Incidência e complicações infecciosas associadas ao uso de cateteres venosos centrais em população pediátrica de um hospital universitário

Abstract

Introduction:Pediatric patients at intensive care units usuallyrequire the use of central venous catheters (CVC) however improper practices at insertion of CVC and daily maintenance may contribute to increased risk of catheter related bloodstream infection. Organize programs and systematically improve preventive measures are essential to reduceinfection rates associated with use of central line catheters and thus improve the quality of health care settings. Objective:To evaluate adherence to guidelines for preventionof IAC, with assessment of infection rates and identify possible risk factors for IAC recommendations regarding appropriate follow-up and insertion of CVC. Methods: We conducted a prospective cohort study, with patients admitted to the Pediatric Intensive Care Unit (PICU) of a university hospital, with central venous catheterization performed in the bed side of the ICU or in the Operating Room, from January 2010 to December 2011. Patients were followed through out hospitalization and the occurrence of IAC. Active search was performed daily prospective data related to the practice of CVC insertion in patients in the PICU through monitoring forms and through documents from the Operating Room. Results:Considering 255 catheter insertions, the incidencedensity of IAC was 13:55 per 1000 CVC-days. It was observed that, regarding the variablesrecommended in the prevention bundle, there was no association with increased risk for infection when evaluated surgical hand antisepsis, the use of maximum barrier precautions and chlorhexidine for skin antisepsis. Multivariate analysis showed that the time of catheter for less than seven days remained protective effect IAC (p <0.01, odds ratio = 0.29, 95% CI = 0.12, 0.72). Conclusion:The healthcare team responsible for CVC insertion should rigorously assess the need for permanence of the CVC and remove it, preferably within seven days, as this preventive measure is important. However, for those patients who have no indication of removal of the CVC, monitoring with clinical evaluation and request for additional blood cultures should be rigorous.