Competências da equipe multiprofissional para as medidas de prevenção da infecção da corrente sanguínea relacionada ao cateter venoso central

Abstract

Central venous catheters are essential in health care, particularly in the intensive care unit. However, despite its benefits, it can cause complications including bloodstream infection, resulting in high morbidity and mortality, prolongation of time and increased costs of hospitalization. However, such infection can be prevented by interventions performed at the time of catheters insertion and manipulation. This study aimed to evaluate the competence of multiprofessional team from adults intensive unit care for the measures to prevent bloodstream infection related to central venous catheter. It was a quasi-experimental study, performed in an intensive care unit of a public hospital and urgency and emergency in Belo Horizonte, Minas Gerais. The population was composed of the medical and nursing team responsible for insertion and maintenance of central venous catheters. Data collection took place in three distinct phases: Pre-intervention period + direct observation of the professionals' practices; Period of intervention and period after intervention. Statistical analysis was performed using the Data Analysis and Statistical Software program, version 14. Descriptive, univariate, Poisson regression and Chi-square tests were performed. A 95% confidence interval with a significance level of 5% was considered. The project was approved by the Research Ethics Committee of the Federal University of Minas Gerais (CAAE 53642016.1.0000.5149). A total of 131 professionals participated in this study, including 89 nursing technicians, 22 physicians and 20 nurses. In the pre-intervention period, the median self-referenced knowledge in the different questions surveyed was 42.8% and by professional category, the medical team obtained a percentage of 70%, followed by nursing technicians with 38% and nurses with 28.5%. During the direct observation, there was a low overall adherence by nurses and technicians, especially hand hygiene (22.7%) and disinfection of the hub (10.4%), and a 100% adherence of the medical team was observed when using the maximum precautionary barrier during catheter insertion. In the post-intervention period, the adherence of professionals to hand hygiene before administering medication increased from 2.1% in the pre-intervention to 20.9%, in 48 and 86 opportunities observed respectively, and also in the use of gloves when changing the 78.6% in the pre-intervention period, with 14 observations for 100% in 26 observed opportunities (p <0.05). Although these measures have been highlighted in addition, excepting the use of gloves, the increase of hand hygiene is considered extremely limited, evidencing still a gap between the percentage reached and the ideal for adhesion of this measure. Considering the findings, the importance of a greater investment in the discussion for prevention of bloodstream infection, as well as in the continuing education of the teams in their weaknesses demonstrated in the present study, especially to the maintenance measures such as the disinfection of the hub and time recommended to change dressings. Even if catheter insertion was satisfactory for the use of barrier measures, these are not sufficient when the catheter maintenance measures are not used at satisfactory levels by the staff, especially the nursing staff.