Compliance to the practices of control and prevention of ventilator-associated pneumonia in a public teaching hospital

Background: The indicators of control and prevention of infection associated to health services are not capable to recognize the real conditions in which assistance practices are performed. Therefore, the processual clinical indicators (pci) have been used to evaluate the conformity level of these events in relation to the available recommendations.

Objective: Analyze the conformity the practices of control and prevention of ventilator-associated pneumonia (vap) by means of specifically elaborated pci. These practices corresponded to: a) evaluation of adherence to specific measures: abmaintaining the bed in 30-45 degrees; daily respiratory physiotherapy; use of sterile solutions for nebulizers and inhalers; material of respiratory therapy in use respecting routine of change; b)adherence to oral hygiene; c) adherence to hand-washing procedures when performing orotracheal aspiration, change of tape of the orotracheal cannula  and oral hygiene.

Methods: The quality of practices and procedures was evaluated through an applied research characterized by a prospective transversal and analytical design in an adult intensive care unit.

Results: The sample was based on the expected conformity of 80%, with 1,748 evaluations distributed among the selected practices performed by means of direct observation and registers in patient records. Instruments and evaluators were submitted to tests for measuring compliance. The general conformity adhesion index obtained in the specific measures of control and prevention of vap was 68.0%, of which the afternoon shift presented the greatest index (72.4%) and the morning shift with the lowest index (63.2%). The index of general conformity to the practice of oral hygiene was 60.1%, of which the morning shift presented the best index (72.4%) and the night shift with the worst (47.4%). Among the mentioned modalities the largest conformity was the chlorhexidine 0.12% application in all shifts, but only the morning shift reached the minimum expected conformity (90% in the morning; 73.7% at night and 72.9% in the afternoon). The less accepted modality was oral hygiene in all shift works. General conformity of hand hygiene practice in the performance of selected procedures was only 10.7%, the largest conformity represented by orotracheal aspiration (18.5%), followed by tape change (7.9%) and oral hygiene (5.3%). The morning shift obtained the best adherence (16.7%) and night shift the worst (3.1%). In this practice the best index of conformity was observed among the physiotherapists (25.8%), followed by nurses (15.6%) and the nursing assistants and technicians (4.4%). Conclusions: The lack of the expected adherence in all the evaluations justify a review of the rules and routines established, as well as the elaboration of strategies capable to assure a permanent adherence to the control and prevention practices of vap.