Ferramenta para implementação dos requisitos higiênico-sanitários em serviços de nutrição e dietética hospitalar

Abstract

The goal of this study was to develop a quality tool for Nutrition and Dietetics Hospital Services and evaluate the hygienic sanitary conditions of these places before and after the implementation of this tool, according to the view of the internal and external auditor. Also, to evaluate the satisfaction of the internal auditors regarding the tool, check the hygienic sanitary conditions of the hands of manipulators and surfaces in contact with food after improvements and training and evaluate the satisfactionf the patients regarding the meals served after implementation of the tool. This research was divided in three studies (1 - preparation and implementation of the tool; 2 - Review of the hygienic sanitary conditions of the hands and contact surfaces; 3 - evaluation of the satisfaction of patients regarding the meals served). The sample was composed by 15 Nutrition and Dietetics Hospital Services. To establish the quality tool, we used the requirements of the laws and regulations of Brazil. The tool is composed by four support instruments, divided in: 1 - Evaluation and quality planning; 2 - A guide for the development of the Manual of Best Practices; 3 - A guide for the development of Standard Operating Procedures and Instrument; 4 - A guide for the development of the Essential Operational Controls. After the development of the tool, we performed an initial evaluation of the hygienic sanitary requirements at each site through the application of the Instrument 1 by the internal and external auditor. The technician responsible for the Nutrition and Dietetics Hospital Services was considered the internal auditor and the external auditor was a professional with experience in the food area, which evaluated all the locations. After the implementation, the internal auditors received the results of the external auditor and other instruments of the tool, and the deadline of one year for the implementation was stipulated. At the end of the deadline, the internal and external auditors applied again the instrument 1. Then, the internal auditors completed a questionnaire to evaluate their satisfaction regarding the quality tool. The evaluation of the hygienic sanitary conditions of the hands and contact surfaces was divided into two stages. First, we evaluated the requirements of hygiene and microbiological analyzes on hands and contact surfaces. Then, the locations received the results and recommendations of adequacy, which were asked to be fulfilled in two months. After this, the local that showed improvements participated in the second stage, with training and new collection of microbiological analyzes. To evaluate the satisfaction of the patients regarding the meals served, we prepared a questionnaire with classifications sucha as: Great; Fair and Poor. In the evaluation of the internal auditors, the instruments were considered Great. After the implementation of the tool there was significant increase in the percentage of overall suitability and requirements, both in the evaluation of the internal external auditor. It was found that in the percentage of overall suitability, before the application of the tool, there was a statistically significant difference in the evaluation between the auditors, and this fact was not observed after the application of the tool. In the evaluation of the meals served, it was found that in the overall average, the requirements were considered Great. It is concluded that the quality tool was effective in adjusting the criteria for the hygienic sanitary control in Nutrition and Dietetics Hospital Services, according to the view of the internal and external auditors and helped in the understanding of the internal auditors, provided a more critical view of the requirements and decreased differences between evaluators. It is seen that the hygienic sanitary conditions of the hands and contact surfaces got better. After the improvement, the patients were satisfied with the meals served due to the implementation of the tool.