MEDIDAS PARA LA REDUCCIÓN DE INFECCIÓN ASOCIADA A CATÉTER CENTRAL EN RECIÉN NACIDOS: REVISIÓN INTEGRATIVA

Curan, Gabriela Ramos Ferreira; Rossetto, Edilaine Giovanini

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LITERATURE REVIEWS • Texto contexto - enferm. 26 (1) • 2017 • https://doi.org/10.1590/0104-07072017005130015 copiar

MEDIDAS PARA LA REDUCCIÓN DE INFECCIÓN ASOCIADA A CATÉTER CENTRAL EN RECIÉN NACIDOS: REVISIÓN INTEGRATIVA

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo

realizar una revisión integrativa sobre las estrategias presentes en los bundles para la reducción de infección de corriente sanguínea por catéter central en los recién nacidos.

Método

se realizó una búsqueda en la base Cochrane Library, IBECS, PubMed, Lilacs, Medline y Scielo, el uso de los términos "bundle", "infección asociada a catéter", "control de infecciones", "prevención", "enfermería basada en evidencia", "medicina basada en la evidencia" y "catéter venoso central". Los criterios de inclusión fueron: publicaciones de 2009 abril de 2014; presentación en portugués, Inglés o Español; estudios en poblaciones neonatales o pediátricos y neonatales que describen el uso y/o evaluación de bundles o protocolos para controlar la infección asociada a catéter central.

Resultados

15 estudios publicados fueron seleccionados entre 2009 y 2013. La principal información extraída de los estudios se sistematizaron en 1) las medidas adoptadas para la prevención de la infección del torrente sanguíneo catéter central de acuerdo con el nivel de evidencia científica, y 2) las estrategias utilizadas para la ejecución de pruebas en la práctica asistencial.

Conclusión

se observó una gran variedad de prácticas adoptadas, tanto concordantes con la evidencia científica como discordante. La sistematización en este estudio puede contribuir a la práctica, lo que facilita el uso de la mejor evidencia para cada contexto, y con la investigación, señalando las lagunas de conocimiento para guiar investigaciones futuras.

DESCRIPTORES:
infecciones relacionadas con catéteres. Enfermería basada en la evidencia. Enfermería neonatal.; Paquetes de atención al paciente. Catéteres.

Scientific evidence	Level
Placement of Central Venous Catheter
Hand hygiene^{9-10,19-20,22-24,26-27,29}	IA^*
Maximal barriers during central venous catheter insertion^{9,19-20,22-24,26, 29}	IA^*
Skin cleansing with chlorhexidine at 0.2% and air drying^{9-10,21,24, 29}	IA^*
Keep preassembled insertion kits ^{9-10,20,23,26}	IB^†
Establish a team with special training to exclusively provide care for the placement and maintenance of central lines^10,21,23,25	IB^†
Central Venous Catheter Maintenance
Hand hygiene ^{9-10,19-20,22-24,26-27, 29}	IA^*
Using sterile transparent semipermeable dressing or sterile gauze^9,22-23,27	IA^*
Dressing: rubbing the catheter site with chlorhexidine, alcohol at 70% or povidone-iodine and letting it air dry^9,23,26	IA^*
Rubbing the infusion system with alcohol or clorexidine^9,23,30	IA^*
Minimize infusions and multiple access routes^21-22	IA^*
Add 0.5ml of heparin in the total parenteral nutrition²¹	IA^*
Change infusion systems after 96 hours or before if there is blood or suspicion of infection²⁵	IA^*
Daily assess the need to keep catheter^{9,19-20,22-23,26,29}	IB^†
Daily observe signs of infection on the catheter site and the aspect of dressing^9-10,23,26	IB^†
Change dressing if dirty, wet, loose or constricting^10,21,25	IB^†
Standardize aseptic placement and change of infusion systems^{9,22- 24,30}	IB^†
Use a sponge impregnated with chlorhexidine on the insertion site at every change of dressing^20,22	IB^†
Dressing: change gauze every two days or before if dirty, wet or loose^20,25	II^‡
Keep the infusion system closed/use closed infusion system^{10,23,25,27,30}	II^‡

Intervention	Level
Rub the injector with chlorhexidine for different durations established for rubbing and drying^22,24-25	--
Use of glove procedure every time catheter is manipulated^20,23	--
Use sterile glove and mask to change sterile dressing^23-24	--
Use double or three-lumen catheters to ensure there is one that is exclusive to parenteral nutrition²⁴	--
Promote enteral nutrition to remove the central venous catheter early on²⁷	--
Avoid the use of dyed/colored solutions on stumps that may received a catheter later¹⁰	--
Insert umbilical catheters in pairs to checklist the catheter insertion¹⁰	--
Not placing patients with umbilical catheter in the prone positon¹⁰	--
Changes of fluids and infusions of umbilical catheters made by a medical staff¹⁰	--
Dressings: use preassembled dressing kits²⁰	--
Flush syringes are single use only²³	--
Use clean gloves to check the system if not using a closed system²⁶	--
Use sterile gloves to setup a closed system and at least clean gloves to install it²⁶	--
Use flush syringes previously aspired by the manufacturer or in the pharmacy using sterile technique²⁶	--
Comply with diagnostic criteria and measurement standards for nosocomial infections²⁷	--
Identify the catheter with date of insertion and infusion system and connections with the date they were changed³⁰	--
Avoid femoral site if possible/standardize the insertion sites^{10,19, 29}	≠
Clean the stump or site of the peripherally inserted central catheter with iodine-based solution¹⁰	≠
Dressing: change transparent dressings every seven days or before if dirty, wet or loose²²	≠
Change infusion systems within an interval between 72 and 96 hours, or before if there is blood or suspicion of infection³⁰	≠

Strategies
Education/training/workshops on the central venous catheter-associated blood stream infections concept^{9-10,19,23-24,26-27-29}
Meetings with the staff/teleconferences^{9,19-20,23,26,28-29}
Discussing infection rates in the unit^{19-20,24,26, 28-29}
Daily checklists to verify bundles compliance^{9 -10,20,23,28}
Feedback to the team concerning performance of bundles^{19-20,23-24,28-29}
Use of posters/reminders^{19-20,23-24,28-29}
Establish one or more leaders to prevent central venous catheter-associated blood stream infections^19,23-24,29
Goals to decrease infection rates and improve adherence to bundles^20,26
Autonomy to interrupt the insertion procedure if the team fails to observe any of a bundle's items^11,26
Anonymous and random nursing auditing²⁴
Applying tests or quizzes for the team²⁰
Provide training to workers²⁰
Ensure there is one antisepsis dispenser in every bed²⁴
Prohibit accessories below elbow, including sleeves and long nails²⁴
Establish a competition among employees to encourage their participation in the process²⁴
Promote commemorative celebrations on the project's aniversaries²⁴
Update practices by email and provide printed copies to staff²⁴
Visit facilities with good practices and rates²³
Involve other sectors that also use catheters (e.g., anesthesiology and radiology) ²³
Disseminate guidelines and tools²⁷

Universidade Federal de Santa Catarina, Programa de Pós Graduação em Enfermagem Campus Universitário Trindade, 88040-970 Florianópolis - Santa Catarina - Brasil, Tel.: (55 48) 3721-4915 / (55 48) 3721-9043 - Florianópolis - SC - Brazil
E-mail: textoecontexto@contato.ufsc.br

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[1] Correspondence: Gabriela Ramos Ferreira Curan Rua Reverendo João Batista Ribeiro Neto, 75, ap 1903 86055-645 - Gleba Palhano, Londrina, PR, Brasil E-mail: gabrielacuran@yahoo.com.br