Positive deviance as a strategy to prevent and control bloodstream infections in intensive care.

Francimar Tinoco De Oliveira,Maria Manuela Frederico Ferreira,Advi Catarina Barbachan Moraes,Amanda Trindade Teixeira De Bessa,Marluci Andrade Conceição Stipp,Silvia Teresa Carvalho De Araújo

doi:10.1590/s1980-220x2016182303212

Abstract

To describe the application of positive deviance as a strategy to prevent and control bloodstream infections. An intervention study with nursing and medical team members working in an intensive care unit in a university hospital, between June and December 2014. The four steps of the positive defiance methodology were applied: to define, to determine, to discover and to design. In 90 days, 188 actions were observed, of these, 36.70% (n=69) were related to catheter dressing. In 81.15% (n=56) of these dressings, the professionals most adhered to the use of flexible sterile cotton-tipped swabs to perform antisepsis at catheter entry sites and fixation dressing. Positive deviance contributed to the implementation of proposals to improve work processes and team development related to problems identified in central venous catheter care. Descrever a aplicação do Positive Deviance como estratégia na prevenção e no controle da infecção de corrente sanguínea. Estudo de intervenção realizado na Unidade de Terapia Intensiva de um hospital universitário, com os membros das equipes de enfermagem e médica, de junho a dezembro de 2014. Foram aplicados os quatro passos da metodologia Positive Deviance: Definir, Determinar, Descobrir e Desenhar. Em 90 dias 188 ações foram observadas, destas, 36,70% (n=69) estavam relacionadas aos curativos dos cateteres. Em 81,15% (n=56) desses curativos, o uso da haste flexível estéril para realização da antissepsia do local de inserção do cateter e de sua placa de fixação foi a ação de maior adesão. O Positive Deviance auxiliou na implementação de propostas de melhorias de processo de trabalho e no desenvolvimento da equipe para os problemas identificados no cuidado com o cateter venoso central.

Highlights

Short-term Central Venous catheters (CVCs) are devices inserted via venipuncture into central circulation, i.e., in the lower third of the superior vena cava/right atrium junction[1]
The objective of this study was to describe the application of positive deviance as a strategy to prevent and control bloodstream infections. This was a longitudinal, prospective study, whose intervention consisted of applying the PD methodology. It was conducted in a university hospital intensive care unit (ICU) located in the North Zone of the municipality of Rio de Janeiro
Regarding knowledge about Primary Bloodstream Infection (PBSI), the nurses and doctors kept up to date through articles and conferences, and nursing technicians through the institution’s continuing education program, articles, and books, and 9.21% of this multiprofessional team did not seek any form of update

Summary

Introduction

Short-term Central Venous catheters (CVCs) are devices inserted via venipuncture into central circulation, i.e., in the lower third of the superior vena cava/right atrium junction[1]. They include devices inserted into large vessels such as the aorta and pulmonary arteries, the superior and inferior vena cava, and the brachiocephalic, internal jugular, subclavian, external iliac, and common femoral arteries[2] These devices are referred to as “short term” for they lack mechanisms to prevent extraluminal colonization and tend to be used for short periods, between 10 and 14 days. It is the most common type of catheter used in intensive care units (ICUs), accounting for approximately 90.0% of catheter-associated bloodstream infections[1,3]. Educational programs are needed to encourage the participation of multidisciplinary teams in these units to increase adherence to control measures and guide activities that improve inadequate practices, representing an impact strategy to reduce Healthcare-Associated Infections (HAIs)(4)

Methods

Results

Discussion

Conclusion