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Abstract(s)
As infeções associadas a cuidados de saúde são um problema de âmbito global devido à elevada morbi-mortalidade e aos altos custos associados, constituindo uma séria ameaça à saúde pública.
Apresentam-se como um dos maiores riscos associados à hospitalização e são universalmente reconhecidas como um indicador de qualidade dos cuidados de saúde e de segurança do doente.
O impacto das infeções associadas a cuidados de saúde é particularmente relevante na medicina intensiva face à crescente tecnologia médica invasiva, ao elevado número de doentes imunodeprimidos e ao aumento da resistência aos antimicrobianos.
Os objetivos desta dissertação são identificar as infeções associadas a cuidados de saúde mais prevalentes em unidades de cuidados intensivos, esclarecer quais as infeções preveníveis e abordar as principais medidas preventivas que devem ser adotadas para diminuir as taxas destas infeções através de uma revisão bibliográfica que incide sobretudo em documentos oficiais, nacionais e internacionais, de organismos de referência na saúde.
A prevalência de infeções associadas a cuidados de saúde é elevada em doentes admitidos nas unidades de cuidados intensivos onde as infeções mais comuns são as infeções do trato respiratório, as infeções da corrente sanguínea, as infeções do local cirúrgico e as infeções do trato urinário.
As infeções podem ser causadas por agentes infeciosos de fontes endógenas ou exógenas, moduladas por fatores de risco intrínsecos e extrínsecos e os programas intensivos de higiene e controlo de infeção devem focar-se nas infeções teoricamente elimináveis e no controlo dos fatores de risco extrínsecos.
Os principais riscos estão relacionados com a presença de dispositivos invasivos, procedimentos cirúrgicos e exposição a antimicrobianos de largo espetro.
As principais medidas de prevenção e controlo assentam, por um lado, no cumprimento de precauções básicas como higiene das mãos, uso adequado de equipamentos de proteção individual, descontaminação de material, controlo ambiental e isolamento e, por outro lado, no uso racional e parcimonioso de antimicrobianos, utilizando a vigilância epidemiológica de infeções e de resistências como indicador de resultados.
Os programas de controlo devem ser estruturados segundo feixes de intervenção, um conjunto de medidas que promovem um resultado com impacto superior ao da mera adição do efeito de cada uma das medidas, individualmente.
Healthcare-associated infections are a global problem due to high morbidity and associated high costs, posing a serious threat to public health. They are considered as one of the greatest risks associated with hospitalization and are universally recognized as an indicator of the quality of health care and patient safety. The impact of healthcare-associated infections is particularly relevant in intensive medicine in the face of increasing invasive medical technology, high numbers of immunocompromised patients and increased antimicrobial resistance. The objectives of this dissertation are to identify the most prevalent healthcare-associated infections in intensive care units, to clarify which infections are preventable and to approach the main preventive measures that should be adopted to reduce the rates of these infections according to a literature review in national and international official documents, of reference health organizations. The prevalence of healthcare-associated infections is high in patients admitted to intensive care units where the most common infections are respiratory tract infections, bloodstream infections, surgical site infections and urinary tract infections. Infections can be caused by pathogens of endogenous or exogenous sources, modulated by intrinsic and extrinsic risk factors and we must act through intensive programs of hygiene and infection control focused on theoretically preventable infections and control of the latter risk factors. The major risks are related to the presence of invasive devices, surgical procedures and exposure to broad spectrum antimicrobials. The main prevention and control measures are, on one hand, compliance with basic precautions such as hand hygiene, proper use of personal protective equipment, decontamination of materials, environmental control and isolation and, on the other hand, the rational and judicious use of antimicrobials using the epidemiological surveillance of infections and resistance as an indicator of results. The control programs should be structured according to intervention bundles, a set of measures that promote a result that has a higher impact than the simple addition of the effect of each measure individually.
Healthcare-associated infections are a global problem due to high morbidity and associated high costs, posing a serious threat to public health. They are considered as one of the greatest risks associated with hospitalization and are universally recognized as an indicator of the quality of health care and patient safety. The impact of healthcare-associated infections is particularly relevant in intensive medicine in the face of increasing invasive medical technology, high numbers of immunocompromised patients and increased antimicrobial resistance. The objectives of this dissertation are to identify the most prevalent healthcare-associated infections in intensive care units, to clarify which infections are preventable and to approach the main preventive measures that should be adopted to reduce the rates of these infections according to a literature review in national and international official documents, of reference health organizations. The prevalence of healthcare-associated infections is high in patients admitted to intensive care units where the most common infections are respiratory tract infections, bloodstream infections, surgical site infections and urinary tract infections. Infections can be caused by pathogens of endogenous or exogenous sources, modulated by intrinsic and extrinsic risk factors and we must act through intensive programs of hygiene and infection control focused on theoretically preventable infections and control of the latter risk factors. The major risks are related to the presence of invasive devices, surgical procedures and exposure to broad spectrum antimicrobials. The main prevention and control measures are, on one hand, compliance with basic precautions such as hand hygiene, proper use of personal protective equipment, decontamination of materials, environmental control and isolation and, on the other hand, the rational and judicious use of antimicrobials using the epidemiological surveillance of infections and resistance as an indicator of results. The control programs should be structured according to intervention bundles, a set of measures that promote a result that has a higher impact than the simple addition of the effect of each measure individually.
Description
Keywords
Infeções Associadas A Cuidados de Saúde Medicina Intensiva Prevenção Saúde Pública Segurança do Doente