Impacto da implementação de um bundle para a prevenção de pneumonia associada a ventilação mecânica

Abstract

Introduction: Ventilator-associated pneumonia (VAP) is the infection related to health assistance that most affects patients in intensive care units (ICU), extending the length of hospital stay, increasing healthcare costs, and also being the most significant cause of mortality and morbidity in critically ill patients. Several studies suggest the use of prevention bundles for VAP in critically ill patients. However, the effectiveness of these bundles are still controversial. Objective: To assess the impact of implementing a VAP prevention bundle in an ICU of a teaching hospital. Methodology: This is an analytical, correlational, longitudinal and of intervention study carried out in the adult ICU of a teaching hospital in Minas Gerais. From January/2018 to July/2019, a VAP prevention bundle was implemented in the aforementioned intensive care unit and the team's adherence to the following elements was observed: keep headboard elevated between 30 and 45°, maintain cuff pressure between 25 and 30 cmH2O, reduce sedation, perform oral hygiene with chlorhexidine (0.12%) three times a day, verify the possibility of extubation and maintain the mechanical ventilation system in accordance with the country’s current recommendations. Moreover, the study addressed secondary data from hospital records related to the density of VAP and to the medical records of the patients undergoing mechanical ventilation from June/2016 to July/2019. Results: The density of incidence of VAP before the intervention was 4.13 infections per thousand patients on mechanical ventilation/day, and 7.15 infections per thousand patients on mechanical ventilation/day after the intervention. Adherence to the bundle elements were as follows: oral hygiene 100%; elevated headboards 95%; reduction of sedation 95%; possibility of extubation 100%; cuff pressure 85%; maintenance of ventilator circuits 80% and adherence to all elements 55%. When performing the linear regression test after the implementation of the bundle, we observed that the density of VAP decreased when sedation was reduced, extubation and oral hygiene were increased, and adherence to all bundle elements occurred. Conclusion: There was no reduction in the incidence of VAP after the adoption of the preventive measures, perhaps due to underreporting of cases in the period prior to the bundle and the team’s low adherence to the components of the bundle.