Acidentes de trabalho com exposição a material biológico em profissionais de saúde no Brasil: tendência temporal e fatores associados ao uso de equipamento de proteção individual

Abstract

Introduction: According to the World Health Organization (WHO), every year three million health professionals in the world are exposed to blood pathogens through percutaneous accidents. As a precaution to reduce this exposure is the use of Personal Protective Equipment (PPE), which work as barriers to protect the mucous membranes, airways and skin. Objective: To analyze the use of personal protective equipment among health professionals who have suffered work accidents with exposure to biological material occurred in Brazil (ATEMB), in the period from 2010 to 2018. Method: A trend study, ecological type, of time series of the use of PPE by health professionals victims of ATEMB, in Brazil was carried out; and a crosssectional, analytical type study on the factors associated with the use of PPE by health professionals injured in biological material in Brazil. The information was collected from the Ministry of Health's Information System on Notifiable Diseases. Descriptive analysis of the data was performed and the proportions of the use of PPE were calculated. For the analysis of trends on the use of PPE during work accidents, the Prais-Winsten procedure was used for generalized linear regression. The trend of the coefficients was assessed in terms of growth, decline or stability. For the study of associated factors, a descriptive analysis of the data was performed and, subsequently, the univariate analysis to verify the association of the independent variables in relation to the outcome (effective adherence: use of at least three PPE), the model of Poisson regression with robust variance. In multivariate analysis, Poisson regression with robust variance and hierarchical modeling was also used to control possible confounding factors and estimate the prevalence ratios (PR) between the independent variables and the outcome. The research complied with the ethical aspects of Resolutions 466/12 and 510/2016 of the National Health Council, assessed and approved by the Research Ethics Committee of the University Hospital of the Federal University of Maranhão. Results: In the analysis of the time series trend, positive growth was evidenced both for general national data and for all regions of Brazil. Thus, there was an increase in the use of PPE in all regions of the country, but, when analyzing the Federative Units, the trends were heterogeneous. The North region had the highest rates of change in Brazil (especially the states of Rondônia and Amapá́). The Northeast region had the lowest rate of variation between regions and the state of Sergipe was the only one that showed a downward trend. In the Midwest region, only Goiás showed an increasing trend. The South and Southeast regions were the only homogeneous regions, in which all UFs showed an increasing trend. In the study of associated factors, it was identified that, of the 308,997 ATEMBs among health professionals, only 27.38% used three or more PPE at the time of the accident. It was observed in the adjusted analysis that being a professional aged 40 years or less, having 12 years or less of schooling, working in the capital or metropolitan region, working with a technical level occupation, being 10 years old or less or more than 20 years old accidents, accidents due to percutaneous exposure, blood and sharps, were related to greater chances of not using PPE in cases of work accidents. Conclusion: The findings point to the need to strengthen permanent education for health professionals, especially in regions with lower proportions of adherence to the use of PPE and in those that did not show growth in adherence to the use of PPE. The identification of the prevalence and factors associated with occupational accidents among health professionals can allow interventions on risky behavior and improvement in the quality of working conditions.