| dc.description.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. | |
