Incidence of infections associated with the use of invasive devices in an ICU after application of the Improvement Science Method

Objective: To reduce the incidence density of ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLABSI), and catheter-associated urinary tract infection (CAUTI) in the intensive care unit (ICU) using the Improvement Science method. Methods: This was a single-center retrospective cohort study. A collaborative quality improvement team developed and implemented local changes to HAI-related processes and protocols. Pre-intervention, intervention, and post-intervention periods were compared. The study was conducted at the Adult ICU of a hospital in southern Brazil. Variables were analyzed using interrupted time series analysis with segmented linear regression, simple correlation, and hypothesis testing. Results: There was a reduction in the incidence density of all infections. VAP was reduced from 27.2% to 7.2% (p < 0.001), CLABSI from 3.0% to 0.9% (p = 0.017), and CAUTI from 8.3% to 1.8% (p < 0.001). The ICU stay was also reduced from 6.7 to 6 days (p = 0.018). Conclusion: There was an improvement in all the evaluated parameters. Ongoing monitoring of related indicators and adherence to implemented measures are essential to sustain improvements. Applying the Improvement Science methodology can reduce the incidence of HAIs in the ICU

Entendendo a anestesia inalatória na Cesária: revisão sistemática

Introduction: Inhalation anesthesia in cesarean section is a commonly employed anesthetic approach to provide analgesia and anesthesia during the cesarean surgical procedure. This method utilizes inhalation-administered anesthetic agents, usually through a face mask or endotracheal tube, to induce and maintain the required anesthetic state. Methodology: A systematic literature review on "Understanding Inhalation Anesthesia in Cesarean Section" was conducted based on rigorous criteria to ensure the selection of relevant and high-quality studies. The search was delimited by the descriptors "Anesthesia," "Inhalation," "Cesarean Section," and "Inhalation Anesthesia," focusing on the last 5 years (2019 to 2023) and research conducted from April 20, 2023, to November 29, 2023. Result: Pre-delivery procedures required careful anesthetic attention, and the adopted approach could vary significantly depending on the natureIntrodução: A anestesia inalatória na cesariana é uma abordagem anestésica comumente empregada para fornecer analgesia e anestesia durante o procedimento cirúrgico de cesariana. Este método utiliza agentes anestésicos administrados por inalação, geralmente através de uma máscara facial ou tubo endotraqueal, para induzir e manter o estado anestésico necessário. Metodologia: Uma revisão sistemática de literatura sobre "Entendendo a Anestesia Inalatória na Cesariana" foi elaborada com base em critérios rigorosos para garantir a seleção de estudos relevantes e de qualidade. A pesquisa foi delimitada pelos descritores Anesthesia, Inhalatio, Cesarean Section, Inhalation Anesthesia, com foco nos últimos 5 anos (2019 a 2023) e pesquisas realizadas no período de 20/04/2023 a 29/11 /2023. Resultado: Os procedimentos pré-parto exigiram um cuidado de atenção anestésica, sendo que a abordagem adotada pode variar significativamente de acordo com a natureza e a invasividade da intervenção planejada. Desde procedimentos mais simples até intervenções mais complexas, a escolha da anestesia desempenha um papel crucial no conforto do paciente e no sucesso técnico do procedimento. Conclusão: Os agentes anestésicos inalatórios mais comuns incluem o óxido nitroso, sevoflurano, desflurano e isoflurano. O óxido nitroso é frequentemente utilizado em combinação com outros agentes para fornecer analgesia suplementar. Esses agentes atuam no sistema nervoso central