workspace: a cross-sectional study.

Contamination of the breathing circuit and medication preparation surface of an anesthesia machine can increase the risk of cross-infection. To evaluate the contamination of the anesthetic medication preparation surface, respiratory circuits, and devices used in general anesthesia with assisted mechanical ventilation. Cross-sectional, quantitative study conducted at the surgical center of a philanthropic hospital, of medium complexity located in the municipality of Três Lagoas, in the eastern region of the State of Mato Grosso do Sul. Eighty-two microbiological samples were collected from the breathing circuits. After repeating the samples in different culture media, 328 analyses were performed. A higher occurrence of E. coli, Enterobacter spp., Pseudomonas spp., Staphylococcus aureus, and Streptococcus pneumoniae (P < 0.001) were observed. Variations were observed depending on the culture medium and sample collection site. The study findings underscore the inadequate disinfection of the inspiratory and expiratory branches, highlighting the importance of stringent cleaning and disinfection of high-touch surfaces.

Avaliação da clorexidina 0,12% em pacientes de unidade de terapia intensiva: ensaio clínico randomizado

ABSTRACT Objective: To evaluate the antimicrobial effect of 0.12% aqueous chlorhexidine solution on the oral microbiota of patients on mechanical ventilation in Intensive Care Units (ICUs) at 6, 8 and 12 hours after oral hygiene. Methods: This is a randomized clinical trial in which 30 patients admitted to the ICUs of a philanthropic hospital based in Aracaju-SE, selected by spontaneous demand over a period of 2 months according to inclusion criteria, were randomized and equally distributed into three groups. Oral hygiene followed the disinfection protocol adopted by the hospital, the same recommended by the Brazilian Association of Intensive Medical Care (AMIB). Saliva samples were collected before the application of 0.12% chlorhexidine, shortly after application of the solution, and then after 6 hours (TEST 1 Group), 8 hours (TEST 2 Group) and 12 hours (CONTROL Group), according to each group. Results: The material was sent to a clinical analysis laboratory for microbiological evaluation using the bacterioscopy technique, also called Gram stain. The results were tabulated in spreadsheets and analyzed using the Friedman test between groups and Kruskal Wallis test between groups. Conclusion: The study showed no statistical difference between groups and between groups.

A territorialidade da alta complexidade na Região Metropolitana de Belém, Brasil: a saúde especializada é subsidiada pelo SUS?

Abstract This article presents an analysis of the territorial dynamics of the specialized healthcare network, focusing on medium and high complexity care in hospitals in the municipalities that make up the Belém Metropolitan Region. The analysis is based on secondary data from DATASUS available on the National Health Facility Registry (CNES) up to January 2022. The findings show that the private network accounts for the largest proportion of services in the region; however, the service capacity of the SUS is greater than that of the private sector due to the large volume of services outsourced to private facilities via public-private partnerships, with philanthropic hospitals allocating the largest proportion of services to public patients. This should not be confused with universal coverage, as public patient access to private services may be restricted by legal and institutional barriers depending on the form of access (open-door or closed-door).

Cancer patient satisfaction regarding the quality of information received: psychometric validity of EORTC QLQ-INFO25.

to psychometrically validate the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire EORTC QLQ-INFO25 instrument and identify the domains that influence patients' perception of the information received. a cross-sectional methodology with cancer patients in a Brazilian philanthropic hospital institution. Sociodemographic and clinical instruments, EORTC QLQ-C30, EORTC QLQ-INFO25 and Supportive Care Needs Survey - Short Form 34 were used. Analysis occurred using Cronbach's alpha coefficients, intraclass correlation, test-retest and exploratory factor analysis. 128 respondents participated. Cronbach's alpha coefficient was 0.85. The test-retest obtained p-value=0.21. In the factor analysis, one item was excluded. Satisfaction with the information received was 74%, with three areas with averages below 70%. In open-ended questions, there was a greater desire for information. validity evidence was obtained with instrument reliability, consistency and stability. Respondents expressed satisfaction with the information received.

MENTAL HEALTH, PROTECTIVE MEASURES, COVID-19: A STUDY ABOUT HEALTHCARE WORKERS IN BRAZIL

During the COVID-19 pandemic, health workers’ occupational stress increased due to the amount of medicine needed by patients. Aims: This research aims to evaluate the fear generated by the risk of contracting COVID-19 among health professionals working in the intensive care unit of a Brazilian philanthropic hospital. Methods: This cross-sectional study adopted a quantitative approach. We collected data through questionnaires completed by a multi-professional team from an adult intensive care unit. The survey included questions on the professionals’ sociodemographic data and items from the adapted Information Related to the Health Unit and Patient Care questionnaire, the Fear of COVID-19 Scale, and the Patient Health Questionnaire-9. In addition, participants were asked about use of personal protective equipment (PPE) post-vaccination. Results: In total, 108 employees responded. There was an association between the PHQ-9 and the FCV-19S in terms of those respondents do not felt prepared to face COVID-19 and had feelings of insecurity for themselves and their family members due to the pandemic. Besides that, there was an apparent discrepancy between the respondents’ answers and the hospital’s protocol about the reused PPE. Conclusion: This lack of alignment, about protocol and reused PPE, generates more health costs because public resources finance the hospital through the Unified Health System. The use of PPE must continue after vaccination. Restriction policies, such as presenting a vaccination card when entering closed places (which in practice is not happening in most cities in Brazil) and approaching individuals when not using PPE are essential for infection control.

COVID-19 inpatient mortality in Brazil from 2020 to 2022: a cross-sectional overview study based on secondary data

BackgroundIn Brazil, the COVID-19 pandemic found the universal and public Unified Health System (SUS) with problems accumulated over time, due, among other reasons, to low investments, and disparities in resource distribution. The preparedness and response of the healthcare system, involving the SUS and a private sector, was affected by large socioeconomic and healthcare access inequities. This work was aimed at offering an overview of COVID-19 inpatient mortality during the pandemic in Brazil, exploring factors associated with its variations and, specifically, differences across public, private (for-profit) and philanthropic (private non-profit) inpatient healthcare units, providers, and non-providers of services to the SUS.MethodsThis cross-sectional study used public secondary data. The main data source was the SIVEP-Gripe, which comprises data on severe acute respiratory illness records prospectively collected. We also employed the National Record of Health Establishments, the SUS’ Hospitalization Information System and municipalities' data from IBGE. We considered adult COVID-19 hospitalizations registered in SIVEP-Gripe from February 2020 to December 2022 in inpatient healthcare units with a minimum of 100 cases in the period. Data analyses explored the occurrence of inpatient mortality, employing general linear mixed models to identify the effects of patients', health care processes', healthcare units' and municipalities' characteristics on it.ResultsAbout 70% of the COVID-19 hospitalizations in Brazil were covered by the SUS, which attended the more vulnerable population groups and had worse inpatient mortality. In general, non-SUS private and philanthropic hospitals, mostly reimbursed by healthcare insurance plans accessible for more privileged socioeconomic classes, presented the best outcomes. Southern Brazil had the best performance among the macro-regions. Black and indigenous individuals, residents of lower HDI municipalities, and those hospitalized out of their residence city presented higher odds of inpatient mortality. Moreover, adjusted inpatient mortality rates were higher in the pandemic peak moments and were significantly reduced after COVID-19 vaccination reaching a reasonable coverage, from July 2021.ConclusionsCOVID-19 exposed socioeconomic and healthcare inequalities and the importance and weaknesses of SUS in Brazil. This work indicates the need to revert the disinvestment in the universal public system, a fundamental policy for reduction of inequities in the country.

Value stream mapping: an application lean in the process of accountability in a philanthropic hospital

Objective: This study aimed to map the value flow of medical records of a philanthropic hospital, identifying opportunities for improvements in the process. Design/methodology/approach: A qualitative research of descriptive and exploratory bias was developed, in which the sources of evidence emerged from participant observation and documentary analysis. Therefore, data collection took place for three months in 2021, which took place in the administrative sectors of a large philanthropic hospital, and the process chosen to be mapped and analyzed was the surgical record. Result: The analysis of the process took place from the patient's discharge to the delivery of the accounts to the typing/billing sector, where the routine of the post desks was observed and the current flows were mapped through the Value Stream Mapping tool (VSM), with several wastes being detected. The time spent in the process was approximately 56 days, after the suggested improvements and drawing up the map of the future situation, this time was reduced to 28 days. With the application of the tool, waste was identified and eliminated in the mapped process, generating a possibility of cost reduction. Originality/value: The study stands out as it seeks to link the context of value stream mapping in a hospital space, opening space for new research and contributing to practical results.

Hospital Resilience in Three COVID-19 Referral Hospitals in Brazil

ABSTRACT Health crises, such as the COVID-19 pandemic, challenge health systems in demonstrating resilience—the ability to cope with change, manage challenges, and adapt in order to retain their effectiveness. Understanding how such challenges affect and produce reactions in those involved in this response is extremely important. This study evaluated resilience in three referral hospitals in the city of Recife, Pernambuco, Brazil—one public, one private, and one philanthropic hospital—by examining the coping activities adopted by the nursing staff working on the COVID-19 frontline. A multiple case study was carried out, using a qualitative approach, triangulating data from direct observations, document analysis, and interviews with 21 nursing professionals working in management and care provision. Data were collected from April to October 2020. The interviews were transcribed and analyzed based on the resilience categories defined by Blanchet (2017): absorption capacity, adaptive capacity, and transformative capacity. Four themes were considered relevant to the objectives of this study: institutional support, access to personal protective equipment (PPE), work relationships, and fear and mental health. Adaptive capacity was demonstrated concerning the four themes analyzed, absorption capacity was demonstrated in two themes, and no transformative capacity was identified. The study highlighted that the health crisis was challenging for all the hospitals studied, regardless of their legal-administrative status. No differences were observed among them in terms of resilience.

CHONDROSARCOMA OF THE PROXIMAL HUMERUS IN A STATE PHILANTHROPIC HOSPITAL

Objective: To analyze the clinical and epidemiological profile of patients with chondrosarcoma of the proximal humerus treated at a Philanthropic Hospital over a period of 5 years. Methods: Documentary, exploratory, descriptive study, conducted by 04 medical records of patients admitted to the Orthopedic Oncology service, with a diagnosis of chondrosarcoma located in the proximal humerus in the period 2014 to 2018. The sex, age, staging, radiology, and surgery performed were investigated. The data obtained were analyzed by descriptive statistics with the aid of the RStudio software. The study was approved by the Research Ethics Committee. Results: All patients were female, and the age ranged from 37 to 50 years. The most frequent symptom was mild local pain, there was no evidence of loss of function at the time of diagnosis. Radiology showed an expansive, lobulated lesion with intermingled calcification. Histology, two cases of grade I chondrosarcoma, one case grade II and one grade III. Enneking I staging 50% and Enneking II in 2 cases. Surgery ranged from local curettage to en bloc resection. Recurrence was null at follow-up time. Conclusion: It is a rare disease with a small number of cases, but it initiates an analysis for further studies in its epidemiology and treatment.

Efficacy Of Strategies To Reduce Absenteeism Due To Musculoskeletal Disorders In A Philanthropic Hospital

Efficacy Of Strategies To Reduce Absenteeism Due To Musculoskeletal Disorders In A Philanthropic Hospital

1792. Different Patterns of Antibiotic Use in Different Administrative Categories: An Overview of 10 years (2009/2018) of a Statewide Surveillance Program in Sao Paulo, Brazil

Abstract Background To describe intensive care unit (ICU) antibiotic use in different administrative categories based on data reported to the Nosocomial Surveillance System of the State Health Department (SHD) in the State of Sao Paulo. Methods This ecological study describes at an aggregated level the antibiotic use in adult ICU reported to São Paulo SHD, from 2009 to 2018. ICUs were categorized by hospital administrative category (private, public, and philanthropic). Public hospitals were subdivided into two administrative sub-categories as Social Health Organization (SHO), which administration is private but public funded, or direct public administration (DPA). Resistance phenotype incidence and antibiotic use correlation was calculated for meticilin-resistant Staphylococcus aureus (MRSA) and glycopeptide use, third generation cephalosporin (3GC)-resistant Enterobacterales and carbapenem use, carbapenem-resistant gram-negative bacilli (CR-GNB) and polymyxins use. Results The average number of hospitals reporting annual data on antibiotic use was 386. A total of 17.490.966 patient-days were included. Total antibiotic use in ICUs increased from 588.16 in 2009 to 943.12 DDD/1000pd in 2018 (p&amp;lt; 0,01). The DDD (defined daily dose) of antibiotic was higher in public hospitals (mean 889.11 DDD/1000pd), than in the private hospitals (mean 849.07 DDD/1000pd) and in the philanthropic hospitals (mean 48 785.12 DDD/1000pd) (p&amp;lt; 0.05). Positive correlations were detected between glycopeptide use and MRSA incidence, polymyxins use and CR-GNB incidence. A weak negative correlation between carbapenems use and 3GC-resistante Enterobacterales incidence were found. Figure I:Antimicrobial use by therapeutic class between 2009 and 2018 in DDD / 1000 patient-daysTable I:Antibiotic use by therapeutic class by administrative type in DDD/1000 patients-dayTable II:Antibiotic use in public hospital by subgroup between 2009 and 2018 in DDD/1000 patients-day Conclusion We found higher use of antibiotics in public hospitals than in private and philanthropic. Differences in antibiotic use were observed among SHO e DPA public hospitals. These data provide important information for formulating hypotheses and public health strategies to improve antimicrobial prescription. Disclosures All Authors: No reported disclosures.

An economic study of neuro-oncological patients in a large developing country: a cost analysis.

Neuro-oncological patients require specialized medical care. However, the data on the costs incurred for such specialized care in developing countries are currently lacking. These data are relevant for international cooperation. The present study aimed to estimate the direct cost of specialized care for an adult neuro-oncological patient with meningioma or glioma during hospitalization in the largest philanthropic hospital in Latin America. The present observational economic analysis describes the direct cost of care of neuro-oncological patients in Santa Casa de São Paulo, Brazil. Only adult patients with a common primary brain tumor were included. Due to differences in the system records, the period analyzed for cost estimation was between December 2016 and December 2019. A group of patients with meningiomas and gliomas was analyzed. The estimated mean cost of neurosurgical hospitalization was US$4,166. The cost of the operating room and intensive care unit represented the largest proportion of the total cost. A total of 17.5% of patients had some type of infection, and 66.67% of these occurred in nonelective procedures. The mortality rate was 12.7% and 92.3% of all deaths occurred in emergency procedures. Emergency surgeries were associated with an increased rate of infections and mortality. The findings of the present study could be used by policymakers for resource allocation and to perform economic analyses to establish the value of neurosurgery in achieving global health goals.

Discussion Guide for the Alves Article.

Discussion Guide for the Alves Article.

SCAPE ROOM AS A SENSITIZATION AND EDUCATION STRATEGY ABOUT PRESSURE INJURY PREVENTION

Objective: To report the experience of using the escape room as an educational and awareness strategy for the prevention of pressure injuries in the hospital context. Methods: This is an experience report about an activity developed in November 2021, with professionals from the multidisciplinary team of a large philanthropic hospital located in the metropolitan region of São Paulo (SP), Brazil. Results: The game was played as an educational strategy associated with other initiatives on the issue, during the annual pressure injury prevention campaign. Eighty-two professionals participated in the activity, including nurses, nursing technicians, nutritionists, and physiotherapists. A total of 57 participants (69.5%) managed to unravel the proposed puzzles and leave the escape room in the proposed time. The reaction evaluation showed a high level of satisfaction with the activity, in addition to numerous compliments on the chosen methodology, as well as the creativity in which the topic was approached and developed. Conclusion: The use of a methodology based on the interaction of the participants, such as escape rooms, associated with other educational activities seems to be interesting to promote learning and awareness about pressure injury prevention.

Tratamento de pacientes com diagnóstico de tumor ósseo de células gigantes: Experiência de um hospital filantrópico no Piauí, Brasil

Objective To evaluate the treatment of patients with giant cell tumors of bone treated from 2009 to 2019 in a philanthropic hospital, as well as to try and determine the regional clinical and epidemiological profile, aiming to enrich the Brazilian data set and compare our findings with those of the literature. Methods An analytical, observational, and cross-sectional study with retrospective data collection and a quantitative approach, analyzing medical records of patients with giant cell tumors treated at a philanthropic hospital from 2009 to 2019. Results We evaluated 49 medical records; 55.1% of the patients were women, 53.1% were aged between 20 and 40 years, 69.4% of the cases were Campanacci grade III, and 30.6% affected the proximal end of the tibia. The rate of pathological fractures secondary to the tumor and pulmonary metastasis was low. More than 69% of the patients underwent intralesional surgery. Recurrence occurred in 16.3% of the cases. Conclusion The criteria used for the diagnosis, classification, and treatment at our service followed the standards established by the literature, and they can guide further research and improve local prognosis in the future.