Partnership Among Hospitals To Reduce Healthcare Associated Infections: A Quasi-Experimental Study In Brazilian ICUs

Abstract

Background: Healthcare-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. Methods: A quasi-experimental study in 5 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 of 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).Result: A 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. Conclusions: Given 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.Trial registration: Promoted by Brazilian Ministry of Health. Approved by the Hospital das Clínicas – UFPE Ethics Committee (No. 3,307,293).

Don’t just do it—Conducting and publishing improvement science in infection prevention and antibiotic stewardship

“…10,46,47 Significant rate reduction in each HAI has been achieved through sharing of effective interventions from individual healthcare settings and multicenter collaborations that have utilized improvement science methodology to identify effective practices. 10,[48][49][50][51] Prevention bundles Determinants of HAIs are typically complex and multifactorial, and multimodal changes are required to reduce infections sustainably. 47 Contrary to most research studies in which a single intervention is tested under very controlled circumstances, improvement science seeks to improve outcomes in real-world settings, often testing multiple interventions simultaneously.…”

“…11,66 Another multicenter collaborative of 5 adult hospitals in Brazil reduced CLABSI, CAUTIs and VAPs. 51 Regular communication and collaboration among collaborative members has been cited as a key factor for their success. 67 Even though reaching zero HAIs may not be achievable, continued efforts to identify novel risk factors and to implement interventions to address them as well as application of improvement science to sustain improvements will continue to push the boundaries of preventable harm.…”

Risk Factors of Healthcare-associated Infections Among Pediatric Hospitalized Patients in Chinese General Hospitals From 2001 to 2020: A Systematic Review and Meta-Analysis

“…Current literature has con rmed that up to 70% of HAIs cases could be preventable (13,14). This shows that the identi cation of the risk factors on HAIs is essential to help the policy-makers and hospital managers to develop the prevention and control strategies and allocate the relevant resources to protect the susceptible hospitalized patients, resulting in the reduction on the occurrence of HAIs (15).…”