Impacto de um pacote de medidas na redução de infecções de corrente sanguínea associadas à cateter venoso central neonatos internados em uma unidade de terapia intensiva neonatal brasileira

Abstract

Catheter associated bloodstream infections (CA-BSI) are frequent, often fatal and costly in the Neonatal Intensive Care Units (NICU), particularly low birth weight neonates of in units of developing countries like Brazil. The aim of our study was to evaluate the impact of a bundle for prevention and control of CA-BSI in critically neonates, including those with low weight, in a level III NICU of HC-UFU. The study design was prospective cohort, with infants submitted to central venous catheter (CVC) use. Surveillance was conducted by the National Healthcare Safety Network (NHSN) to screen hospital infections (HIs). Catheters tips were analyzed by quantitative and semi-quantitative techniques. A total of 251 newborns were evaluated, over 105 episodes of IHS (41.8%), and ICS were the most frequent infection (64.0%), including only four episodes (5.9%) related to the device. The rates of nosocomial neonatal sepsis in the pre-intervention period were 32.0% and 24.1 per 1000 CVC-days, and they reduced significantly (P = 0.04) to 19.6 % and 14.9 per 1000 CVC-days in the postintervention period. The use of ≥ three antibiotics and length of stay ≥ 8 days were independent risk factors for ICS in the logistic regression analysis. The most frequent etiological agents of these infections was coagulase negative Staphylococcus (45.8%), mainly S. epidermidis (90.9%). A simple and inexpensive intervention based on a few procedures, resulted in reduction CA-BSI in critically neonates. The perspective is to continue the study c in the future in order to make this success sustainable.