Neumonía asociada a la ventilación mecánica: medidas preventivas y su implementación en un hospital público.
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Abstract
Introducción: las infecciones relacionadas con la atención sanitaria representan un problema importante para la seguridad de los pacientes. La neumonía asociada a la ventilación mecánica (NAV) es la principal causa de infección nosocomial en las unidades de cuidados intensivos de adultos.
Se define como “bundle” a un conjunto de medidas para el cuidado de la salud, que contribuyen a mejorar la calidad de la atención de los pacientes disminuyendo la incidencia de infecciones nosocomiales.
Objetivos: 1) Describir las medidas de prevención de NAV, 2) Realizar la evaluación de cada medida preventiva con una matriz de ponderación para generar un bundle local.
Métodos: se realizó una revisión monográfica de la literatura y, para la creación de un bundle local, se utilizó una matriz de priorización.
Resultados: las medidas preventivas para NAV son: formación y entrenamiento apropiado de los profesionales en la manipulación de la vía aérea, higiene estricta de las manos, higiene bucal utilizando clorhexidina, control y mantenimiento de la presión del neumotaponamiento, posición de la cabecera a 30-45°, favorecer los procedimientos que permitan disminuir de forma segura la intubación y/o su duración y evitar los cambios programados de tubuladuras, humidificadores y tubos traqueales.
El bundle local quedó conformado por 4 medidas: higiene estricta de las manos, higiene bucal utilizando clorhexidina, control y mantenimiento de la presión del neumotaponamiento y cabecera elevada entre 30º y 45º.
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