Efetividade do banho no leito descartável com e sem clorexidina na prevenção de infecção relacionada a assistência à saúde: estudo observacional
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Data
2022-02-24
Autores
Paulela, Débora Cristina
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Universidade Estadual Paulista (Unesp)
Resumo
O banho no leito, cuidado humano básico importante, é deixado para plano de menor importância pela equipe que o executa, comprometendo o procedimento e facilitando aparecimento de infecção hospitalar. Usam-se produtos que lesionam a pele, deixando o paciente propenso a infecções. Presume-se que pode disseminar microrganismos no ambiente hospitalar. Estudo demonstrou eficácia do banho no leito descartável em 90% comparada a 20% do banho no leito convencional, que colonizou 80% dos participantes. Demonstrou-se em estudo que bacias de banho estavam contaminadas após processamento manual. Estado de São Paulo, implantou o banho no leito descartável em três enfermarias, sendo uma que atende pacientes clínicos, Clínica Médica I, uma atende pacientes clínicos e cirúrgicos, Neurologia e Neurocirurgia e uma cirúrgica, Gastrocirurgia. A implantação do produto para banho no leito descartável foi realizada em junho de 2017. Em junho de 2019, a Comissão de infecção hospitalar solicitou o acréscimo de clorexidina degermante a 2% ao banho no leito descartável. Esta solicitação deu-se devido a pesquisas que apontaram a redução das taxas de infecção hospitalar após a implantação de banho diário com clorexidina degermante a 2%. Objetivo. Avaliar o impacto do BLD com e sem clorexidina na incidência de IRAS em pacientes de três enfermarias de um hospital universitário do interior do Estado de São Paulo. Método. Estudo observacional, analítico, retrospectivo, antes e depois da implementação do banho no leito descartável com e sem clorexidina, em três enfermarias de um hospital universitário do interior do Estado de São Paulo. Resultados. No período do estudo 6487 pacientes foram admitidos nas três enfermarias, 2612 tiveram prescrição de enfermagem para banho no leito e 858 pacientes com idade entre 15 a 102 anos tiveram exames de culturas com resultados positivos, 271 pacientes tiveram óbito como desfecho clínico. Teste de comparação de proporções, demonstrou significância estatística na redução da positividade de culturas (p<0,0001) no P2 e P3 quando comparados com P1 após a implantação do banho no leito descartável e do banho no leito descartável acrescido de clorexidina degermante a 2%. Na análise referente a culturas de vigilância, incluindo produtores de carbapenemases, os testes de comparação de proporções Resumo 7 também demonstraram significância estatística quando comparados os três períodos das três enfermarias, P2 com P1 (p<0,0001) e P3 com P1 (p<0,0001). A análise de dados demográficos, comparando o P2 com P1 e P3 com P1, na enfermaria de CMI houve relevância estatística, maior número altas e menor número de óbitos. Na enfermaria de NCL/NCR houve relevância no número de óbitos na comparação do P3 com o P1 e na enfermaria de Gastrocirurgia não houve diferença estatística. A análise de dados de cateter venoso central, não houve significância estatística nos períodos analisados nas três enfermarias. Na análise do dispositivo sonda vesical de demora, na Clínica Médica I houve relevância estatística em comparação do P2 ao P1 e não houve diferença na comparação do P3 ao P1. Na enfermaria de Neurologia/Neurocirurgia houve relevância estatística nas comparações do P2 e P3 com P1. Não houve relevância estatística na Gastrocirurgia. Conclusões. A comparação do banho no leito convencional com o banho no leito descartável e do banho no leito descartável acrescido de clorexidina degermante a 2% diferiu em aspectos relevantes como no número de positividade de culturas, incluindo-se culturas de vigilância, houve redução de positividade de culturas coletadas dos pacientes, quando comparados os períodos, P2 com P1 e P3 com P1 nas três enfermarias. Comparando o uso de cateter venoso central e culturas positivas de ponta de cateter não houve diferença estatística nas três enfermarias. Referente a sonda vesical de demora houve significância estatística na enfermaria de Clínica Médica I no P2 comparado ao P1, na enfermaria de Neurologia/Neurocirurgia houve relevância estatística quando comparados o segundo e terceiro períodos com o primeiro. Na enfermaria de Gastrocirurgia não houve diferença estatística.
The bed bath, an important basic human care, is lowered to a less important plan by the team that performs it, compromising the procedure and facilitating the appearance of hospital infection. Products that damage the skin are used, leaving the patient prone to infections. It is assumed that it can spread microorganisms in the hospital environment. A study has demonstrated the efficacy of the bath in the disposable bed in 90% compared to 20% of the ones in conventional bed, where 80% of the participants were colonized. A study has shown that bath basins had been contaminated after manual processing. The State of São Paulo has implanted the disposable bed bath in three wards, where one is for clinical patients (Clinical Medicine 1), another one for clinical and surgical patients, neurology and neurosurgery and a third one for surgery, gastrosurgery. The implantation of product for bath in the disposable bed was carried out in June 2017. In June 2019, the hospital infection commission requested the addition of 2% chlorhexidine to the bath in the disposable bed. This request was due to research that pointed to a reduction in the rates of nosocomial infection after the implantation of a daily bath with 2% chlorhexidine. Objective. To evaluate the impact of disposable bed bath (DBB) with and without chlorhexidine on the incidence of HAIs in patients from three wards of a university hospital in the countryside of the state of São Paulo. Method. Observational, analytical, retrospective study, before and after the implementation of the disposable bed bath with and without chlorhexidine, in three wards of a university hospital in the countryside of the State of São Paulo. Results. During the study period 6487 patients were admitted to the three wards, 2612 had a nursing prescription for bed bathing and 858 patients aged 15 to 102 years had culture tests with positive results, 271 patients died as a clinical outcome. Proportion comparison test has demonstrated statistical significance in reducing the positivity of cultures (p <0.0001) in P2 and P3 when compared to P1 after implantation of the disposable bed bath and the disposable bed bath plus 2% chlorhexidine. In the analysis referring to surveillance cultures, including carbapenemase producers, the proportion comparison tests have also demonstrated statistical significance when comparing the three periods of the three wards, P2 with P1 (p <0.0001) and P3 with P1 (p <0, 0001). The analysis of demographic data, comparing P2 with P1 and P3 with P1, in the CMI ward, there has been statistical relevance, higher number of discharges and lower number of deaths. In the NCL / NCR ward, a relevance in the number of deaths in the comparison of P3 with P1 and in the Gastrosurgery ward, there has been no statistical difference. The analysis of data from central venous catheter has shown no statistical significance in the periods analyzed in the three wards. In the analysis of the delayed urinary catheter, in Clinical Medicine 1 statistical relevance has ocurred in comparison of P2 to P1 and no difference in the comparison from P3 to P1. In the Neurology / Neurosurgery ward, statistical relevance in the comparisons of P2 and P3 with P1. No statistical relevance in Gastrosurgery. Conclusions. The comparison of the bath in the conventional bed with the bath in the disposable bed and the bath in the disposable bed plus 2% chlorhexidine has differed in relevant aspects such as in the number of positivity of cultures, including surveillance cultures, there has been a reduction in positivity of cultures collected from patients, when comparing the periods, P2 with P1 and P3 with P1 in the three wards. Comparing the use of central venous catheter and positive catheter tip cultures, there has been no statistical difference in the three wards. Regarding the delayed bladder probe, statistical significance in the Medical Clinic I ward in P2 compared to P1, in the Neurology/Neurosurgery ward statistical significance when comparing the second and third periods with the first. In the Gastrosurgery ward, there has been no statistical difference.
The bed bath, an important basic human care, is lowered to a less important plan by the team that performs it, compromising the procedure and facilitating the appearance of hospital infection. Products that damage the skin are used, leaving the patient prone to infections. It is assumed that it can spread microorganisms in the hospital environment. A study has demonstrated the efficacy of the bath in the disposable bed in 90% compared to 20% of the ones in conventional bed, where 80% of the participants were colonized. A study has shown that bath basins had been contaminated after manual processing. The State of São Paulo has implanted the disposable bed bath in three wards, where one is for clinical patients (Clinical Medicine 1), another one for clinical and surgical patients, neurology and neurosurgery and a third one for surgery, gastrosurgery. The implantation of product for bath in the disposable bed was carried out in June 2017. In June 2019, the hospital infection commission requested the addition of 2% chlorhexidine to the bath in the disposable bed. This request was due to research that pointed to a reduction in the rates of nosocomial infection after the implantation of a daily bath with 2% chlorhexidine. Objective. To evaluate the impact of disposable bed bath (DBB) with and without chlorhexidine on the incidence of HAIs in patients from three wards of a university hospital in the countryside of the state of São Paulo. Method. Observational, analytical, retrospective study, before and after the implementation of the disposable bed bath with and without chlorhexidine, in three wards of a university hospital in the countryside of the State of São Paulo. Results. During the study period 6487 patients were admitted to the three wards, 2612 had a nursing prescription for bed bathing and 858 patients aged 15 to 102 years had culture tests with positive results, 271 patients died as a clinical outcome. Proportion comparison test has demonstrated statistical significance in reducing the positivity of cultures (p <0.0001) in P2 and P3 when compared to P1 after implantation of the disposable bed bath and the disposable bed bath plus 2% chlorhexidine. In the analysis referring to surveillance cultures, including carbapenemase producers, the proportion comparison tests have also demonstrated statistical significance when comparing the three periods of the three wards, P2 with P1 (p <0.0001) and P3 with P1 (p <0, 0001). The analysis of demographic data, comparing P2 with P1 and P3 with P1, in the CMI ward, there has been statistical relevance, higher number of discharges and lower number of deaths. In the NCL / NCR ward, a relevance in the number of deaths in the comparison of P3 with P1 and in the Gastrosurgery ward, there has been no statistical difference. The analysis of data from central venous catheter has shown no statistical significance in the periods analyzed in the three wards. In the analysis of the delayed urinary catheter, in Clinical Medicine 1 statistical relevance has ocurred in comparison of P2 to P1 and no difference in the comparison from P3 to P1. In the Neurology / Neurosurgery ward, statistical relevance in the comparisons of P2 and P3 with P1. No statistical relevance in Gastrosurgery. Conclusions. The comparison of the bath in the conventional bed with the bath in the disposable bed and the bath in the disposable bed plus 2% chlorhexidine has differed in relevant aspects such as in the number of positivity of cultures, including surveillance cultures, there has been a reduction in positivity of cultures collected from patients, when comparing the periods, P2 with P1 and P3 with P1 in the three wards. Comparing the use of central venous catheter and positive catheter tip cultures, there has been no statistical difference in the three wards. Regarding the delayed bladder probe, statistical significance in the Medical Clinic I ward in P2 compared to P1, in the Neurology/Neurosurgery ward statistical significance when comparing the second and third periods with the first. In the Gastrosurgery ward, there has been no statistical difference.
Descrição
Palavras-chave
Banhos, Clorexidina, Cuidados de enfermagem, Indicadores de morbimortalidade, Avaliação de serviços de saúde, Baths, Nursing care, Evaluation of effectiveness, Effectiveness of interventions, Chlorhexidine, Catheter-related infections, Infecções relacionadas a cateter, Avaliação de eficácia, Efetividade de intervenções