PREVENTIVE CARE IN CONTACT PRECAUTION: NURSING CARE IN THE INTENSIVE CARE UNIT 1

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1 PREVENTIVE CARE IN CONTACT PRECAUTION: NURSING CARE IN THE INTENSIVE CARE UNIT 1 ROSSATO, Karine 1 ; GIRARDON-PERLINI, Nara Marilene 2 ; MISTURA, Claudelí 4 ; ROSO, Camila Castro 5 ; CAMPONOGARA, Silviama ABSTRACT The Intensive Care Unit (ICU) is considered as a critical unit of the nasocomial environment where often it is cared of patients that need of contact precautions to control the dissemination of microorganisms. Independent of the clinical condition and the presence or absence of infection of the sick it is essential that the standard precaution is adopted for all health professionals in particular nursing that is more directly in contact with the patient. This measure has intention of to prevent the transmission of microorganisms. The aim of this study is to report the experience as nursing student together health team of an ICU in the perspective of the preventive care to patients in contact precautions. It is an experience report experienced in the ICU at the Hospital Universitário de Santa Maria (HUSM). As results it was observed that between the nursing professionals and students there is the preoccupation in to wash the hands to the end of each procedure and not only before and after him removing an important measure for the prevention of infections. The experience made possible to perfect the knowledge relative to the context of prevention of infection, the paper of the professionals of the unity in this intention as well as to evidence that is 1 Trabalho de Relato de Experiência. Universidade Federal de Santa Maria (UFSM). 2 Apresentadora. Curso de Enfermagem da Universidade Federal de Santa Maria (UFSM). Integrante do Grupo de Pesquisa Cuidado Saúde e Enfermagem. Santa Maria, Rio Grande do Sul, Brasil. E- mail: kaka.rossato@hotmail.com 3 Orientadora. Enfermeira. Doutora em Enfermagem. Professora Adjunto do Departamento de Enfermagem e do Programa de Pós Graduação em Enfermagem da UFSM. Integrante do Grupo de Pesquisa Cuidado Saúde e Enfermagem. Santa Maria, Rio Grande do Sul, Brasil. 4 Enfermeira. Mestranda em Enfermagem do Programa de Pos Graduação em Enfermagem da UFSM. Integrante do Grupo de Pesquisa Cuidado Saúde e Enfermagem. Santa Maria, Rio Grande do Sul, Brasil. 5 Enfermeira. Doutoranda em Enfermagem. Bolsista CAPES. camilaroso@yahoo.com.br 6 Enfermeira. Doutora em Enfermagem. Professora Adjunta do Departamento de Enfermagem da Universidade Federal de Santa Maria (UFSM), Santa Maria, RS, Brasil. silviaufsm@yahoo.com.br 1

2 necessary an commitment between all the members team for the change of routines of work and the search for positive results in the prevention of the dissemination of microorganisms. Keywords: Intensive Care Units; Cross Infection; Nursing Care. RESUMO A Unidade de Terapia Intensiva (UTI) é considerada como uma unidade crítica para o ambiente hospitalar onde, frequentemente, cuida-se de pacientes que necessitam de precaução de contato para o controle da disseminação de microrganismos. Independentemente da condição clínica e presença ou não de infecção do enfermo, é fundamental que a precaução padrão seja adotada por todos os profissionais de saúde, em destaque a enfermagem, que está mais diretamente em contato com o paciente. Tal medida tem a finalidade de evitar a transmissão de microrganismos. O objetivo deste estudo é relatar a experiência como estudante de enfermagem junto à equipe de saúde de uma UTI na perspectiva do cuidado preventivo com pacientes em precauções de contato. Trata-se de um relato de experiência vivenciado na UTI do Hospital Universitário de Santa Maria (HUSM). Como resultados observou-se que entre os profissionais e estudantes de enfermagem existe a preocupação em lavar as mãos ao término de cada procedimento e não antes e depois dele, eliminando uma importante medida para a prevenção de infecções. A experiência possibilitou aperfeiçoar o conhecimento em relação ao contexto da prevenção de infecção, sobre o papel dos profissionais da unidade nesse intuito, bem como constatar que é preciso um compromisso entre todos os membros da equipe para a mudança de rotinas de trabalho e busca por resultados positivos diante da prevenção da disseminação de microorganismos. Descritores: Unidades de Terapia Intensiva; Infecção Hospitalar; Cuidados de Enfermagem. 1. INTRODUCTION The Intensive Care Unit (ICU) is considered as a critical unity for the nosocomial environment. In the ICU are several patients and the patients that have diseases or clinical favorable conditions to the nosocomial infections. Very of these patients are already infected 2

3 when are admitted in the unity. The most of the patient interned are subjected to the invasive procedures. In this context it is cured of patients that need contact precaution for the control of dissemination of microorganisms resistant or not to the antibiotics. The contact precaution is indicated in the cases of suspicion or confirmation of colonization or infection for a microorganism in which the contact is a fountain of transmission (1). Frequently, the patients interned in ICU need invasive procedures with the installation of veined catheter, urinary catheter, drains, endotracheal tube, between others. These procedures compromise the barriers of natural defense of the organisms becoming more sensitive and exposed to the risk of infections. A of the principal forms of dissemination of the infectious agents in the hospitals is for the hands because the consequence of do not to washing of the hands is the crossed transmission of pathogen. The pathogens are transplant for other individuals through of the professional that did not wash the hands acting as vehicle of transmission (2). In this form, independently of the state of infection of the patient is fundamental that the standard precaution is adopted for all the health professionals. The nursing occupies a bigger distinction to be more directly in contact with the patient, avoiding the transmission of microorganisms for other patients and for the health professionals themselves. 2. OBJECTIVE This study aims to report the experience as nursing student together the health team of the ICU in the perspective of the preventive care with patients in contact precautions. 3. METHODOLOGY It is an experience report experienced in the Hospital Universitário de Santa Maria (HUSM) that is a teaching with assistance turned to the development of the teaching, research and health assistance. The activities developed are extracurricular and they were performed through the Nursing Complementary Formation Program (NCFPRO) (3), which articulates teaching and extension in the spaces of attention to the health enlarging the process of academic formation. The activity was developed in a nosocomial unity of Intensive Care Unit and it occurred in July of 2011 with duration of twenty days. The choice of the unity was determined 3

4 for the personal interest and the consideration for the importance of the nursing care to patient with several diseases. In this place act professionals of different areas such as: doctors, nurses, nutritionists, physiotherapists, psychologists, nursing technicians, between others. The aim traced for this activity of extension was to accompany the nurse in the actions of his competence with approach in the preventive cares of infection in the assistance and implementation of the nursing process. The activities involve the exchange of experiences with the professionals of the team (scientific-technician), the care to patient and his relatives and workings of the dynamic of a unity. 4. RESULTS AND DISCUSSION The first contact with the ICU was during the classrooms theoretician-practice performed in the fifth semester of nursing graduation. The duration of this curricular activity was relatively short and with focus in the realization and observation of several procedures of the unity as such: the technical cares, the routine of the unity, the dialog with relatives and patients, between others. With the realization of these activities, I realized that there was a significant number of patients with bacterial infections and therefore emerged the interest in to deepen the knowledge in the preventive cares to the critical patients that need contact precautions. During the progress of the existences it was searched to observe between the professionals and, principally the nurses, who these were using the ways of preventing the dissemination of microorganisms and with what frequency. In this sense, the attention was directed to the cares developed in situations of straight contact with a patient that requires the washing of the hands. It is emphasize that between the nursing professionals and students there is a preoccupation in the washing of hands predominantly to the end of procedures, removing so an important measure for the prevention of infections. However it was perceived that the use of the apron is a conduct present during the realization of the majority of the procedures in private bed or nor privative, promoting a protection to the skin and the clothes of the professional and reducing the possibility of transmission and dissemination of microorganisms. Also it is certificated that the asepsis was 4

5 observed in the majority of the objects that the team using with each patient, for example, the thermometer, the sphygmomanometer and the stethoscope. The care of asepsis was not observed in objects that even not being in straight contact with the patient pass of hands in hands transmitting microorganisms as such the appliance of test of peripheral glucose (HGT) and the nursing drawing boards. So, for the preventive care of all the patients independent of the diagnosis, clinical condition and state of infection is fundamental that the health professionals, in distinction the nursing, adopt the standard precaution in the daily life because so avoid the transmission of microorganisms for other patients and for the health professionals themselves (4). 5. CONCLUSION The realization of this academic extracurricular activity in the ICU was constituted in the possibility to perfect the knowledge relative the way as the nursing team of the ICU used the measures of contact precaution, contributing for better to understand about the process relative the prevention and dissemination of the microorganisms more and more frequents in these nosocomial unities. Being the washing of the hands one of the most simple measures, effective and with less cost in the prevention of the nosocomial infections. It was realized that the nursing team of the ICU was not performed frequently the cleaning of the hands, not before and not after of any proceeding. Every patient hospitalized is subject to risks and it can dye to infections. It is necessary that there is a commitment between all the members of the team for the change of work routines in the search for positive results. So, the participation of all the professionals of the health area that made straight assistance and / or indirect to the patients are responsible for the adoption of preventive measures relative to the infections. 6. REFERENCES 1 Bolick Dianna, Bolyard EA,Tablan VOC. Segurança e controle de infecção. Tradução de Henrique Cosendey. Rio de Janeiro: Reichmann & Affonso Editores; Trabasso P. Adesão à lavagem das mãos ainda é pequena. Rev Meio de Cultura. 2002; 19:

6 3 Beuter M, Neves ET, Magnago TSBS, Weiller TH. Programa de Formação Complementar em Enfermagem/PROFCEN [digitado]. Santa Maria, Ministério da Saúde (Br). Portaria nº 2616 de 12 de maio de Diário Oficial (Brasília); 1998 maio 25. 6