The Hospital Infection Control Service: historical landmarks and current challenges
In 1968, the first Hospital Infection Control Control Commissions appeared, and in 1976 there was a government determination to create commissions in hospitals that belong to the social security system, with low effectiveness and insipient inspection.
The Hospital Infection Control Service (SCIH) had the major milestone of its creation in 1983, Ordinance MS 196/83. Since then, there has been an incessant search for the reduction or elimination (the latter, seen as unattainable) of hospital infection (or hospital-acquired infection (HAI), with a view to the lack of essential care for its “control”. Thus, actions related to the health assessment of structure are observed, not guided by the epidemiological study.
The first Brazilian Congress on Hospital Infection takes place in 1989, and after years without major historical references of SCIH’s national performance, associated with the Regional Conference on Prevention and Control of Hospital Infections in 1990, the need for national Prevention Commissions was put on the agenda of HAI. This Commission had been implemented by the National Hospital Infection Control Program (PNCIH) and, consequently, created the National Hospital Infection Control Division.
In 1992, through Ordinance 930/92 of the MS, with the objective of guaranteeing epidemiological surveillance actions, it was based on the United States model, Centers for Disease Control. This activity was under the guardianship of SCIH, bringing to the institutions the need to guarantee human and material resources to perform the service.
In the following years, Law number 9.431 (1997), makes the Infection Control Program mandatory for all institutions at the hospital level. Ordinance 2,616 (1998) and RDC 48 (2000) point out as guidelines the mandatory composition of Hospital Infection Control Commissions in hospitals, in addition to addressing the Commission’s competencies.
In this period, in 1999 the National Health Surveillance Agency (ANVISA) was created, an autarchy linked to the Ministry of Health, and through Resolution RDC nº. 48/2000 the sanitary inspection related to Infection Control in Hospitals was defined.
Allied to the inspection practice, RDC nº. 48/2000 establishes the system for evaluation / inspection of Hospital Infection Control Programs, serving to support this practice.
At the beginning of 2000, the National Hospital Infection Control Plan (PNCIH) is linked to Anvisa, maintaining its actions at the level of health auditing, with an advance observed in the legislation applied to the prevention of HAI, with a focus on compliance with standards and production guidance manuals.
Nowadays, with the task of improving care practice, through the standardization of medicines and medical-hospital materials, preparation of guides and protocols in addition to training, the SCIH balances several attributions, represented by a series of indicators, within a hospital.
This critical function, at the same time so important, proves to be increasingly distant from its real role, as the time of dedication and the level of training active in this service are insufficient. There is a low capacity to guide practices due to the existence of obsolete clinical experiences and dissociated from epidemiology; absence of systemic analysis of the data; and finally, control programs little integrated with the hospital’s essential practices, revealing the low autonomy for decision making and dissociation from the institutional strategy.
Thus, the institutions’ lack of interest on the subject is evidenced, which reflects in the low relevance and impact of the actions performed by SCIH. Simple actions such as hand hygiene become the target of large campaigns with low effectiveness for direct patient care. High hospital costs are associated with HAI, with a small association of laboratory technology in favor of assertive practices in care and a growing presence of multi-resistant microorganisms, challenging for care.
Given the context, the work to reduce HAI in hospital environments is challenging, as the prerogative for the SCIH’s performance is auditing and data collection. Around this scenario, there are some of the main challenges to be built:
- Conduct the SCIH at a strategic level, through its empowerment for decision making, with consistent and timely measures for the control of hospital-acquired infection (HAI) and better operational efficiency;
- Make prevention the focus of SCIH, mainly related to antibiotic therapy and antibiotic prophylaxis, with effective support from the Clinical Pharmacy and automated support from the laboratories;
- Provide the institution with guidelines regarding the prevention and treatment of HAI, through protocols, routines, courses and training; according to the clinical profile of the units and association with the interdisciplinary team
- Direct involvement in disinfection and sterilization practices, outlining methods and guiding good practices;
- Epidemiological focus for data collection and interpretation, for an adequate assessment of structure, process, and results.
So, the following reflection is up to us: Are health institutions prepared to act effectively in this scenario?