Análise da utilização dos bundles para prevenção de infecções em pacientes queimados
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Data
2018-02-19
Autores
Baruffi, Natália Grossi Visoná
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Universidade Estadual Paulista (Unesp)
Resumo
Estudo retrospectivo e documental cujo objetivo foi analisar a efetividade do protocolo bundles como ferramenta para prevenção de Infecções Relacionadas à Assistência a Saúde (IRAS) de indivíduos internados em Unidade de Terapia Intensiva de Queimaduras (UTIQ) de um hospital terciário do interior paulista. Inicialmente, efetuou-se o levantamento de dados dos prontuários de todos os indivíduos que apresentaram IRAS internados na UTIQ de janeiro de 2008 a dezembro de 2016 e coletadas informações referentes aos que apresentaram infecções abordadas no protocolo bundles, compreendidos como as pneumonias associadas à ventilação mecânica (PAV), Infecção de corrente sanguínea (ICS) por uso de cateter venoso central e infecção do trato urinário (ITU) por uso de sonda vesical de demora, dividida em dois momentos: M1 (2008 a 2010) e M2 (2011 a 2016) pré e pós implantação do protocolo respectivamente. Dos 612 indivíduos admitidos na UTIQ nos dois momentos, 58,4% são do sexo masculino, a média de idade da população do estudo foi de 44,1 ± 15,3 anos. Em relação à área queimada, a média calculada em porcentagem foi de 33 +/- 18,5%, e o grau de queimadura predominante foram os de 2º e 3º graus (61,1%), tendo o fogo como agente causal com maior ocorrência (76,5%). O microrganismo com maior percentual de notificações 91 (36,7%) foi o Acinetobacter baumanii, também relacionados com os casos de PAV e ICS, enquanto que a Candida albicans (8,5%) aparece como o microrganismo mais frequente nos casos de ITU, 267 indivíduos (43,6%) apresentaram IRAS, sendo 49 (55,8%) resultantes de infecções por dispositivos invasivos de longa permanência, 179 (29,2%) evoluíram a óbito, sendo 74 dos óbitos (41,3%) relacionados/causados por infecções. Comparando os dois momentos, não foi observada associação significativa entre os indivíduos que apresentaram infecção hospitalar, o número total de infecções por dispositivos invasivos e os óbitos relacionados/causados por infecções. A incidência de IRAS, não diminuiu após o uso do protocolo, entretanto ao analisar separadamente os tipos de infecção, evidenciou-se que o uso dos bundles mostrou-se efetivo para prevenção de PAV e ICS em queimados.
A retrospective and documentary study aimed at analyzing the effectiveness of the Bundles protocol as a tool for the prevention of Health Care Related Infections (IRAS) of individuals hospitalized in an Intensive Care Unit of Burns (UTIQ) of a tertiary hospital in the countryside of São Paulo State. Initially, data were collected from the medical records of all individuals who presented IRAS hospitalized at the ICUQ from January 2008 to December 2016 and it has been collected the information referring to those who presented Bundle-related infections, known as pneumonias associated with mechanical ventilation (PAV), bloodstream infection (ICS) by the use of the central venous catheter and urinary tract infection (UTI) by use of the bladder catheter, divided into two moments: M1 (2008 to 2010) and M2 (2011 to 2016), before and after the implantation of the protocol, respectively. From the 612 individuals admitted in the ICUQ at both moments, 58.4% were males, the mean age of the study population was 44.1 ± 15.3 years old. In relation to the burned area, the mean calculated in percentage was 33 +/- 18.5% and the predominant degree of burn was those of 2º and 3º degrees (61.1%), with fire being the causal agent with the highest occurrence (76.5%). The microorganism with the highest percentage of reports 91 (36,7%) was Acinetobacter baumanii, it also related to cases of PAV and ICS, while Candida albicans (8.5%) appears as the most frequent microorganism in cases of UTI. 267 individuals (43.6%) presented IRAS, of which 49 (55.8%) resulted from invasive device infections. Regarding deaths during the same period, 179 individuals (29.2%) of the total hospitalizations died, of which 74 death (41.3%), was related/caused by infections. Comparing the two moments, no significant association was observed among the individuals who presented hospital infection, the total number of infections by invasive devices and deaths related/caused by infections, that is, the incidence of IRAS, did not decrease after the use of the protocol, but when analyzing the types of infection separately, it was evidenced that the use of Bundles was effective for the prevention of PAV and ICS in burns.
A retrospective and documentary study aimed at analyzing the effectiveness of the Bundles protocol as a tool for the prevention of Health Care Related Infections (IRAS) of individuals hospitalized in an Intensive Care Unit of Burns (UTIQ) of a tertiary hospital in the countryside of São Paulo State. Initially, data were collected from the medical records of all individuals who presented IRAS hospitalized at the ICUQ from January 2008 to December 2016 and it has been collected the information referring to those who presented Bundle-related infections, known as pneumonias associated with mechanical ventilation (PAV), bloodstream infection (ICS) by the use of the central venous catheter and urinary tract infection (UTI) by use of the bladder catheter, divided into two moments: M1 (2008 to 2010) and M2 (2011 to 2016), before and after the implantation of the protocol, respectively. From the 612 individuals admitted in the ICUQ at both moments, 58.4% were males, the mean age of the study population was 44.1 ± 15.3 years old. In relation to the burned area, the mean calculated in percentage was 33 +/- 18.5% and the predominant degree of burn was those of 2º and 3º degrees (61.1%), with fire being the causal agent with the highest occurrence (76.5%). The microorganism with the highest percentage of reports 91 (36,7%) was Acinetobacter baumanii, it also related to cases of PAV and ICS, while Candida albicans (8.5%) appears as the most frequent microorganism in cases of UTI. 267 individuals (43.6%) presented IRAS, of which 49 (55.8%) resulted from invasive device infections. Regarding deaths during the same period, 179 individuals (29.2%) of the total hospitalizations died, of which 74 death (41.3%), was related/caused by infections. Comparing the two moments, no significant association was observed among the individuals who presented hospital infection, the total number of infections by invasive devices and deaths related/caused by infections, that is, the incidence of IRAS, did not decrease after the use of the protocol, but when analyzing the types of infection separately, it was evidenced that the use of Bundles was effective for the prevention of PAV and ICS in burns.
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Palavras-chave
unidade de queimados, bundles, infecção, prevenção e controle, burn unit, bundles, infection, prevention and control