Padrões espaciais do trabalho da enfermagem e sua relação com os acidentes de trabalho por exposição a material biológico, Manaus, Amazonas, 2009-2013

Abstract

The research had the general objective is to analyze the spatial distribution of occupational accidents by exposure to biological material in nursing workers crowded in private and public health services in the city of Manaus, between 01 January 2009 and December 31, 2013 and, specific objectives: to describe the network of public and private health services that provide nursing services according to the distribution by districts and health districts in Manaus, state of Amazonas; to characterize the profile of nursing workers who were victims of occupational accidents by exposure to biological material in health care facilities and Manaus; to analyze the relationship between the distribution of occupational accidents and the concentration of the nursing workforce by level of complexity of care by health districts and neighborhoods of Manaus. Exploratory and descriptive study, the territorial basis of the Network Health Care of Manaus with nursing services, with use of digital cartographic base of the Manaus City. The study population consisted of nurses who suffered Occupational Accidents with Exposure to Biological Materials in Establishment Health Care in Manaus, Amazonas, Brazil, from January 1, 2009 to December 31, 2013, with records in the System Diseases Information Notification (SINAN). The database was built from the records of ATEMB the SINAN and the population of nurses including: nurses, technicians and nursing assistants registered in the System of National Register of Health Establishment (SCNES). The data were processed using the ArcView program, including how to layer information the outlines of the polygons of the 63 districts included in the four health districts (Disa North, Disa South, Disa East and West). The analysis variables obtained from SINAN were ATEMB the occurrence of site; Brazilian Classification of Occupations (CBO); and year of occurrence. The variables were obtained from SCNES: Coordinate Geographic 's Health Care Establishment (EAS); Nature of Care Establishments Health, aggregated into two categories (public and private nature); and Hierarchy Level (level 1-9) defining the complexity of services. For description of the Network Health Care in Manaus (RAS), concerning the distribution of EAS in hierarchical levels 1 to 9. For a description of RAS were created thematic maps that allowed us to visualize the distribution of the RAS by neighborhood and health districts. For description of the health care network with nursing services, applied to analysis of specific procedures established by the geographical coordinates of health care facilities for neighborhoods and health districts, inserted in the census mesh Manaus. The process of timely spatial analysis was prepared by the set of points distributed in the areas (Disa) in accordance with the lease of points (ATEMB events). To study the spatial distribution of health indicator health establishment with nursing services, we chose to estimate the intensity of the indicator point throughout the study area, with getting the indicator by neighborhood and health district in class intervals in polygons. The results, the discussions and conclusions of this dissertation are described in three articles that make up the final text of the essay. Article 1: The study shows that in Manaus there are 409 public and private health service units that offer nursing services. There was dispersion in the distribution of health care establishment by health district with concentration of notifications in southern health district, which has the largest number of health and more complex units (40.34 %). There was a significant percentage of not notifying health care occupational accidents by exposure to biological material (87.29 %), with possible underreporting of instances of new cases and those reported in the 5 years study, reported only one case by health unit, with the average health units and high complexity responsible for much of the occurrences, especially those publicly. Article 2: Were registered 224 ATEMB in 52 EAS with SE to the total of 409 existing, the professional technician and nursing assistants were more affected (90.2 %), the female was referred to the Most (89.7%), the age group of largest range occurrence was 27-35 years of age (41.5%) e statutory civil servants was the situation labour market more affected (17.0%). The high complexity hospital and outpatient presented largest records (49.1%) of ATEMB. The type of exposure More notified was a percutaneous (81.7 %), the biological material was blood (84.0 %) as the main circumstances in the were accidents occurred by the lancing for blood glucose (19.7%) and for intravenous medication (19.1%), as an agent to tendon lumen accident as needles (72.3 %). Most workers (69.5 %) used IPE and 55.35% presented as vaccines on time. Article 3: The South DISA is the area that has the highest concentration of EAS. The DISA North did not register any neighborhood in the corresponding rate range to 1-4 nurses per thousand inhabitants. There was low EAS coverage of Manaus , with the highest concentration in DISA South. We conclude that the biological risk they are exposed to the nurses and occupational accidents by exposure to biological material point to the need for development of a worker's health management plan for monitoring of industrial accidents.