Rol de enfermería en prevención y control de infecciones en UCI asociadas a la atención: Revisión sistemática
Nursing role in prevention and control of infections in ICUs associated with care: A systematic reviewBarra lateral del artículo
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Introducción: Las infecciones asociadas a la atención de la salud (IAAS) constituyen una amenaza significativa en unidades de cuidados intensivos (UCI), incrementando la morbimortalidad, prolongando la estancia hospitalaria y elevando los costos sanitarios. Objetivo: Identificar y evaluar las estrategias de enfermería más efectivas para la prevención y control de IAAS en pacientes de UCI. Métodos: Revisión sistemática siguiendo guías PRISMA 2020 y JBI. Se realizó búsqueda en cinco bases de datos (PubMed: n=1,123; Scopus: n=892; Web of Science: n=654; CINAHL: n=108; LILACS: n=70) de estudios publicados entre 2015-2025. Se identificaron 2,847 registros iniciales, eliminando 892 duplicados. Tras cribado de 1,970 registros y evaluación de 89 textos completos, se incluyeron 30 estudios. Resultados: Se incluyeron 9 revisiones sistemáticas/meta-análisis, 10 estudios observacionales, 7 revisiones narrativas, 2 estudios cualitativos, 1 estudio Delphi y 1 protocolo de revisión. Las intervenciones estandarizadas de enfermería como higiene de manos, paquetes de medidas para dispositivos invasivos y baños con clorhexidina reducen significativamente la incidencia de neumonía asociada al ventilador y bacteriemia relacionada con catéter. Los paquetes de medidas pueden reducir hasta 40% las IAAS en UCI. El incremento del personal de enfermería se asocia consistentemente con menores tasas de IAAS. En definitiva, el liderazgo visible, apoyo de enfermeras jefe y motivación del personal son factores clave para mantener adherencia a protocolos. Conclusiones: La prevención efectiva de IAAS requiere un enfoque integral que combine medidas técnicas basadas en evidencia, liderazgo sólido, recursos suficientes y formación continua.
Introduction: Healthcare-associated infections (HAIs) constitute a significant threat in intensive care units (ICUs), increasing morbidity and mortality, prolonging hospital stays, and raising healthcare costs. Objective: To identify and evaluate the most effective nursing strategies for the prevention and control of HAIs in ICU patients. Methods: A systematic review was conducted following PRISMA 2020 and JBI guidelines. Five databases (PubMed: n=1,123; Scopus: n=892; Web of Science: n=654; CINAHL: n=108; LILACS: n=70) were searched for studies published between 2015 and 2025. An initial 2,847 records were identified, eliminating 892 duplicates. After screening 1,970 records and evaluating 89 full texts, 30 studies were included. Results: Nine systematic reviews/meta-analyses, 10 observational studies, 7 narrative reviews, 2 qualitative studies, 1 Delphi study, and 1 review protocol were included. Standardized nursing interventions such as hand hygiene, invasive device bundles, and chlorhexidine baths significantly reduce the incidence of ventilator-associated pneumonia and catheter-related bacteremia. These bundles can reduce HCAIs in the ICU by up to 40%. Increased nursing staffing is consistently associated with lower HCAI rates. In short, visible leadership, support from senior nurses, and staff motivation are key factors in maintaining protocol adherence. Conclusions: Effective HCAI prevention requires a comprehensive approach that combines evidence-based technical measures, strong leadership, sufficient resources, and ongoing training.
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Blot S, Ruppé E, Harbarth S, Asehnoune K., Poulakou G., Luyt C, Rello J, Klompas, M, Depuydt, P, Eckmann C, Martín-Loeches I, Póvoa P, Bouadma L, Timsit J, Zahar J. Healthcare-associated infections in adult intensive care unit patients: Changes in epidemiology, diagnosis, prevention and contributions of new technologies. Intensive & Critical Care Nursing. 2022;70;103227-103227. https://doi.org/10.1016/j.iccn.2022.103227
Duszynska W, Rosenthal V, Szczesny A, Zajaczkowska K, Fułek M, Tomaszewski J. Device associated–health care associated infections monitoring, prevention and cost assessment at intensive care unit of University Hospital in Poland (2015–2017). BMC Infect Dis. 2020; 20:853. DOI: 10.1186/s12879-020-05482-w
Bailey C, Teixeira J, Reis N, Chawłowska E, Rocha P., Czech-Szczapa B, Godinho A, Agrelos J, Jaracz K, Fontoura C, Lucas P, Pinto M. Current Approaches on Nurse-Performed Interventions to Prevent Healthcare-Acquired Infections: An Umbrella Review. Microorganisms. 2025; 13. https://doi.org/10.3390/microorganisms13020463
Fontana T. As infecções hospitalares e a evolução hisórica das infecções [Hospital infection and the historical evolution of infection]. Revista brasileira de enfermagem. 2006; 59(5): 703–706. https://doi.org/10.1590/s0034-71672006000500021
Khan I, Basu A, Kiran S, Trivedi S, Pandit P, Chattoraj A. Device-Associated Healthcare-Associated Infections (DA-HAI) and the caveat of multiresistance in a multidisciplinary intensive care unit. Med J Armed Forces India. 2017: 73(3):222-231. doi: 10.1016/j.mjafi.2016.10.008.
Mendonça G, Da Silva Belém J, Pinheiro K, De Sousa Guedes S, Aguiar A, Ambé A, Rodrigues B, Souza R, Coêlho K, Carvalho B, Teles, S, De Vasconcelos, L, Soares T, Peixoto D. Care and Infection Control Measures in the Intensive Care Unit with Emphasis on Nursing Roles: Narrative Review. Journal of Advances in Medicine and Medical Research. 2024. https://doi.org/10.9734/jammr/2024/v36i95573
Maslamani A, Almutair M, Zaila S, Alonazey S, Albogami A, Alrashedi A, Almotiab M, Alanazi S, Albariqi B, Albogami H, Arishi, M, Alsayed H, Alalyani R, Aldhafeeri B, y Aldhafeeri M. Nosocomial or Hospital-acquired Infections-Main Role of Nursing, Health information, Laboratory Professionals, and Health Security Workers. Journal of Ecohumanism. 2024. https://doi.org/10.62754/joe.v3i8.6661
Cappelli E, Zaghini F, Fiorini J, y Sili A. Healthcare-associated infections and nursing leadership: A systematic review. Journal of infection prevention, 17571774241287467. Advance online publication. 2024. https://doi.org/10.1177/17571774241287467
Alanazi F, Lapkin S, Molloy L, Sim J. Healthcare-associated infections in adult intensive care units: A multisource study examining nurses' safety attitudes, quality of care, missed care, and nurse staffing. Intensive & critical care nursing. 2023; 78: 103480. https://doi.org/10.1016/j.iccn.2023.103480
Verdezoto M, González D. Intervenciones de Enfermería en la prevención de las infecciones asociadas a la atención sanitaria en las unidades de cuidados intensivos. Una Revisión Sistemática. Reincisol. 2025;4(7):3891-3904. DOI: https://doi.org/10.59282/reincisol.
García J, Mesa I, Ramírez A, Segovia A. Prevención de infecciones asociadas a la atención en salud: revisión sistemática. Jah. 2021. https://www.jah-journal.com/index.php/jah/article/view/83
García R. Gestión de infecciones intrahospitalarias y estancia hospitalaria en UCI adultos en un hospital de Lima, 2023. Rev Peru Med Intensiva. 2023;6(3):125-138. https://hdl.handle.net/20.500.12692/125814
Pereira L, Fazenda E, Pereira H, Mendes M, Anjos M. Effectiveness of nursing interventions on preventing the risk of infection in adult inpatients: protocol for a systematic review. Syst Rev. 2025; 14:28. DOI: 10.3390/nursrep15060210
Frost S, Alogso M, Metcalfe L, Lynch J, Hunt L, Sanghavi R, et al. Chlorhexidine bathing and health care-associated infections among adult intensive care patients: a systematic review and meta-analysis. Crit Care. 2016; 20:379. DOI: 10.1186/s13054-016-1553-5
Lavallée J, Gray T, Dumville J, Russell W, Cullum N. The effects of care bundles on patient outcomes: a systematic review and meta-analysis. Implement Sci. 2017;12(1):142. DOI: 10.1186/s13012-017-0670-0
Mitchell B, Shaban R, MacBeth D, Wood C, Russo P. The burden of healthcare-associated infection in Australian hospitals: A systematic review of the literature. Infect Control Hosp Epidemiol. 2018;39(10):1165-1175. DOI: 10.1016/j.idh.2017.07.001
Sartelli M, Bartoli S, Borghi F, Busani S, Carsetti A, Catena F, Cillara N, Coccolini F, Cortegiani A, Cortese F, Fabbri E, Foghetti D, Forfori F, Giarratano A, Labricciosa F, Marini P, Mastroianni C, Pan A, Pasero D, Scatizzi M, Viaggi B, Moro M. Implementation Strategies for Preventing Healthcare-Associated Infections across the Surgical Pathway: An Italian Multisociety Document. Antibiotics (Basel). 2023 6;12(3):521. doi: 10.3390/antibiotics12030521
Batran R, Ayed A, Batran A, Ejheisheh M, Alassoud B, Hayek M, Batran A.
Determinants of Nurses’ Compliance with Infection Prevention and Control Practices in Critical Care Units SAGE Open Nurs. 2025.doi: 10.1177/23779608251339193
Kim J, Kang, J. Infection control nursing competency model for nurses in intensive care units: A Delphi study. American journal of infection control. 53(2): 203–209. 2025. https://doi.org/10.1016/j.ajic.2024.09.022
Alanazi F, Lapkin, S, Molloy L, Sim, J. Healthcare-associated infections in adult intensive care units: A multisource study examining nurses’ safety attitudes, quality of care, missed care, and nurse staffing. Intensive & critical care nursing. 2023; 78: 103480. https://doi.org/10.1016/j.iccn.2023.103480
Alnadawy O, Albogami N, Alfahmi M, Haqwi N, Takroni A, Dowaid, E. (2024). Nursing Interventions for Preventing Hospital-Acquired Infections. International Journal of Scientific Research and Management (IJSRM). https://doi.org/10.18535/ijsrm/v12i11.mp03
Alshehari A, Saeed A. Strategies for Improving Healthcare Workers’ Compliance with Infection Control Measures in Intensive Care Units: A Systematic Review and Meta-Analysis. Intensive Care Res. 2024; 4: 201–209. https://doi.org/10.1007/s44231-025-00077-y
Arzilli G, De Vita E, Pasquale M, Carloni L M, Pellegrini M, Di Giacomo M, Esposito E, Porretta A, Rizzo C. Innovative Techniques for Infection Control and Surveillance in Hospital Settings and Long-Term Care Facilities: A Scoping Review. Antibiotics (Basel, Switzerland). 2024; 13(1): 77. https://doi.org/10.3390/antibiotics13010077
Ashiq S, Liaqat J, Liaqat M, Nouman A. Awareness and practices for infection control measures in nurses working in intensive care units. Biological and Clinical Sciences Research Journal. 2025; 6(3): 153-156. https://www.researchgate.net/publication/391440546_Awareness_and_Practices_for_Infection_Control_Measures_in_Nurses_Working_in_Intensive_Care_Unit
Bailey C, Teixeira J, Reis N, Chawłowska E, Rocha P, Czech-Szczapa B, Godinho A, ˛aczyk, G, O Agrelos J, Jaracz K, Fontoura C, Lucas P, Pinto M. Current Approaches on Nurse-Performed Interventions to Prevent Healthcare-Acquired Infections: An Umbrella Review. Microorganisms. 2025;13. https://doi.org/10.3390/microorganisms13020463
Blot S, Ruppé E, Harbarth S, Asehnoune K, Poulakou G, Luyt C, Rello J, Klompas M, Depuydt P, Eckmann C, Martín-Loeches I, Póvoa P, Bouadma L, Timsit J y Zahar J. Healthcare-associated infections in adult intensive care unit patients: Changes in epidemiology, diagnosis, prevention and contributions of new technologies. Intensive & Critical Care Nursing. 2022; 70; 103227-103227. https://doi.org/10.1016/j.iccn.2022.103227
Boev C, Kiss E. Hospital-Acquired Infections: Current Trends and Prevention. Critical care nursing clinics of North America. 2017; 29 (1); 51-65. https://doi.org/10.1016/j.cnc.2016.09.012
Cappelli, E. Healthcare associated infections management inside ICUs: Role of the head nurse in encouraging adherence to infection prevention control practices. Infection Prevention Forum, infermeristica Journal. 2024; 3(4). https://riviste.fupress.net/index.php/if/article/view/2923
Cappelli E, Fiorini J, Canzan F, Livigni L, Carnevale A, Sili A. Healthcare Associated Infections Management inside Intensive Care Units: “What do nurses think about their head nurses?” A qualitative pilot study. infermieristica journal. 2024. https://doi.org/10.36253/if-2923
Cappelli E, Zaghini F, Fiorini J, Sili A. Healthcare-associated infections and nursing leadership: A systematic review. Journal of infection prevention, 17571774241287467. Advance online publication. 2024; 6 (2). https://doi.org/10.1177/17571774241287467
Chiles-Huera K, Chimborazo-Aroca P, Mejías, M. Cuidados de enfermería en la prevención de infecciones asociadas a catéteres venosos centrales (CVC). MQRInvestigar. 2025; 9(2): 562. https://doi.org/10.56048/MQR20225.9.2.2025.e562
Duszynska W, Rosenthal V, Szczesny A, Zajaczkowska K, Fułek, M, Tomaszewski J. Device associated –health care associated infections monitoring, prevention and cost assessment at intensive care unit of University Hospital in Poland (2015–2017). BMC Infectious Diseases. 2020; 20. https://doi.org/10.1186/s12879-020-05482-w
Fontana R. As infecções hospitalares e a evolução hisórica das infecções [Hospital infection and the historical evolution of infection]. Revista brasileira de enfermagem. 2006; 59(5): 703–706. https://doi.org/10.1590/s0034-71672006000500021
Frost S, Alogso M, Metcalfe L, Lynch J, Hunt L, Sanghavi R, Alexandrou E, Hillman K. Chlorhexidine bathing and health care-associated infections among adult intensive care patients: a systematic review and meta-analysis. Critical Care. 2016; 20. https://doi.org/10.1186/s13054-016-1553-5
Hammoud S, Amer F, Lohner S, Kocsis B. Patient education on infection control: A systematic review. American journal of infection control. 2020; 48(12): 1506–1515. https://doi.org/10.1016/j.ajic.2020.05.039
Juspar A, Narmi N, Narmawan N. Determinant Factors of Nurse’s Compliance with Prevention of Application Standards in Health Care Associated Infection (HAIS) Prevention Effort in ICU and UGD Kendari Hospital. KLASICS. 2022; 26 (2). https://doi.org/10.46233/klasics.v2i01.663.
Kilpatrick M, Hutchinson A, Manias E, Bouchoucha S. Paediatric nurses’, children’s and parents’ adherence to infection prevention and control and knowledge of antimicrobial stewardship: a systematic review. American journal of infection control. 2021; 49 (5): 622-639 https://doi.org/10.1016/j.ajic.2020.11.025
Kim, E. J, Kang, J. Infection control nursing competency model for nurses in intensive care units: A Delphi study. American journal of infection control. 2025; 53(2): 203–209. https://doi.org/10.1016/j.ajic.2024.09.022
Lavallée J, Gray T, Dumville J, Russell W. Cullum N. The effects of care bundles on patient outcomes: a systematic review and meta-analysis. Implementation science: IS. 2017; 12(1): 142. https://doi.org/10.1186/s13012-017-0670-0
Maslamani A, Almutairi M, Zaila S, Alonazey S, Albogami A, Alrashedi A, Almotiab M, Alanazi S, Albariqi B, Albogami H, Arishi M, Alsayed H, Alalyani R, Aldhafeeri B, Aldhafeeri M. Nosocomial or Hospital-acquired Infections-Main Role of Nursing, Health information, Laboratory Professionals, and Health Security Workers. Journal of Ecohumanism. 2024; 3(8): 12-31. https://doi.org/10.62754/joe.v3i8.6661
Mendonça G, Da Silva Belém J, Pinheiro K, De Sousa Guedes S, Aguiar A, Ambé A, Rodrigues B, Souza R, Coêlho K, Carvalho B, Teles S, De Vasconcelos, L, Soares T, Peixoto I, Sardinha D. Care and Infection Control Measures in the Intensive Care Unit with Emphasis on Nursing Roles: Narrative Review. Journal of Advances in Medicine and Medical Research. 2024; 36 (9): 256-264. https://doi.org/10.9734/jammr/2024/v36i95573
Mitchell B, Gardner A, Stone P, Hall L, Pogorzelska-Maziarz, M. Hospital Staffing and Health Care-Associated Infections: A Systematic Review of the Literature. Joint Commission journal on quality and patient safety. 2018: 44 (10): 613-622. https://doi.org/10.1016/j.jcjq.2018.02.002
Nasiri A, Balouchi A, Rezaie-Keikhaie K, Bouya S, Sheyback M, Rawajfah O. Knowledge, attitude, practice, and clinical recommendation toward infection control and prevention standards among nurses: A systematic review. American journal of infection control. 2019: 47 (7): 827-833. https://doi.org/10.1016/j.ajic.2018.11.022
Nurcholis N, Laksanano G, Yudyarto H, Mulyadi A. Overview of nurses in the prevention and control of healthcare associated infections (hais) at kardinah. Juru Rawat. Jurnal Update Keperawatan. 2021; 1(1): 1-20. https://doi.org/10.31983/juk.v1i1.8032
Rahman I, Hermawan R, Lismayanti L, Nurapandi A, Gunawan A. Relationship between nurse motivation and prevention actions (hais) in icu and hcu rooms. jurnal mutiara ners. 2023; 6(1): 17–27. https://doi.org/10.51544/jmn.v6i1.3465
Santos-Costa P, Paiva-Santos F, Graveto J, PrevInf Group. Nursing Students’ Perceptions of a Novel Education Approach to Prevention and Control of Healthcare-Associated Infections: Insights from PrevInf Pilot Study. Nursing reports (Pavia, Italy). 2024; 14(2):1494–1503. https://doi.org/10.3390/nursrep14020112
Todo Bom L, Mata S, Cunha M, Marquês D, Dixe D. Effectiveness of Nursing Interventions on Preventing the Risk of Infection in Adult Inpatients: Protocol for a Systematic Review. Nursing reports (Pavia, Italy). 2025; 15(6): 210. https://doi.org/10.3390/nursrep15060210
Tozzo P, Delicati A, Caenazzo L. Human microbiome and microbiota identification for preventing and controlling healthcare-associated infections: A systematic review. Frontiers in Public Health. 2022; 10. https://doi.org/10.3389/fpubh.2022.989496
Page J, McKenzie J, Bossuyt P, Boutron I, Hoffmann T, Mulrow C, Shamseer L, Tetzlaff J, Akl E, Brennan, E, Chou R, Glanville J, Grimshaw J, Hróbjartsson A, Lalu, M, Li T, Loder E, Mayo-Wilson E, McDonald S, McGuinness A, Moher D. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ (Clinical research ed.). 2021; 372 (71). https://doi.org/10.1136/bmj.n71