Prevalence of errors causing events allegedly attributable to vaccination/immunization: systematic review and meta-analysis

OBJECTIVE

To identify the prevalence of errors that caused events supposedly attributable to vaccination or immunization.

METHOD

Systematic literature review with meta-analysis carried out on the Medline, Cochrane Library, Cinahl, Web of Science, Lilacs, Scopus; Embase; Open Grey; Google Scholar; and Grey Lit databases; with studies that presented the prevalence of immunization errors that caused events or that provided data that allowed this indicator to be calculated.

RESULTS

We evaluated 11 articles published between 2010 and 2021, indicating a prevalence of 0.044 errors per 10,000 doses administered (n=762; CI95%: 0.026 - 0.075; I2 = 99%, p < 0.01). The prevalence was higher in children under 5 (0.334 / 10,000 doses; n=14). The predominant events were fever, local pain, edema and redness.

CONCLUSION

A low prevalence of errors causing events was identified. However, events supposedly attributable to vaccination or immunization can contribute to vaccine hesitancy and, consequently, have an impact on vaccination coverage.

Performance indicators of Primary Care of the Previne Brasil Program

OBJECTIVE

to analyze the scope of the performance indicators of the Previne Brasil Program of Primary Health Care.

METHOD

an observational, descriptive study with a quantitative approach was carried out using secondary data, referring to the years 2020 and 2021, in the five Brazilian regions (North, Northeast, South, Southeast and Midwest), available in the Primary Health Care Information System. Descriptive statistics, relative frequencies and measures of central tendency and semiparametric modeling were used considering a 5% confidence interval.

RESULTS

there was evidence of evolution in the rates of performance indicators in most Brazilian regions in 2021, compared to 2020, however, the North and Midwest regions had incipient or negative rates, compared to the Southeast region. Despite the evolution in the rates of the indicators, few States managed to reach the goals established by the Ministry of Health for the strategic actions of prenatal care and women's health; and no state achieved the goal in strategic action on chronic diseases.

CONCLUSION

it is considered important to monitor the evolution of current indicators, envisioning their qualification so that they can evaluate primary health care and assistance, as well as guarantee the achievement of goals by ensuring funding for primary care actions.

Vaccination coverage in children under one year of age and associated socioeconomic factors: maps of spatial heterogeneity

OBJECTIVE

to analyze vaccination coverage spatial distribution in children under one year old and the socioeconomic factors associated with meeting the recommended goals in Minas Gerais.

METHODS

an ecological study, carried out in 853 municipalities in the state. Pentavalent, poliomyelitis, meningococcal conjugate, yellow fever, rotavirus, and 10-valent pneumococcal conjugate vaccination coverage were analyzed. Scan statistics and multiple logistic regression were performed to identify spatial clusters and factors associated with meeting coverage goals.

RESULTS

spatial analysis revealed clusters with risk of low coverage for all vaccines. Number of families with per capita income of up to 1/2 wage, Minas Gerais Social Responsibility Index and percentage of the poor or extremely poor population were associated with meeting the established goals.

CONCLUSIONS

the results are useful for designing interventions regarding the structuring of vaccination services and the implementation of actions to increase vaccination coverage in clusters with less propensity to vaccinate.

Condições de vida, saúde e trabalho de profissionais de enfermagem frente à pandemia de COVID-19

Introdução: A carga horária, condições e as adversidades nas situações de trabalho, ambientes e ambiência, segurança e insegurança somados às incertezas proporcionadas pela pandemia de COVID-19, podem levar ao adoecimento laboral, notoriamente entre os profissionais de enfermagem, essenciais e indispensáveis a todos os níveis assistenciais de saúde. Objetivo: Analisar as condições de vida, saúde e trabalho dos profissionais de enfermagem que buscaram por um serviço de suporte ético-emocional durante a pandemia de COVID-19. Material e Métodos: Estudo transversal descritivo realizado em Minas Gerais, Brasil, entre agosto e dezembro de 2020. Incluiu-se profissionais atendidos pela Comissão de Suporte Ético-Emocional do COREn-MG, aplicando, via ligação telefônica, um instrumento com questões relacionadas às condições de vida, saúde e trabalho. Realizaram-se análise descritiva. Resultados: Participaram 58 profissionais. A maioria mulheres (93,1%), técnicas de enfermagem (69%). A maioria relatou uso de medicação contínua (63,8%), destacando-se antidepressivos (43,3%) e ansiolíticos (27%). Transtornos de ansiedade (15,5%) e depressão (12,1%) destacaram-se. A maioria (48,3%) considerou o dimensionamento das equipes insuficiente (25,9%) e trabalhava em serviços com assistência a pacientes com COVID-19 (81%) e 50% relataram preconceito decorrente desta assistência. Conclusão: Este estudo traça o perfil acerca das condições de vida, saúde e trabalho dos profissionais de enfermagem, que buscaram pelo serviço de suporte ético-emocional do COREn-MG, durante a pandemia de COVID-19, contribuindo para a reflexão sobre o processo de produção e reprodução da vida destes trabalhadores em Minas Gerais.

Incidence of immunization errors in the state of Minas Gerais, Brazil: a cross-sectional study, 2015-2019

OBJECTIVE

To evaluate the incidence of immunization errors in the public health service of the state of Minas Gerais, Brazil.

METHODS

This was a cross-sectional study, based on errors reported on the National Immunization Program Information System between 2015 and 2019. A descriptive analysis and calculation of the incidence for the state's health macro-regions were performed.

RESULTS

A total of 3,829 notifications were analyzed. Children younger than 1 year old were the most affected (39.1%) and the intramuscular route accounted for 29.4% of the errors. The most frequently reported error was administration of vaccines outside minimum and maximum recommended ages (37.7%). There was a higher incidence of errors in Vale do Aço (26.5/100,000) and Triângulo do Norte (22.6/100,000) macro-regions.

CONCLUSION

Immunization errors showed a heterogeneous incidence among the macro-regions of the state of Minas Gerais, between 2015-2019, and the administration of vaccines outside minimum and maximum recommended ages was the most frequently reported error.

Uso do Sistema de Informação de Imunização do Brasil: qual a realidade?

Introdução: A informação em saúde é essencial na tomada de decisões no âmbito das políticas públicas e tem se apresentado como instrumento essencial na interpretação de fenômenos. Assim, o estudo teve como objetivo avaliar o uso do Sistema de Informação de Imunização pelos profissionais de enfermagem. Materiais e métodos: Estudo transversal analítico realizado num município da Macrorregião Oeste de Minas Gerais, com profissionais de enfermagem por meio de um checklist validado. Para análise, utilizou-se um sistema de escores, classificado como: adequado, parcialmente adequado, não adequado e crítico. A mediana foi utilizada como medida-resumo para a análise descritiva e o Teste Qui-Quadrado de Pearson, para comparação de proporções. Resultados: Dos 104 profissionais de enfermagem, 14,4% relatam fazer uso dos registros para a gestão da informação em vacinação, 93,3% realizam o controle de estoque dos imunobiológicos, sendo esta a única atividade classificada como adequada. A produção do relatório de listagem de faltosos (39,4%), produção do relatório de cobertura vacinal (36,5%) e divulgação das informações consolidadas produzidas (17,3%) foram classificados como críticos. Não houve associações estatisticamente significativas entre as variáveis estudadas. Discussão: A subutilização das informações do sistema de informação traz consequências para os serviços de imunização, como baixas coberturas vacinais e oscilações nas proporções de abandono, além dificultar o planejamento e a tomada de decisões dos gestores das salas de vacinação. Conclusões: O uso das informações dos sistemas de informação precisa ser reconhecido pelos profissionais como necessário, útil e aplicável, sendo parte do processo de trabalho em sala de vacinação.

Suporte ético-emocional à profissionais de enfermagem frente à pandemia de COVID-19: relato de experiência

Resumo Objetivo Descrever a experiência de planejamento, execução e avaliação de um serviço de suporte ético-emocional para profissionais de enfermagem frente à pandemia de COVID-19. Método Relato de experiência no âmbito da Comissão de Suporte Ético-Emocional do Conselho Regional de Minas Gerais, Brasil, desenvolvido entre os meses de abril e dezembro de 2020 e operacionalizado através de ligações telefônicas e mensagens via aplicativo de comunicação. Resultados Foram atendidos 241 profissionais. Foram revelados e declarados sentimentos, emoções, vivências e problemas oriundos do cotidiano de trabalho da enfermagem diante do contexto pandêmico. Tais problemas reforçam a eminência, a urgência e o valor que o suporte teve para a vida, trabalho e saúde dos profissionais atendidos, configurando-se como uma estratégia de saúde e de intervenção indispensável à promoção, prevenção, segurança e proteção da saúde mental frente à pandemia. Os atendimentos culminaram na redução de sentimentos negativos; na percepção aumentada (identificação de potenciais ameaças e contextos de “gatilhos”); na valorização pessoal; no autoconhecimento e autocuidado. Considerações finais e implicações para a prática O suporte fez-se inovador para área da saúde e da enfermagem ao constituir-se como uma estratégia multidisciplinar promotora, aconselhadora e facilitadora do cuidado em tempos de COVID-19. Encoraja-se a manutenção desta estratégia após a pandemia.

Evaluation of the Psychometric Properties of the Immunobiological Agent Conservation Assessment Scale

INTRODUCTION AND OBJECTIVE

The cold chain of immunobiological agent conservation occupies a strategic position in the immunization system and, therefore, needs to be evaluated. This study psychometrically evaluated the Immunobiological Agent Conservation Assessment Scale (Escala de Avaliação da Conservação de Imunobiológicos-EACI).

METHODS

Methodological study carried out in Minas Gerais, Brazil, including 275 immunization rooms, divided into three stages: (a) pilot study; (b) internal consistency and temporal reproducibility; (c) criterion validity and structural validity.

RESULTS

The EACI items were analyzed for comprehension and clarity; presenting internally consistency (Cronbach's alpha: 0.72 [95% CI: 0.666-0.763]) and temporal reproducibility (ICC: 0.948 [95% CI: 0.911-0.981]), in addition to explaining 72% of the variance and discriminating the groups criteria (p = .0025).

CONCLUSION

The EACI is psychometrically reliable and valid and is the first assessment instrument available for this construct.

Adequacy assessment of immunobiological agent conservation in the Western Health macro-region of Minas Gerais State, Brazil: a descriptive study, 2017

OBJECTIVE

To describe the adequacy of immunobiological agent conservation in vaccination rooms in the municipalities of the Western health macro-region of the state of Minas Gerais, Brazil.

METHODS

This was a descriptive study, based on a validated scale, with a maximum score of 15 points. A descriptive analysis and an association test between the scores obtained by the municipalities and variables of the external context were performed.

RESULTS

275 out of a total of 295 existing vaccination rooms were evaluated. Immunobiological agent conservation in the West macro-region obtained an average score of 4 points (standard score, 0 to 15). There was a poor availability of immunization supplies aimed at immunobiological agent conservation, and work processes, that require improvement. Small municipalities presented better immunobiological agent conservation (p=0.011).

CONCLUSION

Immunobiological agent conservation in vaccination rooms in the Western health macro-region of Minas Gerais State was considered inadequate.

[Primary Healthcare e-SUS: determinant attributes for the adoption and use of a technological innovation]

The study aimed to analyze the adoption and use of the Primary Healthcare e-SUS (PHC e-SUS) as a technological innovation from the perspective of workers in primary healthcare (PHC). This was a sequential exploratory mixed-methods study (QUAN → qual) in municipalities in the interior of São Paulo state, Brazil, drawing on Diffusion of Innovation Theory. The quantitative component was analytical cross-sectional, applying a validated questionnaire to 114 PHC workers. The model was tested by applying partial least squares structural equation modeling (PLS-SEM) using SmartPLS 2.3.0. The qualitative study was descriptive-exploratory, using interviews (n = 10) with thematic content analysis, aimed at understanding the attributes that did not influence the adoption and use of PHC e-SUS. The attributes "experimentation", "ease of use", "relative advantage", and "compatibility" did not display statistical significance, indicating that they were not determinant attributes for the adoption and use of PHC e-SUS. Integration of the data evidenced failures in connectivity; lack of time to feed the system in real time and training; lack of prior experimentation; abrupt presentation of the system; and lack of skill with the technology. The results can assist other municipalities in Brazil with the implementation of the PHC e-SUS in relation to the importance of the organizational infrastructure, as well as training in the technology's use and handling. The study contributes to reflections and proposals for interventions in the problems faced in daily work with the adoption and use of a technological innovation such as the PHC e-SUS.

Factors related to the adoption of the Brazilian National Immunization Program Information System

Background

One way to optimize the adoption and use of technological innovations is to understand how those involved perceive, assess and decide to use them. This study aims to analyze the attributes that influence the adoption and use of the Brazilian National Immunization Program Information System (NIPIS) from the perspective of vaccination room workers.

Methods

This is a mixed method research, and a quantitative cross-sectional analytical study, with concomitant triangulation of data, carried out in a region of Brazil by using the Diffusion of Innovation Theory. We used a questionnaire with 183 nursing professionals who work at vaccination rooms in 12 municipalities. To test the research model, partial least squares structural equation modeling (PLS-SEM) and SmartPLS 2.3.0 have been applied to estimate the model. The qualitative research had a descriptive-exploratory character, using interviews (n = 18) analyzed through thematic analysis.

Results

The model proposed showed a mean correlation between the perceived attributes in the adoption and use of NIPIS. The results of the multiple regression indicated that the attributes “relative advantage” and “image” have a significant effect at 5% level (T > 1.97), positively influence the adoption and use of NIPIS; the attribute “voluntary use” negatively influences the adoption and use of the system; the attributes “experimentation”, “compatibility”, “profitability”, and “ease of use” did not influence the adoption and use of NIPIS. Emphasis has been placed on aspects that weaken the adoption and use of NIPIS such as lack of good quality internet and resistance to use the technology by some professionals. Workers perceive the importance of NIPIS for the municipality and point out that technological innovation provides data at an individual level, inserted in real time, which makes it possible to assess vaccination coverage. Lack of an unstable internet compromises data release due to system slowness.

Conclusions

The mixed method allowed an in-depth analysis of the adoption and use of NIPIS in the Western Health Macroregion of Minas Gerais State, and similarities were observed in the results. The attribute “relative advantage” is the one that most influences the adoption and use of NIPIS, which is the strongest predictor of innovation adoption rate.

Acceptance and use of the Information System of the National Immunization Program

Objective:

to analyze the acceptance and use of the Information System of the National Immunization Program in primary health care vaccination rooms.

Method:

a unique case study of a qualitative approach in the light of the Unified Theory of Acceptance and Use of Technology. Data collection included an interview with 18 professionals responsible for the implementation of the information system, observation of vaccination rooms in 12 municipalities of the West Macro-region of Minas Gerais, selected from a preliminary study. Data was systematized and analyzed through Content Analysis.

Results:

the interviewees are satisfied with the usefulness and ease of the system usage, but do not have the same satisfaction with the organizational infrastructure due to the lack of computers and low Internet connectivity in the health units, as well as with the incipient training for the use of the information system and the lack of skills with the technology among the human resources.

Conclusion:

nursing professionals perceive advantages in the acceptance and use of the Information System of the National Immunization Program. It was clear that the vaccinated individual’s history control and the decrease of records in paper are evidenced as facilitators of this acceptance. The system was considered reliable and secure.

Validity of an instrument to evaluate the immunobiological cold chain

Objective: To develop and to test the validity of content and layout of a multidimensional tool to evaluate maintenance of the cold chain for immunobiological conservation.Method: A methodological study carried out in three steps: integrative review; development of theoretical and logical model for the development of the tool; implementation of the Delphi Technique to test the validity of content and layout. The Content Validity Index (CVI) and Content Validity Ratio (CVR) were calculated considering appropriate those values greater than or equal to 75% and 0.4, respectively.Results: The instrument consisted of 7 questions about structure and 20 about process, subdivided into three components: Transportation/Reception (n=3); Storage/Handling (n=13); Supervision/Permanent education (n=4). The CVI value was 87.4%, with values equal to 85.7% and 89% in the structure and process dimensions, respectively. The process components obtained CVI values equal to 88.9, 88.9 and 89.2%, respectively. The CVR was 0.8, with values equal to 0.7 and 0.8 in the structure and process dimensions. As for the layout validation, the questionnaire was considered intelligible.Conclusion: The study provides an instrument with validity of content and layout for health professionals in charge of the supervision of activities of immunobiological conservation, ensuring the maintenance of the immunogenic quality of the products offered to the population.

Conocimiento de los profesionales de la salud sobre la vacunación en gestantes: construcción y validación de contenido de un instrumento

Introducción: El papel de los profesionales de la salud es crucial para suministrar información sobre vacunación y tranquilizar a las gestantes sobre la seguridad y los beneficios de la inmunización para la madre y los niños. La falta de recomendación del inmunobiológico se puede asociar a las dificultades en la indicación y contraindicación clínica, el manejo de los efectos colaterales y de las reacciones adversas a los inmunobiológicos y por la falta de capacitación del profesional. Adicionalmente, la falta de instrumentos de medición, para el cuidado en la sala de vacunación, justifica la construcción y validación de herramientas para tal fin. Objetivo: Construir y validar el contenido y la apariencia de un instrumento que evalúa el conocimiento de profesionales de la salud sobre la vacunación de gestantes. Materiales y Métodos: estudio metodológico para la elaboración de un instrumento de medición. Se utilizó la Técnica Delphi para validar el contenido y la apariencia de los elementos. Se calculó el Índice de Validación del Contenido (IVC) y el Content Validity Ratio (CVR) para calcular el grado de concordancia entre los jueces. Para obtener la puntuación del instrumento, además de los ítems de evaluación del conocimiento, también se envió a los jueces una escala de criterios de puntuación para evaluar el conocimiento de los profesionales en función de las recomendaciones del Ministerio de la Salud sobre la vacunación del gestante. Resultados: Todos los ítems del instrumento obtuvieron un IVC variable de 90% a 100% y un CVR entre 0,7 y 1,0, confirmando la validez del contenido. Discusión y Conclusiones: El instrumento presentó un índice de validez de contenido satisfactorio y se puede utilizar para evaluar el conocimiento sobre vacunación de la gestante.