Análise de adesão ao bundle de prevenção de pneumonia associada à ventilação mecânica após uma intervenção em UTI neonatal e pediátrica de um hospital militar do Rio de Janeir.

Abstract

Ventilator-associated pneumonia (VAP) in neonatal (NEO ICU) and pediatric intensive care units (PED ICU) represents one of the most common injuries related to the use of invasive devices. There are a series of measures (bundles) that, when used together, can contribute to the reduction of VAP rates. To analyze the multidisciplinary team's adherence to VAP prevention measures before and after a systematized intervention. Methods: Before-and-after study in which VAP prevention bundles were applied. Data from neonates admitted to the NEO ICU and children admitted to the PED ICU of a military hospital, submitted to invasive mechanical ventilation (IMV), between 2021 and 2022, were used, and the following measures were verified: maintenance of the headboard elevated 30-45°, absence of visible dirt and condensed liquid in the IMV circuit and in the bacteriological filter, monitoring of cuff pressure, performing oral hygiene and performing physiotherapy. The same measures were standardized and evaluated before and after an educational intervention with the multidisciplinary team, collecting 150 pre-intervention observations and 150 post-intervention observations. Thirty-one patients were analyzed: 28 from the NEO ICU and 3 from the PED ICU. The 150 pre-intervention bundle observations were made in 15 children and 150 post-intervention observations in 16 children. The pre-intervention adherence rates for the items headboard between 30 and 45º, circuit without dirt, circuit without condensation, oral hygiene and physiotherapy were 79.3%, 86%, 74.7%, 6.7% and 96%, respectively. After the intervention, the same values for the same items were: 96.7% (p<0.001), 100% (p<0.001), 97.3% (p<0.001), 97.3% (p<0.001) and 99.1% (p=0.137), respectively. There was an increase in the team's adherence to VAP prevention items from 62% (pre-intervention) to 98% after the educational intervention. The incidence rate of VAP in the NEO ICU and PED in the pre-intervention period went from 12.8 per 1000 MV-day to 8.4 per 1000 MV-day in the post-intervention period, indicating a decrease of 34.4%. The rate of adherence to the package of measures was high and the bundle was systematically adopted by the teams at UTI NEO and UTI PED. The current study showed a statistically significant increase in team adherence after educational measures on preventing pulmonary infection in patients on IMV, in relation to the following items: headboard between 30 and 45º, circuit without dirt, circuit without condensation and oral hygiene. There was a reduction in VAP rates in the post-intervention period and greater adherence to the specific prevention bundle.