Measures used in intensive care units to prevent infection: an integrative review

Objective: to verify measures used in intensive care units to prevent infection related to health care. Methods: integrative review based on the data sources LILACS, SCOPUS, PubMed Central, Science Direct, Web of Science and CINAHL, whose descriptors used were: Infection Control and Intensive Care Units. Sample consisting of 146 studies. Results: thematic categories related to the relevant infection prevention measures were listed, developed in Intensive Care Units: bloodstream infection prevention measures, assistance-related pneumonia prevention measures, urinary tract infection prevention measure and preventive measures associated with general care. Conclusion: among the established thematic categories, care with skin preparation, oral hygiene, correct handling of the urinary catheter and daily bath with antiseptic were most frequently identified. Descriptors: Infection Control; Intensive Care Units; Nursing; Review; Universal Precautions. RESUMO Objetivo: verificar medidas utilizadas em unidades de terapia intensiva para prevenção de infecção relacionada à assistência à saúde. Métodos: revisão integrativa, a partir das fontes de dados LILACS, SCOPUS, PubMed Central, Science Direct, Web of Science e CINAHL, cujos descritores utilizados foram Infection Control e Intensive Care Units. Amostra constituída por 146 estudos. Resultados: elencaram-se categorias temáticas relacionadas às medidas de prevenção de infecção pertinentes, desenvolvidas em Unidades de Terapia Intensiva: medidas de prevenção de infecção da corrente sanguínea, medidas de prevenção de pneumonia relacionada à assistência, medida de prevenção de infecção do trato urinário e medidas de prevenção associadas aos cuidados gerais. Conclusão: dentre as categorias temáticas estabelecidas, identificou-se com maior frequência o cuidado com a preparação da pele, a higiene oral, o manuseio correto do cateter urinário e o banho diário com antisséptico. Descritores: Controle de Infecções; Unidades de Terapia Intensiva; Enfermagem; Revisão; Precauções Universais. 1Universidade Federal do Rio Grande do Norte. Santa Cruz, RN, Brazil. Corresponding author: Ana Clara Dantas Avenida Rio Branco, S/N, Centro. CEP: 59200-000. Santa Cruz, RN, Brazil. E-mail: anaclaradaantas@yahoo.com. br EDITOR IN CHIEF: Ana Fatima Carvalho Fernandes ASSOCIATE EDITOR: Renan Alves Silva Ana Clara Dantas1 Jéssica Naiara de Medeiros Araújo1 Anália Andréia de Araújo Nascimento1 Quenia Camille Soares Martins1 Mércio Gabriel de Araújo1 How to cite this article: Dantas AC, Araújo JNM, Nascimento AAA, Martins QCS, Araújo MG. Measures used in intensive care units to prevent infection: an integrative review. Rev Rene. 2020;21:e44043. DOI: https://doi.org/10.15253/2175-6783.20202144043 Dantas AC, Araújo JNM, Nascimento AAA, Martins QCS, Araújo MG Rev Rene. 2020;21:e44043. 2 Introduction Intensive Care Units are designed to care for critically ill and hemodynamically unstable patients. Due to the critical health conditions they present and the invasive procedures necessary for the recovery and maintenance of life, these individuals are highly susceptible to infections during hospitalization in this sector(1). Infections Related to Health Care are acquired in care procedures, in which patients are submitted or during hospitalization, and are associated with a significant increase in morbidity and mortality rates, directly reflecting on patient safety. In the occurrence of these infections, pneumonia, urinary tract infections, bloodstream infections and surgical site infections are considered as the main ones(2). In Brazil, data from 2017 showed that the highest rates of infection in Adult Intensive Care Units are ventilator-associated pneumonia, 11.5 per 1,000 devices-day, whereas in neonatal Intensive Care Units, there is a predominance of primary laboratory bloodstream infections, 8.6 per 1,000 devices-day, in neonates weighing less than 750 grams. In Pediatric Intensive Care Units, there were no major discrepancies between the incidence densities in primary laboratory bloodstream infections, urinary tract infection and ventilator-associated pneumonia(3). In the United States of America, there were 24,223 episodes of ventilator-associated pneumonia in 2018 in general acute care hospitals. As for urinary tract infections, 22,015 infections associated with the catheter were reported. Regarding bloodstream infections, there were 19,188 cases of infections associated with the central line(4). Multicenter study, based on active surveillance, carried out in Intensive Care Units, showed the incidence of Health Care-Related Infections in 22.6% of patients, in which the mortality rate associated with these infections was 10.8%(5). Research shows that the reduction of these infections occurs by up to 70.0%, when health establishments and their professionals understand the severity of infections and assume the responsibility for putting infection control programs into practice(6). Thus, the relevance of preventive measures that can be carried out through simple actions, such as hand hygiene, monitoring of asepsis measures, processing of articles and surfaces and use of personal protective equipment is perceived(2). Despite the considerable scientific advances related to infection control, there is difficulty in carrying out preventive actions by the professional team and other obstacles, such as inadequate physical space, lack of resources to implement aseptic techniques and high patient turnover(6). Thus, searching for scientific evidence on infection prevention measures and synthesizing the results, through an integrative literature review, allows the analysis of broad data in a clear way and, consequently, fosters the knowledge of health professionals about actions and measures preventive measures, in order to promote the control of infections related to health care, especially in Intensive Care Units. From the given context, the objective was to verify measures used in intensive care units to prevent infection related to health care.