RESUMO
OBJECTIVE: Rapid worldwide dissemination of SARS-CoV-2 has prompted dental professionals to optimise their infection control procedures. To help identify areas of opportunity for protecting dentists and their patients, the aim of this investigation was to analyse Mexican dentists' early perceptions of their risk of exposure to SARS-CoV-2 and their need for comprehensive infection control education. METHODS: This cross-sectional survey was conducted from May 9 to June 3, 2020, during the social distancing phase in Mexico. The survey adhered to relevant guidelines for ethical research design. The questionnaire was designed with Google Surveys and applied online in Spanish. The questionnaire included items on demographics and clinical specialisation. To obtain time-sensitive perceptions, statements were preceded by "While SARS-CoV-2 circulates in the community and new COVID-19 cases are reported"; responses were collected in a 5-point Likert-type scale. RESULTS: The survey's link received 1524 "clicks." Over 25 days, 996 dentists participated (39% men; 89% working in Mexico and 11% in other Spanish-speaking Latin American countries). Most participants (73%) fully agreed that "Looking after patients will pose a risk for the dentist." Total agreement was more common (P = .0001) amongst dentists in Mexico (76%) than amongst those in other countries (53%). Knowing someone with COVID-19 was more common amongst Mexican dentists (P = .0008). The perceived need for enhanced infection control procedures increased with age (P = .0001). Forty-nine percent totally agreed that they sterilise dental handpieces between patients. One-third expressed total agreement that everyone in their clinic was trained in infection control. CONCLUSIONS: Amongst this nonprobabilistic self-selected sample of dentists, age and country of work influenced their perceptions about occupational exposure to SARS-CoV-2 and infection control needs. This survey revealed areas of opportunity to improve infection control education and training for dental professionals.
Assuntos
COVID-19 , SARS-CoV-2 , COVID-19/prevenção & controle , Estudos Transversais , Odontólogos , Feminino , Humanos , Controle de Infecções , Masculino , Inquéritos e QuestionáriosRESUMO
Abstract Introduction: Patient safety has become a core value in health organizations, requiring the use of significant resources in order to avoid accidents during hospital stay. Health care can create risks, and patient safety is the most important objective in care quality. Failure Mode and Effects Analysis (FMEA) is a preventive tool that helps anticipate potential errors and adverse events, setting up barriers to prevent them from happening, or mitigating their effects or, in the event they do happen, mitigating their impact on the most vulnerable link in health care, namely, the patient. Objectives: To analyze, using the FMEA tool, mobilization of intubated critical ill patients in the Intensive Care Unit. Method: A brainstorming session was held within the service to identify the most frequent potential errors in the process. Subsequently, the FMEA method with its different phases was applied, prioritizing risk according to the RPN (Risk Priority Number) index and selecting improvement actions for those with an RPN greater than 300. Results: The result was the identification of 101 failure modes, of which 46 exceeded the RPN of 300. As a result of this work, 63 improvement actions have been proposed for those failure modes with NPR scores above 300. Conclusion: The conclusion of the study is that FMEA was a useful tool for anticipating potential failures in the process and proposing improvement actions for those that exceeded an RPN of 300.
Resumen Introducción: La seguridad del paciente ha adquirido un valor estratégico en las organizaciones sanitarias, empleando numerosos recursos para evitar accidentes durante la estancia hospitalaria. La asistencia sanitaria puede generar un riesgo y la seguridad del paciente es el objetivo más importante de la calidad asistencial. AMFE es una herramienta preventiva, lo que supone una anticipación a los posibles errores y eventos adversos, poniendo barreras para que no sucedan o si lo hacen mitigar sus efectos sobre la parte más vulnerable de la atención sanitaria, el paciente. Objetivos: Analizar, a través de la herramienta AMFE (Análisis Modal de Fallos y Efectos), la movilización del paciente crítico intubado en la Unidad de Cuidados Intensivos. Método: Para ello se realizó una tormenta de ideas dentro del servicio para decidir los posibles errores más frecuentes en el proceso. Posteriormente, se aplicó el método AMFE, con sus fases, priorizando el riesgo conforme al índice NPR (Numero de Priorización de Riesgo), seleccionando acciones de mejora en los que tienen un NPR mayor de 300. Resultados: Como resultado hemos obtenido 101 modos de fallo de los cuales 46 superaban el NPR de 300. Tras nuestro resultado, se han propuesto 63 acciones de mejora en aquellos modos de fallo con puntuaciones NPR superiores a 300. Conclusiones: La conclusión del estudio es que AMFE permite anticiparnos a los posibles fallos del proceso para proponer acciones de mejora en aquellos que superan un NPR de 300.
Assuntos
HumanosRESUMO
El Análisis de Causa-Raíz (ACR) es una forma de estudio retrospectivo de eventos adversos destinado a detectar las causas subyacentes de los mismos para proteger a los pacientes mediante la modificación de los factores dentro del sistema de salud que los provocaron y prevenir sus recurrencias. Si bien esta concepción centrada en la seguridad del paciente ha visto un importante auge en la atención médica, la odontología no ha sido llevada de igual manera probablemente por presentar daños más leves, procedimientos ambulatorios (con la consiguiente falta de seguimiento de muchos eventos adversos) y prácticas fundamentalmente privadas (cuyos conflictos afectarían potencialmente los resultados comerciales). Dado que no hay precedentes en Chile, se presenta un evento adverso producido en la Clínica Odontológica Docente Asistencial de la Facultad de Odontología de la Universidad de La Frontera y su ACR, desarrollado como primera intervención del Centro Chileno para la Observación y Gestión del Riesgo Sanitario de esa institución. Se plantean las necesidades de implementar un sistema explícito de categorización de eventos adversos en esa disciplina y de apoyar políticas de cultura en seguridad para el paciente odontológico, y se discute el papel de las instituciones universitarias para reconocer las áreas de vulnerabilidad en sus clínicas y así reforzar y mejorar la calidad de sus prácticas sanitarias.
Root cause analysis (RCA) is a retrospective study of adverse events performed to detect the underlying causes of these events to protect patients by modifying the factors within the health system that caused them and preventing their recurrences. Although this paradigm focused on patient safety has seen a significant increase in medical care, dentistry has not been carried out in the same way, probably because of milder injuries, outpatient procedures (with the consequent lack of follow-up of many adverse events) and basically private practices (whose conflicts would potentially affect commercial outcomes). Since there is no precedent in Chile, we present an adverse event produced at the Dental Clinic of the Faculty of Dentistry of the University of La Frontera and its RCA, performed as the first intervention of the Chilean Center for the Observation and Management of Health Risk of that institution. The needs to implement an explicit system of categorization of adverse events in this discipline and to provide support for cultural safety policies for the dental patient are discussed. The role of university institutions in recognizing areas of vulnerability in their clinics and to strengthen and improve the quality of their health practices is also discussed.