AVALIAÇÃO DE UM PROGRAMA DE INTERVENÇÕES NA LIMPEZA E DESINFECÇÃO DE SUPERFÍCIES EM UNIDADE DE TERAPIA INTENSIVA PEDIÁTRICA

Abstract

Florence Nightingale's Environmental Theory established that the intentional modification of the environment can promote health and prevent disease. A contaminated environment may facilitate the transmission of pathogens, especially when there are failures in surface cleaning and disinfection processes. However, gaps remain in the scientific literature regarding the details and effects of training for workers responsible for these tasks, who are often overlooked. These professionals also require investigation into their levels of motivation, satisfaction, performance, and commitment. This study aimed to evaluate the impact of a multimodal intervention program on professional knowledge and surface cleaning and disinfection in a Pediatric Intensive Care Unit (PICU), as well as to examine related human factors. This was a sequential, multi-method quantitative study conducted in a PICU in the Midwest region of Brazil. Thirty-five healthcare workers responsible for surface cleaning and disinfection participated, including 6 nurses, 17 nursing technicians, and 12 hygiene and cleaning staff members. Five high-touch surfaces were selected for monitoring: the medication table, feeding table, companion’s armchair, bed elevation control, and patient’s bed. The study comprised three phases: Baseline (Phase I), Multimodal Intervention (Phase II), and Medium-Term Follow-up (Phase III). Monitoring methods included adenosine triphosphate (ATP) testing, visual inspection, total aerobic colony count, and fluorescent marker analysis. The study received approval from the Research Ethics Committee of the Federal University of Mato Grosso do Sul. Results showed that post-intervention, participants demonstrated a higher frequency of correct responses regarding hygiene practices, infection control, identification of critical surfaces, and proper use of personal protective equipment. Regarding surface monitoring, the visual inspection pass rates were 75%, 95%, and 90% in Phases I, II, and III, respectively. ATP pass rates were 67.5%, 77.5%, and 70%, while fluorescent marker approval rates were 22.5%, 25%, and 30%. CFU count approval rates were 67.5%, 75%, and 62.5%, respectively. There was a significant reduction in mean values for the patient’s bed in Phase I (p = 0.009), and in Phase II for both the patient’s bed (p = 0.046) and the medication preparation table (p = 0.018), with no significant differences observed in Phase III. Overall, surface cleaning and disinfection had a more substantial impact in Phases I and II, with less variation in Phase III across all monitoring methods. Additionally, the study found that levels of motivation, satisfaction, performance, and commitment among workers were moderate. Lower motivation levels were noted only in aspects related to extrinsic factors, particularly remuneration. Furthermore, higher education levels among workers were associated with greater affective (p = 0.038) and instrumental (p = 0.007) commitment. In conclusion, short-term improvements in surface cleaning and disinfection practices, as well as enhanced professional knowledge regarding cleaning and disinfection, were observed following the multimodal intervention. The findings also highlight the need for institutional strategies to recognize and support these workers, including salary adjustments, which were identified as a key factor in demotivation.