RESUMO
BACKGROUND: The objective of this study was to analyze the impact of a multidimensional infection control approach and the use of the International Nosocomial Infection Control Consortium (INICC) Surveillance Online System on central line-associated bloodstream infection (CLABSI) rates from June 2003-April 2010. METHODS: We conducted a prospective, before-after surveillance study of 2,564 patients hospitalized in 4 adult intensive care units (ICUs) and 424 patients in 2 pediatric ICUs of 4 hospitals in 2 cities of Colombia. During baseline, we performed outcome surveillance of CLABSI applying the Centers for Disease Control and Prevention's National Healthcare Safety Network definitions. During intervention, we implemented the INICC multidimensional approach and the ISOS, which included a bundle of infection prevention practice interventions, education, outcome surveillance, process surveillance, feedback on CLABSI rates and consequences, and performance feedback of process surveillance. Bivariate and multivariate regression analyses were performed using a logistic regression model to estimate the effect of the intervention on the CLABSI rate. RESULTS: The baseline rate of 12.9 CLABSIs per 1,000 central line (CL) days, with 3,032 CL days and 39 CLABSIs, was reduced to 3.5 CLABSIs per 1,000 CL days, with 3,686 CL days and 13 CLABSIs, accounting for a 73% CLABSI rate reduction (relative risk, 0.27; 95% confidence interval, 0.14-0.52; P=.002). CONCLUSIONS: Implementing the INICC multidimensional infection control approach for CLABSI prevention was associated with a significant reduction in the CLABSI rate of ICUs of Colombia.
Assuntos
Infecções Relacionadas a Cateter/epidemiologia , Cateterismo Venoso Central/efeitos adversos , Infecção Hospitalar/epidemiologia , Monitoramento Epidemiológico , Controle de Infecções/métodos , Sepse/epidemiologia , Adulto , Idoso , Infecções Relacionadas a Cateter/prevenção & controle , Colômbia/epidemiologia , Estudos Controlados Antes e Depois , Infecção Hospitalar/prevenção & controle , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sepse/prevenção & controle , Adulto JovemRESUMO
La participación de la familia en escenario avanzados, como la reanimación cerebro-cardio-pulmonar (RCCP), se convierte en un elemento fundamenta l en el cuidado del paciente en riesgo inminente de muerte, y permite dar una mirada más humanizada al contexto de la reanimación. Sin embargo, se han generado varios debates fundamentados en las percepciones del personal de enfermería, la familia y el paciente que ha sobrevivido, debido a que ellos son los tres actores implicados en este escenario. Por tal motivo, este artículo busca analizar estas percepciones, a fin de reconocer a la familia como pieza primordial en la evolución clínica del paciente; promover el desarrollo de un nexo de unión entre la familia, el equipo y el paciente, y favorecer una mayor aceptación ante la realidad de la muerte y el proceso de duelo. Así, el profesional de enfermería es la persona más idónea para asumir el acompañamiento y la orientación a la familia en ese momento...
The family involvement in advanced scenarios, such as cardiopulmonary-cerebral resuscitation (CPCR), can becomea key element in the care for patients at imminent risk of death and allows for a more humane approach to the context of resuscitation. However, there are various debates grounded on the perceptions of the nursing staff, the family and the patients who have survived, as they are the three actors involved in this scenario. Therefore, this paper analyzes these perceptions in order to recognize the family as fundamental part in the patient's chinical course; promote the development of a bond between the family, the team and the patient; and encourage greater acceptance of the reality of death and its grieving process. Thus, the Nurse Practitioner is the best-suited individual to offer support and guidance for the family at that time...
A participaçâo da familia em cenário avançados, corno a reanimaçâo cardiopulmonar (RCP), se convette em um elemento fundamental no cuidado do paciente em risco iminente de morte, e permite dar urna olhada mais humanizada ao contexto da reanimaçâo. Porém, tém gerado varios debates fundamentados ñas percepçôes do pessoal de enfermagem, a familia e o paciente que sobreviveu, devido a que eles sâo os très atores implicados neste cenário. Por tal motivo, este artigo procura analisar estas percepçôes, com o objetivo de reconhecer a familia como peça primordial na evohiçào clinica do paciente; promover o desenvolví mento de um nexo de uniáo entre a familia, a equipe e o paciente, e favorecer urna maior aceitaçâo diante da realidade da morte e do processo de luto. Assim, o profissionai de enfermagem é a Presencia de la familia en escenarios comò la reanimación cerebro-cardio-pulmonar..
