Prevenção de pneumonia associada à ventilação mecânica - uma oportunidade de melhoria

Abstract

Objective: To increase adherence of the preventive practices concerning Ventilator-associated pneumonia (VAP) in intensive care units (ICU), through an internal improvement cycle. Methodology: A quality improvement cycle, quasi-experimental design before-after was applied in two ICUs of a public hospital in the northeast of Brazil, with a total of 19 beds. Nine quality criteria related to the prevention of VAP were established and a composite indicator with which to assess the baseline level of quality and later two more subsequent assessments at intervals of four months seeking measure possible improvements acquired during these periods. The Pareto chart was used to represent the frequency of non-compliance of each criterion assessed in three moments. It was used the point estimation and the confidence interval (95%) for the measurement of the criteria. To quantify the effectiveness of the intervention, it calculated the absolute and relative improvement, beyond the statistical significance of the absolute improvement through unilateral test value of z. Results: There was a slight improvement on all criteria when comparing the first two assessments, but this initial comparison, only one criteria showed a statistically significant improvement (p <0.05). In the second comparison between the 1st and 3rd evaluations, the results showed improvement in the performance of all the criteria almost, where the nine established criteria, eight showed improvement, and six with a statistically significant improvement (p <0.05), with two improvement without significance and one criteria has worsened in the percentage of compliance. The composite indicator, which summarizes all the criteria evaluated, obtained a significant improvement of almost 40% (p<0.05) in the second comparison. Conclusions: The implementation of an internal improvement cycle was an important tool in quality management for the adoption of best practices for the prevention of VAP in ICU.