Avaliação dos conhecimentos dos sintomáticos respiratórios sobre a coleta de amostras de escarro para exames diagnósticos de Tuberculose

Abstract

The quality of pulmonary tuberculosis (PTB) diagnostic exams is intrinsically related to the quality of sputum samples forwarded to the laboratory. Amongst the actions related to the collection of such samples, implies the disclosure of information within health service centers and the incorporation of this information by the patient. Considering this fact, this study had as objective to evaluate the knowledge of patients with respiratory symptoms suspicious of PTB regarding the collection of sputum samples for diagnostic exams, according to the orientations established by the Brazilian Department of Health. This refers to a descriptive, transversal, case detection study. The case was constituted by 138 male and female patients suspected with PTB, assisted by the Center of Reference in Sanitary Pulmonology (CREPS - Centro de Referência em Pneumologia Sanitária) Cardoso Fontes , from September 2010 through February 2011 and health professionals responsible for providing guidance for collecting sputum samples. Three sputum samples were collected from each patient, being the first at the health service center; the second at the patient s residence, on the following morning; and the third also at the patient s residence, on the day after the delivery of the second sample. The orientation for the collection of the third sample was conducted following the rules defined by the Brazilian Health Department, and during the delivery of the second sample at the laboratory service of CREPS Cardoso Fontes. In order to evaluate the knowledge of patients regarding the collection of sputum, the orientations given by the Brazilian Health Department were used as a parameter. The results obtained from the sputum smear microscopy analysis were compared to those obtained from cultures and analyzed according to the patient s knowledge and the sample quality. In order to determine co-positivity or co-negativity, table 2x2 was used. In order to evaluate the level of significance (p ≤0,05), the non-parametrical binomial test was used. The results showed that the cases of pulmonary tuberculosis (PTB) confirmed were majorly found on male patients, with low education, and who have previously received BCG. Cough was present on all PTB patients and the majority looked for medical help one month after appearance of the symptoms. The conclusion was total unawareness of patients on issues related to motivation and bio-safety on the collection of sputum samples. On what refers to the knowledge regarding the expectoration process, PTB patients had larger percentages of awareness, on 8 out of 10 recommended orientations, in comparison to those that did not have their diagnosis confirmed. The procedure with the smaller percentage of knowledge was the repetition of actions directly related to bronco-pulmonary sputum liberation. Preliminary, guidelines for biosafety and motivation are not being provided by professionals, whereas the flow directions are carried out routinely. There was no significant incorporation of knowledge concerning the main procedures for an adequate sputum. The conclusion was that after detailed orientation following the recommendation of Brazil s Health Department, the patient was capable of producing sputum samples with satisfactory aspect and volume in order to conduct the exam. Such results suggest urgency on the need for educational mechanisms that allow the transfer of all orientations homogeneously, using communication techniques that provide the understanding and incorporation of knowledge by people with different educational levels.