Prescription errors influenced mortality of patients with Ventilator-associated pneumonia, underscoring the challenge of proper Ventilator-associated pneumonia treatment, which requires continuous reevaluation to ensure that clinical response to therapy meets expectations.

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Objective: Evaluate the relation of nursing workload, evaluated by the Nursing Activities Score (NAS), with the occurrence of Ventilator-associated Pneumonia (VAP) in an Intensive Care Unit (ICU) and the impact of VAP on hospitalization costs.Methods: Retrospective cohort study in Adult ICU of a high complexity Brazilian university hospital. The profile, outcomes, costs, and daily NAS from patients were collected. We also proposed some workload indicators based on NAS daily evaluation.Results: The study included 195 patients, 27.17% diagnosed with VAP. VAP was more prevalent in patients diagnosed with trauma on admission. The total costs of care were higher for VAP patients. In all multivariate models tested were predictive for VAP: the patient's intubation that occurs in days prior of the ICU admission day (higher risk if occurs in days prior the ICU admission day) and ventilation time prior ICU (higher risk if higher time). We found others predictors, but these were dependent on the model tested. Additional risk predictors were tracheostomy, propofol use, neuromuscular blocker use and the higher NAS from admission. The protective factors found were the percentage of adequacy of the assignment based in NAS that measure if the workload measured by the NAS was offered and the increment in NAS during the ventilation time.Conclusions: The offering of an adequate nursing work scale (adequate number of professionals for the care), as a function of the nursing workload measured by the NAS, could be effective in the reduction of VAP, hospital stay time and hospital costs.

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Objective: To evaluate the main risk factors for catheter-related bloodstream infection (ICSRC) and its effects on the outcome of death in patients admitted to an adult intensive care unit (ICU). Methods: Retrospective study performed at an ICU. Data on potential risk factors for ICSRC (sociodemographic profile, unit and insertion pathway, responsible for the dressing) were collected and the death outcome was evaluated. Results: 268 central venous catheters (CVC) were inserted in 209 patients, 13.4% with at least one ICSRC and 36.36% of the patients died; 11.9% of the CVC were punctured in the jugular vein and 13.8% in the subclavian vein infected. Length of stay longer than 14 days and place of insertion of the CVC outside the ICU increased the chances of infection in the subclavian and jugular routes (OR: 2.25 and 0.27). The chances of infection in the jugular route increased with tracheostomy (OR: 3.83). The risk of death increased with ICSRC, hospitalization for trauma and APACHE> 22. Conclusion: Evaluation and intervention in the conditions of insertion and care of the CVC outside the ICU seems to be the crucial point for the decrease of the infections and mortality of patients subsequently admitted to the ICU. Descriptors: Catheter-Related Infections, Catheters, Intensive Care Units, Risk Factors. RESUMOObjetivo: avaliar os principais fatores de risco para infecção de corrente sanguínea relacionada ao cateter (ICSRC) e seus efeitos no desfecho de óbito, em pacientes internados em uma unidade de terapia intensiva (UTI) adulto. Métodos: Estudo retrospectivo, realizado em uma UTI. Foram coletados dados sobre os fatores de risco potenciais para ICSRC (perfil sociodemográfico, unidade e via de inserção, responsável pelo curativo) e avaliado o desfecho óbito. Resultados: 268 cateteres venosos centrais (CVC) foram inseridos em 209 pacientes, sendo 13,4% com pelo menos uma ICSRC e 36,36% dos pacientes evoluíram para óbito; 11,9% dos CVC puncionados na veia jugular e 13,8% na veia subclávia infectaram. O tempo de permanência maior que 14 dias e local de inserção do CVC fora da UTI aumentaram as chances de infecção nas vias subclávia e jugular (OR: 2,25 e 0,27). As chances de infecção na via jugular aumentaram com traqueostomia (OR: 3,83). O risco de óbito aumentou com ICSRC, internação por trauma e APACHE >22. Conclusão: A avaliação e intervenção nas condições de inserção e cuidados do CVC fora da UTI parece ser o ponto crucial para diminuição das infecções e mortalidade dos pacientes posteriormente admitidos na UTI. Descritores: Infecções relacionadas a cateter, Cateteres, Unidades de terapia intensiva, Fatores de risco. RESUMÉNObjetivo: evaluar los principales factores de riesgo para la infección del flujo sanguíneo relacionado con el catéter (ICSRC) y sus efectos en el desenlace de defunción, en pacientes internados en una unidad de terapia intensiva (UCI) adulto. Métodos: Estudio retrospectivo, realizado en una UTI. Se recolectar datos sobre los factores de riesgo potencial para ICSRC (perfil sociodemog...