Revista de Saúde Pública (Jun 2002)

Estrategia de atención de niños hospitalizados por infecciones respiratorias agudas bajas A strategy for the management of hospitalized children with acute lower respiratory infections

  • Ana M Ferrari,
  • María C Pirez,
  • Alicia Ferreira,
  • Ivonne Rubio,
  • Alicia Montano,
  • Rosa Lojo,
  • Graciela Palomino,
  • Gustavo Giachetto,
  • Alvaro Galiana,
  • María J Sarachaga,
  • Silvana Mercado,
  • Osvaldo Martinez,
  • Marta Alberti,
  • Hector Chiparelli,
  • Soledad Mateos,
  • Adriana Varela,
  • Daniela Sandín,
  • Cecilia Montenegro,
  • Gabriela Algorta,
  • María Albini

DOI
https://doi.org/10.1590/s0034-89102002000300006
Journal volume & issue
Vol. 36, no. 3
pp. 292 – 300

Abstract

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OBJETIVO: Mejorar la calidad de la atención hospitalaria de los niños con infecciones respiratorias agudas bajas, aumentar los conocimientos sobre esa patología y mejorar la eficiencia en el uso de los recursos asistenciales, por medio de una estrategia que se denominó Plan de Invierno.MÉTODOS: La estrategia se basó en la utilización de protocolos de diagnóstico y tratamiento, internación por cuidados progresivos y por enfermedad, adecuación de los recursos asistenciales y creación de un sistema de registro permanente, informatizado. Se incorporó la investigación sistemática de la etiología viral para racionalizar el uso de la medicación y reducir las infecciones intrahospitalarias. RESULTADOS: Durante la aplicación del Plan (19/V-19/IX/99) ingresaron 3.317 niños; 1.347 (40.61%) presentaban infecciones respiratorias agudas bajas. Se captaron 1.096 (81%), de los cuales 71% eran menores de un año. Predominaron las infecciones respiratorias virales (68%). Los criterios de ingreso fueron saturación de oxígeno OBJECTIVES: To improve the quality of care provided to hospitalized children having acute lower respiratory infections (ALRI), to increase the knowledge on this health condition, and to broaden the utilization of health care resources through a program called "Winter Plan". METHODS: The program comprised the use of guidelines for diagnosis and treatment, disease-oriented hospitalizations to provide an increased level of care, management of health care resources and implementation of computerized medical records. Systematic investigation of viral etiology was performed in order to rationalize the use of medications and reduce nosocomial infections. RESULTS: During program implementation (19/V-19/IX/99), 3,317 children were admitted; 1,347 (40.61%) had ALRI, of which 1,096 (81%) were included in the study. Of them, 71% aged less than 1 year. Most ALRI were viral (68%). Admission criteria were: oxygen saturation <95%, tachypnea, retractions or pleural effusion (92.4% of the children). The demand magnitude prevented compliance with isolation guidelines in all cases. Treatment guidelines were followed in a high percentage of cases: 73% of children having bronchiolitis and 72% of those with viral pneumonia received no antibiotics and 96% of children with bacterial pneumonia were put on antibiotics as recommended; use of bronchodilators and corticosteroids was reduced. Medication costs were reduced especially in the corticosteroid group, which meant a greater impact on hospitalization costs. CONCLUSIONS: To decrease ALRI morbidity and mortality there is a need to continue improving the quality of health care during hospitalization and to reinforce health promotion actions and preventive programs at the primary level.

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