Understanding of the Accompanying Family on the Prevention of Infections Related to Healthcare Compreensão do Familiar Acompanhante sobre Prevenção das Infecções Relacionadas à Assistência em Saúde

The objective of this study was to analyze the understanding of the accompanying family member regarding the prevention of Healthcare Related Infections (IRAS). A descriptive study with a qualitative approach, carried out with 20 companions of patients in the medical and urological clinics of a general hospital in Teresina-PI. The analysis and discussion were based on answers about demographic data and open-ended questions, in which the profile of the interviewees was obtained according to age, sex, schooling, period of stay, companions, and patient admission for understanding the thematic categories. Two thematic categories emerged: "Companions 'Understanding on IRAS" and "Companions' Perception Regarding Orientations Received on IRAS". The results presented in this study facilitate the understanding, resolution and utilization of implementation strategies to improve the quality of the guidance provided by the health team to the companions. It is considered paramount that the nurse and the multi professional team promote quality guidelines that can benefit clients not only in the hospital environment, but also in high contact with society, improving the quality of life.


Introduction
In recent years, infections have been placed as the focus of studies of researchers in the most diverse fields of healthcare (1) .
Healthcare-related infection (IRAS) is defined as that acquired during or after the patient's hospitalization and that manifests during their stay or even after discharge when it is related to hospitalization or hospital procedures (2) .
IRAS represents a serious global problem that threatens patient safety and is one of the main causes of morbidity and lethality associated with clinical, diagnostic and therapeutic procedures provided to the population, requiring effective prevention and control actions by the health services (3) . Infections afflict both patients and professionalsand can develop excessive suffering and financial expense (4). They may also result in legal lawsuits and compensations in cases of proven negligence during the care provided (5) .
IRAS are considered public health challenges, affecting more than 15% of patients hospitalized, worsening with the emergence of bacterial resistance (6) . The control of IRAS in the health units includes hand hygiene practices, which, in compliance with legal and ethical requirements, improve the quality of patient care. The advantages of these practices are visible, from the reduction of morbidity and mortality of patients to the reduction of costs associated with the treatment of infections (7) .
Thus, the importance of implementing hand hygiene practices in reducing infection rates is evident, and most practitioners agree that this practice is the simplest, most effective and most valuable way to prevent the transmission of microorganisms in the environment where nursing care occurs (6) .
The presence of family members in hospital units has become increasingly frequent, they develop care actions with their hospitalized relative, which is often based on empiricism. Care actions are carried out in face of the fragility related to the demand of nursing professionals within the hospitals and the family assumes a posture that resembles solidarity (8) .
One of the actions performed by family members refers to infection prevention measures. However, the meaning and usefulness of preventive measures of infection are often not well understood by the nursing team, increasing the possibility of transmission, and may cause harm to the patient's rehabilitation process and bring risks to the companions and professionals themselves (9) . The interaction of the caregivers with the health team is extremely important for both, because the valorization of this interaction is based on their greater participation in the care plan (8) .
In Brazil, companions' stay in hospitals have encountered difficulties due to the lack of structure and organization for the well-being of these people. The family, during the follow-up process in the public hospital, provides care such as patient hygiene, food and mobility at random, without guidelines or instructions, due to the scarcity of human resources (8) . These practices

Results
The table below shows the profile of the companions who were interviewed according to age, sex, schooling, period of stay, companions and patient admission, which were used to understand the thematic categories. This circumstance corroborates a study, in which all the companions were women, due to the fact that the female figure is, in most cases, the main responsible for care actions (9) .
The data from the study showed that most of the companions were in a socially productive age group and needed to take time away from work for better inpatient care (11) .
Regarding the level of education, the following was predominant:basic education level with 10 (50%),high school was 07 (35%) and higher education 03 (15%). These data are in agreement with the research that revealed in the studied population, that the majority has incomplete basic education. The author (12) emphasizes that knowing the level of education of the companions is important, since they receive the information and orientation of the health team, from the perspective of health education and the learning capacity of the people.
The predominant hospitalization time was the period from 48 hours with 18 of the subjects (90%), followed by subjects who have stayed for more than 24 hours, 02 (10%). The study (13) shows that the longer the patient and sibling 0 (0%). A study (12) shows that wivesare the ones to take care of their partners, mainly because of the common life project assumed by the marriage and the commitment to be together in sickness and health.

Discussion
In the transcription analysis of the interviews, the central ideas, key expressions and also the organization of the discourses of the two themes that emerged from the two guiding categories were identified.

The companions' understanding of IRAS
In this category, we sought to analyze the speeches of the companions regarding IRAS. It was observed that most respondents (11) (14) .
There are also, multiresistant bacteria, which can be transmitted through direct or indirect contact with the patient (9) . One study (15) indicates that the level of understanding of family members / companions related to hand hygiene practice was significantly seen, since most of them stated that they understood the importance of this measure for the safety of the patient and for themselves.
Admittedly, the practice of hand hygiene reduces significantly the transmission of microorganisms and, consequently, decreases the incidence of predictable IRAS, reducing morbidity and mortality in health services (16) .
According to a study (17)  According to the following reports:  (17) . According to a research (16)  we highlight the few associated professional experience and the lack of time to forget the practices, directly influencing the inadequate behavioral attitudes in the work environment (18) .
It is necessary that health professionals seek to provide information in a clear way, allowing the reduction of anxiety and informing the caregivers that precaution is important so that they do not become a means of disease dissemination within the hospital environment (9) . Nurses are aware of their responsibility for the quality of care they provide to patients and the guidelines given to caregivers, as well as those related to the institution, ethics, laws and standards of the profession, and the contribution of their performance in valuing the care and satisfaction of patients (19).
Nurses are experiencing difficulties in the control of IRAS due to a lack of human and material resources, outdatedness and lack of preparation to implement care and better guidance to the caregivers (20). It is essential to the organization, planning and implementation of protocols, prevention and control programs of IRAS, as well as investments in training for health professionals (21) . The IRAS Control Committee is responsible for the training of health professionals, aiming to minimize risks and diseases related to IRAS (22). As the following  (23).

Conclusion
The objective of this study was to analyze It is considered paramount that nurses and multiprofessional teams promote quality guidelines that can benefit clients not only in the hospital environment, but also post-discharge in contact with society, improving the quality of life.