Práticas assistenciais e de gestão na prevenção das infecções primárias da corrente sanguínea

Abstract

The Primary Bloodstream Infections are classified as those laboratory confirmed by positive blood culture results in patients using a Central Venous Catheter, making the performance of managers and professionals in preventing the occurrence of these events in the Intensive Care Units increasingly important. The objective was to analyze the management and assistance practices related to the prevention of Primary Bloodstream Infections associated with the central venous catheter in the Intensive Care Unit of a university hospital. It is a mixed approach study in which methodological triangulation was used in data collection from the combination of quantitative and qualitative methods. A questionnaire structured with open and closed questions about the knowledge and perception of the measures of prevention of primary bloodstream infections associated with the central venous catheter, a systematic observation checklist that did not participate in the procedures of catheter insertion, preparation, administration of medication and change of dressing, and finally, a focal group was carried out. The population consisted of 25 physicians, 19 nurses and 64 nursing technicians who handled the central venous catheter during the study period, as well as a member of the Hospital Infection Control Service, who was in charge of the technique and a representative of the nursing intensive care unit coordination, representative of the hospital's nursing division, two representatives of health care management and a representative of the Patient Safety Center. Quantitative data was analyzed through descriptive statistics and presented in table forms. For that, Microsoft Excel 2017 and SPSS 25.0 were used. In order to verify the level of significance, the Chi-square test was applied, and Fisher's exact test was used for the cases below five. The significance level was set at p-value <0.05. For the qualitative data, the content analysis was used by Minayo with the use of Atlas Ti software. The research was approved by the Research Ethics Committees of the Federal University of Rio Grande do Norte and Onofre Lopes University Hospital, according to its consolidated opinion no. 2,721 .411 / CAAE: 80013817.8.3001.5292. Among those surveyed, it was observed that the majority were female (59.26%), in the age group up to 40 years (70.37%), predominantly the nursing technician (59.26%). Concerning the knowledge of the prevention measures for central venous catheter bloodstream infection, the majority (62.04%) received training on hand hygiene (90.74%), affirmed (60.19%) the existence of a catheter bundle, has knowledge of the principles of prevention proposed by the bundle (58.33%) and worked with this type of methodology (58.73%). Most feel that service management motivates them to conduct safe care with an institutional policy (72.22%) and recognize that it is difficult to follow safe practices altogether (50%). Regarding the perception and performance of professionals in relation to the prevention measures for central venous catheter bloodstream infections, most physicians reported that they always (92%) sanitized their hands, always (88%) used correct paramentation, always (80%) perform adequate preparation of the skin, always (56%) avoid puncture of the femoral vein as a site of choice and almost always (48%) perform daily checking and recording as to the necessity of the device, providing removal when not necessary. It was observed that these professionals achieved in practice hand hygiene (96%), with a predominance of the technique of surgical brushing (96%), adequate preparation of the skin (93%) with spontaneous drying of the antiseptic (96%) and choice of insertion site opting for femoral insertions in only 6%. The nurses and nursing technicians always reported cleaning of the hands (88%) during maintenance of the devices, but the practice was inadequate for the preparation procedures (36%), medication administration (10%) and dressing changes (52%). There was a predominance of the technique of simple hygiene of the hands with soap and water, in detriment of the use of alcoholic preparations before preparation (80.65%) and medication administration (57.69%). Hub friction at the time of administration was present in 65% of the observations. There was no protection of the dressings of the central venous catheter (65%) during the bath and the coverage of choice the gauze and the adhesive tape predominated (86%). The development of the dissertation product occurred from the focus group discussion with the managers on the main difficulties pointed out by the professionals in the institutional context to survey solutions so they can be effective in the prevention of primary bloodstream infections. Thus, the research results point out that the change of a reality depends on the behavior change of the involved actors, a reflection of both the professionals about their practices, and the managers in the accomplishment and conduct of the prevention actions being fundamental and necessary.