Eficácia da aplicação de um conjunto de medidas na prevenção de pneumonia e traqueobronquite associadas ao ventilador

Abstract

Background. Ventilator-associated respiratory infection, pneumonia or tracheobronchitis, is the most common intensive care unit-acquired infection. Implementation of preventive measures sets (bundles), multidisciplinary rounds and educational initiatives directed toward healthcare workers, seems to have greater effectiveness in reducing these infections. Objectives. Testing effectiveness of a preventive measures bundle in reducing the incidence of ventilator-associated pneumonia and tracheobronchitis, assessing also the influence of professionals’ compliance with the measures on incidence variation. Methods. Quasi-experimental pre-post intervention study, with an historical control, conducted in two intensive care units from regional hospitals. For a period of six months, in 108 patients intubated and ventilated for 48 hours or more, a five-measures prevention bundle was applied, consisting of healthcare workers hand hygiene, daily interruption of sedation and assessment of readiness to wean, oral hygiene with chlorhexidine, head-of-bed elevation, and maintaining tracheal tube intracuff pressure. Control group was composed of the 105 patients intubated and ventilated for 48 hours or more in the same period from previous year. Results. Ventilator-associated respiratory infection incidence decreased from 20.35 pre-intervention to 13.58 / 1,000 ventilator days (p = .24), post-intervention. Number of days between infections analysis in a control chart revealed a post-intervention shift of the process towards out of control state. Pneumonia decreased from 7.75 to 6.79 / 1,000 (p = .78) and tracheobronchitis from 12.60 to 6.79 / 1,000 (p = .16). Also hospital mortality, average length of stay and number of ventilation days were not significantly altered by intervention. Professionals’ compliance with bundle measures was 76,2% per nursing shift. Discussion. Low number of infections legitimized the use of statistical process control method, which revealed statistical significance of post-intervention reduction in the incidence of ventilator-associated respiratory infection. Pneumonia and tracheobronchitis occurred in insufficient numbers for revelation of significance in the observed reduction. Professionals’ compliance with bundle measures was lower than reported in literature, probably due to insufficiencies in educational aspect of the study. Conclusion. Supporting study hypothesis, ventilator-associated respiratory infection incidence was reduced by application of a preventive measures set, according to bundles method.

Date of Award	17 May 2012
Original language	Portuguese
Awarding Institution	Universidade Católica Portuguesa
Supervisor	José Augusto Gamito Melo Cristino (Supervisor)