Abstract
OBJETIVO: Avaliar o impacto de intervenções interdisciplinares nos indicadores de infecção de corrente sanguínea relacionada ao cateter venoso central e microrganismos isolados, em uma Unidade de Terapia Intensiva Pediátrica. MÉTODOS: Estudo de intervenção do tipo antes e depois. Foi criado um programa educativo e constituída uma equipe interdisciplinar de intervenção composta por médicos e enfermeiros da unidade e do Serviço de Controle de Infecção Hospitalar. As intervenções foram compostas por medidas diretas e indiretas educativas e processuais. O período pré-intervenção (Fase 1), de junho de 2003 a maio de 2004, foi comparado ao período pós-intervenção nas Fases 2 (junho de 2004 a maio de 2005) e 3 (junho de 2005 a maio de 2006). As taxas de infecção foram comparadas por ANOVA, sendo significante p<0,05. RESULTADOS: Foram avaliados 1.234 pacientes entre 1º de junho de 2003 e 31 de maio de 2006. A densidade de incidência de infecção de corrente sanguínea relacionada ao cateter venoso central foi de 22,72 por 1.000 dias de cateter na Fase 1; diminuiu para 6,81 e 5,87 nas Fases 2 e 3, respectivamente (p<0,01) e não houve diferença entre as Fases 2 e 3. Os Gram-positivos representaram 57% dos microrganismos isolados no período pré-intervenção e 45 e 58%, respectivamente, nos períodos pós-intervenção. CONCLUSÕES: A abordagem educacional interdisciplinar e o estabelecimento de normas para inserção e intervenção no processo de manutenção de cateteres reduziram as taxas de infecção da corrente sanguínea relacionada ao cateter venoso central em uma Unidade de Terapia Intensiva Pediátrica.
Highlights
Central venous catheters (CVCs) are used to infuse solutions that are capable of irritating the vascular tunica intima, as is the case with high osmolality parenteral nutrition and with the pharmaceuticals used for cancer chemotherapy, and they make hemodynamic monitoring possible with critical patients
The National Healthcare Safety Network (NHSN) is an information network that is administrated by the Centers for Disease Control (CDC) and is responsible for unifying surveillance systems aimed to ensure the safety of patients and health professionals
This study was conducted at a tertiary University Hospital with 377 beds, 10 of which are in a Pediatric Intensive Care Unit (PICU) that treats children with both clinical and surgical pathologies
Summary
Central venous catheters (CVCs) are used to infuse solutions that are capable of irritating the vascular tunica intima, as is the case with high osmolality parenteral nutrition (greater than 800 to 900mOsm/L) and with the pharmaceuticals used for cancer chemotherapy, and they make hemodynamic monitoring possible with critical patients. The results of studies into the risk factors for central venous catheter-associated bloodstream infections (CVCBSI) allied to newly-developed technologies and improved CVC insertion and maintenance techniques have made it possible to establish guidelines for the control of these infections[1,2,3,4]. A recent intervention study demonstrated a 40% reduction in CVC-BSI rates among patients in a clinical intensive care unit at a Brazilian University Hospital after an educational program and implementation of surveillance strategies[5]. Its most recent report contains data from 2006 provided by 36 pediatric intensive care units (PICUs) in the United States and the median CVC-BSI rate is 3.5 per 1,000 central venous catheter days[8]
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