Análise das Medidas de Prevenção e Controle da Infecção do Trato Respiratório Relacionada à Ventilação Mecânica Invasiva.

Abstract

ABSTRACT Healthcare-Related Infections (HAIs) are defined as those acquired after a patient is admitted to a healthcare facility, and which manifest themselves during hospitalization or even after discharge. In Intensive Care Units (ICUs), Ventilator-Associated Pneumonia (VAP) is characterized as the second most prevalent HAI, predominantly affecting patients who require invasive respiratory support. A significant part of the interventions related to the prevention of VAP are focused on care practices, making the professional nurse essential in the process of breaking the infectious chain. Thus, evaluating the use of preventive measures is essential to ensure the effectiveness of preventive actions, optimize resources, reduce the incidence of VAP infections and improve Patient Safety (PS). The aim of this study was to assess the compliance of ventilator-associated pneumonia (VAP) prevention and control measures in high-risk patients and to verify the presence of an association between the least compliant prevention measures and the onset of VAP in the same period. This is an integrative literature review, followed by an observational, analytical and cross-sectional study carried out with patients in an Adult Intensive Care Unit (ICU) of a hospital located in the municipality of Três Lagoas, in the state of Mato Grosso do Sul. Data was collected in January and February 2023, using the items that make up the Indicator for Assessing Adherence to Measures for the Prevention and Control of Pneumonia in Patients at Risk (IRPR), as well as checking for the presence of condensate in the circuit. The unit of analysis was the set of opportunities to observe practices related to preventive measures. The integrative literature review, carried out using databases and virtual libraries, indicated that the nursing care most used to prevent VAP is: positioning the headboard between 30º and 45º, simple hand hygiene, oral hygiene with chlorhexidine or 0.12% aqueous chlorhexidine, and monitoring cuff pressure. Adherence to VAP prevention and control measures contributes to better clinical outcomes because, when properly applied, they reduce the length of stay of patients on mechanical ventilation and have a positive impact on the incidence density of VAP. With regard to assessing compliance with VAP prevention and control measures in high-risk patients and verifying the association between the least compliant prevention measures and the onset of VAP in the same period, 1,030 assessments were carried out, distributed equally between the morning (515 assessments) and afternoon (515 assessments) shifts, on 206 occasions for each preventive measure. The absolute numbers of observations indicated that overall compliance with prevention and control measures was 53.8%, with the afternoon shift showing the best results at 61.2%. These figures show that the care provided is less than expected, since the expected compliance rate for this study was ≥ 80%. The control measure with the lowest percentage of compliance was the presence of condensate in the circuit, both in the morning (94.2%) and in the afternoon (93%). The use of sterile solutions for nebulizers and humidifiers and the routine change of the inhalation therapy circuit were the control measures that showed 100% compliance in both shifts. No significant association was found between the presence of condensate in the circuit and the occurrence of VAP in the same period (p = 0.467). It can be concluded that VAP prevention and control practices in the ICU studied need to be improved. However, it is possible to infer that, in this specific environment, the failure to reach 80% in the overall compliance index did not have an impact on the incidence of VAP.

Keywords: Pneumonia Associated with Mechanical Ventilation. Intensive Care Units. Health Care. Infection. Prevention & Control. Nursing Care.