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ADHERENCE TO STANDARD PRECAUTI ON I N THE PERI PHERAL VASCULAR ACCESS
1Melissa Alv es Cir elli2 Rosely Mor alez de Figueir edo3 Sílv ia Helen a Zem - Mascar en h as4
Cir elli MA, Fig u eir ed o RM, Mascar en h as SHZ . Ad h er en ce t o st an d ar d p r ecau t ion in t h e p er ip h er al v ascu lar access. Rev Lat ino- am Enfer m agem 2007 m aio- j unho; 15( 3) : 512- 4.
This pr ospect ive and quant it at ive st udy w as car r ied out in a sm all pr ivat e gener al hospit al, w her e t he adh er en ce t o st an dar d pr ecau t ion in t h e per iph er al v ascu lar access w as ev alu at ed. Th e dat a w er e collect ed t h r ou gh a qu est ion n air e aim in g t o ch ar act er ize t h e n u r sin g t eam ’s k n ow ledge an d opin ion abou t st an dar d pr ecaut ions and t he av ailabilit y of m at er ials. I n addit ion, a sy st em ized obser v at ion of t he pr ocedur es of v ein punct ur e and m edicine adm inist r at ion w as per for m ed. I t w as ident ified t hat 84.4% of t he punct ur es had been carried out w it hout gloves or previous hand w ashing; in 29.7% of t he procedures, needles w ere recapped and 93.2% of t he professionals report ed adequat e m at erial supply. Concluding, t he professionals expose t hem selves and pat ient s t o unnecessary risks of infect ion. The nursing t eam m ust be t he focus of cont inuous int ervent ions and fut ur e act ions in or der t o m inim ize t he r isk of infect ion in t he pr ocedur e of per ipher al vascular access.
DESCRI PTORS: infect ion cont r ol; educat ion cont inuing; nur sing
SI GUI ENDO LAS PRECAUCI ONES PADRÓN PARA PROCEDI MI ENTO DE I NSERCI ÓN
VASCULAR PERI FÉRI CO
Est udio prospect ivo, cuant it at ivo, realizado en un hospit al general privado de poca com plej idad, donde fue ev aluado el seguim ient o de las pr ecauciones pat r ón par a r ealizar inser ción v ascular per ifér ica. Los dat os f u er on r ecolect ad os p or m ed io d e u n cu est ion ar io, con el ob j et iv o d e d et er m in ar las car act er íst icas d el con ocim ien t o y d e op in ión d el eq u ip o d e en f er m er ía sob r e los t em as d e ad h esión , p r ecau cion es p at r ón , d i sp o n i b i l i d a d d e m a t er i a l es; y p o r o b ser v a ci ó n si st ém i ca d e l o s p r o ced i m i en t o s d e p u n ci ó n v en o sa y adm inist ración de m edicam ent os. Se ident ificó que 84,4% de las punciones fueron realizadas sin guant es y sin lavado previo de m anos, 29,7% de las veces hubo reut ilización de aguj as y 93,2% de los profesionales afirm ó t ener una adecuada cant idad de m at er iales. Se concluyó que los pr ofesionales exponen a sus pacient es y a sí m ism os a riesgos de infección innecesaria. El equipo de enferm ería debe enfocar su int ervención y act ividades fut ur as con el obj et iv o de m inim izar el r iesgo de infección dur ant e el pr ocedim ient o v ascular per ifér ico.
DESCRI PTORES: cont r ol de infecciones; educación cont inua; enfer m er ía
ADESÃO ÀS PRECAUÇÕES PADRÃO NO ACESSO VASCULAR PERI FÉRI CO
Est u do pr ospect iv o, qu an t it at iv o, r ealizado n u m h ospit al ger al pr iv ado de pequ en o por t e, on de f oi avaliada a adesão às pr ecauções padr ão no acesso vascular per ifér ico. Os dados for am colet ados por m eio de q u est ion ár io, v isan d o a car act er ização d o con h ecim en t o e d a op in ião d a eq u ip e d e en f er m ag em sob r e os t em as ad esão às p r ecau ções p ad r ão e a d isp on ib ilid ad e d e m at er iais e p or ob ser v ação sist em at izad a d os pr ocedim ent os de punção v enosa e adm inist r ação de m edicam ent os. I dent ificou- se que 8 4 , 4 % das punções for am r ealizadas sem luv as e sem lav agem pr év ia das m ãos 29, 7% das v ezes houv e r eencape de agulhas e 93,2% dos pr ofissionais afir m ou ser adequada a ofer t a de m at er ial. Conclui- se que os pr ofissionais ex põem a si pr ópr ios e os pacien t es a r iscos de in f ecção desn ecessár ios. A equ ipe de en f er m agem dev e ser f oco de int ervenção e ações fut uras visando m inim izar o risco de infecção no procedim ent o de acesso vascular periférico.
DESCRI TORES: cont r ole de infecções; educação cont inuada; enfer m agem
1
St udy funded by PI BI C/ CNPq - 2004/ 2005; 2 RN, PI BI C/ CNPq grant holder, e- m ail: m el_cirelli@hot m ail.com .br; 3 RN, Advisor, Adj unct Professor Nursing Depart m ent . e- m ail: rosely@power.ufscar.br; 4 RN, Adj unct Professor Nursing Depart m ent , e- m ail: silviazem @power.ufscar.br. Federal Universit y of São Carlos
Disponible en castellano/ Disponível em língua portuguesa SciELO Brasil w w w .scielo.br/ rlae
Rev Lat ino- am Enferm agem 2007 m aio- j unho; 15( 3) : 512- 4 w w w .eer p.usp.br / r lae
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I NTRODUCTI ON
T
he m ain goal of est ablishing so called basic or st andar d pr ecaut ions ( SP) is t o r educe m or bidit y,l i m i t i n g h ea l t h t ea m s’ a n d p a t i en t s’ co n t a ct w i t h
secr et i o n s, b o d y f l u i d s, sk i n l esi o n s an d b l o o d( 1 ).
Healt h professionals’ non- adherence t o SP by has been
ex t ensiv ely not ified( 2- 3), and ev idences hav e show ed
t hat it s use dim inishes t he risk of blood exposure( 3).
Pe r i p h e r a l v e n o u s a cce ss a n d m e d i ca t i o n
adm in ist r at ion ar e t h e pr ocedu r es w it h gr eat er r isk
of exposure t o blood perform ed by t he nursing t eam( 4).
S t u d i e s c o n t r i b u t i n g t o t h e a d v a n c e m e n t o f
k now ledge, pr ov iding suppor t t o act ions t hat aim t o
in t er r u p t t h e ep id em iolog ical t r an sm ission ch ain of
i n t r a - h o sp i t a l p a t h o g e n s, a r e o f g r e a t a ca d e m i c
in t er est an d social r elev an ce. Th er ef or e, t h is st u dy
aim ed t o ev alu at e t h e k n ow ledge of an d adh er en ce
t o SP in t he per ipher al v enous access pr ocedur e by
t he nur sing t eam of a sm all gener al hospit al.
METHODOLOGY
Th i s i s a p r o sp e ct i v e , q u a n t i t a t i v e st u d y,
perform ed bet ween August 2004 and June 2005 wit h
a nur sing populat ion w or k ing day shift s at a pr iv at e
general hospit al in t he int erior of São Paulo. I n t ot al,
29 of t he 35 pr ofessionals w or k ing at t he inst it ut ion
par t icipat ed in t he st udy. The pr oj ect was appr ov ed
by t he I nst it ut ional Review Board at UFSCAR ( Opinion
0 4 7 / 0 4 ) a n d a l l p a r t i ci p a n t s si g n ed t h e f r ee a n d
infor m ed consent t er m .
D a t a c o l l e c t i o n w a s p e r f o r m e d i n t h r e e
st ages, as follow s: 1. Applicat ion of a quest ionnair e,
a i m i n g t o c h a r a c t e r i z e t h e s t u d y p o p u l a t i o n ’ s
k n ow led g e an d op in ion ab ou t SP; 2 . sy st em at ized
ob ser v at ion ( 1 2 8 h s) of t h e p er f or m an ce of v en ou s
access procedures and 3. evaluat ion of t he opinion of
nursing professionals about t he physical st ruct ure and
a v a i l a b i l i t y o f m a t e r i a l . Re co r d s w e r e m a d e p e r
p r o c e d u r e , g u a r a n t e e i n g c o n f i d e n t i a l i t y t o t h e
subj ect s, and analy zed t hr ough sim ple st at ist ics and
descr ipt iv e an aly sis.
RESULTS AND DI SCUSSI ON
I n t he knowledge evaluat ion st age, only nine
professionals ident ified t he SP concept correct ly, while
t h e w r on g con cep t of “ r isk p at ien t ” ap p ear s in 1 6
r esponses. This concept infr inges t he pr inciple of SP,
t hat is, t he fact t hat t hey are applicable t o any and all
pat ient s. I n t he ev aluat ion of how pr ofessionals see
t h eir ow n ad h er en ce t o SP, ap p r ox im at ely 5 0 % of
t hem ack now ledge not using glov es in v enipunct ur e
or int ravenous m edicat ion adm inist rat ion. On t he ot her
h an d , t h e d i st r i b u t i o n o f si n k s an d t h e su p p l y o f
m at erials like liquid soap, piercing and cut t ing m at erial
collect ors and paper t owels were considered adequat e
by m or e t han 90% of t he pr ofessionals.
I n t h e secon d st age, 6 4 v en ipu n ct u r es an d
1 7 5 cases of in t r av en ou s m edicat ion adm in ist r at ion
w er e ev alu at ed. Fr om t h ese, 8 4 . 4 % pu n ct u r es an d
82.8% adm inist rat ions were perform ed wit hout gloves.
Hand w ashing befor e t he pr ocedur e occur r ed in only
15.6% of punct ures and 10.3% of adm inist rat ions ( Table
1 ) . Th e n e e d l e s w e r e r e c a p p e d a f t e r 2 9 . 7 % o f
punct ur es and 13. 1% of m edicat ion adm inist r at ions.
These sam e pr ofessionals r epor t ed t hat t he phy sical
s t r u c t u r e a n d m a t e r i a l s u p p l y w e r e a d e q u a t e .
Th er ef o r e, t h i s f act o r d o es n o t co l l ab o r at e t o t h e
professionals’ non- adherence t o t his prim ary m easure.
Lit er at u r e g iv es j u st if icat ion s f or t h e n on
-adherence t o SP, such as t he urgency of t he procedure,
rush, loss of abilit y when using gloves, non agreem ent
wit h t he precaut ion, unpredict able circum st ances, low
r isk pat ient s, am ong ot her s( 3).
Tab le 1 – Dist r ib u t ion of ob ser v ed con d u ct s in t h e
v e n i p u n c t u r e a n d m e d i c a t i o n a d m i n i s t r a t i o n
pr ocedur es. São Car los, SP, 2 0 0 5
s t c u d n o
C Venipuncture Intravaednmoinusistmraetdioicnation
s e v o l g o
N 54 154
e r o f e b g n i h s a w d n a
H 10 18
r e t f a g n i h s a w d n a
H 18 20
l e g l o h o c l a f o e s
U 6 14
d o o l b o t e r u s o p x e n i k
S 3 0
e h t r e t f a g n i d r a c s i D e r u d e c o r p 8
3 114
g n i p p a c e r r e t e h t a c / e l d e e
N 19 23
d e m r o f r e p l a t o
T 64 175
Adherence t o st andard precaut ion...
Cirelli MA, Figueiredo RM, Mascarenhas SHZ.
Rev Lat ino- am Enferm agem 2007 m aio- j unho; 15( 3) : 512- 4 w w w .eer p.usp.br / r lae
Th e n on - adh er en ce t o h an d w ash in g is t h e
m ain r out e t hr ough w hich pat hogens ar e t r ansm it t ed
inside t he hospit al, while t he use of gloves decreases
exposur e t o blood bor ne pat hogens by 35 t o 50%( 5).
The non- recapping of needles is st ill a great cause of
accident s w it h pier cing and cut t ing m at er ial( 6).
I t was also observed t hat only 65.1% of t he
p r of ession als d iscar d ed g lov es an d p ier cin g - cu t t in g
514
adm inist r at ion. This assessm ent is im por t ant in v iew
o f t h e f a c t t h a t a c c i d e n t r a t e s c a u s e d b y t h e
inadequat e handling, t ransport at ion and discarding of
pier cing and cut t ing m at er ial r em ain high( 7).
CONCLUSI ON
I n conclusion, t he st udy populat ion does not adher e
t o t he SP sat isfact or ily, especially r egar ding t he use
of g lov es, h an d w ash in g an d t h e n on r ecap p in g of
n eed les.
We b eliev e t h at t h e d issem in at ion of t h ese r esu lt s
m igh t lead people t o r ef lect abou t t h e ef f icien cy of
current educat ion act ions adopt ed by inst it ut ions. We
su g g est t h at m or e in n ov at iv e m od els, w it h sh ar ed
r esp on si b i lit y am on g t h e d i f f er en t act or s i n v ol v ed
should be st udied and st im ulat ed.
REFERENCES
1 . Sr id h ar MR, Boop at h i S, Lod h a R, Kab r a SK. St an d ar d p r ecau t ion s an d p ost ex p osu r e p r op h y lax is f or p r ev en t in g infect ions. I ndian J Pediat r 2004. [ on line] . Av ailable fr om : < h t t p : / / w w w . i j p p ed i at r i csin d ia. or g / ar t icle. asp ?issn = 0 0 1 9 -5 4 -5 6 ; y e a r = 2 0 0 4 ; v o l u m e = 7 1 ; i s s u e = 7 ; s p a g e = 6 1 7 ; epage= 6 2 6 ; au last = Sr idh ar > ( 1 5 Febr u ar y 2 0 0 5 ) .
2 . Doeb b elin g BN, Vau g h n TE, McCoy KD, Beek m an n SE, Woolson RF, Fer gunson KJ, et al. Per cut aneous inj ur y, blood e x p o su r e , a n d a d h e r e n ce t o st a n d a r d p r e ca u t i o n s: a r e hospit al- based healt h car e pr ov ider s st ill at r isk ? Clin I nfect D i s 2 0 0 3 ; 3 7 ( 8 ) : 1 0 0 6 - 1 3 .
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5. Caixet a RB, Barbosa- Branco A. Acident e de t rabalho, com m at er ial b iológ ico, em p r of ission ais d e saú d e d e h osp it ais públicos do Dist rit o Federal, Brasil, 2002/ 2003. Cad de Saúde Pú b l i ca 2 0 0 5 ; 2 1 ( 3 ) : 7 3 7 - 4 6 .
6 . Mar zi al e MHP, Ni sh i m u r a KYN, Fer r ei r a MM. Ri sco s d e con t am in ação ocasion ad os p or acid en t es d e t r ab alh o com m at erial perfurocort ant e ent re t rabalhadores de enferm agem . Re v La t i n o - a m En f e r m a g e m 2 0 0 4 j a n e i r o - f e v e r e i r o ; 1 2 ( 1 ) : 3 6 - 4 2 .
7. Canini SRMS, Gir E, Machado AA. Accident s w it h pot ent ially h azar d o u s b i o l o g i cal m at er i al am o n g w o r k er s i n h o sp i t al su p p o r t i n g se r v i ce s. Re v La t i n o - a m En f e r m a g e m 2 0 0 5 Au g u st ; 1 3 ( 4 ) : 4 9 6 - 5 0 0 .
Recebido em : 1.2.2006 Aprovado em : 26.1.2007 Adherence t o st andard precaut ion...
Cirelli MA, Figueiredo RM, Mascarenhas SHZ.
