Avaliação do impacto da carga de trabalho da equipe de enfermagem de unidade de terapia intensiva adulto sobre a incidência de pneumonia associada à ventilação mecânica

Abstract

Introduction: The excessive workload of nursing professionals has been cited as one of the risk factors regarding hospital infection, such ventilator-associated pneumonia (VAP). Objectives: Evaluate the relationship between the nursing workload and other risk factors to the occurrence of ventilator-associated pneumonia (VAP) in an Adult Intensive Care Unit (ICU). Materials and Methods: This is a retrospective cohort study, occurred in an 30-bed tertiary care intensive care unit at a university hospital in of Uberlândia (HCU-UFU). The study included all patients admitted to the ICU of the HCU-UFU from January to June 2014, older than 18 years and receiving invasive mechanical ventilation therapy for a period more than 48 hours. Data were obtained from the medical records. The profile was collected; measurements used; laboratory tests; severity scores; outcomes; length of hospital stay; mechanical ventilation data; costs; and the NAS (Nursing Activities Score) in a daily frequency. Patient care items were evaluated: head elevation at 30º, adequate cuff pressure and oral hygiene with and without clorexedine. Results: There was a total of 195 patients included in the study and of these 53 (27.0%) presented VAP. The average age of study participants was 52.84 years, where 61.27% of the patients were male. There was no noted significant statistical difference in relation to the admission diagnosis among the groups with and without VAP, as well as Apache (P = 0.485) and SAPS (P = 0.498).There was a higher total cost of hospitalization (P = 0.005) and mechanical ventilation times (P <0.001) and the length of stay in the ICU (P <0.001) in patients with VAP. There were 40 micro-organisms isolated (75.5%) patients, 16 (40.0%) were resistant, being outstanding Acinetobacter baumannii (50.0%), Pseudomonas aeruginosa (41.7%). In the multivariate models, the following were predictive for VAP: the patient's intubation site (LTOT) P = 0.038 (higher if out of the ICU); neuromuscular blocker P = 0.025; presence of tracheostomy P = 0.019; use of sedative propofol P = 0.003; time of mechanical ventilation in ICU pre admission (TVMENF) P = 0.003; and NAS at admission P = 0.01. The percentage of adequacy to the NAS (NAS-psa) P = 0.008 and the increase of the NAS (NAS-i) P = 0.029 are protective for VAP. There were no differences in adherence to the items of the package of VAP prevention measures. Conclusion: The total cost of hospitalization is higher in the VAP group. VAP is associated with increased length of intensive care unit stay and longer duration of mechanical ventilation. The bacteriological profile of the patients was gram negative. The risk of VAP increases in tracheostomized patients, who used neuromuscular blocker, propofol and trauma hospitalization. The time of mechanical ventilation and pre-hospitalization intubation to the ICU, the NAS admission and mean NAS scores are predictive for VAP. The percentage of adequacy of the scale, as a function of the workload predicted by the NAS, was effective in showing the relation between suitability in the design and reduction of PAV. Adherence to the package of measures for the prevention of VAP (Bundle) was not different in patients with or without VAP.