Atuação interprofissional na prevenção da pneumonia associada à ventilação mecânica em Unidade de Terapia Intensiva

• Ano de defesa: 2021
• Autor(a) principal: Teixeira, Louziane Karina Tavares de Sousa
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal do Rio Grande do Norte; Brasil; UFRN; PROGRAMA DE PÓS-GRADUAÇÃO EM SAÚDE E SOCIEDADE
• Palavras-chave em Português: Infecção hospitalar; Unidades de Terapia Intensiva; Respiração artificial; Adulto
• Link de acesso: https://repositorio.ufrn.br/handle/123456789/46587

The intensive care unit is a sector intended for critically ill patients, where ventilatory support is provided by a device named mechanical ventilator, which, although necessary, can trigger some adverse events when used invasively, among them ventilator-associated pneumonia (VAP). Accordingly, the prevention of this infection is a challenge to ensure the quality of care in health services. One strategy that has been successfully adopted for prevention refers to the implementation of protocols, designed and applied in a collective and interprofessional manner, which can stimulate the adherence of professionals to the recommended measures. This research aimed to understand how interprofessional action can be configured as a strategy for prevention of ventilator-associated pneumonia in an adult intensive care unit and to develop, together with the intensive care unit professionals, a protocol of safe and interprofessional practices for prevention of ventilator-associated pneumonia. This is a Convergent Care Research, with quantitative and qualitative approaches, conducted in the adult intensive care unit of a university hospital, from April to June 2021. Data collection was performed in two stages: the first corresponded to the application of a semi-structured questionnaire that had the participation of 18 nurses, 9 physiotherapists, 5 physicians and 23 nursing technicians, while the second consisted of the accomplishment of convergence groups that included educational activities addressing the most relevant themes introduced in the questionnaires. The convergence groups enabled moments of discussion and knowledge exchange among 16 participants, who were 5 nurses, 5 physiotherapists, 1 physician and 5 nursing technicians, who supported the collective design of the protocol. Quantitative data were analyzed according to descriptive statistics and displayed in tables, using Microsoft Excel 2017 and SPSS Statistics software. For qualitative data, the Atlas Ti, version 9.1, software was used, following the steps of apprehension, synthesis, and theorization. The first step of the research sought to make a diagnosis on the prevention of VAP in the unit, revealing the professionals’ knowledge and performance. Regarding knowledge of VAP preventive measures, all physicians and physiotherapists said they were aware of them, followed by nursing technicians (95.7%) and nurses (94.4%). Elevating the headboard from 30 to 45° corresponded to the best-known preventive measure among professionals, cited by physicians (100%), nurses (94.4%) and nursing technicians (65.2%), followed by oral hygiene with antiseptic. Only nursing technicians (21.7%) and physiotherapists (11.1%) included hand hygiene as a known measure. On the other hand, in professional practice, hand hygiene was one of the measures that professionals said they performed more frequently, where most of them (87.27%) always performed it and the others (12.73%) almost always, as well as elevating the headboard, reported by nursing technicians (100%), physiotherapists (77.8%), nurses (55.6%) and physicians (40%). Participation in multiprofessional visits was often performed by physicians, but physiotherapists (77.8%) said they sometimes participated, while nurses (69.6%) and nursing technicians (50%) never participated. Regarding aspiration of secretion, physicians (60%) and (40%), respectively, attributed it to physiotherapists and nursing technicians; nurses (5.6%) attributed the aspiration to nursing technicians, and 26% of these professionals attributed the aspiration to physiotherapists and nurses. Physicians and nurses attributed the removal of fluids from the circuit to physiotherapists and nursing technicians. Changing humidifiers and monitoring cuff pressure were reported by professionals as being the physiotherapists’ attribution, and these professionals did not attribute to any others. Nurses, nursing technicians and physiotherapists placed the removal of sedation as the physicians’ attribution. All physiotherapists reported knowing the practices developed by other professionals in the prevention of VAP, followed by nursing technicians (73.9%), nurses (61.1%) and physicians (60%). Of the participating professionals, (78.18%) had heard about interprofessional work, most of them (76.36%) characterized it as the joint action of professionals in a team, others pointed to the fact that the team has a common goal, and few referred to professionals having different skills. Concerning the professionals’ knowledge about the use of a protocol as a strategy for prevention of VAP, most reported knowing, being more than half of the physiotherapists (66.7%), followed by nursing technicians (52.2%), physicians (40%) and nurses (38.9%). The results of the questionnaires were introduced in a booklet format to the surveyed professionals, in order to contribute to the discussions in the convergence groups. From the analysis of the oral reports of the convergence groups, it was possible to categorize the data, which revealed three categories: Intensive care unit professionals’ performance and teamwork; Relevance of care and difficulties in adhering to the protocol related to professional practice and performance and Content of the VAP prevention protocol. The group discussions enabled dialogue and reflection by the professionals, as well as the elaboration of the protocol based on interprofessionalism, focused on the reality of the intensive care unit. In this context, the products of the research aim, besides standardizing the VAP preventive actions in the adult intensive care unit, to consolidate the adherence of professionals to preventive measures, thus resulting in a reduction in the incidence rates of VAP.