Melhoria da qualidade na implantação dos protocolos para prevenção de infecções relacionadas à assistência à saúde em unidades de terapia intensiva no Rio Grande do Norte

Abstract

Introduction: Healthcare-associated infections (HAIs) are common adverse events in healthcare facilities, especially in intensive care units (ICUs), impacting patient safety and recovery. The prevention of healthcare-associated harm as a result of failures in healthcare processes and structures is a growing global challenge. The National Health Surveillance Agency has highlighted the low level of compliance with protocols to prevent these infections, indicating the urgent need to implement effective interventions to improve compliance and ensure better patient safety outcomes. The implementation of prevention measures, such as "bundles", based on current scientific evidence is essential to reduce healthcare-associated infections and improve the quality of care. Objective: To improve the implementation of infection prevention protocols in hospitals with ICU beds in the network of the Rio Grande do Norte State Department of Public Health. Methodology: This is a cycle of improvement based on action research, with a quasi-experimental before and after design, approved by the Human Research Ethics Committee (Opinion 6.413.818 and CAAE 73815823.4.0000.5292). The aim of the study was to evaluate the protocols for the prevention of primary bloodstream infections associated with the use of central venous catheters and the prevention of pneumonia associated with mechanical ventilation. Protocol improvements were planned based on an affinity diagram and a Gantt chart. Data were collected before the planned improvement interventions and after the interventions were implemented between 2023 and 2024. Results: An overall absolute improvement of 29.76% and a relative improvement of 44.6% were observed in the criteria evaluated for the implementation of infection prevention protocols in ICUs. The results show significant improvements, particularly in the implementation of the ventilator-associated pneumonia protocol, with proven training for healthcare professionals, and in the care of central venous catheter removal, minimizing the risk of complications and contamination. It should be noted that the figures show significant absolute increases. The criterion of demonstrated training in the prevention of ventilator-associated pneumonia increased from 14.3% to 71.4%, an improvement of 57.1 percentage points, reflecting significant progress in the construction of protocols and the prioritization of training for healthcare professionals. Conclusion: The results of this study indicate a significant improvement in the implementation of infection prevention protocols, especially those for the prevention of VAP and proven training of health professionals. In terms of noncompliance analysis based on the Pareto chart, a significant reduction in noncompliance was observed, highlighting the effectiveness of the corrective actions taken. In addition, the data show consistent progress, with a positive impact on care and compliance with institutional protocols.