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Introduction: Intensive Care Unit (ICU) acquired pneumonia prolongs hospitalization and influences mortality rates. Educational interventions with health professionals are relevant preventive strategies for healthcare-associated infections. Objective: To evaluate the result of an educational activity on adherence to the maintenance of a high decubitus, above 30 degrees, as a measure for preventing ventilator-associated pneumonia. Methods: Quasi-experimental study with a pretestposttest design conducted in the ICU of the University Hospital of Londrina from March to June 2010, divided in three periods (preintervention, intervention and post-intervention). During study period, 49 health professionals were trained. Direct observations of the decubitus’ height were performed before and after training and clinical data of patients admitted to the ICU were collected. Adherence to the recommendation of high decubitus was defined as maintenance of decubitus above 30 degrees in each observation. Results: There was an increase in the mean of decubitus’ angle from pre-intervention period (27.85±6.76 degrees) to post-intervention (30.70±8.18 degrees; p<0.001), although this difference did not persisted in the third month postintervention observation (29.46±6.19 degrees). Conclusion: The educational activity was transiently effective in increasing adherence to maintain high decubitus during hospitalization, but the adherence decreased progressively, showing the need for a continuous intervention to maintain results.
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2. Bassi GL, Ferrer M, Marti JD, Comaru T, Torres A. Ventilator associated pneumonia. Semin Respir Crit Care Med. 2014;35(4):469-81. http://dx.doi.org/10.1055/s-0034-1384752
3. Keyt H, Faverio P, Restrepo MI. Prevention of ventilator associated pneumonia in the intensive care unit: a review of the clinically relevant recent advancements. Indian J Med Res. 2014;139(6):814-21.
4. Suhas P, Kundra P, Cherian A. Polyurethane cuffed versus conventional endotracheal tubes: Effect on ventilator-associated pneumonia rates and length of Intensive Care Unit stay. Indian J Anaesth. 2016;60(3):163-7. http://dx.doi.org/10.4103/0019-5049.177871
5. Wang L1, Li X, Yang Z, Tang X, Yuan Q, Deng L, et al. Semirecumbent position versus supine position for the prevention of ventilator-associated pneumonia in adults requiring mechanical ventilation. Cochrane Database Syst Rev. 2016;1:CD009946. http://dx.doi.org/10.1002/14651858.CD009946.pub2
6. Ferreira CR, Souza DF, Cunha TM, Tavares M, Reis SS, Pedroso RS, et al. The effectiveness of a bundle in the prevention of ventilator-associated pneumonia. Braz J Infect Dis. 2016;20(3):267-71. http://dx.doi.org/10.1016/j.bjid.2016.03.004
7. Vasilevskis EE, Pandharipande PP, Graves AJ, Shintani A, Tsuruta R, Ely EW, et al. Validity of a Modified Sequential Organ Failure Assessment Score Using the Richmond Agitation-Sedation Scale. Crit Care Med. 2016;44(1):138-46. http://dx.doi.org/10.1097/CCM.0000000000001375
8. Hashmi M, Asghar A, Shamim F, Khan FH. Validation of acute physiologic and chronic health evaluation II scoring system software developed at The Aga Khan University, Pakistan. Saudi J Anaesth. 2016;10(1):45-9. http://dx.doi.org/10.4103/1658-354X.169474
9. McMullen KM, Boyer AF, Schoenberg N, Babcock HM, Micek ST, Kollef MH. Surveillance versus clinical adjudication: differences persist with new ventilator-associated event definition. Am J Infect Control. 2015;43(6):589-91. http://dx.doi.org/10.1016/j.ajic.2015.03.004
10. Ellery AEL, Bosi MLM, Loiola FA. Integração ensino, pesquisa e serviços em saúde: antecedentes, estratégias e iniciativas. Saude Soc. 2013;22(1):187-98. http://dx.doi.org/10.1590/S0104-12902013000100017
11. Beckert ME. Correspondência verbal/não verbal: pesquisa básica e aplicações na clínica. In: Abreu-Rodrigues J, Ribeiro RM. Análise do comportamento: pesquisa, teoria e aplicação. Porto Alegre: Artmed; 2005; p.229-44.
12. Mietto C, Pinciroli R, Patel N, Berra L. Ventilator associated pneumonia: evolving definitions and preventive strategies. Respir Care. 2013;58(6):990-1007. http://dx.doi.org/10.4187/respcare.02380
13. Bassi GL, Torres A. Ventilator-associated pneumonia: role of positioning. Curr Opin Crit Care. 2011;17(1):57-63. http://dx.doi.org/10.1097/MCC.0b013e3283428b31
14. Rello J, Lode H, Cornaglia G, Masterton R, VAP Care Bundle Contributors. A European care bundle for prevention of ventilator associated pneumonia. Intensive Care Med. 2010;36(5):773-80. http://dx.doi.org/10.1007/s00134-010-1841-5
15. Van Nieuwenhoven CA, Vandenbroucke-Grauls C, van Tiel FH, Joore HC, van Schijndel RJ, van der Tweel I, et al. Feasibility and effects of the semi recumbent position to prevent ventilator associated pneumonia: a randomized study. Crit Care Med. 2006;34(2):396-402.
16. Sud S, Friedrich JO, Taccone P, Polli F, Adhikari NK, Latini R, et al. Prone ventilation reduces mortality in patients with acute respiratory failure and severe hypoxemia: systematic review and meta-analysis. Intensive Care Med. 2010;36(4):585-99. http://dx.doi.org/10.1007/s00134-009-1748-1
17. Mauri T, Berra L, Kumwilaisak K, Pivi S, Ufberg JW, Kueppers F, et al. Lateral-horizontal patient position and horizontal orientation of the endotracheal tube to prevent aspiration in adult surgical intensive care unit patients: a feasibility study. Respir Care. 2010;55(3):294-302.
18. Blot S, Lisboa T, Angles R, Rello J. Prevention of VAP: Is zero rate possible? Clin Chest Med. 2011;32(3):591-9. http://dx.doi.org/10.1016/j.ccm.2011.05.008