Partnership among hospitals to reduce healthcare associated infections: a quasi-experimental study in Brazilian ICUs

BMC Infectious Diseases

Research Article

Ladjane Santos Wolmer de Melo¹  Maria Verônica Monteiro de Abreu¹  Claudia Fernanda de Lacerda Vidal¹  Heloisa Ramos Lacerda²  Maria Carolina Andrade Lins de Albuquerque³  Bernuarda Roberta de Oliveira Santos⁴  Maria das Graças Washington Casimiro Carreteiro⁵  Maria Fernanda Aparecida Moura de Souza⁶ 

[1] Clinics Hospital of Pernambuco, Federal University of Pernambuco, Recife, Pernambuco, Brazil;Department of Clinical Medicine, Federal University of Pernambuco, Recife, Pernambuco, Brazil;Getulio Vargas Hospital, Recife, Pernambuco, Brazil;Oswaldo Cruz Hospital, University of Pernambuco, Recife, Pernambuco, Brazil;PROCAPE Hospital, University of Pernambuco, Recife, Pernambuco, Brazil;Pelopidas Silveira Metropolitan Hospital, Recife, Pernambuco, Brazil;

关键词: Healthcare-associated infections;    Breakthrough series;    Collaborative;    Intensive care units;    Prevention bundles;   

DOI  :  10.1186/s12879-021-05896-0

 received in 2020-07-07, accepted in 2021-02-12,  发布年份 2021

来源: Springer

【 摘 要 】

BackgroundHealthcare-associated infections (HAIs) are relevant in developing countries where frequencies can be at least 3 times higher than in developed countries. The purpose of this research was to describe the intervention implemented in intensive care units (ICUs) to reduce HAIs through collaborative project and analyze the variation over 18 months in the incidence density (ID) of the three main HAIs: ventilator associated pneumonia (VAP), central line-associated bloodstream infections (CLABSIs) and catheter-related urinary tract infections (CAUTIs) and also the length of stay and mortality in these ICUs.MethodsA quasi-experimental study in five public adult clinical-surgical ICUs, to reduce HAIs, through interventions using the BTS-IHI “Improvement Model”, during 18 months. In the project, promoted by the Ministry of Health, Brazilian philanthropic hospitals certified for excellence (HE), those mostly private, certified as excellence and exempt from security contributions, regularly trained and monitored public hospitals in diagnostics, data collection and in developing cycles to improve quality and to prevent HAIs (bundles). In the analysis regarding the length of stay, mortality, the IDs of VAP, CLABSIs and CAUTIs over time, a Generalized Estimating Equation (GEE) model was applied for continuous variables, using the constant correlation (exchangeable) between assessments over time. The model estimated the average difference (β coefficient of the model) of the measures analyzed during two periods: a period in the year 2017 (prior to implementing the project) and in the years 2018 and 2019 (during the project).ResultA mean monthly reduction of 0.427 in VAP ID (p = 0.002) with 33.8% decrease at the end of the period and 0.351 in CAUTI ID (p = 0.009) with 45% final decrease. The mean monthly reduction of 0.252 for CLABSIs was not significant (p = 0.068). Length of stay and mortality rates had no significant variation.ConclusionsGiven the success in reducing VAP and CAUTIs in a few months of interventions, the achievement of the collaborative project is evident. This partnership among public hospitals/HE may be applied to other ICUs including countries with fewer resources.

【 授权许可】

CC BY   
© The Author(s) 2021. corrected publication 2022

【 图 表 】

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