RESUMO
BACKGROUND: Antimicrobial resistance has become one of the world's most important public health problems. Accordingly, nursing strategies to manage antimicrobials in hospital environments are fundamental to promoting patient health. The aim of this study was to summarise the best evidence available on nursing strategies for the safe management of antimicrobials in hospital environments. METHODS: This qualitative systematic review used meta-aggregation in accordance with the recommendations of the Joanna Briggs Institute. The protocol was registered in the data base of the Prospective Register of Systematic Reviews under No. CRD42021224804. The literature search was conducted, in April and May 2021, in the following data bases and journal repositories: Latin American and Caribbean Health Sciences Literature (LILACS) via the Virtual Health Library (VHL), Medical Literature Analysis and Retrieval System on-line (Medline) via PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scientific Electronic Library Online (SciELO) and Excerpta Medica Database (EMBASE). The findings of each study were summarized and the results were meta-aggregated in JBI SUMARI software. RESULTS: The search resulted in a total of 447 studies and, after selection, the review included 26 studies, in which 42 nursing strategies were identified. The strategies were first categorised as care- or stewardship-related and then into the subcategories: Screening, Administration, Monitoring and Discharge, Nursing Team, Multi-professional Teams, Patients and Institutional Leadership. The 42 strategies were meta-aggregated and represented in flow diagrams. The best evidence was synthesized related to nursing strategies in the safe management of antimicrobials in the hospital environment. CONCLUSIONS: Nurses play an indispensable function in antimicrobial stewardship in the hospital environment, because they work directly at the core of safe patient care. Significant contributions by nursing towards reducing antimicrobial resistance were found in care-related practice, education activities, research and policy.
RESUMO
Objetivo: identificar as evidências disponíveis na literatura sobre os incidentes clínicos relacionados a sobreutilização de dispositivos invasivos em unidades de terapia intensiva (UTI). Método: revisão integrativa de literatura nas fontes de dados: PUBMED, EMBASE, CINAHL, WEB OF SCIENCE e LILACS. Foram incluídos estudos que abordem incidentes clínicos relacionados a sobreutilização de dispositivos assistenciais em Unidades de Terapia Intensiva. Foram excluídos estudos que não foram realizados em pacientes adultos; estudos que abordem dispositivos que não são manipulados pela equipe de enfermagem. Resultado: Foram incluídos para análise 15 estudos. Os principais incidentes clínicos relacionados ao tempo de uso dos dispositivos invasivos em UTI são as infecções. Os dispositivos predominantes para esta ocorrência foram: tubo orotraqueal, cateter vesical de demora e cateter venoso central. Tempo médio verificado para cada dispositivo: tubo orotraqueal considerando seis estudos foi de 7,7 dias; cateter vesical de demora foi de 8,2 dias baseado em sete estudos; cateter venoso central foi 12 dias, cálculo através de informações de oito estudos. Conclusão: a sobreutilização de dispositivos está relacionada a aumento do risco de incidentes, tendo como os principais evidenciados as infecções hospitalares.
Objective: to identify the evidence available in the literature on clinical incidents related to the overuse of invasive devices in intensive care units (ICU). Method: integrative literature review in the data sources: PUBMED, EMBASE, CINAHL, WEB OF SCIENCE and LILACS. Studies addressing clinical incidents related to overuse of assistive devices in Intensive Care Units were included. Studies that were not conducted in adult patients were excluded; studies that address devices that are not manipulated by the nursing staff. Results: Fifteen studies were included for analysis. The main clinical incidents related to the time of use of invasive devices in ICU are infections. The predominant devices for this occurrence were: orotracheal tube, indwelling urinary catheter and central venous catheter. Mean time verified for each device: orotracheal tube considering six studies was 7.7 days; indwelling urinary catheter was 8.2 days based on seven studies; central venous catheter was 12 days, calculated using information from eight studies. Conclusion: the overuse of devices is related to increased risk of incidents, with hospital-acquired infections as the main evidenced.
Objetivo: identificar la evidencia disponible en la literatura sobre incidentes clínicos relacionados con el uso excesivo de dispositivos invasivos en las unidades de cuidados intensivos (UCI). Método: revisión bibliográfica integradora en las fuentes de datos: PUBMED, EMBASE, CINAHL, WEB OF SCIENCE y LILACS. Se incluyeron los estudios que abordaban los incidentes clínicos relacionados con el uso excesivo de dispositivos de asistencia en las Unidades de Cuidados Intensivos. Se excluyeron los estudios que no se realizaron en pacientes adultos; los estudios que abordan dispositivos que no son manipulados por el equipo de enfermería. Resultados: Se incluyeron quince estudios para el análisis. Los principales incidentes clínicos relacionados con el tiempo de uso de dispositivos invasivos en UCI son las infecciones. Los dispositivos predominantes para esta incidencia fueron: tubo orotraqueal, sonda urinaria permanente y catéter venoso central. El tiempo medio verificado para cada dispositivo: tubo orotraqueal considerando seis estudios fue de 7,7 días; catéter urinario permanente fue de 8,2 días basado en siete estudios; catéter venoso central fue de 12 días, calculado utilizando la información de ocho estudios. Conclusión: el uso excesivo de dispositivos se relaciona con un mayor riesgo de incidentes, con las infecciones hospitalarias como principal evidencia.