Adesão às medidas de prevenção de infecção de corrente sanguínea associada ao cateter venoso central: impacto de uma intervenção educativa em cenário simulado em uma unidade neonatal

Abstract

Peripherally inserted central catheters (PICC) are indispensable in assisting newborns (NB) admitted to neonatal units. Despite the benefits regarding its use, they are considered the main risk factor for the occurrence of primary bloodstream infections (IPCS) associated with the central venous catheter (CVC), contributing to increased morbidity and mortality, costs and length of hospital stay. However, PBI-CVC can be prevented by adopting safe practices by nursing professionals during the insertion and maintenance of the central device. This study aims to evaluate the effectiveness of an educational intervention in a simulated scenario in the nursing team's adherence to the practices of prevention of primary bloodstream infection, associated with central venous catheter in a Neonatal Unit. This is a quasi-experimental study, carried out in a neonatal unit of a public hospital in Belo Horizonte, Minas Gerais. The population was composed of the nursing team responsible for the insertion and maintenance of the PICC. The data collection of the study included three moments: pre-intervention or baseline period, intervention, and post-intervention. At the same time, a survey of IPCS-CVC rates was carried out in the period between July 2019 and January 2020. For statistical analysis, software R, version 3.6.3 was used. In all analyzes, the level of significance for statistical inference was 0.05 with a 95% confidence interval. The project was approved by the Research Ethics Committee of the Universidade Federal de Minas Gerais (CAAE: 32994314.0.1001.5149). In assessing the adherence of nursing professionals to the prevention practices of PBI-CVC, 155 observations were made related to the insertion of the PICC with a focus on surgical preparation of the hands, use of the maximum precautionary barrier, antisepsis of the patient's skin, spontaneous drying antiseptic and hand hygiene after insertion. Regarding the manipulation of the PICC (drug administration and dressing change), 435 actions were observed regarding bloodstream infection prevention practices, such as: hand hygiene before and after the medication administration and dressing changes, antisepsis of the newborn's skin and disinfecting the hub. In the pre-intervention period, there was a low global adherence, especially in adequate surgical hand antisepsis 31 (29.03%), in antisepsis at the insertion site 31 (35.48%) and dressing change 45 (26.67 %), waiting time for drying antiseptic 31 (25.81%) and disinfecting hub 100 (20%). After observation, an intervention was carried out with the nursing team through a simulated scenario, which had the central venous catheter bundle in the neonatal unit as its guiding axis. In the post-intervention period, there was a significant improvement in the adherence of nursing professionals at the moment of insertion of the PICC regarding the use of the maximum precautionary barrier 31 (p = 8 0.022) and time of waiting for antiseptic to dry 31 (p = 0.038). During the maintenance of the PICC, there was a significant improvement with regard to the NB's skin antisepsis in dressing changes 45 (p = 0.010) and in the proper disinfection of the hub before drug administration 100 (p <0.01). On the other hand, with regard to the rates of PBI-CVC, these remained similar in the three months following the educational intervention, in comparison with the rates of the previous months. In view of the findings, it appears that the educational intervention in a simulated scenario at the Neonatal Unit had an impact on the professionals' adherence to the safe practices of insertion and manipulation of the PICC, especially in some items, but not in its entirety. In this sense, continuous monitoring and periodic interventions are essential to promote safe practices that help in the prevention and control of PBI-CVC. There is also a need to extend this intervention to the entire multidisciplinary team of the neonatal unit and not just nursing.