Fatores de risco associados às infecções hospitalares na unidade de terapia intensiva de um hospital público da Paraíba

• Autor(a) principal: Barbosa Filho, Waldner Gomes
• Data de Publicação: 2019
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações da UFPB
• Texto Completo: https://repositorio.ufpb.br/jspui/handle/123456789/20187
• topic: Infecção hospitalar; UTI; Epidemiologia; IRAS; Hospital infection; ICU; Epidemiology; CNPQ::CIENCIAS DA SAUDE::SAUDE COLETIVA

Introduction: Health Care Related Infections (IRAS) are considered to be a concern in the quality of health care, turning it into a global magnitude issue. These infections worsen in the Intensive Care Units (ICU) due to the constant invasive procedures performed and also the critical and chronic profile of hospitalized patients. Even though the recent advances in technology and science, infections are still considered complex to be combated. Objective: To identify the risk factors associated with the development of Hospital Infection in patients hospitalized in the HGM ICU. Method: was used for the development of the stud, the case-control method applied to a sample of patients hospitalized in an Intensive Care Unit of the General Hospital of Mamanguape - PB during the period from January 2016 to January 2018. The study population was constituted by patients hospitalized in the Intensive Care Unit for convenience and accessibility. Patients who spent more than 24 hours in the HGM ICU were considered in the study and it was possible to have access to the data of the selected patients. Patients who developed Hospital Infection during the study period were considered as cases, and as a control sample, patients who did not develop Hospital Infection. Data collection, such as sex, age, days of hospitalization, invasive devices, use of antibiotics, origin, discharge and deaths, among others, were done from printed medical records, BAE Electronic Assistance Bulletin, of Hospital Infection (CCIH), administrative documents of identification of patients hospitalized in the ICU, result of cultures and admission and evolution, registry of deaths, transfer, checklist of routines procedures among others. To analyze the results, a logistic regression was used using the hospital infection variable as an outcome (presence or absence) and later applied to Odds Ratio, ROC curve and confusion matrix to aid interpretation and decision making based on the final model. Results: 196 patients of the HGM ICU were evaluated, of which 49% (n = 96) were males and 51% (n = 100) females, with a minimum age of 15 years and a maximum of 97, with mean age of 68.04 years and median of 72 years. The days of hospitalization were recorded, minimum of 1 day and maximum of 66 days, with a mean stay of 10.62 days of hospitalization and a median of 6 days. The prevalence of Hospital Infection was 23% (n = 45) and 77% did not develop. The reported types of IH were: respiratory tract infection 15.8% (n = 31), bloodstream infection 4.7% (n = 9) and urinary tract infection 2.5% (n = 5). The most present microorganisms were: Staphylococcus spp. (coagulase negative) 15% (n = 11), Pseudomonas aeruginosa and Klebsiella pneumoniae with 7% (n = 5) each. We used 22 independent variables, of which 7 were significant (p-value <0.05), ie: days of hospitalization, previous use of invasive respiratory device, days using invasive respiratory device, use of central venous access, days in use of central venous access, days in use of delayed vesical catheter only 2 variables formed the final model: previous (OR 5.37 times with 95% CI between 2.20 and 13.11) and days in use of invasive respiratory device (OR 1.08 times with 95% CI 1.04 to 1.12). The ROC curve showed an area of 78%. Conclusion: according to the findings it was possible to identify which days in the use of invasive respiratory device and patient precedence are risk factors for the development of hospital infection in the HGM ICU, even considering the prevention of hospital infections very complex action. The study may contribute to better actions to prevent and combat hospital infections, and may reinforce decision-making by managers and health professionals against the development of IRAS.